Preface

Natural disasters frequently cause major problems which affect a population's health and hinder a nation's socioeconomic development by draining its scarce financial resources in an effort to repair damages. Often, those damages are so great that neither the efforts of the stricken country nor international cooperation suffice for complete reconstruction and rehabilitation. The Region of the Americas is constantly being struck by natural disasters such as earthquakes, hurricanes, volcanic eruptions, floods, tornados, and landslides among others, which inflict not only a large loss of life, but also damage the service infrastructure, crops, and livestock, and cause ecological disturbances that generate incalculable economic losses.

Practically no country is immune to the risks of nature and, while scientific progress has contributed much to the study of these phenomena, the technology is as yet not available to accurately predict their occurrence; an exception to this is atmospheric phenomena, which can be detected early enough to take some protective measures.

The effects disasters have on the health field cover a broad range of implications stemming not only from the demand for the immediate care of victims, but also from the medium- and long-term effects of the intermittent suspension of basic sanitation services, food shortages, and the interruption of disease surveillance and control programs; these aspects require coordinated efforts and the efficient use of knowledge and resources.

There are probably few areas in which a concerted effort in the health sector is more critically important than in the postdisaster management of emergency measures. Moreover, sudden disasters require that health professionals muster all their technical abilities and energies to solve problems under critical conditions in which facilities and materials are not always available, as they are in normal situations.

The organization of medical care is unquestionably the focal point for coordinating the health sector's response to this host of complex needs, since in relief operations prompt care is critically important for saving lives.

It is worth noting that, however timely the health care response may be, its effect can be nullified if it is disorganized and fragmented, hence inefficient and ineffective. A prompt response must provide first aid and organize a tiered system of care to victims using appropriate techniques as part of a group of coordinated and rationalized efforts.

Institutional organization is of equal importance, for it is not enough to have highly complex and sophisticated physical structures and adequately trained human resources if they are not properly structured to meet the needs that arise for disaster care in or outside a hospital. Hospital establishments must have contingency plans for different kinds of disasters and keep their personnel in continual training. On the other hand, it should be taken into account that a major disaster will require the cooperation of every institution in the health sector. Coordination of public and private institutions in this sector is yet another aspect that deserves special consideration, particularly in countries of the Region where government resources are not always sufficient.

Pursuant to the Resolutions of its Governing Bodies, the Pan American Health Organization is giving special attention within its technical cooperation activities to developing national disaster preparedness programs in the health area. In this context, PAHO has produced guides and technical manuals for the various disciplines involved in planning and coordinating health aid in the wake of natural disasters.

This manual, which complements a series of scientific publications on disaster preparedness issued by PAHO, is aimed at the physician, the paramedic, and the health administrator, and provides general guideline for the organization of health services and technical standards for mass care of disaster victims.

While the manual is based on the traditional organization of health services in Latin America and the Caribbean, its technical concepts are applicable to other countries in and outside the Region of the Americas.

It is hoped that this manual will support the countries' efforts to develop preparedness plans which will mitigate the effects of natural disasters, and that through this effort, a significant contribution will be made to the Governments' unanimously stated aim of attaining "Health for All by the Year 2000."

Carlyle Guerra de Macedo
Director