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close this bookEuropean Workshop on Educational Aspects of Health in Disasters (Council of Europe, 1982, 50 p.)
close this folderPart I
View the documentIntroduction
View the documentObjectives
View the documentTypes of disasters
Open this folder and view contentsRecent involvement of European health personnel in disasters
View the documentEducational needs for health problems of European disasters
View the documentProjection of educational needs for European personnel going outside Europe
View the documentType of post-graduate training needed within Europe
View the documentDraft recommendation (1)
View the documentAcknowledgements

Introduction

The workshop was convened to review the needs within Europe for postgraduate training of health professionals and others in the management of how to cope with the health problems created by disasters. The workshop reviewed both past experience and likely future needs for trained staff. Disasters place unfamiliar demands on health staff, and are often quite different from those for which they are prepared by their basic training and orientation, at present. Consequently, further education in these problems is essential if costly and tragic errors are to be avoided. The workshop defined the specific training needs and formulated outline (recommendations) proposals to meet those needs.

Objectives

In defining the training needs in Europe for health problems of disasters, the workshop will concentrate particularly on two types of disaster: the acute catastrophe which may occur within or outside Europe and the longer term disaster creating massive refugee health problems, often in the third world, but in which many European health workers become involved. In both these situations it is clear that many who are faced with solving the health problems are inadequately trained for the task.

The workshop will analyse past experience, define the likely scale and level of manpower needs for the future, and how they should be trained. The workshop will then outline the required short courses and course modules in terms of objectives, target groups and content. It will decide on European curriculum improvements that can be developed as a series of European intensive courses with a view to including them in European university and post-experience courses in this field.

This initial planning workshop comprises the first in what are conceived of as a series to upgrade teaching and thus the management of health in disasters. It will define the curricula of a set of possible courses, but in two cases it will not be working from a vacuum. In each of the areas of refugee health and in the management of acute disasters a course has already been held in Europe. Subsequent courses are planned, and it will be possible to add to those courses more specific course-workshops to translate the lessons of these specific courses into modules or curriculum units which can be incorporated into teaching in other countries (see Appendix II).

This co-operative effort should stimulate positive developments regarding health preparedness teaching methods; mobility of teachers, researchers and students; quality of training programmes; the process of innovation; communication between educational institutes and society; the pooling of international expertise; the process of technology transfer and transfer of know-how; student guidance; development aid; information for decision-makers and educational planners; improvement of the cost/efficiency ratio; the need for an awareness for disaster planning and rapid assessment techniques.

Types of disasters

The workshop was aware of the great range of disasters, extending down to large-scale accidents such as train crashes. The form of the meetings was, however, on disasters where the existing structure of life of the community is disrupted overall and resources are overwhelmed by the very scale of the disaster. Among those considered were:

- acute castastrophes:

earthquakes


floods


tidal waves, etc;

- displaced persons eg due to drought;

- refugees;

- civil unrest;

- epidemics as constituting natural disasters;

- man-triggered disasters;

- nuclear accidents;

- consequences of nuclear war.

Although the workshop was conscious of the problems posed by nuclear disasters, the issues raised were considered to be sufficiently different to warrant special deliberation elsewhere.

In discussion it become apparent that European health personnel are involved in two major categories of disasters, differing in their location and needs:

- Acute catastrophes may be experienced in many parts of the world; here the prime need is for prompt relief. In practice this means that European workers are largely involved in their own countries’ disaster situations.

- The longer term refugee or displaced persons due to drought or war disasters are, by contrast, much more frequent in third world countries. European workers are generally becoming more involved in such situations through inter and non-governmental organisations.

The two categories of workers who require training are therefore clearly demarcated.

(introduction...)

When looking at health manpower sent to disasters it is logical to divide them into those involved in European disasters and those going to third world countries.

European disasters

Within Europe the personnel demand was for short sudden impact disasters. Where they existed, the main burden of relief, fell upon civil defense and other organisations which can act appropriately. Training here is not exclusively a postgraduate matter and the workshop was conscious that training within organisations needs to be closely integrated with courses of the types proposed.

Third world disasters

A questionnaire was sent to the main European nongovernmental agencies who sent health personnel during 1980-81 to third world disasters, those who replied gave information on more than 700 personnel; of these the largest single group sent to work in the field were nurses (see Table 1). Less than 17% were from professional groups such as nutritionists, water and sanitation engineers, dentists, etc.

Table 1
BREAKDOWN OF HEALTH PERSONNEL

Doctors

33%

Nurses

50%

Other

17%

This is significant because skills in the provision of water supplies, sanitation, logistics, transportation and nutrition, agriculture and administration were needed as much if not more than basic curative care. In future, therefore, either agencies should send a larger proportion of appropriate people, or doctors and nurses need to be given a wider training to encompass these necessary skills.

Over three-quarters of those sent went to refugee camps or war situations in Africa and the Far East with virtually none going to acute disasters (see Tables 2-3). In the past the relief phase in the latter situation generally is too short for help from outside to arrive in time and in these situations the work therefore was done by local organisations.

Table 2
GEOGRAPHICAL DISTRIBUTION OF HEALTH WORKERS

Africa

50%

Asia

40%

Middle East

7%

Latin America

2%

Other

1%

Table 3
PERSONNEL SENT TO DIFFERENT TYPES OF DISASTERS

“Camp” (refugees or displaced persons)

66%

War

21%

Famine

0%

Natural (sudden)

13%

Deficiencies in quality

European disasters

Common failures are:

· delay in assessing the severity of the situation;
· poor co-ordination and planning
· delay in providing first aid
· ignorance of the principle of triage
· poor logistics of supply and referral
· inappropriate relief arriving too late
· personal difficulties of relief workers
· failure to understand the relationship of disaster
· relief to primary health care.

Some of these issues were discussed at the WHO workshop on natural disasters held on 22-25 November at Rabbat (see Appendix IV).

Disasters in the third world

As stated earlier large numbers of European personnel are sent overseas having been recruited by mainly nongovernmental agencies. While there has been some improvement, these workers are often poorly prepared for those tasks which are asked of them. Often too, they are young, inexperienced and poorly briefed.

Common failures are:

· Overemphasis on disease

· Overemphasis on working in clinics as against in the community

· Using inappropriate high technology

· Cultural insensitivity

· Ignoring local resources especially manpower and equipment

· Providing a level of health care which cannot be maintained after the emergency.

· Ignorance of community health including epidemiology, water, sanitation, nutrition and tropical diseases

· Lack of emphasis on training.

Educational needs for health problems of European disasters

When disasters occur they affect everyone in the immediate area, and leadership is required from educated members of the community. The workshop therefore emphasised the need for an increased awareness in European universities of the problems of disasters.

There is a need to promote studies in subjects relating to disasters - their analysis, prediction and prevention, issues in relief and rehabilitation, and the health problems of disaster-prone areas in Europe. Both research and teaching in these areas should be undertaken by European universities.

Personnel in the health sector have a vital role to play in all disaster and emergency planning and action. There is therefore a need for the provision of systematic postgraduate training for medical doctors, veterinarians and pharmacists. Bearing in mind, however, that nurses and public health officers are essential, the training should be open also to these groups.

Such training would also form a sound basis for the supplementary education of health personnel, who might be employed by governments or international agencies for disaster prevention and relief action in developing countries. A short one-week modular course would be sufficient to meet these needs.

The workshop noted with concern that, in general, within Europe the level of education of health personnel in public health and community medicine which is offered by the medical, nursing and veterinary schools is inadequate. This defect becomes crucial in emergencies and disaster situations.

Within Europe there are several geographically defined areas with a high risk of such natural disasters as earthquakes. The workshop considered that the education of relevant personnel in these areas, even at undergraduate level, should include adequate and relevant education on coping with the more prevalent local disasters. Members of many professions - engineering, environmental, social sciences, agriculture for example - have an effect on health in disaster situations and education on coping with health in disasters should not be confined to the traditional “health professions”.

Because of the relative infrequency of major disasters in Europe and the difficulty of access to some refugee communities, there is a need to pool knowledge on a European basis. In the case of high level health officials and of teachers of veterinary public health, for example, courses provided by one or two centres in Europe. Much teaching material for use in national courses may also be most effectively prepared on a European basis.

Throughout Europe there is a need for evaluation teams and where a centralised epidemiological service exists its members should have particular expertise in the assessment and evaluation of disaster work and may need appropriate training. However, at present the problem in most countries is to create such an organisation in the first place.

The workshop was well aware of the important role that the police, fire brigade and military play in assisting with many acute disasters in their own countries. It is likely that they will continue to be involved and more information on their training courses, especially that of the military, would be useful.

Projection of educational needs for European personnel going outside Europe

During the acute phase which at most lasts for a few weeks there is an immediate need for personnel who have considerable training and experience in the assessment of health priorities and planning interventions: they also need special skills such as survey techniques, provision of water supplies, sanitation, implementation of feeding programmes, and the treatment of war injuries where relevant.

Ideally multidisciplinary teams, who have been trained together, should be sent and include an administrator, water engineer, nutritionist etc as well as nurses and doctors.

While ideally the need of this phase should be met by local health services, they are usually already overstretched and so it is likely that their role will be limited to general supervision by senior health administrators, who may or may not be trained in the general principles of disaster management.

Europeans already involved in long-term health work in third world countries may make major contributions during a refugee crisis and should also receive modules of training, even in Europe.

Although the situations are often initially envisaged as short-term emergencies they usually continue for a year or more: there is therefore a need for a steady flow of European personnel who have attended short courses.

In practice it is not realistic to provide manpower norms as the number required will depend on the severity of the situation and the local resources of both manpower and supplies. Generally it is important not to create an artificially high staffing ratio which cannot be maintained once relief teams leave.

The quality of health personnel sent is as important as quantity. There is a need for a greater emphasis of community health skills. In particular staff capable of training refugee and local people have a vital role both in promoting self reliance and in reducing the number of overseas personnel needed.

In view of the longer term commitment in these situations, it is essential that overseas personnel have the skills to co-ordinate the work with the host government’s health plans. From this it is clear that the training of European workers should include a discussion of transcultural problems.

European health workers who become involved in short-term assignments to refugee situations overseas present peculiar problems. Firstly, it is difficult to identify them prior to their becoming involved overseas and secondly, it is often difficult to obtain release of the workers from their permanent post once they have been trained. Nevertheless experience in several countries has shown that there is a large demand from potential volunteers for short courses. Government and health authority views on releasing staff can also be changed. Agencies concerned with refugee relief may also consider maintaining an expert team with good experience, to help plan, evaluate and take a leading part in field work.

Type of post-graduate training needed within Europe

The workshop defined the more important training needs for those directly and indirectly concerned with health, with emphasis on professional health workers and public health engineers in order to keep the topic within manageable proportions.

The workshop was aware that, in relation to disasters within Europe, there are more radical approaches to education for health promotion in disaster situations. For example, emphasis could be placed on training of primary school teachers, of journalists and of those who produce television material, with a view to spreading awareness of the problems to a very wide audience and to the young. There was also a need for those administratively responsible for disaster planning in each country to be more aware of health issues.

The workshop accepted the importance of these routes of communication and was also aware of the importance of social studies of disasters and of work on disaster prevention and and preparedness. All these could, and often did, affect health indirectly. They were not pursued in detail by the workshop because they lay outside the competence of its members and there was a danger of attempting to cover the whole multi-faceted topic and of failing to concentrate adequately to make an impact.

In relation to disasters in developing countries, the ability to intervene on such a broad front is more limited and health professional workers are the main European personnel involved.

It was found convenient to classify the teaching needed by the type of disaster, since more potential students have an orientation primarily towards either the European or the third world scene. Some division was also made between short courses, complete in themselves, and modules for insertion into longer courses; but to some extent these are interchangeable.

The need for some grounding in the subjects at undergraduate level, the need for many more courses for epidemiologists and other trainees, and the concern for nuclear problems, were all accepted but were beyond the scope of this workshop.

In relation to acute disasters, especially in Europe, there was a clear need for modules suited to post-graduate doctors, veterinarians and public health engineers. Nurses, nutritionists and social workers needed either a module or short course depending on whether they were already in a longer post-graduate course.

Specific short courses were needed by various specialist groups, and to illustrate this the workshop drew attention to the need for short courses directed to teachers of veterinary and of human public health, to senior health officials involved in health aspects of disasters, and to accident surgeons whose skills often lead them to be placed in key positions in disasters. There was also a need for a short course to provide an introduction to disaster problems for a variety of health professionals. At this level it was unnecessary to have different courses for different disciplines.

Many courses and all the modules were designed for use at national level. They need replicating in many European countries, even though benefit could be gained from sharing teaching materials. Other short courses, such as for teachers of veterinary public health, or for senior health officials involved in disaster health, were sufficiently specialised that a single course, or few, within Europe would suffice. These topics were specially suitable for courses supported by the Council of Europe.

The overall aim is for all public health specialists to have an understanding of the health problems of disasters. The needs may be illustrated from the veterinary profession.

In the veterinary services of Europe, there is a need for training in disaster work for:

a. those veterinarians working in areas with a high risk of natural disaster;

b. those with a higher probability of being called in to disaster work such as veterinarians employed in the public service and in the military;

c. those with special bilateral twinning arrangements with those working in high risk areas.

In the case of preparation for work in refugee, famine, and other “chronic disaster” problems of developing countries, the needs fall into two clear categories. Firstly, all training courses for professional health workers in such fields as tropical public health and tropical public health engineering need to include a module on refugee health. Secondly, the numerous health workers who go out to refugee situations in the tropics, often under the sponsorship of non-governmental organisations, are in great need of short courses.

Importance of co-ordination in any disaster

The diverse forms of relief in any disaster situation can only be co-ordinated adequately and rapidly if personnel and services are highly organised; the importance of planning delivery of aid, of briefing teams properly and preparing them psychologically for this work cannot be stressed enough. Close liaison with international organisations and a preliminary assessment of local needs by a specially designated person(s) to pinpoint the best forms of intervention is highly desirable. If the trained personnel from the courses proposed are to be utilised adequately, proper organisation is crucial.

Postgraduate training needed within Europe for work in disasters

A. In relation particularly to acute disasters, especially in Europe:

I. Modules for incorporation into longer courses for:

1. courses for doctors studying public health
2. public health engineering courses


II. Short courses for:

3. senior health officials involved in health aspect of disasters
4. accident surgeons
5. teachers of veterinary public health
6. members of the medical and other health professions (introductory)


B. In relation particularly to chronic disaster problems, especially in the third world for:

I. Modules for incorporation into longer courses in

7. tropical medicine and tropical public health
8. tropical public health engineering


II. Short courses for:

9. medical and nursing and other health volunteers

No doubt many other courses and modules are possible, but the small differences from the types described above do not need separate presentation. Also, the persons who may find the above courses useful are likely to include disciplines other than the ones specifically mentioned.

The proposed courses can be found detailed in Appendix III.

Draft recommendation (1)

1. Whilst recognising the notable achievements of certain institutions of higher education and research in the management of health problems related to disasters, the workshop drew attention to the inadequacy of educational facilities and resources in the training of personnel concerned with such emergencies. At least nine different modules or short courses were identified by the participants as needed and it was strongly recommended that the Council of Europe, through its channels of communication and through its own work programme support those courses that are already in existence or currently being planned and encourage the development of courses which are either not currently provided or which require duplication in other countries. The workshop asked that research related to health aspects of disasters be promoted. It was felt useful to address the workshop’s recommendations to the ad hoc Committee of Experts on Earthquake Research set-up by the Committee of Ministers of the Council of Europe.

2. In view of the infrequency of major European disasters, the difficult assess to tropical refugee situations and the limited staff with experience, self-teaching acquires particular importance and the workshop strongly recommended the Council of Europe to encourage the development of case studies, visual aids, and other teaching materials in the form of educational packages that could be made available to European and other countries. Funding such work and encouraging others to do so is a highly cost-effective method of increasing the impact of the limited number of teaching staff in Europe and elsewhere with relevant experience.

3. In view of the limited facilities and expertise in Europe there is a need to encourage the interchange of both materials and teaching staff between the institutions of higher education and research in Europe concerned with education for health-related problems in disasters. The workshop, therefore, recommends the Council of Europe to sponsor and encourage others to sponsor such interchange by providing scholarships for and funding the exchange of teaching staff between institutions both for purposes of teaching and to enable those planning new courses to visit and participate in programmes which are already operational.

4. The workshop recommended that the Council of Europe should co-operate with ASPHER (the Association of Schools of Public Health in Europe) to promote and co-ordinate the development in Europe of courses concerned with disaster health, to encourage participation in these courses and to avoid unnecessary duplication. It is recommended that a meeting of representatives of the schools of Public Health in Europe be organized to discuss the feasibility of introducing appropriate teaching of health management of disasters in their schools and the appropriate way for actually implementing the programs outlines by the workshop. The association of schools of Public Health in the European region, ASPHER, is the appropriate organization to sponsor this meeting in co-operation with the regional office of WHO for the European region. The General Assembly of ASPHER in September 1981 formally approved holding such a meeting with the Council of Europe and regional office of WHO to discuss such issues.

5. The workshop recommended that programmes for the education of public health engineers and veterinary doctors will take due regard to the health problems related to disasters. The Council of Europe and the WHO are recommended to promote an exchange of views on these teaching aspects among institutes for public health engineering and veterinary education and between institutes for public health engineering education, veterinary schools and schools of public health.

6. Meetings between the groups currently involved in teaching disaster management should be supported on a regular basis to improve co-ordination. Existing programmes should be evaluated to determine current training deficiencies, needs and possibilities for improvements.

7. In order to evaluate the progress of these recommendations and to provide a formal channel through which disaster problems in Europe can be identified, it was considered that the workshop should reconvene on a regular basis.

Acknowledgements

We should like to acknowledge the valuable contribution made by various participants in providing the following publications, copies of which are available from the Council of Europe Secretariat:

1. Problemi veterinari delle zone terremotate:



Prof. Adriano Mantovani

2. A short account of the veterinary problems met from 29 November to 9 December 1980 in the area of Alta Irpinia affected by the earthquake:



Prof. Adriano Mantovani

3. Lignes directrices pour l’action vrinaire en cas de catastrophe naturelle:



Prof. Adriano Mantovani

4. Principales maladies d’intt vrinaire qui peuvent se produire a l’occasion de dstres naturels:



Prof. Adriano Mantovani

5. L’ltalia - una penisola in un mare di catastrofi



Tempo Medico 194, September 1981

6. Veterinary traumatology in disasters:



Prof. Lorenzo Masetti

7. Le plan Orsec



M Douard

8. Some details on course requirements are given in doc. DECS/ESR (82) 13