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Pharmaceuticals and Medical Equipment in Disasters
... 26 Equipment Equipment was categorized into clinical, hygiene (hand-washing facilities and water closets), refrigeration, and water pumps. [32][33][34]48,[55][56][57][58][59][60][61][62][63] Clinical equipment was considered items used to treat patients (for example, beds, medical devices, and disposable items). 59,62 Hygiene included practices used for infection control, and refrigeration ensured medicines and food were stored at appropriate temperatures. ...
... 28,29,32,41,44,45,48,49,58,59,61,62,69,72 Shelter included housing and homes, which can be temporary (such as schools) or permanent structures (such as houses). [27][28][29]34,39,49,50,58,76,77,81 Shelter provided a mechanism for people to stay safe and healthy. 29,54,64,81,82 It was also identified as being particularly important for vulnerable populations. ...
... 29,54,64,81,82 It was also identified as being particularly important for vulnerable populations. 29,34,39,58,82 Finally, the impact of a disaster on physical structures included a loss of hospital-style care and basic services for treating patients and maintaining community well-being. 29 23,70 Hygiene was the need to prevent infection and spread of disease. ...
... 26 Equipment Equipment was categorized into clinical, hygiene (hand-washing facilities and water closets), refrigeration, and water pumps. [32][33][34]48,[55][56][57][58][59][60][61][62][63] Clinical equipment was considered items used to treat patients (for example, beds, medical devices, and disposable items). 59,62 Hygiene included practices used for infection control, and refrigeration ensured medicines and food were stored at appropriate temperatures. ...
... 28,29,32,41,44,45,48,49,58,59,61,62,69,72 Shelter included housing and homes, which can be temporary (such as schools) or permanent structures (such as houses). [27][28][29]34,39,49,50,58,76,77,81 Shelter provided a mechanism for people to stay safe and healthy. 29,54,64,81,82 It was also identified as being particularly important for vulnerable populations. ...
... 29,54,64,81,82 It was also identified as being particularly important for vulnerable populations. 29,34,39,58,82 Finally, the impact of a disaster on physical structures included a loss of hospital-style care and basic services for treating patients and maintaining community well-being. 29 23,70 Hygiene was the need to prevent infection and spread of disease. ...
Objectives
The study aim was to undertake a qualitative research literature review to analyze available databases to define, describe, and categorize public health infrastructure (PHI) priorities for tropical cyclone, flood, storm, tornado, and tsunami-related disasters.
Methods
Five electronic publication databases were searched to define, describe, or categorize PHI and discuss tropical cyclone, flood, storm, tornado, and tsunami-related disasters and their impact on PHI. The data were analyzed through aggregation of individual articles to create an overall data description. The data were grouped into PHI themes, which were then prioritized on the basis of degree of interdependency.
Results
Sixty-seven relevant articles were identified. PHI was categorized into 13 themes with a total of 158 descriptors. The highest priority PHI identified was workforce. This was followed by water, sanitation, equipment, communication, physical structure, power, governance, prevention, supplies, service, transport, and surveillance.
Conclusions
This review identified workforce as the most important of the 13 thematic areas related to PHI and disasters. If its functionality fails, workforce has the greatest impact on the performance of health services. If addressed post-disaster, the remaining forms of PHI will then be progressively addressed. These findings are a step toward providing an evidence base to inform PHI priorities in the disaster setting. (
Disaster Med Public Health Preparedness
. 2016;page 1 of 13)
... Disaster-related morbidity from acute traumatic injuries, environmental exposures, and infectious diseases was expected, and medical relief plans focused on these well-recognized consequences of natural disasters. 1 Although survivor needs are likely incident specific, recent evidence suggests that post-disaster medical care often involves few patients with acute conditions 2,3 and many patients with low-acuity complaints. 4 -6 In this report, disease surveillance and pharmaceutical use data from a group of displaced Hurricane Katrina survivors are presented. ...
Preparing for natural disasters has historically focused on treatment for acute injuries, environmental exposures, and infectious diseases. Many disaster survivors also have existing chronic illness, which may be worsened by post-disaster conditions. The relationship between actual medication demands and medical relief pharmaceutical supplies was assessed in a population of 18,000 evacuees relocated to San Antonio TX after Hurricane Katrina struck the Gulf Coast in August 2005.
Healthcare encounters from day 4 to day 31 after landfall were monitored using a syndromic surveillance system based on patient chief complaint. Medication-dispensing records were collected from federal disaster relief teams and local retail pharmacies serving evacuees. Medications dispensed to evacuees during this period were quantified into defined daily doses and classified as acute or chronic, based on their primary indications.
Of 4,229 categorized healthcare encounters, 634 (15%) were for care of chronic medical conditions. Sixty-eight percent of all medications dispensed to evacuees were for treatment of chronic diseases. Cardiovascular medications (39%) were most commonly dispensed to evacuees. Thirty-eight percent of medication doses dispensed by federal relief teams were for chronic care, compared to 73% of doses dispensed by retail pharmacies. Federal disaster relief teams supplied 9% of all chronic care medicines dispensed.
A substantial demand for drugs used to treat chronic medical conditions was identified among San Antonio evacuees, as was a reliance on retail pharmacy supplies to meet this demand. Medical relief pharmacy supplies did not consistently reflect the actual demands of evacuees.
In the past decade, interest in the operational and epidemiologic aspects of disaster medicine has grown dramatically. State, local, and federal organizations have created vast emergency response networks capable of responding to disasters, while hospitals have developed extensive disaster plans to address mass casualty situations. Increasingly, the US armed forces have used both their ability to mobilize quickly and their medical expertise to provide humanitarian assistance rapidly during natural and man-made disasters. However, the critical component of any disaster response is the early conduct of a proper assessment to identify urgent needs and to determine relief priorities for an affected population. Unfortunately, because this component of disaster management has not kept pace with other developments in emergency response and technology, relief efforts often are inappropriate, delayed, or ineffective, thus contributing to increased morbidity and mortality. Therefore, improvements in disaster assessment remain the most pressing need in the field of disaster medicine.
Drug donations are usually given in response to acute emergencies, but they can also be part of development aid. Donations may be given directly by governments, by non-governmental organisations, as corporate donations (direct or through private voluntary organisations), or as private donations to single health facilities. Although there are legitimate differences between these donations, basic rules should apply to them all. This common core of "good donation practice" is the basis for new guidelines which have recently been issued by the World Health Organisation after consultation with all relevant United Nations agencies, the Red Cross, and other major international agencies active in humanitarian emergency relief. This article summarises the need for such guidelines, the development process, the core principles, and the guidelines themselves and gives practical advice to recipients and donor agencies.
Humanitarian assistance to people suffering as a result of catastrophes generally includes large charitable donations of drugs from sources such as private individuals or companies, nongovernmental organizations, United Nations agencies, and foreign governments. Unfortunately, evaluations have repeatedly shown that many of the medical supplies sent are not the appropriate ones.1,2 During the war in Bosnia and Herzegovina, many areas became totally dependent on foreign help for medicines and medical supplies. Information circulated about massive quantities of irrelevant drugs that arrived in Mostar, Tuzla, Gorazde, Sarajevo, and Bihac, cities that were key targets for humanitarian assistance. These rumors prompted us . . .
Resource management is a critical component of disaster preparedness and response. The type and quantity of resources and supplies needed by any particular community will be determined by several factors including the disasters affecting the community, existing resources within the community, resources available from neighboring communities, and the vulnerability assessment of a community. Ideally only needed resources should be requested and delivered. Unsolicited aid can often hamper an emergency response. The needs of a community will change during a disaster. Often the immediate need focuses on the medical sector. Issues such as hygiene, water and shelter will occur later. Disaster planning and logistical management of resources should not only consider the short-term needs of the community but also the long-term consequences of a disaster on the community.
The [US] Nunn-Lugar-Domenici Defense Against Weapons of Mass Destruction (WMD) Act (the WMD Act of 1996) heralded a new wave of spending by the federal government on counter-terrorism efforts. Between 1996 and 2000, the United States of America (US) federal government allocated large sums of funding to the States for bioterrorism preparedness. Distribution of these funds between institutions involved in first-responder care (e.g., fire and safety departments) and hospitals was uneven. It is unknown whether these additional funds had an impact on the level of hospital preparedness for managing mass casualties involving hazardous materials at the local level, including potential terrorist attacks with chemical agents.
(1) To compare 1996 and 2000 measures of preparedness among hospitals of a major US metropolitan area for dealing with hazardous material casualties, including terrorism that involved the use of weapons of mass destruction; and (2) To provide guidance for the improvement of emergency preparedness and response in US hospitals.
In July 1996 and again in July 2000,21 hospitals in one major US city were surveyed by questionnaire. A survey was used to assess the amounts of antidote stocks held available for treatment of casualties caused by toxic chemical agents and institutional response capabilities including the number of showers for decontaminating patients, the level of worker protection, and the number of staff trained to decontaminate patients.
Hospital preparedness for treating and decontaminating patients exposed to toxic chemical agents was inadequate in 1996 and in 2000. From 1996 to 2000, there was no statistically significant change in the lack of hospital preparedness for stocking of nerve agent and cyanide antidotes. Capacity for decontamination of patients, which included appropriate hazardous material infrastructure and trained staff, generally was unimproved from 1996 to 2000 with the exception of an increase of nearly 30% in hospitals with at least one decontamination shower facility.
Hospitals surveyed in this study were poorly prepared to manage chemical emergency incidents, including terrorism. This lack of hospital preparedness did not change significantly between 1996 and 2000 despite increased funds allocated to bioterrorism preparedness at the local level.
The paper addresses the issue of information in disasters relief. It begins by establishing the need for planning and systematic organization in disaster action, in order to produce a long term effect on the vulnerability levels of communities. Information is introduced as a key element in any phase of disaster management. The different informational needs are described by phases; information types and possible sources are briefly described. The organizational network of information collection is presented and the immediate need for research in this field is emphasized.
The damage wrought by the earthquake that recently struck Guatemala evoked a commendable and efficient national response. It also led to international relief activity that was clearly instrumental in assisting the country's short-term recovery efforts. At the same time, this initial recovery period caused a good deal of experience to be gained in the field of disaster management. Some of the lessons derived from the experience are examined, and a number of approaches are suggested for measurably improving both national and international response to future disasters of this kind.
After the 1988 Armenian earthquake, which affected an area with a population of 700,000, international relief operations sent a minimum of 5000 tons of drugs and consumable medical supplies. Because of difficulties with identification and sorting, only 30% of the drugs were immediately usable by the health workers in Armenia. Such quantities posed numerous problems for transportation and storage. Useless and expired agents comprised 11% and 8% of the drugs, respectively. 20% of all the drugs provided by international aid had to be destroyed by the end of 1989.
"The role of physicians and other health workers in the preservation and promotion of peace is the most significant factor for the attainment of health for all." This 1981 resolution of the World Health Assembly (resolution WHA 34.38) recognizes that the greatest threats to the health of the people of the world lie not in specific forms of acute or chronic disease, not even in poverty, hunger, or homelessness, but rather in the consequences of war. Any war, and even preparation for war,1 can of course lead to poverty, hunger, homelessness, and disease. Indeed, these consequences make even "victory," or the quest for "national security" through massive arms expenditures, seem hollow. Among the dangers of war, the greatest single threat lies in weapons of indiscriminate mass destruction, which The Journal recognizes annually with its Hiroshima anniversary issue.Nuclear Weapons
Nuclear weapons remain the most potentially destructive of all these
To describe the type of medical care that disaster medical assistance teams (DMATs) provided to a community struck by a major hurricane.
A prospective study describing the use of DMAT field clinics by a population affected by a major hurricane. Data regarding the type of medical care provided to disaster victims and the acuity of each patient's medical condition were abstracted from medical charts at each field clinic.
Three DMAT field clinics that provided medical care to residents of Kauai, Hawaii, after Hurricane Iniki struck the island on September 11, 1992.
From September 16 to 19, 1992, three DMATs provided medical care to 614 people. The patients' average age was 34 years, and 60% were male. The largest treatment categories were injury (40.4%), illness (38.6%), and preventive services (9.0%). Most illnesses and injuries were minor, and 99% of the patients were ambulatory. Only 33 patients (5.4%) were referred to another medical provider. Referrals were generally for procedures not available in DMAT field clinics rather than for life-threatening conditions.
DMATs sent to assist with the medical needs of a US community struck by a major hurricane should be prepared to deliver basic medical services and primary health care. The need for these medical services will continue beyond the impact phase of a hurricane disaster.
Frequently in the wake of disasters, large amounts of humanitarian supplies arrive from multiple sources within the country or from abroad. Only a portion of these donations actually responds to specific requests from the affected country. A significant part consists of unsolicited donations whose value--in terms of meeting immediate, life-threatening needs--is questioned by many disaster managers. In 1990, WHO initiated a supply management project, known as "SUMA", to provide national authorities with a management tool and the skills to sort and inventory large amounts of relief supplies in a short period of time. It is a technical cooperation programme to assist the local coordinating agency to get an accurate picture of what is potentially available in the affected area, and to sort the most valuable relief items from those of doubtful usefulness. National authorities have developed their SUMA teams in many situations, both in Latin America and the Caribbean; this article describes three of these experiences. A flood in Costa Rica, in 1995, where the Red Cross assumed national responsibility for managing relief supplies donated locally. The earthquake in Paéz, Colombia, also in 1995, where the National Disaster Committee activated SUMA for all supplies sent to the disaster area, with the exception of specialized health shipments channelled through the Ministry of Health. In Haiti, in 1994, a complex disaster was compounded by a tropical storm. All civilian supplies arriving at the airport were processed by the SUMA team which included customs officers among its members. The traditional problem of unsorted and inappropriate supplies, noted in most international disasters, seems to have been negligible, a trend which can perhaps be credited to 20 years of preparedness activities in Latin America and the Caribbean. The superficial analysis of the data underlines the potential for operational research on the standardized databases generated by SUMA.
After recent terrorist attacks, new attention has been focused on health care facility decontamination practices. This article reviews core issues related to the selection of appropriate personal protective equipment for health care facility decontamination personnel, with an emphasis on respiratory protection. Existing federal regulations focus primarily on scene response and not on issues specific to health care facility decontamination practices. Review of existing databases, relevant published literature, and individual case reports reveal some provider health risks, especially when the exposure involves organophosphate agents. However, reported risks from secondary exposure to contaminated patients at health care facilities are low. These risks should be adequately addressed with Level C personal protective equipment, including air-purifying respirator technologies, unless the facility determines that specific local threats require increased levels of protection.