medical importance of natural disasters

8/14/2019 Medical importance of natural disasters

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MEDICALIMPORTANCE OF



Definition

Disaster medicine is a system of study and medical practice associatedprimarily with the disciplines of

emergency medicine and publichealth concerned with the health andmedical and emotional issues of

disaster casualties.



The Dual-Wave

First wave of patients appears within15 to 30 minutes of the impact of thedisaster,comprised primarily of the

walking wounded

After 30-60 minutes, the second wave are patients unable to get to the ED

by themselves because of the needfor extrication or transport and theseverity of their injuries.



Voluntary Medical Personnel

individuals responding to the scenewith some degree of medicalexpertise

Most health care providers areunfamiliar with prehospital protocolsor capabilities

due to the severe conditions at thedisaster site, physicians and nursesusually cannot provide care that isan more so histicated than that



Disaster Supplies

materials needed for a disasterresponse

disaster response during the initial 24hours usually relies on the availableresources within the disaster-strickencommunity



TRIAGEderived from the French word trier, which means “to sort”



DISASTER TRIAGE

employed when the local resourcesare unable to provide immediate careon a timely basis to all casualties

needing such care. “to do the greatest good for the

greatest number of casualties.”

Well-performed triage at the entrypoint of the hospital (usually the ED)is the most important factor in asuccessful mana ement for a mass



Triage Categories

Priority 1 or immediate (RED)

Priority 2 or delayed (YELLOW)

Priority 3, minimal, or nonurgent (GREEN)

Expectant patients (BLACK)



Principles of Triage

based on consensus opinion, not onclear scientific research.

performed under great emotional and

physical distress does not involve treatment of

casualties

a dynamic process, which need to berepeated on casualties who must wait

requires that the capabilities of theED and the health care facility (HCF)



Why Manage Children Differently?

A child's cranium relative to the restof their body is larger, and the neckmusculature and spinal column are

not fully developed. The greater relative body surface area

of children, having minimal

subcutaneous fat, thinner epidermis,and an immature behavioral responseto the colder environment



Care of the Pregnant Woman

In utero fetal growth is adverselyaffected in the weeks following amajor disaster

Earthquake is associated with shortergestational length, presumably aresult of the stress of the event

Other effects includes prematuredelivery, missed abortion, birthasphyxia, premature rupture of membranes, and intrauterine rowth



DISASTER&

H PITAL



Hospital Planning for the Severe

hospitals often prepare for a pendingdisaster by discharging as manypatients as possible

Most of the common bedside devicesused for laboratory testing or patientmonitoring have a battery life of only

2 to 12 hours Skilled health care providers may

become the only functioning“monitorin s stem” in ver short



Hospital Evacuation

deciding to initiate evacuation anddetermining destinations forevacuated patients

avoiding patient influx to otherfacilities that are in need of evacuation

tracking patients transporting patient records and

medications



Acceptable Minimal Level of Care

Maintenance of stability of thecasualty's vital systems.

Prevention of further deterioration or

injury. Monitoring of casualties should be

regular and systematic

Reassessment and reprioritization of casualties for treatment and transportshould be done on a periodic basis.

Compassion, reassurance, and



PHARMACEUTICALS IN DISASTERS



Volume of Pharmaceutical Agents

In the aftermath of the Armenianearthquake on December 7, 1988,more than 5,000 tonne of drugs

and medical supplies were donated tothe region. Even with the erection of 32 new warehouses, only 70% of the

donations could be regionally housed.Fifty people took more than 6months to review the drugs beforethey were able to gain a reasonable



Expiration of Pharmaceutical

Expired or soon-to-expire drugs arerepeatedly seen in large internationalrelief missions.

Some drugs are not safe when expired.One notable drug in this category istetracycline, which may result innephrotoxicity. Expired products are

widely regarded as therapeuticallyuseless and possibly dangerous, andthey create a sorting and disposal

roblem for eo le on scene at



Drug Dumping

Benefits include decreased risks andcosts associated with storage,substantial tax deductions, and the

avoidance of destruction cost, which isestimated at U.S. $2,000 per tonne.Bosnia and Herzegovina received anestimated 17,000 tonne of unusablemedication. Even after deductions fortransport cost to the region, the donorsmay have saved $25.5 million, whilecreating a problem that cost therecipients $34 million for the



Identification of Pharmaceutical

After the Armenian earthquake, noneof the boxes of donated medicalsupplies were written in the local

language, and very few were evenwritten in Russian. Antibiotics with atleast 238 different names labeled in

21 languages were on hand. Onlyone-third were legible with theinclusion of the generic names.



LITERALLY “DISASTER

”



Pharmaceutical Donation

No drug should be sent without a specific requestor prior clearance by the receiving nation

No drug should be sent that is not on the list of essential drugs of the receiving nation (or if not

available) on the WHO list of essential drugs No drug should arrive with a future life (before

expiration date) of less than 1 yr Labeling of the drug should be in the appropriate

language(s) and should contain the genericname, strength, name of the manufacturer, andexpiration date

Labeling on the outside of the package shouldcontain the same information as above, plus thetotal quantity of drugs in the package



PUBLIC HEALTHINTERVENTION



Environmental Health

Potable Water

Excreta Disposal

Vector Control Shelter

Nutrition



COMMUNICABLE DISEASECONTROL AND EPIDEMICMANAGEMENT



Waterborne diseases

Diarrhoeal disease

Hepatitis A and E

Leptospirosis



Diseases associated with crowding

Measles

Meningitis

Acute respiratory infections (ARI)



Vector-borne diseases

Malaria

Dengue

Other diseases associated withnatural disasters

Tetanus



Public Health Surveillance

Rapid detection of cases of epidemic-prone diseases is essential to ensurerapid control

Crude death rates or crude mortalityrates (CDRs or CMRs) are the mostcritical indicators of a population's

improving or deteriorating healthstatus

It should not exceed 1/10,000/day

- - - - -



Immunization

Mass measles immunizationtogether with vitamin Asupplementation are immediate

health priorities following naturaldisasters in areas with inadequatecoverage levels

Tetanus vaccination should beadministered to those casualties withinjuries such as fractures andlacerations



Standardized Case Definitions

health providers should recognizesyndromes or a cluster of symptomsunique to measles, upper respiratory

infections, diarrheal illnesses, meningitis,and malaria

laboratory tests should be used toestablish the presence of the disease

(index cases) of interest and to monitorits progress within the population

Once the index cases have been



“DEAD

BODIES”THE MYTH

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