|Disasters Preparedness and Mitigation - Issue No. 32 - October, 1987 (PAHO)|
The following was prepared by Mrs. Gloria Noel, Emergency Preparedness Adviser in St. John's, Antigua, and Dr. Miguel Gueri, former Emergency Preparedness Adviser now with PAHO's Department of Nutrition.
A community can be defined as a group of people-located within a geographical area that allows close personal contact-who are working together in preparation for a disaster. Thus, a community may be a village, a block of apartments in a large city, an office complex or a hospital. Yet, regardless of the type of community, the principles of disaster planning are the same. For the purpose of this discussion, we will consider a community in the traditional sense - a small village or island. It is this kind of community, more than others, that must rely on itself to manage a disaster situation.
The immediate post-disaster period, the emergency phase, is divided into the isolation period, during which the affected community takes care of the injured, buries the dead and tries to save some of its belongings, and the convergence period, when assistance from external sources arrives. There is no fixed number of days or months for each of these periods. Indeed, these phases may overlap, particularly in slow-onset disasters such as droughts or floods and, to a lesser extent, in sudden-impact disasters such as flash floods or earthquakes.
Isolation is often associated with rural communities. But most communities go through a certain period of isolation following any disaster. The duration depends on a number of factors such as local geography, the type of disaster, or the community's stage of development. The degree of isolation also varies and is usually determined by the community's ability to communicate with the outside world.
If, prior to a disaster, the community is prepared to cope with the isolation period, the health sector will suffer less. Anticipating possible damages and "planned improvisation" or adapting community resources to meet needs is the essence of disaster preparedness at the community level. Components of a community disaster preparedness program include:
Typically, a community profile includes basic health statistics such as "normal" endemic levels which help to detect outbreaks; common chronic conditions which permit sufficient drugs to be stocked; the number of women likely to be pregnant at any given time will alert us to the possibility of miscarriages or premature labor; and the number of small children will help to plan for supplementary feeding. The following minimum data should be made available: birth and death rates; distribution of population by main age groups, sex and physiological status; common endemic and chronic conditions, and the main causes of death.
Basic animal data will reveal the types of animals with which a community is normally in contact; the diseases they may cause; or when they may be considered a source of food. Post-disaster situations may require people and animals to live in closer contact than usual. Some animals may even compete for food or space.
Hazard mapping helps communities to identify and assess all risks to which they are exposed-whether natural or man-made, direct or indirect. This is particularly important for hazards that pose an infrequent but real risk. The town of Arrears, Colombia, for example, was built on the site of a small community that was destroyed in 1840 as result of labors from El Ruiz Volcano. In 1985, the city was again destroyed and 23,000 people lost their lives. Earthquakes are not considered a serious problem in the Caribbean and yet a tsunami destroyed Port Royal, Jamaica in 1692 and an earthquake severely damaged parts of Kingston earlier in this century. Communities that are unable to properly map hazards should request external assistance.
A vulnerability analysis of health care facilities will reveal which are most likely to withstand certain types of disasters. If a health care delivery institution is unlikely to withstand a natural or man-made disaster, the community must make alternate arrangements to cope with its post-disaster health needs. The same applies to health-related structures, such as water supply systems or pharmacies.
An inventory of resources, both human and material, formal and informal, should be listed and mapped-for example, a building that can double as a hospital or a local bus that can be used to transport the injured.
Tasks to be Performed
The community will have to carry out a number of tasks to save lives and safeguard health. These include search and rescue of survivors, stabilizing patients and providing first aid or more sophisticated medical care. Because many important tasks will be performed by volunteers, someone must coordinate their work. Casualties must also be transported establishing some sort of priority, even simple triage. Needs assessment-an important though often forgotten, task-is better carried out by the community itself. Evaluating damages will also help to determine the amount of external assistance required. A means of communication must be established and environmental health concerns must be addressed. This includes an adequate water supply, waste disposal and temporary shelter. Epidemiological and nutritional surveillance must be carried out as well as vector surveillance and control.
Plans of action must be formulated to assign tasks; identify evacuation and referral centers; and set up twinning of communities. Plans must also strengthen or adapt routine health activities; epidemiological surveillance systems; and nutritional surveillance and communications systems.
Once tasks have been identified, human resources can be matched to these tasks. Considerable improvisation, adaptation and imagination will most likely be necessary as well as training in rescue, simple triage or first aid. And, while some communities may have experienced rescue or fire teams, others will have to rely on young healthy individuals to do some of the heavy work.
Some basic routine health activities will have to continue during the emergency-women will continue delivering babies, children will continue to require routine immunizations. Other health activities will have to be modified or strengthened to cope with an abnormal situation.
The concept of "twininng of communities" probably derives from that of "sister cities". Basically it implies an agreement between two communities to assist each other after a disaster. It goes without saying that the better the preparedness plans, the more clearly identified will be the needs for assistance, thus enhancing their usefulness.
After formulating plans, identifying resources and assigning tasks, the community plan must be disseminated. To measure its effectiveness, it will have to be tested by means of simulation exercises, the results of which will serve as an indicator of the need for revision.
Readers who are interested in further information on this subject may wish to consult the following publications:
Carbine, L. Community Preparedness for Disaster (in preparation for publication).
Spiral, E. H. Disaster Management: Comprehensive Guidelines for Disaster Relief, Hans Huber Publishers, Bern, Stuttgart, Vienna, 1979.
Western, K. A. Epidemiologic Surveillance after Natural Disaster, PAHO/WHO, Scientific Publication No. 420, Washington, D.C., 1982.
PAHO/WHO Emergency Health Management after Natural Disaster, Scientific Publication No. 407, Washington, D.C., 1981.
Multi-program Field Training Sessions
Disaster preparedness and prevention are important tasks-too important to be the sole responsibility of the Emergency Preparedness and Disaster Relief Coordination Program. Because PAHO's Member Countries recognize this, several technical programs have joined efforts and organized meetings with their field staff to establish mechanisms for including emergency preparedness activities in the technical cooperation activities of these professionals. In early October, professionals from the Maternal and Child Health Program and Health Services Development will meet in San Jose, Costa Rica. Later in October epidemiologists and statisticians will meet in Caracas, Venezuela to discuss ways in which epidemiological surveillance and information systems can also include information on risks from natural disasters and other emergencies. Finally, sanitary engineers will meet in November in Tegucigalpa, Honduras. Many PAHO professionals in this field have provided valuable support to the countries both in the preparation of contingency plans for water supply systems as well as in preparedness training activities. This interprogram coordination is a most positive step. toward ensuring that PAHO's Member Countries take full advantage of the Organization's well-trained professional staff.
WHO/Indonesia Disaster Workshop
WHO and the Government of Indonesia are organizing a week-long workshop on disaster preparedness and health management to be held in Jakarta from 2-6 November. An estimated 100 participants from a number of countries worldwide will attend the workshop whose format includes general lectures, panel discussions and work groups. Lectures will feature WHO global and regional activities; the epidemiology of disasters in the Caribbean; the use of satellites in disaster monitoring; and several country profiles of disaster preparedness and management. Panel discussions will focus on public health and medical management aspects; community participation and environmental management. For further information contact Dr. H. Abdul Radjak, Chief Sub Directorate for Emergency and Evacuation Services, Ministry of Health, Jl. Percetakan Negara 23 A, Jakarta, Indonesia.
PAHO/WHO Emergency Center, Washington, D.C
Pan Caribbean Disaster Preparedness and Prevention Project, St.
PAHO/WHO, San Jose, Costa Rica
PAHO/WHO, Lima, Peru
Caribbean Program Coordination Bridgetown, Barbados
New Audiovisual Material
The Pan American Health Organization has just released several
new slide programs-Emergency Health Management of Environmental Health and Water
Supply; Prehospital Medical Care in Disaster Situations; and Hospital Medical
Care in Disaster Situations. For a complete description and information on
ordering, see the box "New Slide
MEMO - MEMO - MEMO
We are in the process of updating our mailing list. At the same
time, we are asking you to provide some information about the type of
organization for which you work and your specific disaster-related interests.
Please take a moment to complete the enclosed form and return it as soon as
possible to the address which appears on the reverse side. Thank you for your
PCDPPP Has New Project Manager
The United Nations Disaster Relief Coordinator has appointed Mr. Franklin J. McDonald as the new Project Manager of the Pan Caribbean Disaster Preparedness and Prevention Project (PCDPPP) located in St. John's, Antigua. Since 1980, Mr. McDonald had served as the Director of Jamaica's Office of Disaster Preparedness (ODIPERC). PCDPPP was set up to develop the individual and collective capacity of the 28 participating Caribbean countries and territories to prepare for and mitigate the effects of natural disasters, thereby reducing losses and contributing to development. Activities include training personnel, setting up warning systems, carrying out vulnerability analyses and increasing public awareness and response. Mr. McDonald may be contacted at PCDPPP, P.O. Box 1399, St. John's, Antigua, West Indies.
Disaster Mental Health
The Simon Bolivar Psychiatric Research and Training Program at the University of Illinois at Chicago is preparing a monograph entitled Psychosocial Consequences of Disasters: The Latin American Experience. Its main purpose is to help clinicians to manage the psychosocial aspects of disaster victims, and to help health planners to design, implement and evaluate mental health programs. The monograph will provide an overview of disaster mental health, present common psychiatric disorders seen among victims, give examples of model service delivery programs, discuss organizational response to disasters, and address issues of education and training in disaster mental health.
For information on the scheduled date of publication contact Dr. Bruno Lima, Johns Hopkins University, Department of Psychiatry and Behavioral Sciences, Meyer 4-109, 600 N. Wolfe Street, Baltimore, Maryland 21205, U.S.A.
Disaster Response for the Homeless
The journal Open House International has published a special issue on homelessness and disaster response. The rapidly increasing vulnerability of the poor who must live in homes which offer minimal resistance to the forces of natural disasters and which are often sited in dangerous areas, raises a number of issues that are addressed in this journal such as the most appropriate forms of post-disaster shelter to accommodate the homeless; the best strategy for hazard-resistant building and housing education at the community level; and lessons that can be applied for effective reconstruction planning. For information on ordering contact NBS Services Ltd., Open House International, Mansion House Chambers, The Close, Newcastle upon Tyne NE1 3RE, United Kingdom.
19-21 The Maryland Institute for Emergency Medical Services Systems (MIEMSS) will sponsor the Keith National Trauma Symposium in Baltimore, Maryland. The symposium will explore the prevention of disabilities with the most recent initiatives of injury control. For further information contact Keith National Trauma Symposium, MIEMSS, 22 S. Greene Street, Baltimore, Maryland 21201 U.S.A. or call (301) 328-2399.
11-14 The Florida Chapter of the American College of Emergency Physicians and the Institute of Emergency Medical Services at Mid-Florida Tech will hold the 1988 International Disaster Management Conference at the Hyatt Orlando in Kissimmee, Florida. Topics presented will be of interest to firefighters, EMS personnel, law enforcement and civil preparedness officials, hospital administrators, as well as to physicians, nurses and others who play important roles in these critical incidents. For further information write, Registrar, Florida Chapter ACEP, 5824 S. Semoran Blvd., Orlando, Florida, 32822 U.S.A. or call (305) 281-7396.
Canada: Graduate-level Seminar
The University of Ottawa is offering a graduate-level seminar on emergency management systems. The course will explore the ways in which the emergency system responds, and important and basic concepts of emergency management systems, specifically critical aspects in the planning, development, implementation and evaluation of such systems. The role of international agencies and governments will also be examined. While this course focuses on Canadian issues, it may serve a model for countries interested in developing a similar curriculum. For further information contact Dr. Denis N.J. Caro, Associate Professor, Faculty of Administration, 275 Nicholas, Ottawa, Ontario KIN ANN, Canada.
Colombia: Primary Mental Health Care
The Department of Tolima, Colombia health services organized a training course for doctors and nurses on primary mental health care for victims of disasters. Specifically the training course was designed to enable participants to identify and handle emotional problems that arise, directly or indirectly, from disasters; to establish profiles of the most frequently occurring psychiatric syndromes; and to identify the community and family resources that can help in the readaptation of the community and the individual. For further information or a copy of the report write Dr. Juan Pablo Sarmiento, Coordinador del Plan Nacional de Preparativos para Desastres, Menagerie de Saluda Calls 16, Número 7-39, Bogotá, D.E., Colombia.
Costa Rica: Disaster Education Program
The Ministry of Public Education, concerned with the serious consequences of natural disasters, organized a multidisciplinary technical group to assist in developing a National Prevention Program for Facing Emergency Situations. A three-day training course for teachers was held in July to prepare them to deal with these situations. The program included a simulation exercise of an earthquake and discussions of the consequences of disasters, risk factors and the development of institutional plans. PAHO sees this initiative as an excellent way to disseminate simple health messages about disasters-school children are a valuable resource in passing messages they have learned on to family and community. For further information on this initiative contact Dr. Hugo Prado, Emergency Preparedness and Disaster Relief Coordination Program, Pan American Health Organization, P.O. Box 3745, San Jose, Costa Rica.
Ecuador: Training for Primary Mental Health Workers
The Ministry of Public Health held a training course in Ibarra on primary mental health care for victims of natural disasters. Participants included rural physicians, nurses, civil defense workers, professors, and nursing aides. Because further study of the mental health problems caused by disasters was deemed necessary, a research project was implemented to evaluate the impact of a mental health training program on the abilities of primary health care workers to detect emotional problems in patients that require post-disaster care. For further information or a copy of the report write Dr. Heenan Chavez Bless, Menagerie de Salud Political Division de Salud Mental, Quito, Ecuador.
Haiti: New Director of OPDES
The Government of Haiti has announced the appointment of Major Claude D. Jean, effective 31 July, as the Director of the Office of Disaster Preparedness. For all matters concerning disaster preparedness in Haiti please contact Major Jean at OPDES, 148 Ave. Martin Luther King, Port-au-Prince, Haiti.
Mexico: Disaster Medicine Course
The Juarez Hospital, the National Autonomous University of Mexico and the Zaragoza School of Professional Studies organized the I Course on Medical/Surgical Care after Disasters from 21-30 September. The course was held at the Juarez Hospital which suffered severe damages during the 1985 earthquake when the History central tower collapsed, killing an estimated 560 patients, medical personnel and students. The course, which offered university credit to participants who included doctors, paramedics, nurses and social workers, established a project for providing medical attention in a disaster-stricken area and prepared a hospital disaster plan. The course outline of this very positive initiative may serve other countries to prepare similar programs. For a copy write Dr. Carlos Rojas Enriquez, Hospital Juarez SAS., Plaza de San Pablo 13, Colonia Centro, Mexico 1, D.E. Mexico.
Peru: Hospital Commission Established
As a result of a seminar on emergency health management of disasters, the Hospital de Apoyo No. 6, "Hipolito Umatilla'' has created two committees to prepare and organize the hospital to face emergencies. The Directing Committee is charged with planning Member Countries and the Operating Committee with executing all actions related to disaster management. The Operating Commit tee has prepared a manual on its organization and roles, which outlines the structure of the hospital plan and designates responsible personnel. For a copy write to Dr. Luis J. Díaz, Director, Hospital de Apoyo No. 6 "Hipolito Umatilla'', Lima, Peru.
Trinidad: Chemical Safety Workshop
A three-day workshop on chemical safety for the Caribbean was held from 27-29 April in Trinidad to discuss with public and private sector officials the handling of toxic and hazardous materials in both routine and emergency situations and to assist government agencies to develop contingency plans for responding to chemical emergencies. Participants from six Caribbean nations as well as the U.S. and Canada met in work groups and presented recommendations on the above. For further information contact Dr. Helmond Dyer, Caribbean Program Coordinator, P.O. Box 508, Bridgetown, Barbados.
Tobago: National Workshop
A three-day workshop for health personnel on the role of the health sector in disaster preparedness and management was held in Tobago from 15-17 July 1987. The purpose of the workshop was to strengthen the capabilities of health personnel and the health sector in Tobago in general, and the Scarborough County Hospital in particular, to respond in the event of a disaster. Participants included hospital administrators, health educators, nursing personnel, medical officers, environmental health officers, the Red Cross, and the St. John Ambulance Service. Outlines of disaster management plans for the main County Hospital and two district hospitals were prepared at the workshop. Committees have been established to further develop these plans. The participants made recommendations and discussed strategies for implementing and evaluating emergency preparedness and relief coordination activities. The Emergency Health Coordinator in Tobago will follow up on the implementation of these recommendations. For further details contact: Dr. Lancelot Austin, County Medical Officer of Health, Scarborough Health Centre, Scarborough, Tobago.
Venezuela: Serious Flooding
A tropical storm that began in the afternoon of 6 September caused severe flooding in the Venezuelan states of Aragua and Miranda. Some 75 deaths were attributed to the floods with an additional 100 persons missing. One hundred and forty persons were initially admitted to local hospitals and an excellent and dedicated effort on the part of the local health services quickly reduced that number to 22. Neither medical personnel nor supplies from abroad were required nor requested as the health situation was brought under control. However, health facilities are part of the infrastructure that must receive priority attention. Others include roads, water supply systems and housing.
Caribbean: Terms of Reference for Disaster Health Coordinators
At a meeting last June, national disaster health coordinators established the following terms of reference to strengthen the health sector's capacity to respond effectively to disasters. Ministries of Health are being requested to use these terms of reference as guidelines to ensure that a health coordinator, with clearly defined functions and responsibilities, is designated.
During the preparedness phase
· serves as chairman of health sector disaster committee
During the emergency
· coordinates health sector assessment of needs
· initiates and coordinates health sector rehabilitation projects
The books referred to below have been abstracted from review copies received from the publisher by the Editor of this Newsletter. Except where noted otherwise, none of the books are available from PAHO. The publisher and the list price (when available) are included at the end of the abstracts for readers who are interested in purchasing the books.
Medicine for Disasters. Peter Haskell and Robin Weller, Edge 392 pp., 1987 (English)
When disaster strikes, health care workers, nurses and doctors must be able to react rationally and efficiently. This book about the medical management of disasters, provides fundamental principles and knowledge upon which to base activities. It covers a wide variety of subject areas including medical skills such as assessment; triage; resuscitology and the management of severe trauma and management aspects such as disaster planning; coordination between governments and relief agencies; personnel and training; emergency supplies; patient evacuation; and the media and public relations. Available in November 1987. -f30.00. John Wright, recline House, Redcliffe Way, Bristol BS1 6NX, United Kingdom.
Effective Emergency Response: The Salt Lake Valley Floods of 1983, 1984, & 1985. Ellis L. Armstrong and Howard Rosen. Public Works Historical Society, 58 pp., 1986 (English)
Because all disasters have similar problems and basic management requirements for planning and response, this publication presents an analysis of the decision-making process for emergency flood control operations in Salt Lake County. The purpose is to contribute to the continuing planning process for emergency operations. It stresses the need for hazard assessment and the development of plans that are consistent with the degree of risk. It also summarizes the specific recommendations developed from the study which are both useful and of interest to planners involved in managing emergency operations.
- US$5.00. Public Works Historical Society, 1313 East Keith Street, Chicago, Illinois, 60637 U.S.A.
New Slide Series
PAHO is pleased to announce that the following slide series are now available for distribution:
Emergency Management of Environmental Health and Water Supply is a nine-set slide series designed to assist professionals charged with preparedness for water and sewerage agencies. Each set contains between 30-40 slides and an accompanying script. The detailed scripts can be used by instructors as a guide for their presentations or they can serve as handouts for participants in seminars and workshops. The series includes the following individual titles:
Prehospital Medical Care in Disaster Situations deals with mass casualty management at the disaster site. This Backslide set discusses the on-site command post; the personnel needed to staff it; and their roles and functions. It also deals with security measures; transport; communications; and triage and tagging.
Hospital Medical Care in Disaster Situations is a 39-slide set that offers an introduction to the risks that hospitals face and the main components of a hospital disaster plan. It lists steps that hospitals can take during the preparation phase, when committees are established, logistical arrangements are made and interinstitutional and intersectoral links are forged; the alert phase when the hospital plan is set in motion and facilities are readied; and the emergency phase when disaster victims begin arriving and care is provided. Both of the above sets come with accompanying scripts.
All of the above available in English or Spanish. For further
information on ordering any of these slide programs, please contact the Editor
of this Newsletter.
The articles listed in this section are of interest to health professionals and others responsible for various aspects of disaster relief and Preparedness programs. They have been reproduced and recently added to the collection of articles available from the Editor of this Newsletter. A complete list of available reprints will be circulated to our readers periodically. When making requests, please quote the reference code listed to the left of the publication title.
How to prepare a hospital for an earthquake. Robert Reithreman.
The Journal of Emergency Medicine, Vol. 4, 1986:119-131.
Managing incidents involving hazardous substances. Tee L.
Guidotti, M.D. American journal of Preventive Medicine, Vol. 2(3),
Designing a national disaster medical system. Edward N. Brandt,
Jr., M.D. et al. Public Health Reports, Vol 100(5),
Hurricanes and hospital emergency room visits- Mississippi, Rhode
Island, Connecticut. Morbidity and Mortality Weekly Report, Vol 34
Airport preparedness for mass disaster: a proposed schematic plan.
Gabriel 1. Barbash, M.D. et al. Aviation, Space and Environmental Medicine,
Building damage in Mexico City earthquake. Adrian M. Chandler.
Nature, Vol 320(10), 1986: 497-501.
Requests from the Caribbean
Pan American Health Organization
Disaster Preparedness in the Americas is the Newsletter of the Emergency Preparedness and Disaster Relief Coordination Program of the Pan American Health Organization, Regional Office of the World Health Organization for the Americas. The reported events, activities and programs do not imply endorsement by PAHO/WHO, nor do the statements made necessarily represent the policy of the Organization. The publication of this Newsletter has been made possible through financial support of the Canadian International Development Agency (CIDA).
Correspondence and inquiries should be addressed to: