Kalamata earthquake, 1986

Citation
Kalamata earthquake, 1986

Material Information

Title:
Kalamata earthquake, 1986 psychological reactions and roles for health care workers
Series Title:
Quick response research report ;
Creator:
Laube, Jerri
University of Colorado, Boulder -- Natural Hazards Research and Applications Information Center
University of Colorado, Boulder -- Institute of Behavioral Science
Place of Publication:
Boulder, Colo
Publisher:
Natural Hazards Research and Applications Information Center, University of Colorado
Publication Date:
Language:
English
Physical Description:
[8] leaves : ; 28 cm.

Subjects

Subjects / Keywords:
Earthquakes -- Psychological aspects -- Greece -- Kalamai ( lcsh )
Health care teams -- Mental health -- Greece -- Kalamai ( lcsh )
Disaster victims -- Mental health -- Greece -- Kalamai ( lcsh )
Genre:
government publication (state, provincial, terriorial, dependent) ( marcgt )
bibliography ( marcgt )
non-fiction ( marcgt )

Notes

Bibliography:
Includes bibliographical references (p. [8]).
Additional Physical Form:
Also issued online as part of a joint project with the Louis de la Parte Florida Mental Health Institute (FMHI) Research Library's disaster mental health initiative.
General Note:
Cover title.
General Note:
"Institute of Behavioral Science #6."
Statement of Responsibility:
Jerri Laube.

Record Information

Source Institution:
University of South Florida Library
Holding Location:
University of South Florida
Rights Management:
All applicable rights reserved by the source institution and holding location.
Resource Identifier:
001985199 ( ALEPH )
39083664 ( OCLC )
F57-00039 ( USFLDC DOI )
f57.39 ( USFLDC Handle )

USFLDC Membership

Aggregations:
Added automatically
Natural Hazards Center Collection

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Format:
Book

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1987.
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NaturalHazardsResearchandApplicationsInformationCenter.CampusBox482UniversityofColoradoBoulder,Colorado80309-0482KALAMATAEARTHQUAKE,1986:PSYCHOLOGICALREACTIONSANDROLESFORHEALTHCAREWORKERSJerriLaube1987QuickResponseResearch Report#11This pUblication is partofthe Natural Haz d &Applications Information Centa:r'ss ongoing h. esponse Research Report Seriesttp.llwww.colorado. edu/hazards .InstituteofBehavioralScience #6 (303)492-6818

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KALAMATAEARTHQUAKE1986:PSYCHOLOGICAL REACTIONSANDALOOKATHEALTHCAREWORKERSJerriLaube,Ph.D.Purposes1.Toidentifythepsychologicaleffectofdisasteronhealthcareworkers2.Todeterminethesubjectiveimpactondisastervictims,onemonthaftertheevent3.Toconductacross-culturalcomparisonbetweendisastervictimsinGreeceanddisastervictimsinU.S.A.4.TocomparetheresponsesofhealthcaredisasterworkersinGreecewithresponsesofhealthcaredisasterworkersinU.S.A.EventKalamata,Greece(population50,000)andthesurroundingareawasstruckbyanearthquake,measuring6.2ontheRichterScale,at20:00Saturday,13September1986.Asecondearthquake,measuring5.6ontheRichterScaleoccurredat14:30onMonday15September1986.Twenty-fourdeathswerecontributeddirectlytothedisaster.Seventytoninetypercent(reportsvaried)ofthebuildingsweredamagedordestroyed.Aneighboringvillage,Eleohore,wascompletelydestroyed.Followingtheearthquake,thebuildingswereinspectedforseverityofdamage.Thedamagedbuildingswere marRed withredorgreenpaint.Theredpaintindicatedthatthebuildingwasunsafeanddamagedbeyondrepair.Greenpaintindicatedthebuildingcouldberepaired.Familieswhosehomeshadeitheraredoragreenmarkwereprohibitedbythegovernmentfromusingthesepropertiesandhadtoberelocated.Twelvethousandtents,providedbytheRedCrossandtheArmy,shelteredthemajorityofthevictims.Ninehundredpeoplewerehousedonaprivatecruiseship,theMarianna"9",dockedinKalamata.TwohundredfiftypeoplelivedonaNavaltrainingbattleship,theAris.Theremainingvictims,providedtheirowntemporaryhousing,orfoundshelterinthesurroundingvillages.RedCrossunits,fromGermany,Yugoslavia,andSweden,sentlargetentstobeusedforschoolclasssrooms.AlatershipmentfromSwedenof30metalstoragetypebuildings,wastobeusedwheredeemedmostnecessary--suchastheRedCrossHeadquarters'officesandclinics.TheGermanRedCrossunitprovidedagenerator,largerefrigerator,andworkers.Theycookedand served 4,000meals,two

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KalamataEarthquaketimesaday,forthedisastervictims.ThestaffontheArisandMarianna"9"provldedmealsandlinenforthevictimstheyhoused.SubjectsInterviewswereconductedwith87individualswhowerevictimsoftheearthquake.Ofthattotal,10werephysicians,8wereregisterednursesandtheremaining69werestudentnurses.TheImpactofEventScalewasadministeredto83subjects,somefromthehealth-careprovidergroupandothersfromthegeneraldisaster-struckpopulation.InstrumentHorowitz's(Horowitz,WilnerandAlvarez,1979)ImpactofEventScale(IES)wasusedtoassessthevictim'sresponsetotheearthquake.Itisascaleof15currentsubjectivedistressitems,relatedtoaspecificevent.Thescaleisdividedinto2 subscales: intrusion(signsofcognitiveandaffectiveintrusion)andavoidance(blockingorsuppressionofthoughtsandimages).TheIEShasbeenfoundvaluableincollectinglongitudinaldataasitcanbetiedtothesamestressorovertheentirespanofdatacollection.Itisself-administered,short,andeasilyunderstoodandacceptedbypeopleofvariouscultures,educationalandeconomicbackground. Thescoresaredeterminedbyassigningavalueof0,1,3,and5tothefrequencycategoriesforeachitemandthensummingthevaluesforthespecificsubscalesandscaletotal.Reliabilites(Chronbach'salpha)fortheintrusiansubscalewere0.79and,fortheavoidancesubscale,0.82.Test-retestreliabilitywasreportedat0.87forthetotalstressscores,0.89fortheintrusionsubscale,and 0./9 fortheavoidancesubscale.AsthetoolhadtobetranslatedintoGreek,foradministrationintheearthquakearea,itwasimportanttodetermineiftheinternalconsistencywasmaintainedinthesubscales.Thereliabilitycoefficient(Cronbach'salpha)was0.72fortheintrusiansubscaleand0.65fortheavoidancesubscale.Theinternalconsistencyoftheintrusiansubscaleremainedhigh,buttheadvoidancysubscalehaddippedwiththetranslationalthoughnottoolowforuse.InadditiontotheIES,the"healthcareproviderswereinterviewed,withtheassistanceofaninterpretor,todeterminetheirresponsestothestressesofdisasterwork.Astructuredquestionnaireof10items,modifiedfromLaube's(1973),wasused.Duetothelanguagedifficulties,noattemptwasmadetogathertheusualdemographicdata.Theinterviewsweretapedandtranscribed.MethodEntryintothedisasterareawasfacilitatedthroughtheAmericanRedCross,theHellenicRedCross,andtheGovernorofMessiniinGreece.TheHeadoftheHellenicRedCrossdisasterservicesin

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Kalamata Barthquake Kalamatacoordinatedtheinvestigator'sactivitiesinKalamata.ThelanguagedifferencespresentedsomedifficultiesastheinvestigatorcouldspeaknoGreekandalimitednumberof the sUbjectscouldspeakEnglish,namelythephysicians,shopkeepersandsomeofficialsandRedCrossstaff.AUniversityofAustraliastudent,onemergencyleavetobewithhisfamily,servedasan interpreterinmanyofthesessions.Otherwise,communicationtookplacethroughuseofaBerlitzmanual,pre-translatedstatementsandinstructions,andalotofnon-verballanguage.Althoughindividualinterviewswerepreferred,thesUbjectswereinterviewedingroupsbecauseoflimitedaccesstoaninterpreter.Anonymitywasassuredasnonameswererecorded.Onlyageandgenderwererequestedonthepencilandpapertest.Participationintheinterviewsandtestingwasonavoluntarybasis.Alloftheintervieweesdidnottakethetest.Conversely,someofthosethattookthetestwerenotinterviewed.Theinterviewsandtestingtookplaceoverathreeweekspan,beginningfourweeksafterthefirstearthquakeon13Septenber1986.ToincreasethenumberofsubjectsfortheImpactofEventScale,assistancewassecuredfromapsychologist,whowasvolunteeringherserviceinthedisaster,andtheSocialDirectorofthecruiseshipthatwasservingastemporarylivingquartersforthehomeless.Thesetwoindividualsadministeredtheteststotheir"clients"whovolunteeredtoparticipate.Tosecurenormativedata,similiartothatofthemedicalstudentpopulationusedbyHorowitzetal(1979),assistancewassecuredfromthedirectorof'alargeschoolofnursinginAthens,Greece.SheadministeredtheIESto63nursingstudents.Studentsweredirectedonlytorelatetheitemstoasignificanteventintherecentpast.SubjectiveeffectonvictimsasmeasuredbyImpactofEventScaleTherewere9malesinthesamplepopulationof 83: thustherewasnoanalysisforgenderdifferences.Theagerangeforthegroupwas15-60years,themeanwas25.71yearsandthemedianwas20years.Therangefortheintrusiansubscalewas2-41,themeanwas27.26,themedianwas28andthestandarddeviationwas7.52.Therangefortheavoidancesubscalewas5-35,themeanwas21.07,themedianwas21,andthestandarddeviationwas7.67.Therewere8malesinthestudentnursegroupof 63: noanalysiswasneededforgenderdifferences.Theagerangeforthisgroupwas20-51years,themeanwas31yearsandthemedianagewas30years.Therangefortheintrusiansubscalewas0-35,themeanwas12.32,themedianwas12andthestandarddeviationwas8.58.Therangefortheavoidancesubscalewas0-35,themeanwas12.06,themedianwas11,andthestandarddeviationwas8.64.AscanbeseeninTable1,theGreekdisastervictimsscoredhigheronthesubscalesthandidtheAmericanpatientpopulationusedby

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KalamataEarthquakeHorowitz(1979,P215),butthisdifferenceistruealsobetweentheGreekandAmericannon-victimpopulations.TABLE1.MeansandStandardDeviationsOfImpactof EventSubscalesforDisasterVictimsandNursingStudentsinGreeceandPatientsandMedicalStudentsinU.S.A.*PopulationsIntrusianAvoidanceGreeceDisasterVictimsNursingStudentsU.S.A.PatientsMedicalStudentsMen WomenMean27.2712.3221.202.506.10SD7.538.587.903.005.30Mean21.0712.0620.806.9012.70SD7.678.6410.26.8010.80*StatisticstakenfromHorowitz,WilnerandAlvarez,(1979)ImpactofEventScale:Ameasureofsubjectivestress,PsychomaticMedicine4(3),216.UsingthePearsonProduct-Momenttest,correlationsbtweenthesubscalesweredeterminedforthedisastervictimsandforthestudentnurses.Thecorrelationcoefficientwas0.63(p=<.006)forthestudentnursesanditwas0.21(p=<.10)forthedisastervictims.ThisparallelsthefindingsofZilberg,WeissandHorowitz(1982).IntheirstudyonU.S.A.subjects,thesubscalesweresubstantiallycorrelatedintheirfieldsubjectsbuttherewaslittlecorrelationbetweenthesubscalesintheirpatientgroup.Notonlydoesthisindicateacross-culturalpatterning,italsosubstantiatesHorowitz's(1976)theorythatthereisapredictablepatternofresponsefollowingaseverestressevent.Hepostulatedthatintrusivesymptomatologyfollowstheevent,butasthisissopainful,avoidancebehaviorthenoccursasameasureofdefense.ThissuggeststhatcorrelationsontheIESsubscalescouldserveasadiagnostictoolfordetermingthepatient's/victim'spathologyandphaseofrecovery.ComparisonofthetwoculturesispresentedinTable2.Thesignificanceofdifferenceinthesubscalesbetweenthe2groupsinGreeceweredeterminedthroughuseofthet-test.Thefindingsweresignificantforboth,intrusianandadvoidance.(SeeTable3)

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KalamataEarthquakeTable2.PearsonProduct-MomentCorrelationsbetweenIntrusianandAvoidanceSubscalesforPatientsandFieldSubjectsinU.S.A.andbetweenSubscalesforDisasterVictimsandNursingStudentsinGreece* SubjectsGreeceDisasterVictimsNursingStudentsU.S.A.PatientsFieldSUbjectsN836335 37r.21.63.15.70p<.10<.006<.40<.01*U.S.A.statisticsfromZilberg,WeissandHorowitz.(1982)ImpactofEventScale:Across-validationstudyandsomeempiricalevidencesupportingaconceptualmodelofstressresponsesyndromes,JournalofConsultingandClinicalPsychology,50(3),412.Table3.Means,StandardDeviationsandt-testsontheImpactofEventSubscalesforDisasterVictimsandNursingStudentsinGreeceVictimsStudents(N=83 ) (N=63 )SubscalesMM tdfIntrusian27.2712.3211.19144<.006Avoidance21.0712.066.65144<.006HealthCareWorkersReactionsinDisasterSpecificnumberscouldnotbeobtainedduetothelargesizeofthegroupbeinginterviewed,insomeinstances,andthelimitedtimeforworkingwithaninterpreter.Theresultsbelowareasdescribedbythosethatresponded.Themajorityofregisterednursesandphysiciansworked48to60hourswithoutrelief.Asdescribedbyone,wecamebackassoonaswecouldgethereanddidn'tleaveunti11thepatientsweresett1ed--throughdischargeortransfer.Thelongestperiodofworkforthestudentswas10hours.Themajorstressesreported

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KalamataEarthquakeweretheirconcernfortheirfamilies,theaged--"thesadnessontheolderpeople'sfaces"andthechildren--"seeingthechildrenhurtandcrying".Somrtalkedofthecrowded,uncomfortablelivingconditions--tents,noprivacy,nolaundryorbathingfaciliities.Specifictothecareoftheinjuredandthenecessaryevacuationofthehospital,theirmajorconcernsweredisorganization,suppliesandlackofinformation.Table4comparesthemajorstressesof the twocultures.Table 4G MajorStressesofHealthCareWorkersinDisaster:GreeceandU.S.A.ReportedStressesExcessivephysicaldemandsConcernforown/patients'safety IncreasedmedicalresponsibilityConcernforfamilySeeingthepoorsufferInjured/scaredchildrenInjuredolderpersonsSadnessontheolderpeople'sfacesDisorganizationSeeingsomanyinjuredandkilledFeelingsofinadquacytomeetpsychologicalneedsThelivingconditionsLackofinformationKnowingthatlifewillneverbethesameGreecexx.XX X X X X X XXU.S.A.xx xX X X X X X XWhenaskedhowtheymanagedtheirfeelings,manyrepliedthattheydidn'trememberfeelinganything--theyjustworked.Asdescribedbyoneperson,hegot"caughtupintherush"anddidn'tseemtofeelanything.Onlyafewadmittedtocryingasameasureof

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KalamataEarthquaketensionreduction.Onereportedthatshepanicked,feltasifshewere"goingtopieces,veryuncharacteristicfl.Others-reportedhavingsomaticsymptomsofdiarrhea,nauseaandvomiting,butnottooseveretowork.TheresponsesfromthehealthcareworkersinGreecewerenotunlikethosereportedbyLaube(1972)undersimilarconditionsinAmerica. Tothequestionrelatingtothefunniesthappeningduringthedisaster,theimmediateresponsewas"Nothing."Later,onetoldthestoryaboutherunclegettingcaughtunderatable,becausehewastoofat.Notbeingabletogetloose,hejustranoutwiththetablestuckonhisback.Therewereafewsmileswhenthestorywastold, noonelaughed.Truly,evenfourweeksaftertheearthquake,thedevastationwastoogreat.ConclusionsTheearthquakevictimsinKalamata,GreeceexperiencedgreatsUbjectivedistress.Onemonthpostdisaster,bothintrusiveandavoidancesymptomatology,asmeasuredbytheIES,wassignificantlygreaterthannormal.Cross-culturally,intrusivesymptomatologyintheearthquakevictimswasatahigherlevelthanHorowitzetal(1979)reportedforanidentifiedstressedpatientpopulationinAmerica.Theavoidancesymptomatologylevelwassimilarinthetwopopulations.HealthcareworkersinGreeceidentifiedsimilarstressesindisasterashavethoseinAmerica.Inbothpopulations,concernfortheelderly,thechildren,andtheirownfamilywereparamount.Theheavyphysicaldemandsanddisorganizationwerealsoreportedinbothgroups.Emotionalresponsesweresimilarinbothculturalgroups.Therewas,however,onemajordifferenceinhealthcaredeliveryfollowingthe disaster. InGreece,manyofthestaffphysiciansandnursesfromthedisasterareawererelievedbyprofessionalsfromoutsidethearea,somefromasfarawayasAthens(6to7hoursbycar).ThisallowedthosefromKalamatatimetogettheirlivingaccomodationsarranged,takecareoftheirfamiliesandthemselves,asneeded.Underthesocialisttypeofmedicalcare,transferofstaffbetweenhospitalscouldbearranged.ThiscouldnotbeaseasilyimplementedintheprivatesectoroftheU.S.A.

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KalamataEarthquakeREFERENCESHorowitz,M.J.(1976).StressResponseSyndromes.NewYork:Wiley.Horowitz,M.J.,Wilner,N.,&Alvarez,W.(1979).Impactofeventscale:Ameasureofsubjectivestress.PsychomaticMedicine.41,209-218.Laube,J.(1973).Psychologicalreactionsofnursesindisaster.Nursing Researche22 (4),343-347.Zilberg,N.J.,Weiss,D.s.&Horowitz,M.J.(1982).Impactofeventscale:Across-validationstudyandsomeempiricalevidencesupportingaconceptualmodelofstressresponsesyndromes.JournalofConsultingandClinicalPsychology.50,(3),407-417.


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