англ измDisaster medicine

2
1. Introduction
1.1. All disaster: situation around the world
1.2. Definitions for reference, classification
1.3. The consequences of the disaster
2. Disaster circle
2.1. Phases of disaster cycle.
2.2. Disaster management
3. Disaster medicine
3.1. Emergency risk management for health
3.2 .Health and related services

Disasters are often associated with hazards that include
hydrological (floods and landslides), meteorological (extreme
temperatures and storms), climatological (droughts and wildfires) and
geophysical phenomena (earthquakes/tsunamis, volcanic eruptions and
dry mass movements). Hydrological and meteorological
disasters accounted for 47% and 36%, respectively, of all natural
disasters. Globally, 331 natural disasters were registered in 2015,
causing 22 662 deaths and affecting 90.2 million people.
Technological disasters, including industrial and transport
disasters, accounted for one third of all types of disaster in 2015 but
affect smaller numbers of people as they tend to be more localized.
World health statistics, 2016

Unsustainable rural development and urbanization also
place more of the world’s population at risk:
• In the past 30 years, the proportion of people living in
flood-prone river basins has increased by 114% while the
proportion of people living on cyclone-exposed coastlines
grew by 192%.
• Over half of the world’s large cities (2-15 million) are
highly vulnerable to seismic activity.
(UNISDR global assessment report 2011)

Malaysia. Overview of Disaster Occurrences (Natural and Man-made)
Malaysia is a less disaster-prone country in the ASEAN Region. The major and most frequent
disaster is river flood during the rainy season which is sometimes associated with landslides.
The river flood occurs mainly in the eastern part of the country including Kelantan,
Terengganu and Pahang States. The northern part of Sabah State is a high risk area for
landslide; and Kota Bharu, Kelantan State seems to be a high risk area for flood.

Direct effects are those most visible and include the following:
• Death
• Disability
• Psychological trauma
• Damages to public services infrastructure, notably
• Housing
• Systems of water and sanitation
• Clinics and hospitals
• Roads and transportation
Indirect effects may be less overt but are equally destructive and
include:
• Loss of businesses and jobs
• Decreased spending
• Altered family units and social support systems
• Communicable disease epidemics
• Malnutrition
• Increased violence
The consequences of the disaster

DISASTER - a serious disruption of the functioning of a
community or a society causing widespread human,
material, economic or environmental losses that exceed the
ability of the affected community or society to cope using its
own resources. A disaster is a function of the risk process. It
results from the combination of hazards, conditions of
vulnerability and insufficient capacity or measures to reduce
the potential negative consequences of risk
Definitions for reference
(UN Disaster Management Training Program’s).

The United Nations Office for Disaster Risk Reduction. 2015

CRISIS - is an event or series of events
representing a critical threat to the health, safety,
security or wellbeing of a community, usually over
a wide area. Armed conflicts, epidemics, famine,
natural disasters, environmental emergencies and
other major harmful events may involve or lead to
a humanitarian crisis.
(WHO: six-year strategy for the health sector and community capacity
development)

A casualty is a person who is killed, wounded or injured by some
event, and is usually used to describe multiple deaths and injuries due to
violent incidents or disasters. Casualties is sometimes misunderstood to
mean fatalities, but non-fatal injuries are also casualties.

Place of Disasters
When the disaster occurs in the urban areas, it could cause
certain damages to daily life and economic activities and it might be
difficult to control residents due to high population density and dilute
human relations.

Place of Disasters
While in the rural areas, because of insufficient access in terms of
information and transportation, situation and needs of the affected areas
and people might not be properly assessed.

Disaster Stages
Storm, floods and draught are usually predictable and the
damages require relatively long time to be expanded and continued as
compared with earthquake and tsunami. Therefore, it is possible to
prepare for storm, floods and draught well in advance, but it might require
several months for the response. In contrast, an immediate response is
required for earthquake, tsunami and man-made disasters. Its response
might require a massive deployment of resources at once.

Disaster Stages
Secondary Disaster
Secondary disasters could be triggered after some types of
disasters. For example, storm, floods and earthquake could be a trigger for
landslides, flash floods and high tides. Earthquake could trigger tsunami.
Secondary disasters could require more complicated responses for a
longer period.

Mass casualties following disasters are often characterized by a
quantity, severity, and diversity of injuries and other patients that can
rapidly overwhelm the ability of local medical resources to deliver
comprehensive and definitive medical care.
Casualties associated with natural disasters, particularly rapid-
onset disasters, are overwhelmingly due to:
blunt trauma.
crush-related injuries.
drowning.
mental health issues.
Most people affected by natural disasters DO NOT DIE and many
deaths and long term consequences for casualties are preventable with
timely and appropriate intervention

Immediately after impact, severe trauma and wounds are
the most urgent priority for medical management.
Maternal and new born emergency care as well as mental
health effects are other facets of these dramatic situations. In
these settings, trauma is often related to collapsing infrastructure
and transport-related injury, though violence and civil unrest can
also be a follow-on cause of trauma. In flooding and tsunami,
drowning is a major cause of death.
Following the Gujarat earthquake in 2001, the most
commonly injured areas were:
lower extremity (56%).
spinal and pelvic (17%).
upper extremity (13%).
chest and/or abdomen (<4%).
crush syndrome (<2%).
What are the health risks?

The Hazard
Floods are classified among sudden onset phenomena, although
different types may occur with different speeds:
Flash floods;
River floods ( mostly seasonal);
Coastal floods, associated with tropical cyclones, tsunami, storm surges.
Factors influencing the severity of the hazard are: depth of water,
duration, velocity, rate of rise, frequency of occurrence and season.
Factors of Vulnerabilities
Man made and natural factors:
Location of settlements on floodplains;
Non resistant buildings and foundations;
Lack of warning system and awareness of flooding hazard;
Land with little capacity of absorbing rain: i.e. because of erosion or
concrete covering.
FLOODS

For a disaster to be entered into the database
(the International Disaster Database ), at least
one of the following criteria must be fulfilled:
• 10 or more people reported killed;
• 100 or more people reported affected;
• declaration of a state of emergency;
• call for international assistance.

Disaster cycle
Disasters go through characteristic phases, defined as the
disaster cycle. While this cycle helps to provide a framework for
planning and response to a given disaster, it is important to realize that it
is an artificial division with significant overlap between the phases.
 Mitigation (prevention, protection)
 Preparedness (planning, training, exercises)
 Response
 Recovery

DISASTER MANAGEMENT - is the creation of
plans through which communities reduce
vulnerability to hazards and cope with
disasters.

As the first step, mitigation involves all levels of
society, the private sector, and public government. It helps
organizations identify threats, determine vulnerabilities, and
identify required resources needed to prevent the cycle
destruction.
The goal of mitigation activities is to eliminate or
reduce the probability of disaster occurrence or reduce the
effects of unavoidable disasters.

A multidisciplinary approach is necessary to create an
effective mitigation plan. This requires outside resources,
including emergency management and an understanding of
hazards outside of the facility that would impact hospital
operations. For most organizations, the mitigation planning
process begins with identifying potential hazards or
emergency events by conducting a hazard vulnerability
analysis (HVA). These hazards are any event that can
reasonably be expected to occur within a given community
and should include
• Natural events
• Technological failures
• Human threats

Technological hazards include
disruption of vital services such as
water, computer systems, electricity,
or communications and are impacted
by the density and socioeconomic
structure of the surrounding
community. In addition, human
threats, both intentional and
unintentional, should be examined
(e.g., terrorist activity, mass events,
and civil disturbances).

Risk Reduction involves measures designed
either to prevent hazards from creating risks or to
lessen the distribution, intensity or severity of
hazards. These measures include flood mitigation
works and appropriate land-use planning. They
also include vulnerability reduction measures
such as awareness raising, improving community
health security, and relocation or protection of
vulnerable populations or structures.

Prevention
Emergency prevention is based on
vulnerability assessment and
concerns the technical and
organizational means of reducing
the probability or consequences of
disasters and the community's
vulnerability.
Disasters can be prevented by:
• raising awareness
• learning from other disasters and emergencies
• proper and sustainable management of land and
infrastructure
• putting in place early warning systems
• developing national policies and recommendations.

Emergency preparedness can be defined as the
activities and measures designed or undertaken to prepare
for or minimize the effects of a hazard on the civilian
population, to deal with the immediate emergency conditions
that would be created by the hazard, and to effectuate
emergency repairs to, or the emergency restoration of, vital
utilities and facilities destroyed or damaged by the hazard.
The main activities in the preparedness phase revolve
around planning, training, and exercising the plan.

Preparedness
Emergency preparedness is a
programme of long-term
development activities whose
goals are to strengthen the overall
capacity and capability of a
country to manage efficiently all
types of emergency and to bring
about an orderly transition from
relief through recovery and back to
sustainable development.
The goal of emergency preparedness is to strengthen the
capacity of governments, organizations, institutions and
communities to withstand a disaster or emergency
situation.

To date, no recognized guidelines exist to aid the
disaster manager in formulation of a specifi c recovery plan. In
general, recovery entails the process of
• Rebuilding and reshaping the physical infrastructure
• Restoring the social, economic, and natural environment.
The direct and indirect effects of a specifi c disaster,
whether natural or humanitarian, will determine the nature of
such actions.

The WHO defines a mass casualty incident
(MCI) as ‘‘an incident which generates more
patients at one time than locally available
resources can manage using routine procedures’’
(WHO, 2007).
Examples of MCI include disasters due to natural hazards (e.g., floods,
earthquakes, etc.) or manmade disasters such as a bioterrorism attack.
Mass Casualty Management
Management of victims of a mass casualty
event, aimed at minimizing loss of life and disabilities.

Medical surge – аn influx of patients (physical casualties
and psychological casualties), bystanders, visitors, family
members, media and individuals searching for the missing
who present to a hospital or healthcare facility for treatment,
information and/or shelter as a result of a disaster.
Surge capacity – the ability to manage a sudden,
unexpected increase in patient volume that would otherwise
severely challenge or exceed the current capacity of the
health care system.
Concept of Surge Capacity

When medical and health needs of patients exceed
the resources of a system at a given point in time, a surge
system is needed. This includes providing adequate
numbers of appropriately skilled personnel (staff); event-
specific supplies (stuff); and patient care locations, such
as hospitals or alternate care sites plus an incident
management system infrastructure (structure = physical
locations plus management infrastructure).
Concept of Surge Capacity

DISASTER MEDICINE is the area of medical
specialization serving the dual areas of providing health
care to disaster survivors and providing medically
related disaster preparation, disaster planning, disaster
response and disaster recovery leadership throughout
the disaster life cycle.
Disaster medicine specialists provide insight, guidance and
expertise on the principles and practice of medicine both in the
disaster impact area and healthcare evacuation receiving
facilities to emergency management professionals, hospitals,
healthcare facilities, communities and governments.

Health organization for emergencies and disasters
Environmental
health in
emergencies and
disasters: a
practical guide.
WHO

Emergency risk management for health
is multisectoral and refers to:
the systematic analysis and management of
health risks, posed by emergencies and disasters,
through a combination of hazard and
vulnerability reduction to prevent and mitigate
risks, preparedness, response and recovery
measures.

Disaster Risk Management for Health
MASS CASUALTY MANAGEMENT
The medical response to a mass casualty event operates at two broad
locations: on-site and at the hospital.
Defined pre-hospital search and rescue and triage are essential to
determine patient treatment and transport priorities to save lives and
optimise resources.
Many deaths following natural disasters are preventable with rapid medical
care.
Many deaths following natural disasters are preventable with rapid medical
care.
Disasters from natural, technological and societal hazards lead to large
numbers of non-fatal casualties or survivors.
Mass casualty management is the health sectors immediate priority in an
emergency.

Why is there are need for emergency risk management
for health?
Natural, biological, technological and societal hazards put
the health of vulnerable populations at risk and bear the
potential to cause significant harm to public health. Examples of
these hazards are as follows:
Biological: epidemic disease, infestations of pests.
Emergencies, disasters and other crises may cause ill-health
directly or through the disruption of health systems, facilities and
services, leaving many without access to health care in times of
emergency. They also affect basic infrastructure such as water
supplies and safe shelter, which are essential for health.

• Protection of people’s health by all sectors of
society is essential to reducing the risks and
impacts of disasters to maintain health is to
improve lives and livelihoods.
• An all-hazards approach is vital to effectively
manage the risks to health from
hydrometeorological, geological, biological
(such as epidemics and pandemics),
technological and societal hazards.
FUNDAMENTALS OF EMERGENCY AND DISASTER RISK
MANAGEMENT FOR HEALTH

• Greater investments are needed to strengthen
emergency and disaster risk management for health
(EDRM-H) and to ensure resilient and functioning
health and social protection systems.
• Implementation of the Safe Hospitals Initiative is a
key national action and a global priority to ensure
that new and existing health facilities remain
operational in emergencies and disasters.
• Strengthened preparedness and response capacities
from community to national levels are the
foundation of a timely and effective response.
FUNDAMENTALS OF EMERGENCY AND DISASTER RISK
MANAGEMENT FOR HEALTH

EMERGENCY RISK MANAGEMENT FOR HEALTH (ERMH)
Health care systems provide core capacities
for emergency risk management for health.
Some countries affected by emergencies
have limited basic health services and
infrastructure, which in itself hugely compounds
the challenges of disaster response.
Countries with well-developed systems are
often much more resilient and better prepared
for disasters.

LEVELS OF DISASTER
Level I
Local emergency medical services (EMS) and hospital
are able to respond.
• Single area hospital activated
Level II
Multijurisdictional aid is needed.
• Several local hospitals activated
Level III
State or federal aid is needed.
• Request for aid based on state and federal regulations

Grading occurs within 24 hours of completion of a risk assessment for a
sudden onset event, and within five days of an updated risk assessment
for a slow-onset event.

Disaster and Emergency Level in Malaysia

Health systems
Health services in emergencies encompass
primary health care, pre-hospital and
emergency care, hospital care and specialized
services, including mental health and
rehabilitation.
All these components – which include
community-based services as well as the
international relief response – make up a
comprehensive health system.

Primary health care (PHC) focuses on basic
services to improve health status, which in turn builds
community resilience and provides the foundation for
responding to emergencies. Policies and strategies
focusing on PHC can contribute to decreasing
vulnerability and preparing households, communities
and health systems for emergencies. Following an
emergency, focus is often given to acute care needs
and specialist interventions; whilst important, it is
usually chronic and preexisting conditions that prove
the largest burden of disease.

Hospitals and health infrastructure
Health systems are composed of public, private and
nongovernmental facilities which work together to
serve the community; these include hospitals, primary
health care centres, laboratories, pharmacies and blood
banks. Safe hospitals programmes ensure health
facilities are safely built to withstand hazards,
remaining operational in emergencies.

Surge capacity: Health care systems need to prepare
to cope with large numbers of patients. This may require
mobilising staff around the country to aid affected areas.
Flexibility in health care systems: Flexibility to
deliver different functions is an essential component of
health care delivery. This may mean reducing some
services in order to increase others.
Business continuity planning: Plans to maintain the
continuity of health sector operations includes identifying
priority services, mechanisms for response coordination
and communicating with staff and partner organizations.
Developing adaptable and resilient health care
systems

5 Priorities for Action
Priority 1: Emergency risk management for health as a
national and local priority
• Development and implementation of health and multisectoral
polices, strategies and legislation to provide direction and
support for emergency risk management, especially at local
levels.
• Health sector and multisectoral coordination mechanisms at
local and national levels to facilitate joint action on risk
reduction, response and recovery by the various health and
non-health actors.
• Commitment of sufficient resources to support emergency
risk management for health.

Priority 2: Health risk assessment and early warning
• Assessment of risks to health and health systems.
• Determining risk management measures based on risk
assessments.
• Surveillance and monitoring of potential threats to health,
particularly from biological, natural and technological (such as
chemical and radiological hazards) sources to enable early
detection and warning to prompt action by the public, health
workers and other sectors.

Priority 2: Health risk assessment and
early warning
There are three broad elements, which are usually
considered in risk assessment:
• 1. Hazard Analysis: Identification of the hazards and
assessment of the magnitude and probability of their
occurrence.
• 2. Vulnerability Analysis: Analysis of vulnerability of
individuals, populations, infrastructure and other community
elements to the hazards.
• 3. Capacity analysis: Capacity of the system to manage the
health risks, by reducing hazards or vulnerability, or
responding to, and recovering from a disaster.

Priority 3: Education and information to build a culture of
health, safety and resilience at all levels.
Through education, training and technical guidance,
strengthen the knowledge, skills and attitudes of professionals
in health and other sectors for managing the health risks of
disasters.
Information, education and risk communication for
households and communities at risk to promote healthy
behaviours to reduce risks and prepare for disasters. This may
be through raising awareness through the media and
сommunity-based emergency and disaster risk management
programmes.

Priority 4: Reduction of underlying risk factors to health and
health systems
Poverty reduction measures and systems aimed at improve the
underlying health status of people at risk of disasters. New hospitals are
built with a sufficient level of protection and existing health care
infrastructure is strengthened to remain functional and deliver health
services in emergency situations.
Protection of other vital infrastructure, and facilities that have the
potential to generate risks to public health, such as water and sanitation
systems and chemical facilities, should also apply risk management
measures.
Adherence to building standards and retrofitting of vulnerable health
infrastructure, protection of ecosystems, and ensuring effective insurance
regimes and microfinance initiatives to ensure business continuity across
all health care settings.

Priority 5: Emergency preparedness for effective health
response and recovery at all levels.
Emergency preparedness, including response planning,
training, pre-positioning of health supplies, development of
surge capacity, and exercises for health care professionals and
other emergency service personnel, is critical for the effective
performance of the health sector in the response.

Medical aspects of disaster response
The medical management of people following a disaster may involve
some or all of the following activities:
• First aid
• Assessment and triage of victims in order to prioritize treatment
• Decontamination of people exposed to chemicals or radioactive
materials
• Diagnosis
• Special and general supportive medical care
• Monitoring and prophylaxis against infection
• Long-term follow-up
• Psychiatric or psychological support.
Adequate protection for health care
providers against contamination and
infection is also critically important for an
effective medical response.

Health-care facilities are hospitals, primary health-
care centres, isolation camps, burn patient units,
feeding centres and others.
In emergency situations, health-care facilities are
often faced with an exceptionally high number of
patients, some of whom may require specific medical
care (e.g. treatment of chemical poisonings).
Health-care facilities

Health and related services
Recognizes the wide range of health-care
services and related measures for ERM-H. Includes:
1. Health care services
2. Public health services
3. Specialized services for specific hazards.

Health care services
• Primary health care services (Trauma care)
• Mental health care
• Chronic illness care
• Handling remains of the dead
 Injury prevention and trauma care
 Mental health and psychosocial support
 Sexual and reproductive health
 Child health
 Non-communicable diseases
 Management of dead and missing
Health care or healthcare is the maintenance or improvement of health via
the diagnosis, treatment, and prevention of disease, illness, injury, and
other physical and mental impairments in human beings.

• Primary health care services (Trauma care)
Primary care refers to the work of health
professionals who act as a first point of consultation for all
patients within the health care system.
Primary care is often used as the term for the health
care services which play a role in the local community.
• Chronic illness care
Common chronic illnesses usually treated in
primary care may include, for
example: hypertension, diabetes, asthma, COPD,
depression and anxiety, back pain/

• A mental health professional is a health care
practitioner or community services provider who
offers services for the purpose of improving an
individual's mental health or to treat mental illness.
• Mental health care

Public health in disaster
Public health standards include safe drinking
water, food, shelter, and medical care.
 Communicable diseases prevention
 Environmental health
 Food and nutrition

Environmental health
Human beings cannot survive without
water. Provision of adequate supplies of safe
water is an absolute priority in any emergency
response. Poor hygiene, overcrowding and
pests can be lethal during emergencies.

Communicable disease control
Control of communicable diseases is a
major problem during disasters,
especially where large concentrations of
people are living in unsanitary conditions

Communicable diseases prevention
The public health model involves the prevention
of disease through numerous methods:
• Early detection
• Treatment
• Prophylaxis
• Isolation
• Quarantine
• Education
• Decontamination

Emergencies, conflicts, and disasters
happen frequently, including natural disasters,
chemical or radiological incidents, complex
emergencies, and deliberate events. A substantial
fraction of the disease burden derived from these
events is attributable to environmental risk factors.

Environmental health is the branch of public
health that is concerned with all aspects of the natural
and built environment that may affect human health.
Environmental health is focused on the natural and built
environments for the benefit of human health, whereas
environmental protection is concerned with protecting the natural
environment for the benefit of human health and the ecosystem.
Three basic disciplines generally contribute to the field of
environmental health:
1. Еnvironmental epidemiology
2. Toxicology
3. Exposure science.

1. Environmental epidemiology studies the relationship
between environmental exposures (including exposure to
chemicals, radiation, microbiological agents, etc.) and human
health.
2. Toxicology studies how environmental exposures lead
to specific health outcomes, generally in animals, as a means
to understand possible health outcomes in humans.
3. Exposure science studies human exposure to
environmental contaminants by both identifying and
quantifying exposures.

Detection and alert
Detecting events as early as possible
allows effective and efficient preventive
measures to be initiated that avoid or
minimize the costs to human health.
Early detection and alert of ongoing events
is a crucial factor to ensure that appropriate
response measures can be taken in a timely
manner. Under certain circumstances, early
detection and alert of ongoing incidents can
even greatly attenuate their consequences.
WHO has been developing a system to
rapidly identify, verify and alert for incidents
of (potential) international public health
concern, including those involving
environmental health hazards.

Water and sanitation, along with food and
shelter, are the most important human needs in
an emergency
People in Haiti resorted to drinking
river water after Hurricane Matthew

Food and nutrition, shelter
The Sphere Project—Humanitarian Charter and Minimum Standards in
Disaster Response. 2004.

Long-term medical aspects
Once the acute phase is over, there may
also be longer-term problems that need to be
addressed. These include identifying and
managing health problems resulting from
trauma, injuries, internal organ damage or
carcinogenic changes, and also the
psychosocial impact of the emergency.

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