Course Disasters and their Effects ​on the Population

Coordinating the activities of all these organizations poses a tremendous challenge. Following a natural disaster the host nation’s government/agencies and military are likely to have operational command. Most nations now have defined governmental authorities responsible for global disaster planning and response, as well as coordinators for individual sectors such as health. External agencies or governments play a supportive role in providing technical assistance and resources. PAHO has developed a number of technical manuals and training activities to assist nations in the planning of coordinated disaster responses at the regional and national level.

In complex emergencies related to a conflict, the armed forces or government authorities will have the command of operations, including the coordination of humanitarian help. The coordination in this scenario can be particularly difficult if the hostile groups are stationed nearby and try to block assistance of civilians. In this context, humanitarian help can be used as a political and strategic instrument.

Medical Volunteering

Following a disaster many pediatricians and other health professionals volunteer for a limited time. During the initial response phase, the greatest pediatric needs include air transport teams, surgical teams (a surgeon, OR nurse, anesthesiologist, and critical care pediatrician), as well as pediatricians with training and experience in emergency medicine and critical care. Volunteers may have to be self sufficient for a period of time in terms of food, water, and shelter. Volunteers should work through an established NGO or governmental agency rather than simply “show up” to help. Volunteers should be prepared to respond quickly, as the quicker the response teams can provide appropriate care, the more effective they can be at saving lives and limiting morbidity.

It is critical to attempt to reunite children with their families as soon as possible and pay special attention to reducing their vulnerability in all disaster response planning.

Part of preparation is anticipating the types of injuries that will be seen with different types of disasters. When sending a response team into a disaster during the acute response phase, it is important to have the personnel with the ability to treat the most likely injuries seen with the specific type of disaster. In a major earthquake like the one in Haiti in January 2010, one would expect the majority of the casualties to be secondary to traumatic injuries related to collapsed buildings.

Therefore, a team should be prepared to have personnel and supplies that can be used to treat crush injuries, a large number of open wounds, along with a variety of orthopedic injuries. In a disaster involving an explosion (large industrial accident or terrorist attack), the pattern of injuries would include many of the same traumatic injuries as seen in an earthquake, but would also include a large number of burns and blast injuries such as blast lung. Personnel required in this type of disaster should include those with training in caring for burns as well as experience with other traumatic injuries.

In the first days following the Haiti earthquake, there were a large number of complex orthopedic injuries that required emergent treatment. These included open fractures, traumatic amputations, and crush injuries. The treatment of these injuries included fracture reductions, wound debridement, and amputations. Thus it was essential to have personnel with the training to perform the needed procedures. Personnel with training in emergency medicine, general surgery, and orthopedics are best suited to be part of the initial response team when a large number of traumatic injuries are expected.

Supplies that are essential in caring for these patients include plaster splinting/casting supplies, wound dressing supplies, and medications for pain control and sedation. When caring for open wounds, the ability to appropriately irrigate and clean wounds can greatly reduce subsequent secondary infections of these wounds. Response teams should come prepared with supplies that would be able to provide pressure irrigation of wounds with either clean water or saline, antibiotic ointments, and large supplies of wound dressings. A large number of the orthopedic injuries can be treated with casting or splinting. Plaster casting material is far superior in this setting since casts made of fiberglass cannot be easily removed without a cast saw, whereas patients/families can be instructed to remove a plaster cast by soaking it in water.

Table 4 provides a list of pediatric equipment that, if possible, should be brought in if not available on site.

Communication in a disaster situation is essential between disaster relief team members as well as with coordinating groups and logistical support personnel in home countries. Modern technology has provided many different types of communication devices, which have different advantages and disadvantages. Communication networks and contingency plans are an essential part of the disaster preparedness phase. Radios are useful for short range communications when a disaster relief team is separated. However, they are limited by range and will not allow communication with the other teams or organizations that are a long distance away.

Satellite phones are ideal for communication with the team as well as with the home country. They provide a reliable method of communication when telephone services are not working or there is no infrastructure, because they rely on orbiting satellites to transmit data. However, they are a scarce resource as well as an expensive resource. The main drawback for many portable satellite phones is that the phone’s antenna needs an unobstructed view of the sky.

Cellular phones are an ideal method for communication. Voice calls can be made to team members as well as to coordinate in the home country. E-mail and SMS texting are other methods of communicating through the cellular network. However, cellular technology is dependent on a cellular infrastructure and network that has survived a disaster. The cellular networks may also become overwhelmed by the number of people attempting to use it in the time after the disaster, thus emergency/disaster relief providers and organizations need to have a communication system that is reliable and free of interference.

The availability of the internet through various means including satellite links and data over cellular networks has allowed for many novel methods of communication over the internet. There are traditional methods such as electronic mail. Web blogs also allow relief workers as well as those affected by the disaster to reach out to the world. Other social media tools such as Facebook and the microblogging service Twitter allow almost instantaneous updates from the field.

Mental health considerations

Disaster response providers are often thrust in to a high stress situation with exposure to situations they may have never experienced before. The degree of destruction and death will likely be much greater than what the health care providers are accustomed to dealing with in their daily lives. Local first responders and medical providers thrust in to the role of the initial emergency response phase may be faced with the additional stress of personally knowing many of the victims (or their family members) that they are caring for.

The emotional impact of large scale destruction, suffering, and death will elicit different responses in different people, but all volunteer providers should recognize how their experiences can affect their wellbeing both emotionally and physically. The emotional stress experienced by disaster response providers has been well documented after events such as 9/11 and Hurricane Katrina. The affect of stress is amplified by the long hours of intense work experienced during the response to a disaster. Environmental conditions (such as extreme heat/cold/rain/flooding), lack of sleep, and inadequate nutrition impair a provider’s ability to deal with the stressful situation.

Crisis response workers and managers, including first responders, public health workers, construction workers, transportation workers, utilities workers and other volunteers, are repeatedly exposed to extraordinarily stressful events. This places them at higher than normal risk for developing stress reactions (Pan American Health Organization [PAHO], 2001). It is important for all disaster response providers to recognize the potential emotional stress they will be entering before arriving on scene. Stress prevention and management needs to be considered and addressed from the start of the deployment in order to prevent problems. By anticipating stressors and individuals’responses to these stressors, the response team and individuals can potentially prevent a crisis within the team of care providers.

The US Department of Health and Human Service, Substance Abuse and Mental Health Services Administration (SAMHSA), and Center for Mental Health Services (CMHS) have published a guide focusing on general principles of stress management and offers simple, practical strategies that can be incorporated into the daily routine of managers and workers. It also provides a concise orientation to the signs and symptoms of stress. 

While most people are resilient, the stress response becomes problematic when it does not or cannot turn off, that is, when symptoms last too long or interfere with daily life. Table 5 provides a list of the common stress reactions.