In 1994, the emergency room experienced an internal disaster: a flood. The basement of Roberts Hospital had a foot of water in it. It was about 9 p.m. on a Friday, and we were able to bring the 10 or 12 patients from the ward to the recovery room. We released those who could be released, welcomed those we could admit and closed at 3 a.m. The emergency room remained closed for a week until the damage could be repaired. Other possibilities for internal disasters include power outages, chemical or radiological accidents, fires and explosions, bomb threats, and elevator problems. An example of an infectious disease after a disaster is pulmonary coccidioidomycosis, which was observed after the Northridge earthquake in 1994 due to increased exposure to dust. In Southern California, coccidioidomycosis increases with each early construction and the dry dirt it lives in is disturbed and turned into dust so that it can be carried by the wind. Another example is the increased incidence of giardiasis in Montana in 1980 following the eruption of Mount St.
Helens. The ashfall caused heavy water runoff due to obstruction of streams and streams, and thus an increase in the pathogen in this area. We also have limited capacity to treat victims. At the time of the sarin attack, 74% of patients had no injuries; This is part of the mass hysteria effect. One hospital treated 641 patients in a single day. (We see 250 patients in our emergency room on a busy day.) In addition, 20% of hospital staff treating sarin victims were infected themselves. Federal plans do not take into account individual hospital capacity, and some hospitals are not very well prepared to care for disaster victims. Unfortunately, this puts a strain on hospitals, which are better prepared to care for infected patients. As a Level 1 trauma center in a large metropolitan area, Baylor must play a leading role in preparing for bioterrorism and caring for citizens who are victims of such attacks. Hopefully, this article and the articles on bioterrorism that will appear in the July 2001 issue will help raise awareness of the problems we face as a major medical centre, thereby helping to improve our response to such disasters and save lives. All disasters are low-probability events. Even if they do, at least in the United States, there are few casualties.
Because of this, people tend to become apathetic: “What`s going to happen, what`s going to happen. What control do I have over it? This is a major obstacle to combating the future threat of bioterrorism. President Clinton said that in the next 20 or 30 years, we`re going to have a biological terrorist attack. Interest in bioterrorism has been somewhat sparked by the Oklahoma City bombings, the sarin attack in Tokyo, and the gas attacks in the Iran-Iraq war. In the following sections, I provide an overview of some natural and man-made disasters, specific clinical entities related to disasters, disaster planning, and the future of disaster medicine. President Carter founded FEMA in 1979. It includes the National Fire Administration, civil defense, and insurance programs under its auspices, and it can call other federal agencies as needed, including the Department of Transportation, the U.S. Army Corps of Engineers, the Environmental Protection Agency, and the Department of Agriculture. FEMA does not respond to disasters alone, but only at the invitation of a governor.
FEMA had management problems in the 1980s, but has since become much more efficient and responsive to the needs of disaster victims. An improvement in 1992 was the development of the Federal Response Plan, under which the American Red Cross pooled its resources with the 26 federal agencies under FEMA. The Joint Commission on Accreditation of Health Care Organizations commissions the preparation and review of hospital disaster plans. At Baylor, we hold a disaster exercise twice a year. Nevertheless, we are probably experiencing the “paper plan syndrome”. Although the plans are written on paper, the holes become visible when they are put into action. We found problems during our drilling and solved these problems, but in other circumstances, other holes may appear. Disasters disrupt traditional infection control mechanisms: safe food, clean water, access to health care and vector control. These problems are worse in developing countries than in developed countries, but much may also depend on climate. In cold weather, people congregate and spread diseases; In hot weather, vectors such as mosquitoes can become a problem. Disasters do not bring new pathogens. Instead, infectious diseases are caused by pathogens endemic to the region or introduced by refugees.
For this reason, mass vaccines are rarely useful, with the exception of the measles vaccine, which has proven useful in past disasters. The first phase of the implementation phase is search and rescue. At first, survivors among the local population do this work, dispelling another myth called “disaster syndrome”; It was believed that survivors walked around dazed and apathetic after disasters. In reality, even the lightly wounded stick together and quickly get involved in the search for survivors. Most lives are saved from day one or two to the first day; Often, however, rescuers themselves can become victims. There are many types of man-made disasters. On an individual basis, planes, trains and cars are the main sources. Technical disasters such as the collapse of the Hyatt Regency Skywalk in Kansas City can kill and injure groups of people. When a large number of people gather for a concert or sporting event, mass accidents can occur, for example, when people are crushed.
Many articles have been written describing the medical needs for these major events, including the number of doctors and nurses needed and the amount of water needed to prevent people from becoming hyperthermic or dehydrated by heat. I will focus on 2 man-made disasters: hazardous materials and radiation. Interestingly, compared to Third World countries, the United States does not have disasters of exceptional proportions. In U.S. history, only 6 disasters have had mortality rates >1000 (table), and only 10 to 15 disasters per year result in >40 injuries. The total number of deaths from American disasters from 1900 to 1967 is small compared to the number of road deaths – 53,000 – in 1967 alone. The National Disaster Medical Treatment System is another disaster relief programme; It was launched in 1981 and consists of volunteer rescue teams (currently 61 of them) that can be quickly assembled and brought to a disaster site. Each team is autonomous, with approximately 35 medical and support staff. Teams can be deployed for up to 2 weeks. People are injured in hurricanes in a variety of ways. Storm surges, in which the ocean is literally ingested and dropped on a coastal area, are responsible for 90% of all cyclone-related deaths. People are also injured by broken glass or debris caught in the wind, house collapses and mudslides.
Electric shocks can occur after the disaster. The risk of electric shock is particularly high in motorhomes, where the wiring is not as well grounded. Another injury called “cyclonic syndrome” occurs when people cling to trees in the midst of rising waters and wind. They tend to have abrasions on the chest and medial arms and thighs. Overall, mortality and morbidity rates associated with cyclones remain low, except in the event of storm surges or flash floods. As with floods, most injuries consist of cuts and scratches, which are often contaminated, as well as fractures. Normally, we think of disasters as acute situations, but they can also be chronic. The famine in North Korea in the early 1990s killed an estimated 2 million people. The chronic pollution in Love Channel happened over a period of 20 or 30 years, but was always a disaster. A major disaster occurs every day around the world, and natural disasters requiring international assistance occur every week.
Over the past 20 years, 3 million deaths and $50 billion in property damage have been attributed to disasters. As more people move to disaster-prone areas — including seismic zones, floodplains and coastal areas in the United States — the risk will increase in the coming years. Based on the introductory quote, Isaiah could be considered one of the first disaster epidemiologists. “Catastrophe” comes from the Latin word astrum, which means star. The ancients believed that earthquakes, volcanoes and the like were ordered by the sky. Even today, we don`t have much control over these natural disasters, but we do have control over their effects. The recovery phase consists of a reassessment of the scene for missing victims, withdrawal from pre-hospital services and debriefing of those involved. Debriefing includes critical incident stress management.
Health workers assisting disaster victims often become stressed and depressed. FEMA professionals help workers vent and release their feelings. Overall, disaster relief should take place in 3 phases: activation, implementation and recovery. The media described the industrialized world`s response to the Guatemala disaster as a “second catastrophe.” No initial field assessment has been conducted.