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MEDICALIMPORTANCE OF
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Definition
Disaster medicine is a system of study and medical practice associatedprimarily with the disciplines of
emergency medicine and publichealth concerned with the health andmedical and emotional issues of
disaster casualties.
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The Dual-Wave
First wave of patients appears within15 to 30 minutes of the impact of thedisaster,comprised primarily of the
walking wounded
After 30-60 minutes, the second wave are patients unable to get to the ED
by themselves because of the needfor extrication or transport and theseverity of their injuries.
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Voluntary Medical Personnel
individuals responding to the scenewith some degree of medicalexpertise
Most health care providers areunfamiliar with prehospital protocolsor capabilities
due to the severe conditions at thedisaster site, physicians and nursesusually cannot provide care that isan more so histicated than that
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Disaster Supplies
materials needed for a disasterresponse
disaster response during the initial 24hours usually relies on the availableresources within the disaster-strickencommunity
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TRIAGEderived from the French word trier, which means “to sort”
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DISASTER TRIAGE
employed when the local resourcesare unable to provide immediate careon a timely basis to all casualties
needing such care. “to do the greatest good for the
greatest number of casualties.”
Well-performed triage at the entrypoint of the hospital (usually the ED)is the most important factor in asuccessful mana ement for a mass
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Triage Categories
Priority 1 or immediate (RED)
Priority 2 or delayed (YELLOW)
Priority 3, minimal, or nonurgent (GREEN)
Expectant patients (BLACK)
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Principles of Triage
based on consensus opinion, not onclear scientific research.
performed under great emotional and
physical distress does not involve treatment of
casualties
a dynamic process, which need to berepeated on casualties who must wait
requires that the capabilities of theED and the health care facility (HCF)
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Why Manage Children Differently?
A child's cranium relative to the restof their body is larger, and the neckmusculature and spinal column are
not fully developed. The greater relative body surface area
of children, having minimal
subcutaneous fat, thinner epidermis,and an immature behavioral responseto the colder environment
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Care of the Pregnant Woman
In utero fetal growth is adverselyaffected in the weeks following amajor disaster
Earthquake is associated with shortergestational length, presumably aresult of the stress of the event
Other effects includes prematuredelivery, missed abortion, birthasphyxia, premature rupture of membranes, and intrauterine rowth
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DISASTER&
H PITAL
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Hospital Planning for the Severe
hospitals often prepare for a pendingdisaster by discharging as manypatients as possible
Most of the common bedside devicesused for laboratory testing or patientmonitoring have a battery life of only
2 to 12 hours Skilled health care providers may
become the only functioning“monitorin s stem” in ver short
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Hospital Evacuation
deciding to initiate evacuation anddetermining destinations forevacuated patients
avoiding patient influx to otherfacilities that are in need of evacuation
tracking patients transporting patient records and
medications
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Acceptable Minimal Level of Care
Maintenance of stability of thecasualty's vital systems.
Prevention of further deterioration or
injury. Monitoring of casualties should be
regular and systematic
Reassessment and reprioritization of casualties for treatment and transportshould be done on a periodic basis.
Compassion, reassurance, and
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PHARMACEUTICALS IN DISASTERS
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Volume of Pharmaceutical Agents
In the aftermath of the Armenianearthquake on December 7, 1988,more than 5,000 tonne of drugs
and medical supplies were donated tothe region. Even with the erection of 32 new warehouses, only 70% of the
donations could be regionally housed.Fifty people took more than 6months to review the drugs beforethey were able to gain a reasonable
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Expiration of Pharmaceutical
Expired or soon-to-expire drugs arerepeatedly seen in large internationalrelief missions.
Some drugs are not safe when expired.One notable drug in this category istetracycline, which may result innephrotoxicity. Expired products are
widely regarded as therapeuticallyuseless and possibly dangerous, andthey create a sorting and disposal
roblem for eo le on scene at
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Drug Dumping
Benefits include decreased risks andcosts associated with storage,substantial tax deductions, and the
avoidance of destruction cost, which isestimated at U.S. $2,000 per tonne.Bosnia and Herzegovina received anestimated 17,000 tonne of unusablemedication. Even after deductions fortransport cost to the region, the donorsmay have saved $25.5 million, whilecreating a problem that cost therecipients $34 million for the
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Identification of Pharmaceutical
After the Armenian earthquake, noneof the boxes of donated medicalsupplies were written in the local
language, and very few were evenwritten in Russian. Antibiotics with atleast 238 different names labeled in
21 languages were on hand. Onlyone-third were legible with theinclusion of the generic names.
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LITERALLY “DISASTER
”
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Pharmaceutical Donation
No drug should be sent without a specific requestor prior clearance by the receiving nation
No drug should be sent that is not on the list of essential drugs of the receiving nation (or if not
available) on the WHO list of essential drugs No drug should arrive with a future life (before
expiration date) of less than 1 yr Labeling of the drug should be in the appropriate
language(s) and should contain the genericname, strength, name of the manufacturer, andexpiration date
Labeling on the outside of the package shouldcontain the same information as above, plus thetotal quantity of drugs in the package
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PUBLIC HEALTHINTERVENTION
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Environmental Health
Potable Water
Excreta Disposal
Vector Control Shelter
Nutrition
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COMMUNICABLE DISEASECONTROL AND EPIDEMICMANAGEMENT
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Waterborne diseases
Diarrhoeal disease
Hepatitis A and E
Leptospirosis
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Diseases associated with crowding
Measles
Meningitis
Acute respiratory infections (ARI)
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Vector-borne diseases
Malaria
Dengue
Other diseases associated withnatural disasters
Tetanus
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Public Health Surveillance
Rapid detection of cases of epidemic-prone diseases is essential to ensurerapid control
Crude death rates or crude mortalityrates (CDRs or CMRs) are the mostcritical indicators of a population's
improving or deteriorating healthstatus
It should not exceed 1/10,000/day
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Immunization
Mass measles immunizationtogether with vitamin Asupplementation are immediate
health priorities following naturaldisasters in areas with inadequatecoverage levels
Tetanus vaccination should beadministered to those casualties withinjuries such as fractures andlacerations
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Standardized Case Definitions
health providers should recognizesyndromes or a cluster of symptomsunique to measles, upper respiratory
infections, diarrheal illnesses, meningitis,and malaria
laboratory tests should be used toestablish the presence of the disease
(index cases) of interest and to monitorits progress within the population
Once the index cases have been
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“DEAD
BODIES”THE MYTH
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