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Because of recent threats to public health such as terrorist attacks and natural catastrophes, there has been a sweeping emphasis, among entities both public and private, on disaster preparation. It is ironic that, although many resources have been focused on preventing deaths involving disasters, little research has been performed on how people die in these events.
On 1 group in particular—workers—the burden of disasters has not been adequately assessed. The resiliency of a community—its “intrinsic capacity predisposed to a shock or stress to adapt and survive by changing its nonessential attributes and rebuilding itself”1—depends greatly upon the workforce. For isolated events, such as the September 11, 2001 terrorist attacks, epidemiologists have catalogued with great detail the health effects of occupational exposures to the incident itself and its aftereffects. 2,3,4 Contributions to the field of occupational health, however, have for the most part overlooked natural disasters. The circumstances under which workers are injured could shed light on the dangers involved in disaster response and assist prevention activities.
One of the challenges to assessing mortality is determining the boundary by which a death becomes associated with a disaster. Unfortunately, a unifying definition for what constitutes a disaster-related death has evaded the public health establishment. 5–7 Determining the casualty counts for disastrous events typically depends on local health authorities, who as physicians, coroners, or medical examiners will use professional judgment in assessing disaster victimization. The fundamental principles of these judgments, however, have yet to be sufficiently elaborated. They also have not been standardized across local jurisdictions. What separates a disaster death from a nondisaster death in the United States may not be so much a categorical line as a county line.
Death documentation (in the form of death certificates and autopsy reports) serves to trace somatic divergence, not societal disequilibrium. It seeks causes mainly within the scope of the corpse, the body physical. It is not customary for presiding physicians, nor binding upon them, to reveal causes within the social body. Rarely does death accounting explain, or even attempt to explain, the social or environmental roots of a death.8 Thus, for those harmful phenomena drawn as much by their social as their biological component, such as wars and large-scale natural disasters,...