Preventive Medicine in Humanitarian Emergencies

Transportation and communication are critical components of the disaster response strategy. Two-way communication systems such as radios, telephone, and Internet capability are critical for disseminating information, ­communicating among disaster workers, and planning outside help. Use mass media for providing emergency instructions and health education. The condition of roads, waterways, and landing strips/fields is also important for evacuating people who are injured and receiving emergency aid. Motor vehicles, fuel sources, and boats may be important for rapidly establishing a logistical bridge into disaster-affected areas.

Security is another need that is sometimes overlooked by health workers. Security may be needed to carry out the initial rapid emergency needs assessment or to maintain control of victims seeking basic supplies or health care access. While health workers probably will not be called upon to establish security for disaster affected populations, they can facilitate protection from crime, looting, and exploitation by sharing information regarding criminal activity with security forces. Health workers can also provide security for unaccompanied minors by quickly taking control of these children and keeping them safe from exploitation until family reunification or another permanent solution can be achieved.

Given the Ebola epidemic in West Africa, Hepatitis E outbreak in South Sudan, Yellow Fever in Sudan and the repeated cholera and malaria outbreaks in various disaster situations and influenza epidemics it is important to evaluate whether a clinical facility has an adequate epidemic preparedness plan. Is there a current plan for your facility? How does this plan integrate with regional plans? Have you considered contingency plans for yourself or your coworkers in terms of providing child care or family member care if they become sick? Additional staffing needs may be large. Is there a requirement for all your facilities health-care workers to be vaccinated, and do those plans have a method in place for those who refuse vaccination to prevent the spread of disease (nonclinical work, rules for wearing proper masks)? Depending on the epidemic characteristics, certain populations may be more affected than others, or there may be vast numbers of mildly infected patients with few critical patients or an outbreak with many critical patients. Establishing triage systems to sort these patients, a daily surveillance of the types of these patients and degree of illness, as well as antibiotics, anti-malarials, intravenous fluids, safe blood masks, vaccines, anti-virals should be addressed. Finally, establishing “alternate care guidelines” can provide a framework for dealing with a potentially large number or patients in a system that may become quickly overwhelmed. Resource allocation, ethical considerations and the legal channels to enact these “alternate care guidelines” should ideally be spelled out a priori.