The document discusses student's knowledge on disaster medicine based on a study conducted in Albania. It provides an overview of disasters, disaster medicine, triage principles, and the disaster management cycle. The study assessed 100 medical students' familiarity with disaster medicine concepts through a questionnaire. It found that most students had little knowledge and no prior training in disaster medicine but were interested in attending relevant courses. Classroom and practical training were the preferred learning methods. The conclusions indicate a need to incorporate disaster medicine topics into medical curricula to better prepare future health professionals.

1. Student’s knowledge
on disaster medicine
Dr. Enida Xhaferi
University of Medicine, Tirana, Albania

2. Disasters’ overview
▪ The frequency and intensity of disasters have increased
substantially over the past few decades. Consequences include
great suffering, massive mortality, enormous economic losses,
environmental damage and lasting psychological disorders of the
survivors.
▪ Disasters are low probability high impact events. They can strike
without warning, indiscriminate in the victims choice, and have
the potential to overcome even the most prepared of systems
▪ Examples include: the terrorist attacks of September 11, 2001; the
2004 Pacific Ocean tsunami; Hurricane Katrina 2005; the 2010
earthquake in Haiti; the 2011 earthquake and tsunami in Japan;
Superstorm Sandy of 2012, Ebola outbreak in West Africa 2014,
armed conflicts.

3. Disaster overview
• Community members and government agencies
have high expectations regarding the quality of
medical care provided during a disaster response.
For this reason health care professionals must
develop an understanding of the basics of
disaster medicine and be ready to integrate into
the response system if and when disaster strikes
in their community.

4. Disaster medicine
.
▪ Disaster medicine covers all aspects of disaster response including :
management and the incident command systems, triage and clinical
competences for providing effective care with extremely limited
resources, psychological caring for victims and responders.
• It is derived from the intermingling of emergency medicine with disaster
management. Disaster medicine specialist must be familiar with elements
of disaster planning, mitigation, assessment, response, recovery and must
have knowledge of multiple other medical disciplines like: public
health, primary care, surgery, infectious diseases, toxicology considering
the fact that disasters result in different types of injury and disease
patterns. He is a practicing specialist from another field of medicine
first and also a disaster specialist.
▪ The nature and extent of the event determines the appropriate medical
response

5. Disaster definition
• The World Health Organization (WHO) defines a
disasters as sudden disruptive ecological
phenomena of a magnitude to require external help.
• American Red Cross (ARC) defines either natural or
manmade disasters as occurrences that cause human
suffering and create needs that the victims cannot
alleviate without assistance.

6. Types of disasters
▪ Natural disasters include : earthquakes, floods, tsunamis,
tornadoes, hurricanes/typhoons, volcanic eruption, pandemic
influenza, snow storms, avalanche, solar storm, landslide,
famine.
▪ Man-made disasters
▪ Industrial accidents/ chemical release, technological disasters,
vehicle crashes (car, plane, bus), mass casualty events,
explosions, fires, radiation leak.
▪ Human conflicts : armed conflicts/wars, terrorism, intentional
chemical, biological, radiologic, or toxin releases.
▪ Internal disasters (fire, explosion or hazardous materials spill
within the hospital facility), external disasters (outside the
hospital); acute of non acute.

7. Disaster cycle and management
Disaster prevention, preparedness, response, and recovery may
be simplified by using the disaster cycle as a model for these
events.
Disaster cycle : Inter-disaster phase (local risk
assessment techniques)
• Prodromal (pre impact phase -
• mitigation activities)
• Impact phase (not much to be done)
• Rescue phase (post impact - search and
rescue activities advanced life support)
• Recovery

8. Disaster management cycle
Disaster management can be
studied in the following four
phases
Prevention and mitigation-
(vulnerability analysis, zoning)
Preparedness- (emergency
exercising, warning systems)
Response - (search and rescue,
emergency operations)
Recovery
Disaster
Preparedness
Mitigation
Response
Recovery
Disaster
Management

9. Classification of disasters based on
resources needed
 Level I disasters - require only local resources, usually an escalated
EMS response, municipal resources, and community agencies.
 Level II disasters are more extensive - requiring regional resources at
the state level. There may be requirements for special equipments,
such as cranes or earth-moving equipment. Some skilled personnel
may be needed, such as specialized search and rescue organizations or
confined space medicine teams.
 Level III disasters - widespread and massive disasters requiring state
military and other resources.

10. Chain of command
➢ It is government’s obligation to protect the life
and property of its citizens
➢ Disasters are managed at the local and central
level
➢ Multiple government agencies are involved in
disaster management and committees with
specific duties are established.

11. Triage principles
➢ The word triage is derived from the French word trier, which
means ‘‘to sort.’’ Triage has evolved throughout history
➢ Rapid classification of injured on the basis of severity of
injuries and chances of survival.
➢ High priority given to those having better prognosis by simple
intensive care
➢ Victims requiring great deal of attention and questionable
prognosis given lowest priority

12. Types of triage
• Daily triage - performed daily in ED, the most severe patients are
identified to get early evaluation and treatment, all patients treated)
• Incident triage - emergency care system becomes more stressed but
still intensity care is provided to the most severe patients; other
resources might be used; all patients get care)
• Disaster triage - doing the greatest good for the greatest number with
limited resources; the focus shifts into identifying the seriously injured
casualties who have a good chance of survival with immediate medical
interventions.
• Tactical and military triage – similar but mission oriented
• Triage of special situations – when weapons of mass destruction with
radiation, biological, or chemical contaminants are present.

13. Triage categories
Triage category is identified by use of a c colored band or trauma/disaster tag that is
placed on the patient to document that triage has been done.
 Red - First priority, most urgent
 Life-threatening conditions present but the patient can likely be stabilized and, if given immediate
care, will probably survive - massive hemorrhage that can be controlled with a simple operative
procedure (shock and hypoxia present).
 Yellow – second priority, urgent
 The injuries have systemic implications or effects, but patients are not yet in life-threatening
shock or hypoxia; can likely withstand a 45- to 60-min wait without immediate risk when given
appropriate care (isolated femur fracture) .
 Green – third priority, non urgent
 Injuries are localized; patients generally are unlikely to deteriorate for several hours, if at all.
 Black – expectant patients
 Only a minimal chance of survival even if significant resources are expended. (95% third degree
burn)

14. Triage team
• Health care responders must be experienced in
elements of initial trauma and illness care that
support triage on a mass scale, in order to
identify and treat as many victims as possible
who have “an opportunity for survival.” Triage
plans must be well designed, and performed in
accordance with accepted medical practice and
with the goal of identifying victims at high risk for
life threatening injuries that are potentially
salvageable.

15. Psychological distress
• Acute stress disorder reaction, occurs shortly
after the traumatic event and is characterized by
feeling emotionally numb, derealization,
depersonalization, perseveration on the event,
and sometimes amnesia to the event or to things
surrounding the event
• Post traumatic stress disorder if it lasts for more
than one month.

16. Infectious diseases
• Most post disaster infections are directly related to the
usual pathogens of that area; full epidemic outbreaks are
rare; infectious disease outbreaks occur, in the post
impact or recovery phases
• Airborne (measles, upper respiratory disease,
tuberculosis, meningitis), water-borne (Vibrio cholerae,
Shigella dysenteriae, Salmonella typhi infections,
hepatitis A and E, and leptospirosis),or vector-borne
(malaria, Murray Valley encephalitis, Ross River virus
outbreaks, Eastern equine encephalitis) mechanisms are
often enhanced during a disaster.

17. Disaster medicine education
• Recently, disaster medicine education has started
appearing in the medical education curricula.
Many countries have conducted various research
projects focusing on a wide range of topics to
improve the efficacy of rescue and relief in
disaster situations (Delooz et al. 2007; Kaiser et
al. 2009; Kaji et al. 2010; Pfenninger et al. 2010;
Scott et al. 2010; Haraoka et al. 2012; Jacquet et
al. 2014)

18. Study
• This study aims to asses familiarity of students of
the University of Medicine/ Faculty of Technical
Medical sciences with disaster medicine
concepts, evaluate training needs and define the
preferred teaching method

19. Study methodology
• This is a cross-sectional study of 100 master
students selected at random. A self administered
structured questionnaire was distributed to the
students containing questions regarding their
knowledge about disaster medicine and previous
training; triage categories, first aid steps,
(students knowledge was scored in a scale 1-5
point) and their preferred learning method.

20. Results
• The mean age of the students was (22.97±2.44), there
were 89 females and 11 males in the group.
47% percent of the students had not heard about disaster
medicine or had any knowledge about its topics; 93%
percent had never attended academic courses on
disaster medicine; 96% percent related that they would
like to attend a course on disaster medicine as part of
their training (no statistically significant difference
between males and females, χ2=0.5; p=0.4) and
considered knowledge of disaster medicine important
for their future career..

21. Results
Males got better scores
than females and there
was statistically
significant difference in
gender triage knowledge
(p<.000) and first aid
(p<0.01)

22. Results
• Classroom lecturing/ video information and
practical training were the most preferred
teaching methods selected.

23. Conclusions
• Students in this study did not have much knowledge about
disaster medicine and would like to attend specific disaster
medicine courses.
• The perception of the importance of education and training
in disaster medicine among medical students has already
been widely demonstrated. Our results accurately reflect
the conclusions of previous studies and provide further
evidence that students are very sensitive toward these
issues. This may be due to increased media coverage of
issues such as terrorism, public health emergencies, and
humanitarian crisis.

24. Comments
• Health professionals are key components of disaster
responding - they should be sufficiently trained on all
aspects of disaster management and be able to perform
timely and effective medical rescue procedures.
• Medical schools in many parts of the world have begun
to incorporate disaster related topics into their curricula;
educative information should be provided to the general
public as well.

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