2nd Disaster Surgery Workshop Davos 2013

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

7. Reality

8. Hospital
Haiti 14th January 2010
Triage
Brazzaville April 2012
Surgery
Operating Theater
Anesthesia
Equipment
Consumables
Medicine
Nursing cares
Physiotherapy

9. Primary health cares
Trauma
Non Communicable Diseases
Obstetric
Haiti February 2010
Brazzaville April 2012
Haiti January 2010

10. Internal Displaced Persons IDP
Shelter
Water/Sanitation
Brazzaville April 2012
Food/nutrition
Haiti February 2010
Brazzaville April 2012

11. Internal Displaced Persons IDP
Non Food Items
Protection
Haiti January 2010
Mental Health
Brazzaville April 2012
Haiti January 2010

12. Disaster?

13. 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

14. Earthquake
Haiti 2010

15. Typhoon
Philippines 2013
Leyte island, Ormoc city

16. Tsunami
Indonesia 2005

17. War
Gaza strip 2009

18. Floods
Pakistan 2010

19. 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

20. Health needs during disaster?

21. support
substitution
!
Vacuum effect

22. EVENT
Timeline Disaster
« SIMPLE » EMERGENCY
D2
D4
D7
D14
D21
Search and Rescue
SAR
EVENTS
COMPLEX EMERGENCIES
D28

23. EVENTS
COMPLEX EMERGENCIES
Security
EVENTS:
Bombings, Air Strikes
Army, Police interventions
Food distributions
Rumors….

24. COMPLEX EMERGENCIES
Timeline
Elective Surgery
Emergency Surgery
Children
Adults
Elderly
Complex post operative care
Rehabilitation
Mobilisation
Prothesis
Orthesis

25. 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

26. COMPLEX EMERGENCIES
Timeline
Obstetric
Physiological deliveries
Ceasarian sections
Newborn
Breastfeeding

27. COMPLEX EMERGENCIES
Elective Surgery
Emergency Surgery
Rehabilitation
Medicine (NCD)
Communicable diseases (CD)
Obstretric
Mental Health

28. EVENTS
COMPLEX EMERGENCIES (Armed conflicts)
Emergency (War) Surgery

29. COMPLEX EMERGENCIES (Armed conflicts)

30. COMPLEX EMERGENCY (Armed conflict)
Non Communicable Diseases
Communicable Diseases
Mental Health
Obstetric
Emergency (War) Surgery

31. COMPLEX EMERGENCIES
Timeline
Water
Quantity
Quality (water sanitation)
Access
Food
Food distribution
Food security
Breastfeeding …
Shelter
Temporary shelter (tarpaulin)
Local shelter

32. COMPLEXE EMERGENCIES
Elective Surgery
Emergency Surgery
Rehabilitation
Medicine (NCD)
Communicable diseases (CD)
Obstretric
Mental Health
Water
Food
Shelter

33. 
Health
care
Public
health
Non-food items
Water + Sanitation
Nutrition
P. Perrin 2002 ICRC

34. 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

35. 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

36. Take home message
Despite the type, the intensity of the disaster
“Life goes on”

37. God bless you “Madiba”