Posttraumatic stress disorder, depression, and alcohol and tobacco use in public health workers after the 2004 Florida hurricanes.

OBJECTIVE: We examined the relationship of probable posttraumatic stress disorder (PTSD), probable depression, and increased alcohol and/or tobacco use to disaster exposure and work demand in Florida Department of Health workers after the 2004 hurricanes. METHODS: Participants (N = 2249) completed electronic questionnaires assessing PTSD, depression, alcohol and tobacco use, hurricane exposure, and work demand. RESULTS: Total mental and behavioral health burden (probable PTSD, probable depression, increased alcohol and/or tobacco use) was 11%. More than 4% had probable PTSD, and 3.8% had probable depression. Among those with probable PTSD, 29.2% had increased alcohol use, and 50% had increased tobacco use. Among those with probable depression, 34% indicated increased alcohol use and 55.6% increased tobacco use. Workers with greater exposure were more likely to have probable PTSD and probable depression (ORs = 3.3 and 3.06, respectively). After adjusting for demographics and work demand, those with high exposure were more likely to have probable PTSD and probable depression (ORs = 3.21 and 3.13). Those with high exposure had increased alcohol and tobacco use (ORs = 3.01 and 3.40), and those with high work demand indicated increased alcohol and tobacco use (ORs = 1.98 and 2.10). High exposure and work demand predicted increased alcohol and tobacco use, after adjusting for demographics, work demand, and exposure. CONCLUSIONS: Work-related disaster mental and behavioral health burden indicate the need for additional mental health interventions in the public health disaster workforce.

Florida Department of Health workers' response to 2004 hurricanes: a qualitative analysis.

OBJECTIVE: Examinations of the demands on public health workers after disaster exposure have been limited. Workers provide emergency care while simultaneously risking injury, damage to personal property, and threats to their own and their family's safety. We examined the disaster management experiences of 4323 Florida Department of Health workers 9 months after their response to 4 hurricanes and 1 tropical storm during a 7-week period in August and September of 2004. METHODS: Participants completed a self-report questionnaire focused on work performance, mental and physical health, daily functioning, sleep disturbance, physiological arousal, and injury and work demand at the time of the hurricanes, and answered open-ended questions that described their experiences in more detail. RESULTS: A qualitative analysis conducted from the write-in data yielded 4 domains: (1) work/life balance; (2) training for disaster response role; (3) workplace support; and (4) recovery. CONCLUSIONS: Study findings highlighted a number of concerns that are important to public health workers who provide emergency care after a disaster and, in particular, multiple disasters such as during the 2004 hurricane season. The findings also yielded important recommendations for emergency public health preparedness.

Sleep and arousal as risk factors for adverse health and work performance in public health workers involved in the 2004 Florida hurricane season.

BACKGROUND: We examined the relation of sleep disturbance and arousal to work performance, mental and physical health, and day-to-day functioning in Florida Department of Health (FDOH) employees 9 months after the 2004 Florida hurricane season. METHODS: FDOH employees were contacted via e-mail 9 months after the 2004 hurricanes. Participants (N = 2249) completed electronic questionnaires including measures of sleep disturbance, arousal, work performance, physical health, mental health, day-to-day function, hurricane injury, and work demand. RESULTS: More than 18% of FDOH employees reported ≥ 25% reduced work performance and 11% to 15.3% reported ≥ 7 "bad" mental or physical health days in the past month. Sleep disturbance and elevated arousal were strongly associated with impaired work performance (odds ratios [ORs] 3.33 and 3.34, respectively), "bad" mental health (ORs 3.01 and 3.64), "bad" physical health (ORs 3.21 and 2.01), and limited day-to-day function (ORs 4.71 and 2.32), even after adjusting for sex, race, age, education, and marital status. CONCLUSIONS: Among public health workers exposed to the 2004 hurricanes, sleep disturbance and arousal were associated with personal and work impairment. Future research should continue to examine the effect of repeated exposure to disasters in first responders.

Expectations training for miners using self-contained self-rescuers in escapes from underground coal mines.

National Institute for Occupational Safety and Health researchers conducted a study to investigate the human response issues related to wearing a self-contained self-rescuer (SCSR). The goal was to develop training to educate miners on what they could expect from their units during an escape. Subjects included miners who had experience wearing SCSRs, manufacturers, and researchers. Results identified nine key areas of concern: (1) starting the unit, (2) unit heat, (3) induction of coughing, (4) unit taste, (5) difficulty in breathing while wearing the unit, (6) quality of the air supplied, (7) nose clips, (8) goggles, and (9) the behavior of the breathing bag. In addition, researchers reviewed the literature on human response under duress. This article describes the expectations training program, which comprises the findings of the SCSR study and what is known about the normal human response in an emergency. The authors present background on SCSRs and the SCSR switchover procedure mandated in the recent federal Mine Improvement and New Emergency Response Act of 2006, which provided the impetus for the expectations training.

Reducing non-contact electric arc injuries: an investigation of behavioral and organizational issues.

PROBLEM: It is estimated that 5 to 10 arc flash explosions occur in electric equipment every day in the United States. In the mining industry the largest single injury category of electrical injuries are caused by non-contact electrical arcs. METHOD: This investigation progressed in two phases: (a) 836 Mine Safety and Health Administration (MSHA) reports of electric arcing incidents that occurred over a period of 11 years were reviewed, and (b) personal interviews were conducted with 32 individuals. A theoretical Safe Job Performance Model guided the study. RESULTS: Behavioral dimensions were identified and included the effect of worker experience, judgment and decision-making ability, behavioral and organizational controls, and safety culture. SUMMARY: The National Institute for Occupational Safety and Health (NIOSH) conducted an investigation of behavioral components associated with arc flash incidents and developed recommendations for interventions based on findings. IMPACT ON INDUSTRY: This study fills a vacuum in electrical training with a focus on the organizational and behavioral aspects of arc flash incidents. The research is cross-cutting in its scope, in that the results apply not only to mining and construction, but many other industries employing electricians. Although the majority of mine electrical injuries are the results of burns from electrical arcs, few miners are aware that such a hazard exists. A safety training program, which includes a video and an instructor's discussion guide, was developed for electricians based on this study's findings. "Arc Flash Awareness" was released in 2007 (DHHS NIOSH Publication No.2007-116D) and is available through 1-800 CDC INFO. Phone: 1-800 232-4636 or email cdcinfo@cdc.gov. It is also available from MSHA at MSHADistribution@dol.gov or 304-256-3257 (DVD-576). Private industry is producing Portuguese and Spanish language translations.

The virtual network supporting the front lines: addressing emerging behavioral health problems following the tsunami of 2004.

The devastation wreaked by the 2004 tsunami in the Indian Ocean required extensive multinational and nongovernmental relief efforts to address the massive loss of infrastructure, people, and society. This article addresses approaches to behavioral incident management from a process perspective, through the lens of one official stateside channel of emergency operations. The process highlights the formation and connectivity of multidisciplinary teams that virtually supported the efforts of a seven-person, on-scene, behavioral health team aboard the USNS Mercy as part of Operation Unified Assistance in the Indian Ocean. Frontline health diplomacy and behavioral health relief efforts were greatly augmented by the virtual network of support from leading experts around the globe. Future disaster response and recovery efforts ought to build on the success of such virtual support networks, by planning for appropriate technology, expertise, and mutual aid partnerships.

The concept of degraded images applied to hazard recognition training in mining for reduction of lost-time injuries.

INTRODUCTION: This paper discusses the application of a training intervention that uses degraded images for improving the hazard recognition skills of miners. METHOD: NIOSH researchers, in an extensive literature review, identified fundamental psychological principles on perception that may be employed to enhance the ability of miners to recognize and respond to hazards in their dangerous work environment. Three studies were conducted to evaluate the effectiveness of the degraded image training intervention. A model of hazard recognition was developed to guide the study. RESULTS: In the first study, miners from Pennsylvania, West Virginia and Alabama, who were taught with the aid of degraded images, scored significantly better on follow-up hazard recognition performance measures than those trained using traditional instructional methodologies. The second and third studies investigated the effectiveness of the training intervention at two mining companies. Data collected over a 3-year period showed that lost-time injuries at mines in Alabama and Illinois declined soon after the training intervention was instituted. IMPACT ON INDUSTRY: Further exploration of the hazard recognition model and the development of other interventions based on the model could support the validity of the steps in the hazard recognition model.