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Assessment for possible intervention in the disaster area


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Emergency Surgery Workshop Davos 2011: Presentation by Johan von Schreeb, MD, Senior Researcher in Disaster Medicine, Karolinska Institute and Co-Founder & Former President, MSF Sweden, Stockholm, …

Emergency Surgery Workshop Davos 2011: Presentation by Johan von Schreeb, MD, Senior Researcher in Disaster Medicine, Karolinska Institute and Co-Founder & Former President, MSF Sweden, Stockholm, Sweden

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  • Vilken behovsbedömning gjordes innan dessa 12 personer drog?
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    • 1. Assessment for possible intervention in the disaster area Johan von Schreeb MD, PhD, Specialist general surgery Divisionen for Global Health (IHCAR), Karolinska Institutet, Stockholm, Sweden
    • 2. Needs assessment
      • Pre disaster context?
      • Type of disaster?
      • Magnitude of disaster?
      • Mandate? Role?
      • Capacity, experience and knowledge?
      • Operational strategy? Arrival?
      • Exit strategy?
      • Other actors?
      11-12-14 Namn Efternamn
    • 3. Health Children d y ing before age 5 per 1000 live births (log) Gross National Income per capita in US dollar, exchange rate (log) 10 100 200 50 40 20 5 4 300 30 3 Money Afghanistan Albania Algeria Angola Argentina Australia Austria Azerbaijan Bahrain Barbados Belarus Belgium Belize Benin Bhutan Bolivia Bosnia Botswana Bulgaria Burundi Cambodia Cameroon Canada Central African.R. Chile Colombia Costa Rica Ivory Coast Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominican R. Ecuador Equatorial Guinea Eritrea Estonia Ethiopia Fiji France Gabon Georgia Ghana Greece Guatemala Guinea Guinea- Bissau Guyana Honduras Hungary Iceland Indonesia Iraq Ireland Israel Jamaica Japan Jordan Kazakhstan Kenya Kuwait Latvia Lebanon Lesotho Liberia Lithuania Madagascar Malaysia Maldives Mali Malta Mauritania Mauritius Mexico Mongolia Morocco Mozambique Namibia Nepal Netherlands New Zeeland Nicaragua Niger Oman Panama Papua N.G. Paraguay Peru Philippines Poland Portugal Qatar Romania Rwanda Sao Tome Saudi Arabia Sierra Leone Singapore Slovenia Solomon Islands Somalia South Africa Spain Sri Lanka Suriname Swaziland Sweden Syria Tajikistan Togo Trinidad & Tobago Tunisia Turkmenistan Uganda Ukraine United Arab Emirates UK Uruguay Uzbekistan Venezuela Zambia Zimbabwe Bahamas Brunei Congo Rep. Gambia Kyrgyz Rep. Libya St Lucia Vietnam Serbia Slovakia South Korea Laos Macedonia Iran North Korea USA Malawi Finland Switzerland Norway Germany Thailand Burkina Faso Senegal Yemen India China Egypt Brazil Turkey Grenada St Vincent & G Tonga Luxemburg Bangla desh 200 10 000 100 500 2 000 50 000 1 000 20 000 300 5 000 3 000 Population (millions) 1 000 Data for 2004: World Bank & UNICEF, estimates in italic © 20070123 Sub-Saharan Africa Arab states Europe Americas Asia & Pacific Regions 100 10 <1 1 6 7 8 60 70 80 Vanuatu Samoa Armenia Cape Verde El Salvador Timor-L. Sudan Comoros Bhutan Italy Tanzania Congo D.R. Moldova Haiti Low Middle High Nigeria
    • 4. Natural disasters and needs 11-12-14
    • 5. Japan March 2011
      • Three disasters (Earthquake, Tsunami, Nuclear accident)
      • 19 Medical evacuation from the area
      • Rapid mobilisation of 340 DMAT teams (1 500 staff)
      • One international Fieldhospital
      12/14/11 Name Surname Kobe 1995 March 2011 Injured 44 000 5 000 Dead 6 500 25 000 Ratio Injured/dead 7 0,2
    • 6. Time Non trauma Emergency Trauma Elective Hospital resources (need/use)
    • 7. Earthquake Days after EQ Non trauma Emergency Trauma Elective 2 3 4 Hospital resources (need/use) 1
      • SOD-related trauma
      • Trauma complications
      • Indirect caused Infectious diseases
      • Accumulated elective care needs
      von Schreeb, J, et al. Foreign field hospitals in the recent sudden onset disasters in Iran, Haiti, Indonesia, and Pakistan. Prehosp Disaster Med 2008 Mar-April; 23 (2):144-51.
    • 8. Mandate and role?
      • Affected government is responsible!
      • No international legal framework for interventions in non-conflict areas
      • Different international actors and mandates
        • NGO
        • UN
        • Government agencies
        • Military
        • Others
      • Who is deciding to send relief, why and what role??
    • 9. Capacity, expereince and knowledge
      • Need a logistic machinery
      • Experience and knowledge of adapted surgical principles
      • Clear operational strategy
        • Guidelines and protocols
        • Old compartment syndroms
        • Exit strategy?
      • Systems for accountability?
      11-12-14 Namn Efternamn
    • 10. A lot of people wanted to help but…….
      • Dr David Helfet Director of the Orthopedic Trauma Service NewYork Presbyterian Hospital
      • ” On January 13 I contacted the CEO of Synthes who said: We ’ ll give you whatever you need. They provided their company jet. ”
      • ” There were about 1000 patients in the main public hospital. No electricity or water.We left for a small community hospital. ”
      • ” Our supplies disappeared. Patients became angry. We left on a Canadian charter plane. ”
      • Dr Helfet ’ s conclusion: ” You just can ’ t go in alone. It ’ s inefficient, distracts from the work. ”
      Compiled by A Wladis
    • 11. Message
      • Context is everything!
      • Needs assessment
      • Define “why” to deploy, mandate, role and time frame
      • Ensure experience, knowledge and capacities
      • Accreditation and coordination of Foreign Medical Teams is needed
      • More research to define “pragmatic evidence” for surgical practice interventions after disasters
      11-12-14 Namn Efternamn
    • 12.