Key policies and measures in emergency medicine of disaster relief


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Key policies and measures in emergency medicine of disaster relief

  1. 1. Key Policies and Measures in Emergency Medicine of Disaster Relief Ching-Kuei Hsieh Emergency medical relief operation after disaster consists of the following elements and operations that cover three different stages in the aftermath of disaster: (A) Urgent period: a) Forming of rescue command center within 6 hours after disaster. b) Management of Mass Casualty Incident – trauma categorization, priority for immediate treatment, priority for evacuation, dispatching to adapted health facilities, handling and coordinating incoming resources and requests for rescue. c) Local and foreign relief groups cooperate with local command center to provide services. d) Relief groups setting up temporary shelters for their operation and living purposes. (B) Search and rescue period: a) Normally within 1 week after the disaster happened. b) Local and foreign search and rescue teams look for survivors in the ruins. c) Medical relief teams stationing at safety area play as supporting role. (C) Rehabilitation period: a) From the second week until several months or years after the disaster. b) Medical teams have to pay attention to infectious and psychiatric diseases. c) Rehabilitation aspects are manifold in addition to relief of illness and trauma. Since the golden period of emergency medicine relief is within one week after disaster, and most of the local and foreign emergency medical teams are likely to miss it, therefore self-service medical relief measures such as teaching of healthcare know- how, basic medical relief training and distribution of family first-aid kits to survivors are complementary. Key measures in emergency medicine of disaster relief include: (I) Decision making in dispatch of medical team to disaster area. (II) Adopting which types of medical service package. (III) Immediate activation of standard operating procedure. (IV) Establishing model rescue system in advance. (I) Decision making in dispatch of medical team to disaster area.
  2. 2. Decision to dispatch medical team to disaster area is done by evaluating the information collected regarding the aftermath of the disaster. Criteria for evaluation include: • Team readiness (preparedness) and safety. • Offer of dispatch of medical team is accepted by local government/authority of disaster area. • Whether the demands and problems arisen is beyond the capability of the team. • Due to limited resources available, decision on which disaster area chosen for service depends on the principles upheld, characteristics and capacity of the team. • Transport and logistic support/problems. • Possibilities of overlapping among services provided by different medical relief teams at particular areas of disaster. • Whether the original medical facilities at the surrounding of disaster area are still available and could provide referral treatment. • Possibilities of cooperation with other relief teams from various countries. (II) Adopting which types of medical service package: Management of Mass Casualty Incident (MCI) in the aftermath of disaster involves the following four critical medical components: • Search and rescue • Triage and initial stabilization • Definitive medical care • Evacuation This strategy permits teams from various countries to work together to meet disaster- related needs, despite language and cultural barriers. Normally, a team of medical personnel should include minimum 5 physicians: emergency doctor, orthopedic surgeon, internist, family practitioner and psychiatrist. Supporting medical personnel include 6 nurses (2 experienced in emergency room activities, 2 in orthopedic surgery, 1 in public health, 1 in psychiatry), 2 pharmacists, 2 medical technicians, 2 staffs/manager and 1 administrative staff experienced in handling medical records and 2 experienced rescue technicians. Besides, infectious disease emergencies could arise resulting from: • A breakdown of the usual mechanisms of infection control. • The introduction of emergence of pathogens.
  3. 3. • The movement of population into new areas. Components of infectious-diseases surveillance and treatment should include epidemiologist, physicians well versed in the diagnosis and treatment of infectious diseases, nurses that are familiar with infection control procedures, public health officials, etc. Measures of emergency medical relief on the field of disaster: a) Setting up field hospital. Some considerations in setting up and operating a field hospital include: • Facilities – existing structure, such as school, is preferable, but a hospital can be built with tents. • Triage – in waiting area, doctors determine who needs most urgent care. • Outpatient care – children examined for signs of malnutrition; doctors see patients, dispense drugs; separate tents may be needed for man, women and children. • Inpatient care – each tent can hold several overnight patients; patients sleep on cots or mattresses. • Isolation area – for those with highly infectious diseases. • Vaccination – to prevent outbreaks of preventable diseases, such as measles. • Storage – for medical supplies and drugs; refrigeration of vaccines. • Water – often comes from well, or from “bladder tanks” of purified water. • Latrines – toilets located away from patient areas and water supply. • Top health concerns – infected wounds, shock, trauma, respiratory illness, epidemics, risk of vector-borne diseases. b) Teaching of healthcare know-how to survivors such as : • Practical means to avoid contamination of water resource. • Hygienic means to handle faeces. • Hygienic means to handle food. • Personal hygiene. c) Local volunteers training Cooperate with relevant authorities to encourage local workers/volunteers for intermediate and advanced training on handling common diseases such as dehydration caused by diarrhea, malaria, bronchitis, etc.
  4. 4. d) Provide essential drugs and medical equipments for emergency relief such as vaccination to prevent outbreaks of preventable diseases. e) Handling individual patient Due to insufficient medical facility at disaster area, patients require advanced diagnosis and treatment have to be transported to referral hospital. f) Distribution of first-aid kits to survivors of disasters The preparation of medicine kits should consider the following: • Instruction and prescription of drugs/ointment - easily understood by local people. • Drugs should be packed properly such that it is well protected from humidity and light, with leaflet (insert) giving directions for use, warnings and precautions. • Expiry date of medicine given should be at least 3 to 6 months (III) Immediate activation of standard operating procedure. Based on information collected, evaluation and suggestion for proactive medical relief plans could be done. Always adjust plan according to the level of emergency. Standard operating procedure for emergency medical relief is as below: Disaster Information collection  Initial evaluation for decision making  Preparation for team dispatch  Implementation and evaluation Information gathered includes: • Type and characteristics of disaster happened. • Background of the area stricken by the disaster: country, politics, economy, transportation, religion, culture, geography, climate, etc. • Distribution of areas stricken by the disaster particularly those badly hit areas. • Whether there is mass casualty incident happened in any area. • Any outbreak of infectious diseases. • Connection with local authority and government; ensure the dispatch of medical team to the area is welcomed by the relevant authority/government of disaster area • Relief operation by local government and international NGOs. • Living conditions of victims at evacuation shelters. • Local supply chain of medicine/drugs.
  5. 5. • Any hospitals at the vicinity/neighboring states of the disaster areas available for referral for advanced treatment. • Limitation in logistics and transportation that would affect the whole aid operation. Implementation and evaluation: The following affects the efficiency of emergency medicine operation: • Flexibility and mobility of team • Relays of teams dispatched. • On-site flow of service. • Logistics support. • Cooperation with relevant authorities and NGOs; avoid overlapping of services. During the implementation of emergency medicine at disaster area, constant monitoring of sudden occurrence of the following risks: • Recurrence of the disaster or threat to security of team members. • Outbreak of infectious diseases. • Sudden increase of demand - Refugees pouring into the area, etc. • Logistics problems. (IV) Establishing model rescue system in advance. a) Maintain well-trained personnel with high mobility and up-to-date standard operating procedure. b) Establish modular system of medical post/ field hospital with ease of transportation and assembly on site. c) Develop logistic capability and relay of medical teams to support field hospital operation for months. The key principle of disaster care is To Do the Greatest Good for the Greatest Number of Patients, while the objective of conventional medical care is to do the greatest good for the individual patient.