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close this bookDisasters Preparedness and Mitigation - Issue No. 28 - October, 1986 (PAHO)
View the document(introductory text...)
View the documentA Critical Look at National States of Emergency Preparedness
View the documentNews from PAHO/WHO
View the documentOther Organizations
View the documentMember Countries
View the documentUpcoming Meetings
View the documentReview of Publications
View the documentSelected Bibliography

(introductory text...)

ISSN 0251-4494

A Critical Look at National States of Emergency Preparedness

It is particularly encouraging to note that the health sector of Central America and Panama is taking a serious and critical look at their own national state of emergency preparedness.

Recent natural disasters such as the earthquake in Mexico and the volcanic eruption in Colombia have made these countries more mindful of their vulnerability. But natural disasters are not the only risk to which they are exposed. The countries of Central America and Panama are also vulnerable to manmade disasters brought about by mass migrations of refugees and displaced persons.

With this in mind, representatives of the health sector from Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua and Panama met in Tegucigalpa, Honduras from 18-20 August at the "2nd Subregional Meeting on Evaluation of Health Activities in Emergency Situations."


The group recognized the significant efforts initiated by the health sector of the countries in the subregion to satisfy emergency needs caused by disasters. But the countries identified as critical the need to increase financial allocations for emergency preparedness activities, develop operating plans for specific aspects of disaster management, improve continuity of disaster programs in spite of administrative changes, and ensure that disaster preparedness units fall within the ranks of high-level decision makers in national organizational structures.

Emergency planning must be an ongoing process. This is true during non-emergency times when seemingly unrelated activities such as changes in national infrastructure or multisectoral reductions in personnel can alter the logistics of a national plan. And, it is perhaps more critical in the aftermath of a disaster when the opportunity to evaluate strategies, learn lessons from the implications of emergency decisions, and revise disaster plans is at hand.

Manmade disasters brought about by the mass migration of refugees and displaced persons can pose as great a threat as natural disasters. Photo: J. Vizcarra/PAHO

Disaster preparedness was also a topic of discussion among the representatives to the II Health Sector Meeting of Central America and Panama (RESSCAP) which met from 25-29 August in Tegucigalpa. The meeting was attended by Ministers of Health and directors of national Social Security Institutes, with the technical support of PAHO and the participation of international agencies lending technical and financial cooperation. The purpose of the meeting was to collectively analyze the most serious common problems affecting the health sector of the countries in the subregion.

At this meeting, resolutions were passed calling for improvements to the health sector. Among the resolutions was one dealing with emergency preparedness. Below are highlights of Resolution XIII passed at the meeting of RESSCAP:

· to call upon each country to strengthen their existing technical units that deal with emergency health preparedness or create units in those countries which still do not have them.

· to promote the necessary political support for these activities, including the commitment of sufficient resources for their execution.

· to encourage the development and distribution of health sector plans for disasters.

· to motivate the countries to include training in emergency health preparedness in their programs of continuing education.

· to encourage vulnerability assessments of national health institutions, drinking water and sanitation systems and other systems vulnerable to disasters.

· to request that the Director of PAHO consider the need not only to maintain but also increase the Organization's support to national emergency preparedness programs.

· to manifest their concern for the state of health care in temporary settlements for refugees and displaced persons; for the health problems derived from mass migrations presently occurring in the subregion; and express their hope that these areas will be granted the high priority they deserve.

The fact that the countries of the subregion realize that deficiencies exist and much remains to be accomplished is encouraging. The Caribbean subregion also held a meeting last June in Barbados of health disaster relief coordinators to evaluate health activities in emergency situations. The Andean subregion is scheduling a similar meeting In early 1987. Countries of the Region are encouraged to continue this positive trend. Close self-examination of national programs and the sharing of experiences in emergency preparedness and planning is our mutual responsibility. It is never too soon to begin.

Although earthquakes cannot be prevented, mitigation measures can reduce their impact. Photo: J.L. Zeballos, PAHO

Emergencies and disasters often have different meanings for different persons or institutions.

The manual of the World Health Organization defines an emergency as "any situation implying unforeseen, severe and immediate threats to public health."

PAHO has commonly used the term disaster to signify "an overwhelming ecological disruption which exceeds the capacity of a community to adjust, and consequently, requires assistance from the outside."

In planning national programs to fortify a country's ability to withstand or cope with a disaster, it is well to keep in mind several concepts inherent in disaster management.

Prevention. Prevention measures are defined as measures aimed at impeding the occurence of a natural event. Constructing a dam or levy to control floods is one example of a preventive measure. Hurricanes and earthquakes cannot be prevented with the technology presently available.

Mitigation. Mitigation measures are aimed at reducing the impact of a natural disaster on a population or country. Developing and enforcing building codes, for instance, will reduce losses in the event of earthquakes or hurricanes.

Preparedness. Preparedness measures enable individuals and institutions to respond rapidly and effectively to emergency situations created by any type of disaster. Such measures include formulating and updating contingency plans, training personnel, and maintaining inventories of resources.

News from PAHO/WHO

Facsimile Service

PAHO's Emergency Preparedness and Disaster Relief Coordination Program has just installed facsimile service at our emergency center in Washington, D.C. We take this opportunity to provide you with our fax number and, at the same time, to list other means by which you can get in touch with us:

Pan American Health Organization
Emergency Preparedness and Disaster Relief Coordination

Phone: (202)









(outside of the hours of 8 a.m. to 6 p.m., Eastern Standard Time, call 861-3200)

New Fax Number: (202) 775-4578
(24 hours a day)

If your organization or agency has facsimile service, please let us know so that we may add your number to our directory.

Disaster Preparedness Update

The sixth edition of the PAHO Disaster Preparedness Update has just been released. Containing approximately 500 cross-indexed entries, this latest edition of the Update reviews published and unpublished documents and reports of potential interest to the health sector of disaster-prone countries. The material abstracted in the Update deals particularly with the health aspects of disaster preparedness, prevention and relief. Documents can be located by crossreferencing for author, subject, or country in which the activity was performed. Address requests for the latest edition of the Disaster Preparedness Update to the Editor of this Newsletter.

WHO to Cosponsor Disasters and Development Conference

WHO will cosponsor an International Conference on Disasters and Development tentatively slated for September 1988. Although the conference will focus primarily on health and development, its scope will be intersectoral. Preliminary agenda items include the long term impact of disasters, surveillance and monitoring systems, information and communication, and management and policy aspects. Further information will be published in subsequent issues of this Newsletter.

Other Organizations

AMA To Hold International Radiation Conference

The American Medical Association is holding an International Conference on Non-Military Radiation Emergencies at PAHO Headquarters in Washington, D.C. Topics include emergency planning for hospitals; the need to involve physicians and others in the health care community to prepare for and respond to emergencies; the public health risks of nuclear emergencies; and evacuation procedures. Speakers are international experts who have been involved with the Three Mile Island and Chernobyl nuclear accidents. Presentations by emergency health planners, radiation risk experts and government officials will also be included. A training session on communications and relations with the media will be held on Friday afternoon, November 21 and continue into Saturday. We are encouraged to see attention being given to this area. For further information write: Office of the Vice President, Science and Technology, American Medical Association, 535 N. Dearborn Street, Chicago, Illinois 60610 U.S.A. or call toll free in the U.S.: (800) 621-8335.

Earthquake Education Program

The Southern California Earthquake Preparedness Project (SCEPP), with support from FEMA, has developed a long-term earthquake public education program to increase general awareness and preparedness. SCEPP has produced a variety of materials including brochures on guidelines for earthquake preparedness planning and specific preparedness information for special groups such as the disabled and those living in high-rise buildings and mobile homes in areas with a high seismic risk. FEMA has made available camera-ready photostats of a folder designed to carry earthquake preparedness information which you can adapt to your local conditions. Further information on the brochures can be obtained by writing to Federal Emergency Management Agency, Office of Public Affairs, Box 8181, Washington, D.C. 20472.

JICA Visits American Region

A Japanese mission on emergency rescue operations from the Japanese International Cooperation Agency (JICA) visited Chile, Colombia, and Peru to explore the possibility of developing bilateral relations. Areas of interest to the mission were the training of rescue personnel, research and study of disasters, coordination with other donors, decision-making on the dispatch of rescue teams and past examples of disaster management and activities. The health sector of vulnerable countries should perhaps consider JICA as a potential source of bilateral support for national preparedness activities. Many countries in the Region have JICA representatives. For further information contact the representative in the country nearest to you.

Red Cross Pamphlets and Guides

The Golden Gate Chapter of the American Red Cross has prepared a series of pamphlets and guides on earthquake disaster preparedness. Some of the material is directed towards individuals in earthquake-prone areas and covers safety and survival in earthquakes, a family disaster plan, and a personal survival guide. Other material appropriate for business and industry includes a prototype disaster plan and shelter management guidelines. All material available at a nominal cost and most is available in English and Spanish. For a complete list of titles and prices write to the Golden Gate Chapter, American Red Cross, 1550 Sutter Street, San Francisco, California, 94109, U.S.A.

Refugee Health Group Evaluates WHO Kit

The Refugee Health Group at the London School of Hygiene and Tropical Medicine. a WHO Collaborating Center for the health of refugees and other displaced persons, has been commissioned by WHO to evaluate the WHO Emergency Health Kit. The kit was designed in 1984 to supply pharmaceuticals and clinic equipment for 10,000 people for three months after a disaster. Agencies who have used the WHO Emergency Health Kit are invited to make comments on their overall use of the kit and its appropriateness. Contact: Dr. J. Patrick Vaughan, Refugee Health Group, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, England.

UNDRO Conference on International Assistance

Officials responsible for national emergency relief services from some 22 nations and the European Economic Community met in Geneva from 18-20 June to review the shortcomings of international relief assistance. Among the weaknesses encountered at this UNDRO-sponsored meeting were conflicting assessments; the arrival of unsolicited rescue teams and relief supplies, and breakdowns in communications systems. Areas targeted by the group for improvement included advance notification of search and rescue teams and related supplies and anticipating both relief requirements and potential donor response. The Conference participants recommended establishing relief commissions or emergency operations groups in disaster-prone countries, improving information gathering to ensure detailed and accurate assessments and establishing priorities and channels for implementing and disseminating these assessments. For further information on the proceedings of this conference write: Mr. Robert Souria, Chief, Relief Coordination and Preparedness Branch, UNDRO, Palais des Nations, 1211 Geneva 10, Switzerland.

UNHCR Appeals for Improved Coordination Among Refugee Documentation Centers

In 1982, the U.N. High Commissioner for Refugees (UNHCR) established a Refugee Documentation Center in collaboration with the International Council of Voluntary Agencies and the Intergovernmental Committee for Migration. Several voluntary agencies have started their own documentation centers and many other organizations are planning to open similar centers. This has made it essential to coordinate these efforts in a systematic manner. To this end, UNHCR has recently published a set of bibliographic guidelines for indexing, abstracting and storing information and developed a preliminary version of a common refugee thesauras of keywords for identifying documents. Presently UNHCR is working with the European Consultation on Refugees and Exiles (ECRE) to develop an international network compatible among users. Agencies and organizations interested in joining these efforts can contact the UNHCR Refugee Documentation Center, 5-7 Avenue de la Paix, 1211, Geneva 10, Switzerland.

Member Countries

Canada: Pre-hospital Emergency Care Services Guidelines

The Ministry of National Health and Welfare of Canada has issued a set of guidelines for establishing standards for pre-hospital emergency care services. Intended to assist those responsible for planning, organizing and operating institutional programs and services, the guidelines cover patient categorization; education of personnel; data collection, analysis and audits; and disaster planning, among other topics. Also included are several helpful indices with suggested data to be considered and a checklist of suggested equipment for ambulance vehicles. For a copy of the guidelines write: Dr. D.F. Moffat, Health Services Directorate, Health Services and Promotion Branch, Department of National Health and Welfare. Ottawa, Ontario. Canada, K1A 1B4.

Colombia: New Disaster Coordinator

Dr. Juan Pablo Sarmiento Prieto has been named Coordinator of the national disaster preparedness plan under the Ministry of Health. Formerly with the Colombian Civil Defense, Dr. Sarmiento has substantial experience in emergencies and disasters, having coordinated and presented talks at national workshops and seminars on the subject. Dr. Sarmiento can be contacted at the Ministerio de Salud, Bogota, Colombia.

El Salvador: Meeting on Health Care for Displaced Persons

The Ministry of Health convened the first of three planned working meetings on health care for displaced persons. This meeting, which dealt primarily with diarrhea] disease, provided a forum for voluntary and state agencies to discuss health problems. Subsequent meetings will focus on malaria and environmental health. Countries of the Region are encouraged to establish and maintain this type of dialogue between non-governmental organizations and national authorities. For further information contact: Dr. Hugo Prado, Emergency Preparedness and Disaster Relief Coordination Program, Pan American Health Organization, P.O. Box 3745, San Jose, Costa Rica.

Haiti: Serious flooding

Heavy flooding in June in the Cayes region of Haiti, seriously affected some 19 towns and villages approximately 200 kms. south of Port-au-Prince. An estimated 85,000 persons were affected to some degree, 79 were reported dead and more than 600 injured. Bridges, water supply and irrigation systems were destroyed and extensive damage to dams was reported.

Jamaica: Disaster Preparedness Week

Jamaica's Office of Disaster Preparedness and Emergency Relief Coordination (ODIPERC) organized a disaster preparedness week to usher in the hurricane season. A special supplement of to a national newspaper was prepared. It contained articles with information about the disasterous effects of hurricanes - storm surges, wind, flooding, and landslides - and general information to educate the public. Other countries might wish to consider a similar type of publication. For further information or a copy of the supplement contact Mr. Franklin McDonald, Director, Office of Disaster Preparedness and Emergency Relief Coordination, 2A Devon Road, Kingston 10, Jamaica.

Mexico: Hospital Disaster Preparedness Meeting

A workshop on hospital disaster preparedness was held in Mexico at the School of Public Health from 11-15 August. Among the 45 participants were directors of hospitals from states throughout the country and the Federal District and delegates from the Mexican Social Security Institute, the Social Security Institute for Federal Workers, and the Department of the Federal District. The course included a simulation exercise, presentations on disaster-related topics and the use of a self-instruction module. Directors of hospitals committed themselves to preparing, for each of their institutions, internal and external disaster preparedness plans and increasing personnel training. For further information contact: Dr. Raul Carrillo Silva, Director de Prevención de Accidentes y Atención a la Salud en Caso de Desastre, Secretaría de Salud, Presidente Mazarik 490, México, D.F., Mexico.

Peru: Emergency Health Management Seminar

The Ministry of Health of Peru has assigned formal responsibility for disaster preparedness to the deputy director of each of its decentralized departments. The Ministry also sponsored a workshop for the country's ten most vulnerable Departments from 19-20 August in Lima. For further information contact: Dr. Rafael Delgado, Director, Unidad de Desastres, Ministerio de Salud, Lima, Peru.

Peru: Emergency Manual Approved

By a resolution of the Ministry of Health, the Manual of Organization and Functions of the Disaster Preparedness was approved on 8 July. This Manual links the Disaster Preparedness Department with a Sectoral Committee thus ensuring the coordinated participation of all health sector components. both public and private, in prevention as well as relief and rehabilitation activities. For further information contact Dr. Rafael Delgado, Director, Unidad de Desastres, Ministerio de Salud, Lima, Peru.

U.S.: NDMS Simulation Exercise

The National Disaster Medical System, part of the U.S. Public Health Service, staged a day-long simulation exercise on 26 July. The event featured more than 1,000 moulaged patients, the casualties of an explosion at a sporting event. The exercise provided the opportunity for participating military and civilian emergency medical personnel to practice triage and tagging and make decisions about the mobilization of volunteer teams and the transport of the injured to area hospitals and neighboring cities. Two observers from Latin America were invited to attend the exercise. This will allow them the opportunity to stage similar activities at the national level. For further information contact Mr. William Clark, Director, Emergency Field Operations, MIEMSS, 31 S. Greene Street, Baltimore, Maryland, 21201, U.S.A.

Upcoming Meetings


6-18 In support of its contributions to the Plan of Priority Health Needs in Central America and Panama, the government of Spain has organized a course on hospital disaster preparedness, with the technical cooperation of PAHO. The 25 course participants from all countries in Central America and Panama, as well as Mexico and Colombia are directors of hospitals, chiefs of emergency services, health administrators in charge of national emergency preparedness programs. The course will present technical criteria for preparing hospital disaster preparedness plans, prevention measures for reducing the effects of disasters on hospitals, and training programs for hospital personnel charged with providing medical attention to mass casualties.

April 1987

6-10 FEMA, USAID and several California agencies are sponsoring the Second International Earthquake Conference to be held in Los Angeles, California. The Conference will focus on government, private sector and community efforts to develop earthquake research, mitigation, response practices and disaster preparedness. Guidelines and agendas for agencies involved in earthquake emergency planning will be developed during the Conference and presentations will be published in English and Spanish in the Conference Proceedings. For further information contact Councilman Hal Bernson, Conference Coordinator, City Hall Room 236, 200 North Spring Street, Los Angeles, California, U.S.A. 90012.

May 1987

11-14 The World Association on Emergency and Disaster Medicine is holding the 5th World Congress on Emergency and Disaster Medicine in Rio de Janeiro, Brazil. Topics slated for discussion include worldwide organization and management, permanent disaster situations, famines, training, teaching, and information techniques, and the multiple involvement of medical practices in specific types of disasters. For further information contact: Dr. Bernildo Tavares, Organizing Committee, 5th World Congress on Emergency and Disaster Medicine, Caixa Postal 14700, Rio de Janeiro, Brazil.

Review of Publications

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 front PA HO. The publisher and the list price (it-hen available) are included at the end of the abstracts for readers who are interested in purchasing the books.

Air Disaster Response Planning: Lessons for the Future. Eugene E. Grollmes. FEMA Monograph Series 1985, Volume 2, No. 5, 15 pp. (English)

Written for emergency management and allied professionals, this monograph analyzes the effectiveness of the disaster response when two skywalks collapsed at a crowded hotel, resulting in more than 100 deaths. It documents the comprehensive recommendations of both rescue workers and survivors concerning disaster management training, public information, identification of key personnel and equipment, and community planning committees. These recommendations are then applied to developing a strategy for an integrated air disaster response plan.

- Free. Federal Emergency Management Agency, Publications Office, 500 C Street S.W., Washington, D.C. 20472 U. S. A.

The Electronic Media and Disasters in the High-Tech Age. James L. Holton. FEMA Monograph Series, Volume 2, No. 4, 30 pp., 1985 (English)

This monograph examines the relationship between governments and the news media during emergencies and the ways recent changes in communications technology and attitudes have affected this relationship. It explores the growth of the electronic media and raises questions about its effects on the population, primarily - has television caused a shift away from self-reliance to a total dependence on television as the ultimate source for dependable information and guidance during disasters? Interesting reading for those who may find themselves in contact with the media and for all interested in this phenomenon.

- Free. Federal Emergency Management Agency, Publications Office, 500 C Street S.W., Washington, D.C. 20472 U. S. A,

Medical Consequences of Natural Disasters. Lazar Beinin. 160 pp. 45 figs. 40 tables Extensive refs. 1985 (English)

This book reviews the possible health consequences of major natural disasters. It provides an excellent compilation of historical data on both the disaster and the human response. Most of the data and case studies presented are in the immediate aftermath of World War II in the U.S.S.R. It constitutes an unmatched source of information and data from reports and publications in Russian normally unexplored by researchers. The nature of the problems experienced in the post-war era makes most of the conclusions historically important but of limited application to modern-day natural disasters. An epidemiological approach to the analysis of the data should have prompted the author question, in several instances, the scientific validity of available administrative statistics on communicable diseases and casualties. Readers interested in detailed data on historical natural disasters, and especially their health impact on a society recovering from a devastating war, will find that this book provides the best compilation ever published in the English language.

- U.S. $39.00. Springer-Verlag, 175 Fifth Avenue, New York, New York 10010, U.S.A.

International Humanitarian Assistance, Disaster Relief Actions in International Law and Organization. Peter Macalister-Smith. 244 pp. Extensive refs. 1985 (English)

Discusses the relationship between humanitarian assistance and international law and organization and how the latter can contribute to changing the context in which humanitarian problems and responses are set. Chapters deal with relief actions for refugees and during armed conflict, and discusses the role of the Red Cross, the United Nations and other organizations involved in this issue. Useful for those organizations or individuals wishing to gain greater understanding of international relief organization and international law.

- Orders in the U.S. and Canada US$45.00. Kluwer Academic Publishers, 190 Old Derby Street, Hingham, Massachusetts, 02043, U.S.A. Orders from other countries: Kluwer Academic Publishers Group, Distribution Center, P.O. Box 322, 3300 AH Dordrecht, The Netherlands.

Visual Material

The National Geophysical Data Center (NGDC) of the U.S. Department of Commerce is making available a Natural Hazards Photograph Catalog which describes each of some 2,000 photos of the damaging effects of geologic phenomena worldwide. Requests for photos of specific disasters or specific types of damages can be filled. The catalog is free. Photos are available for a nominal reproduction cost. In addition, NGDC also has prepared special slide sets on earthquakes and tsunami. For a copy of the catalog write: The National Geophysical Data Center, NOAA, Code E/GC11, 325 Broadway, Boulder, Colorado 80303 U.S.A.

Selected Bibliography

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.


Toxic chemical disasters and the implications of Bhopal for technology transfer. B. Weiss and T.W. Clarkson. The Milbank Quarterly, Vol. 64(2), 1986:216-240


The Kenner airliner disaster: A 727 falls into a New Orleans suburb. G. P. Morris. Journal of Emergency Medical Services, Vol. 7(6), Sept. 1982:58-65.


Media coverage of disasters: The same old story. T.J. Scanlon and S. Alldred. Emergency Planning Digest, Vol. 9(4), Oct.-Dec. 1982:13-19.


Stress reactions among participants in mass casualty simulations. P.H. Sanner and B.W. Wolcott. Annals of Emergency Medicine, Vol. 12, July 1983:426-428.


Chernobil y la protección civil. Organización Internacional de Protección Civil. Boletín de la Organización Internacional de Protección Civil, 372/373, junio-julio 1986:1-5.


Toxic products from fires. G.E. Hartzell, S.C. Packham and W.G. Switzer. American Industrial Hygiene Association Journal, Vol. 44(4), 1983:248-255.


The breakdown of an emergency system following a gas explosion in Osaka and the subsequent resolution of problems. Tsuguharu Ishida, M.D., Muneo Ohta, M.D., and Tsuyoshi Sugimoto, M.D. The Journal of Emergency Medicine. Vol. 2, 1985:183-189.

Requests from the Caribbean

Those requesting articles from countries in the Caribbean may direct their requests to:

Pan American Health Organization
Emergency Preparedness and Disaster Relief Coordination
525 Twenty-third St. N.W.
Washington, D.C. U.S.A. 20037

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:

The Editor
Disaster Preparedness in the Americas
Pan American Health Organization
525 23rd Street, N.W.
Washington, D.C. 20037, U.S.A.