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Olivier Hagon - Disaster Medicine apart from surgery: What else?
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  • 1. Disaster Medicine: Apart surgery What else? Tacloban Nov 2013 Olivier Hagon MD
  • 2. Good or bad way?
  • 3. Good or bad way?
  • 4. Explosion of Brazzaville 4 March 2012
  • 5. Triage !!? Dead bodies Forensic… First Aid Transport
  • 6. Reality
  • 7. Hospital Haiti 14th January 2010 Triage Brazzaville April 2012 Surgery Operating Theater Anesthesia Equipment Consumables Medicine Nursing cares Physiotherapy
  • 8. Primary health cares Trauma Non Communicable Diseases Obstetric Haiti February 2010 Brazzaville April 2012 Haiti January 2010
  • 9. Internal Displaced Persons IDP Shelter Water/Sanitation Brazzaville April 2012 Food/nutrition Haiti February 2010 Brazzaville April 2012
  • 10. Internal Displaced Persons IDP Non Food Items Protection Haiti January 2010 Mental Health Brazzaville April 2012 Haiti January 2010
  • 11. Disaster?
  • 12. Disaster • “A disaster is sudden, calamitous event that seriously disrupts the functioning of a community or society and causes human, materiel, and economic or environmental losses that exceed the community’s or society’s ability to cope using its own resources. Though often caused by nature, disaster can have human origins” Vulnerability+ Hazard / Capacity = Disaster Sources: EM-DAT Centre for research on the epidemiology of disaster CRED International Federation Red Cross (IFRC) Website
  • 13. Earthquake Haiti 2010
  • 14. Typhoon Philippines 2013 Leyte island, Ormoc city
  • 15. Tsunami Indonesia 2005
  • 16. War Gaza strip 2009
  • 17. Floods Pakistan 2010
  • 18. Complex emergencies • A complex emergency is typically characterized by: – – – – Extensive violence and loss of life; Displacements of population; Widespread damage to societies and economies; The need for large-scale, multi-faceted humanitarian assistance; – The hindrance or prevention of humanitarian assistance by political and military constraints; – Significant security risks for humanitarian relief workers in some areas. Source: EM-DAT Centre for research on the epidemiology of disaster CRED International Federation Red Cross (IFRC) Website
  • 19. Health needs during disaster?
  • 20. support substitution ! Vacuum effect
  • 21. EVENT Timeline Disaster « SIMPLE » EMERGENCY D2 D4 D7 D14 D21 Search and Rescue SAR EVENTS COMPLEX EMERGENCIES D28
  • 22. EVENTS COMPLEX EMERGENCIES Security EVENTS: Bombings, Air Strikes Army, Police interventions Food distributions Rumors….
  • 23. COMPLEX EMERGENCIES Timeline Elective Surgery Emergency Surgery Children Adults Elderly Complex post operative care Rehabilitation Mobilisation Prothesis Orthesis
  • 24. COMPLEX EMERGENCIES Timeline Medicine (NCD) Diabetes Mellitus Hypertension COPD Cancer Malnutrition Chronic mental diseases Communicable diseases (CD) Tetanus Measles Cholera Malaria … Vaccines Prophylaxis … Mental Health Acute stress disorders PTSD
  • 25. COMPLEX EMERGENCIES Timeline Obstetric Physiological deliveries Ceasarian sections Newborn Breastfeeding
  • 26. COMPLEX EMERGENCIES Elective Surgery Emergency Surgery Rehabilitation Medicine (NCD) Communicable diseases (CD) Obstretric Mental Health
  • 27. EVENTS COMPLEX EMERGENCIES (Armed conflicts) Emergency (War) Surgery
  • 28. COMPLEX EMERGENCIES (Armed conflicts)
  • 29. COMPLEX EMERGENCY (Armed conflict) Non Communicable Diseases Communicable Diseases Mental Health Obstetric Emergency (War) Surgery
  • 30. COMPLEX EMERGENCIES Timeline Water Quantity Quality (water sanitation) Access Food Food distribution Food security Breastfeeding … Shelter Temporary shelter (tarpaulin) Local shelter
  • 31. COMPLEXE EMERGENCIES Elective Surgery Emergency Surgery Rehabilitation Medicine (NCD) Communicable diseases (CD) Obstretric Mental Health Water Food Shelter
  • 32.  Health care Public health Non-food items Water + Sanitation Nutrition P. Perrin 2002 ICRC
  • 33. SURGERY Elective Surgery Emergency Surgery Rehabilitation Health care PUBLIC HEALTH Medicine (NCD) Public health Communicable diseases Obstretric Mental Health WATER-SANITATION-NUTRITION- Non Food Items Non-food items Water Water Nutrition Sanitation Food Shelter P. Perrin 2002 ICRC
  • 34. Amputations “Increasingly, the responsible humanitarian surgeon will be required to understand not only surgical principles of amputations, but also to be mindful of what lies beyond the operating theatre for each patient” Consensus Statements Regarding the Multidisciplinary Care of Limb Amputation Patients in Disasters or Humanitarian Emergencies: Report of the 2011 Humanitarian Action Summit Surgical Working Group on Amputations Following Disasters or Conflict L. Knowlton and All Prehospital and Disaster Medicine: Vol. 26, No. 6 Dec 2011
  • 35. Take home message Despite the type, the intensity of the disaster “Life goes on”
  • 36. God bless you “Madiba”