Medical Importance Of Natural

MEDICAL IMPORTANCE OF NATURAL

Definition  Disaster medicine is a system of

study and medical practice associated primarily with the disciplines of emergency medicine and public health concerned with the health and medical and emotional issues of disaster casualties.

The Dual-Wave Phenomenon  First wave of patients appears within

15 to 30 minutes of the impact of the disaster,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 need for extrication or transport and the severity of their injuries.

Voluntary Medical Personnel  individuals responding to the scene

with some degree of medical expertise  Most health care providers are unfamiliar with prehospital protocols or capabilities  due to the severe conditions at the disaster site, physicians and nurses usually cannot provide care that is any more sophisticated than that

Disaster Supplies  materials needed for a disaster

response  disaster response during the initial 24 hours usually relies on the available resources within the disaster-stricken community

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

TRIAGE

DISASTER TRIAGE  employed when the local resources

are unable to provide immediate care on 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 entry point of the hospital (usually the ED) is the most important factor in a successful management 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 on    

clear scientific research. performed under great emotional and physical distress does not involve treatment of casualties a dynamic process, which need to be repeated on casualties who must wait requires that the capabilities of the ED and the health care facility (HCF) known by the triage officer.

Why Manage Children Differently?  A child's cranium relative to the rest

of their body is larger, and the neck musculature 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 response to the colder environment

Care of the Pregnant Woman  In utero fetal growth is adversely

affected in the weeks following a major disaster  Earthquake is associated with shorter gestational length, presumably a result of the stress of the event  Other effects includes premature delivery, missed abortion, birth asphyxia, premature rupture of membranes, and intrauterine growth

DISASTER & HOSPITALS

Hospital Planning for the Severe Environment  hospitals often prepare for a pending

disaster by discharging as many patients as possible  Most of the common bedside devices used for laboratory testing or patient monitoring have a battery life of only 2 to 12 hours  Skilled health care providers may become the only functioning “monitoring system” in very short

Hospital Evacuation  deciding to initiate evacuation and

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determining destinations for evacuated patients avoiding patient influx to other facilities that are in need of evacuation tracking patients transporting patient records and medications provisioning staff to care for the

Acceptable Minimal Level of Care (AMLC)  Maintenance of stability of the   



casualty'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 transport should be done on a periodic basis. Compassion, reassurance, and analgesia should be a treatment

PHARMACEUTICA LS IN DISASTERS

Volume of Pharmaceutical Agents  In the aftermath of the Armenian

earthquake on December 7, 1988, more than 5,000 tonne of drugs and medical supplies were donated to the region. Even with the erection of 32 new warehouses, only 70% of the donations could be regionally housed. Fifty people took more than 6 months to review the drugs before they were able to gain a reasonable idea of what was sent

Expiration of Pharmaceutical Agents  Expired or soon-to-expire drugs are

repeatedly seen in large international relief missions.  Some drugs are not safe when expired. One notable drug in this category is tetracycline, which may result in nephrotoxicity. Expired products are widely regarded as therapeutically useless and possibly dangerous, and they create a sorting and disposal problem for people on scene at

Drug Dumping  Benefits include decreased risks and

costs associated with storage, substantial tax deductions, and the avoidance of destruction cost, which is estimated at U.S. $2,000 per tonne. Bosnia and Herzegovina received an estimated 17,000 tonne of unusable medication. Even after deductions for transport cost to the region, the donors may have saved $25.5 million, while creating a problem that cost the recipients $34 million for the destruction of the agents

Identification of Pharmaceutical Agents  After the Armenian earthquake, none

of the boxes of donated medical supplies were written in the local language, and very few were even written in Russian. Antibiotics with at least 238 different names labeled in 21 languages were on hand. Only one-third were legible with the inclusion of the generic names.

LITERALLY “DISASTER MEDICINE”

Pharmaceutical Donation Guidelines (WHO)  No drug should be sent without a specific request   

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or 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 generic name, strength, name of the manufacturer, and expiration date Labeling on the outside of the package should contain the same information as above, plus the total quantity of drugs in the package

PUBLIC HEALTH INTERVENTION

Environmental Health     

Potable Water Excreta Disposal Vector Control Shelter Nutrition

COMMUNICABLE DISEASE CONTROL AND EPIDEMIC MANAGEMENT

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 with

natural disasters  Tetanus

Public Health Surveillance  Rapid detection of cases of epidemic-

prone diseases is essential to ensure rapid control  Crude death rates or crude mortality rates (CDRs or CMRs) are the most critical indicators of a population's improving or deteriorating health status  It should not exceed 1/10,000/day  or when less-than-5-years-of-age

Immunization  Mass measles immunization

together with vitamin A supplementation are immediate health priorities following natural disasters in areas with inadequate coverage levels  Tetanus vaccination should be administered to those casualties with injuries such as fractures and lacerations

Standardized Case Definitions  health providers should recognize

syndromes or a cluster of symptoms unique to measles, upper respiratory infections, diarrheal illnesses, meningitis, and malaria  laboratory tests should be used to establish the presence of the disease (index cases) of interest and to monitor its progress within the population  Once the index cases have been confirmed by laboratory analysis, further

“DEAD

BODIES” THE MYTH OF DISASTER