Sheryll Brown

Tornado-Related Deaths and Injuries in Oklahoma due to the 3 May 1999 Tornadoes

During the evening hours of 3 May 1999, 58 tornadoes occurred in Oklahoma. One tornado reached F5 intensity and left a widespread path of death, injury, and destruction in and around the Oklahoma City metropolitan area. Other communities across the state were also affected. Data on persons who died or were injured were collected from medical examiner reports, hospital medical records, and follow-up questionnaires. In addition, community surveys were conducted in the damaged areas, and a random telephone survey of people in the Oklahoma City area was conducted. A total of 45 persons died, and 645 survivors were treated at a hospital for injuries/health conditions related to the tornadoes. Detailed analyses were conducted on the 40 deaths and 512 nonfatal injuries that resulted directly from the tornadoes. The average age of persons who died was significantly higher than that of injured survivors. Almost three-fourths (74%) of survivors were treated in an emergency department and released; 26% were hospitalized, with an average stay of 7 days. The most common kinds of injuries were soft-tissue injuries (cuts, bruises, and scrapes), fractures/dislocations, and brain injuries. The most common causes of injuries for survivors were being hit by flying/falling debris and being picked up or blown by the tornado. Probable causes of death included multiple injuries (50%), head injuries (23%), chest trauma (18%), and traumatic asphyxia (10%). The proportion of deaths among injured persons was higher in mobile homes, apartment buildings, and outdoors than in houses. The vast majority of persons received television warnings; few persons received warnings by weatherband radio. Survey data indicated that since the tornadoes there had been only a slight increase in the proportion of persons with a storm shelter on their home premises and in the proportion of persons who know the location of the nearest shelter. Effective preparedness plans should be developed in advance of situations with tornadic potential and implemented in a timely manner when warnings are issued. The accessibility and knowledge of the location of shelters also needs to be increased. Warning systems should be integrated and duplicative, and they should include traditional methods and new technology.

Factors related to posttraumatic stress symptoms in women experiencing police-involved intimate partner violence.

Relationships among intimate partner violence (IPV), Post Traumatic Stress Disorder (PTSD) symptoms, health, and danger, using M.A. Duttons Empowerment framework, were examined among 423 ethnically diverse women in contact with police due to IPV. Significant predictors of PTSD symptoms in multivariate analysis included Danger Assessment score, poor overall health, abuse leading to pain, victim expectations of future injury victimization, feeling unsafe, and shame. Results provide further evidence supporting routine assessment for violent trauma and PTSD as well as the need for research testing holistic interventions for women traumatized by violence.

The Lethality Screen: The Predictive Validity of an Intimate Partner Violence Risk Assessment for Use by First Responders

This research is an examination of the predictive validity of the Lethality Screen, a tool used in conjunction with the Lethality Assessment Program (LAP). This intimate partner violence (IPV) risk assessment is an 11-item version of the Danger Assessment (DA) that was designed to be user-friendly for first responders and to maximize sensitivity. Participants (N = 254) were recruited into the study at the scene of police-involved IPV incidents in one Southwestern state and subsequently participated in two structured telephone interviews approximately 7 months apart. These analyses provide evidence that the Lethality Screen has considerable sensitivity (92%-93%) and a high negative predictive value (93%-96%) for near lethal and severe violence. However, specificity was low (21%). The Lethality Screen also has good agreement with the DA and IPV survivors’ perception of risk. The high sensitivity and low specificity should be considered carefully when determining whether the Lethality Screen is appropriate for particular areas of practice with IPV survivors and/or perpetrators.

The Oklahoma Lethality Assessment Study: A Quasi-Experimental Evaluation of the Lethality Assessment Program

This quasi-experimental field trial examined the effectiveness of the Lethality Assessment Program (LAP), a police–social service collaboration wherein social service practitioners provide advocacy, safety planning, and referral for services over the telephone during police-involved intimate partner violence (IPV) incidents for women at high risk of homicide. We conducted structured telephone interviews with survivors as soon as possible after the incident of violence and again approximately 7 months later. The majority of participants (61.6 percent) recruited during the intervention phase of the study talked to the hotline advocates, and propensity score–matched analyses indicate that women who received the intervention reported using significantly more protective strategies and were victimized by significantly less physical violence than women in the comparison group. While additional research needs to be conducted, this study demonstrates that the LAP is a promising evidence-informed intervention that holds the potential to increase survivors’ safety and foster decisions of self-care.

Collaborating With Police Departments: Recruitment in the Oklahoma Lethality Assessment (OK-LA) Study:

In a study to evaluate a collaborative police and social service intervention, researchers asked police officers to recruit intimate partner violence victims at the scene of domestic violence incidents. This article reviews the process of building successful partnerships with police departments as well as the strategies developed with collaborating police departments to create successful recruitment methods and enhance officer and department engagement with recruitment procedures. Over a period of 298 days, 800 victims were referred to the research study. Of these referrals, we were unable to contact 41.3%; of those contacted ( n = 471), we conducted interv iews with 67.73%.

Factors associated with injury severity in Oklahoma City bombing survivors

BACKGROUND Terrorist bombings are an increasing source of violent death and injury worldwide. Injuries in building bombings have been previously reported in descriptive studies, but no comparative analyses have quantitatively assessed factors influencing the severity of nonfatal bombing injuries. The objective of this study was to identify personal and environmental risk factors for injury severity in the Oklahoma City bombing, on April 19, 1995. METHODS We conducted a retrospective comparative analysis of 509 nonfatally injured occupants of four buildings surrounding the detonation site. The source of data was the 1995 Oklahoma City Bombing database, a registry of all injuries and fatalities related to the bombing. Multivariable logistic regression was used to assess two outcomes: (1) medically-attended injury among injured occupants; and (2) hospital admission among occupants with medically attended injuries. RESULTS Increased odds of sustaining medically attended injuries were associated with being struck by flying glass (adjusted odds ratio [AOR], 5.3; 95% confidence interval [CI], 1.9-14.8) and location above the first floor of buildings (OR, 4.0; 95% CI, 1.4-11.7) after adjustment for other factors. Adjusted odds of hospital admission were associated with location in the collapsed region (AOR, 43.4; 95% CI, 4.4-434.1), being blown by the blast wind (AOR, 5.3; 95% CI, 2.1-13.8), and being trapped (AOR, 3.1; 95% CI, 1.2-7.7). CONCLUSIONS The severity of nonfatal injury in the Oklahoma bombing was primarily associated with structural and environmental factors. Improved architectural design may prevent many injuries in building bombings. These finding provide evidence for future injury prevention activities.

The association between protective actions and homicide risk: findings from the Oklahoma Lethality Assessment Study.

This study focuses on the relationship between women’s risk of homicide as measured by the Danger Assessment and 13 protective actions. Participants (N = 432) experienced an incident of police involved intimate partner violence (IPV) and subsequently completed a structured telephone interview. Most women in this sample experienced severe violence and were classified as being at high risk for homicide. Participants engaged in an average of 3.81 (SD = 2.73) protective actions. With the exception of the use of formal domestic violence services, women in the high-risk category were significantly more likely than women in the lower risk category to have used each of the protective actions examined. Implications for research and practice are discussed.

The lethality assessment program: Which survivors of intimate partner violence are most likely to participate?

Purpose – The purpose of this paper is to examine the differential use of the Lethality Assessment Program (LAP) – a risk-informed, collaborative police-social service intervention – across female victim-survivors of intimate partner violence (IPV) in four police jurisdictions in Oklahoma. Design/methodology/approach – Women visited by the police during the study period participated in semi-structured telephone interviews. Logistic regression was utilized to examine what factors impacted implementation of the LAP. Findings – There was differential use of the intervention based on the following: jurisdiction, severe violence at the incident, perpetrator’s use of a weapon ever in the relationship, PTSD symptomology, and women’s prior protective actions and utilization of domestic violence advocacy services. Research limitations/implications – Future research should examine the decision-making process of survivors and police officers to better elucidate the meaning behind these statistical relationships. Pra...

Intensely Exposed Oklahoma City Terrorism Survivors: Long-term Mental Health and Health Needs and Posttraumatic Growth.

Abstract In this study, we explore directly exposed terrorism survivors’ mental health and health status, healthcare utilization, alcohol and tobacco use, and posttraumatic growth 18½ years postdisaster. Telephone surveys compared terrorism survivors and nonexposed community control subjects, using Hopkins Symptom Checklist, Breslau’s PTSD screen, Posttraumatic Growth Inventory, and Health Status Questionnaire 12. Statistical analyses included multivariable logistic regression and linear modeling. Survivors, more than 80% injured, reported more anxiety and depression symptoms than did control subjects, with survivors’ anxiety and depression associated with heavy drinking (≥5 drinks) and worse mental health and social functioning. While survivors had continued posttraumatic stress disorder symptoms (32 [23.2%] met probable posttraumatic stress disorder threshold), they also reported posttraumatic growth. Survivors had more care from physical, speech, respiratory, and occupational therapists. In this unprecedented long-term assessment, survivors’ psychiatric symptoms, alcohol use, and ancillary health service utilization suggest unmet mental health and health needs. Extended recovery efforts might benefit from maximizing positive growth and coping.

Identifying heat-related deaths by using medical examiner and vital statistics data: Surveillance analysis and descriptive epidemiology - Oklahoma, 1990-2011.

OBJECTIVES Approximately 660 deaths occur annually in the United States associated with excess natural heat. A record heat wave in Oklahoma during 2011 generated increased interest concerning heat-related mortality among public health preparedness partners. We aimed to improve surveillance for heat-related mortality and better characterize heat-related deaths in Oklahoma during 1990-2011, and to enhance public health messaging during future heat emergencies. METHODS Heat-related deaths were identified by querying vital statistics (VS) and medical examiner (ME) data during 1990-2011. Case inclusion criteria were developed by using heat-related International Classification of Diseases codes, cause-of-death nomenclature, and ME investigation narrative. We calculated sensitivity and predictive value positive (PVP) for heat-related mortality surveillance by using VS and ME data and performed a descriptive analysis. RESULTS During the study period, 364 confirmed and probable heat-related deaths were identified when utilizing both data sets. ME reports had 87% sensitivity and 74% PVP; VS reports had 80% sensitivity and 52% PVP. Compared to Oklahomas general population, decedents were disproportionately male (67% vs. 49%), aged ≥65 years (46% vs. 14%), and unmarried (78% vs. 47%). Higher rates of heat-related mortality were observed among Blacks. Of 95 decedents with available information, 91 (96%) did not use air conditioning. CONCLUSIONS Linking ME and VS data sources together and using narrative description for case classification allows for improved case ascertainment and surveillance data quality. Males, Blacks, persons aged ≥65 years, unmarried persons, and those without air conditioning carry a disproportionate burden of the heat-related deaths in Oklahoma.