Koscheyev V S, Leon G R, Greaves I A
Division of Environmental and Occupational Health, School of Public Health, University of Minnesota, Minneapolis 55455, USA.
Prehosp Disaster Med. 1997 Apr-Jun;12(2):120-31.
This paper examines the considerable medical and psychological problems that ensue after disasters in which massive populations are affected for extended and sometimes unknown time periods. The organization of disaster response teams after large-scale disasters is based on experiences as a medical specialist at Chernobyl immediately after this catastrophe. Optimal ways of dealing with the immediate medical and logistical demands as well as long-term public health problems are explored with a particular focus on radiation disasters. Other lessons learned from Chernobyl are explained.
Current concerns involve the constant threat of a disaster posed by aging nuclear facilities and nuclear and chemical disarmament activities. The strategies that have been used by various groups in responding to a disaster and dealing with medical and psychological health effects at different disaster stages are evaluated. The emergence of specialized centers in the former Soviet Union to study long-term health effects after radiation accidents are described. Worldwide, there has been relatively little attention paid to mid- and long-term health effects, particularly the psychological stress effects. Problems in conducting longitudinal health research are explored.
The use of a mobile diagnostic and continuously operating pre-hospital triage system for rapid health screening of large populations at different stages after a large-scale disaster is advisable. The functional systems of the body to be observed at different stages after a radiation disaster are specified. There is a particularly strong need for continued medical and psychosocial evaluation of radiation-exposed populations over an extended time and a need for international collaboration among investigators.
本文探讨了在大规模人群受到长期甚至有时是未知时间段影响的灾难后所产生的大量医学和心理问题。大规模灾难后应急响应团队的组织是基于切尔诺贝利灾难刚发生后作为一名医学专家的经验。探讨了应对即时医疗和后勤需求以及长期公共卫生问题的最佳方法，尤其关注辐射灾难。还解释了从切尔诺贝利吸取的其他经验教训。
当前的担忧涉及老化核设施以及核与化学裁军活动带来的持续灾难威胁。评估了不同群体在应对灾难以及处理不同灾难阶段的医学和心理健康影响时所采用的策略。描述了前苏联出现的研究辐射事故后长期健康影响的专门中心。在全球范围内，对中长期健康影响，尤其是心理压力影响的关注相对较少。探讨了开展纵向健康研究的问题。
建议在大规模灾难后的不同阶段使用移动诊断和持续运行的院前分诊系统对大量人群进行快速健康筛查。明确了辐射灾难后不同阶段需要观察的身体功能系统。尤其迫切需要对受辐射人群进行长期持续的医学和社会心理评估，以及研究人员之间开展国际合作。
