Disaster preparedness training: Who should it reach and how?

The response by the health sector of a disaster-affected country is a revealing indicator of just how much emphasis has been placed on strengthening national institutions and training local health personnel. For the development of human resources - and not the stockpiling of equipment and material - is the key to sound disaster management.

School children and their teachers have become receptive target groups of disaster preparedness training. In Costa Rica, the Ministry of Education has embarked on a successful program aimed at primary school children. In Pinar del Río, Cuba, children are taught first aid skills through role playing. (Photo: Carlos Gaggero/PAHO)

Target Groups

Keeping in mind the vulnerability of each country, who needs to be trained? Perhaps we can approach this question from another angle. Who provides essential health assistance during and immediately following disaster situations? The list is lengthy, considering that the health response to disasters mobilizes all disciplines and depends, to a certain extent, on decisions made by other key sectors. In the Americas, the audience has broadened to include the following groups:

· health professionals from all disciplines (hospital staff and administrators, sanitary engineers, epidemiologists, etc.) Few health sector roles remain unexposed to the basic concepts of disaster preparedness and response;

· special non-health responders play a decisive role in emergencies. No component of this group holds more power than the mass media. Exposing the media to the most commonly-held myths prior to disasters will prevent the dissemination of misinformation regarding health problems after disasters. It will also reduce pressure on decision makers to commit resources to ineffective but highly-visible campaigns. Other key groups include fire and police departments and the armed forces;

· Ministries of Foreign Affairs represent a vital link with the outside world. Too often, requests for medical or other health relief are made by or accepted at the diplomatic level without giving due consideration to technical or scientific criteria. A better understanding of health issues in diplomatic missions can only facilitate the effectiveness of international health relief;

· local communities have the first and last word in the response to emergencies - the first word because outside assistance, especially at the international level, always arrives too late; the last word because most often the affected community is quickly left on its own once the acute emergency phase has passed. Training communities is essential but challenging;

· school children and their teachers are extremely receptive to simple health preparedness education and training. Working together with Ministries of Education, this strategy has proven to be an effective, durable means of influencing public opinion concerning emergency health matters.

Strategies

Disaster preparedness training should be based on the following policies and strategies:

· training of trainers - not all organizations nor all training programs can reach the grassroots level, but preparing a national cadre of experienced trainers is a positive first step. This is an ongoing process, given the variety of disciplines that disaster preparedness encompasses and the ever-expanding scope of issues it addresses. Training of trainers will also ensure the multiplier effect of training;

· courses, workshops, simulation exercises, and drills, all help to create a critical mass of disaster-literate and influential health professionals. But there comes a time when this effort cannot be completely sustained by the international community and disaster preparedness must be institutionalized nationally for long-term survival. One way in which countries can accomplish this is to promote the inclusion of disaster preparedness in the curriculum of schools of medicine, nursing, and engineering;

· once a mechanism has been established to broadly transmit general skills, efforts can be concentrated on developing new areas of technical expertise. Because the field of disaster preparedness is ever expanding, training programs and materials must also be dynamic and up-to-date;

· developing training and educational material and making it available at no cost to qualified institutions and individuals is indispensable if the multiplier effect of training is to be successful. These materials support teaching institutions, Ministries of Health, and NGOs in their role as trainers.

News from PAHO/WHO

WHO Holds 2nd Interregional Meeting

Staff from WHO Headquarters and emergency preparedness and response program managers from the World Health Organization's six regional offices met in Alexandria, Egypt from 11-13 June 1989. Participants coordinated a strategy that will include health aspects and priorities in the activities of the International Decade on Natural Disaster Reduction. Latin America's new Collaborating Center at the University of Antioquia in Colombia was represented at this meeting. Participation of this Region's Collaborating Centers is a first step. However, the member countries of the Americas must play a greater and more active role at the international and interregional level. The European Regional Office (EURO) reported on experiences during the Armenian earthquake. As was the case in this Region, the December disaster provided an opportunity for WHO to cooperate more closely in the rehabilitation and reconstruction phases. Those wishing more information on EURO's experiences may contact Dr. Olavi Elo, Emergency Preparedness and Response, World Health Organization, 20 Avenue Appia, CH-1211, Geneva 27 Switzerland.

WHO African Center Hosts Health Preparedness Course

WHO's Pan African Center for Emergency Preparedness and Response in Addis Ababa, Ethiopia, held an international course on health emergency preparedness and response from 5-23 June. Forty participants primarily from English-speaking African countries attended the course which covered a broad range of topics on managing acute and chronic disasters and their health consequences. The participants outlined emergency preparedness plans that would be applicable to their countries where many suffer the combined effects of drought, famine and social unrest. The meeting also provided a forum for international agencies to share disaster management and relief experiences with the participants. For further information write to Dr. Sandro Calvani, Pan African Center for Emergency Preparedness and Response, P.O. Box 3050, Addis Ababa, Ethiopia.

New Hurricane Video In the Path of a Hurricane It is hurricane season once again, and few have forgotten the trail of destruction left by Hurricane Gilbert last September as it lashed across the Caribbean and Mexico. To strengthen Preparedness activities in the Caribbean, the Pan American Health Organization has produced a new 17 minute video program entitled In the Path of a Hurricane. This is the story of one devastating hurricane, particularly as it affected Jamaica. But it is also the story of all hurricanes and what can be done to prepare for them. Preparedness is key because we cannot prevent hurricanes - and even predicting when and where a storm will hit is not always accurate. For those in the path of a hurricane, preparedness is the best means of mitigating its effects. And one of the best ways to prepare is by learning from the experience of past hurricanes, such as Gilbert. For information on ordering a copy of this program, contact the Editor of this Newsletter

Other organizations

Partners of the Americas Hosts Emergency Preparedness Seminar

The Paraguay-Kansas partnership of Partners of the Americas hosted 30 participants from Argentina, Uruguay, Chile and Paraguay at a flood mitigation workshop. The workshop was the first of a three-part program; the second and third phases involved a week-long partnership visit by the northern committee members to their southern counterpart and the follow-up project planning. The South American Regional Team of OFDA/AID, Argentina's national health disaster coordinator and PAHO's subregional adviser supported Partners in this workshop. The seminar included a daylong simulation and presentations during which the countries of the Southern Cone discussed flood mitigation and planning and the health and financial impact of flooding during the period 1965-1987. For a complete report contact Mr. Howard Spiegelman, Emergency Preparedness Program, Partners of the Americas, 1424 K Street N.W., Washington, D.C. 20005, USA.

Red Cross Team in Armenia

Seven national Red Cross Societies assembled a 15-member team of doctors, nurses, and physiotherapists to treat nineteen patients with spinal cord injury resulting from the Armenian earthquake last December. The League of Red Cross and Red Crescent Societies team, working with Armenian doctors and nurses, will provide rehabilitation care for a six-month period. Plans for this type of aid, or similar relief assistance, should be made in the Americas. It is much more useful than the rush of inappropriate or non-specialized medical teams that arrive in the first days after many disasters. For more information write Medical Division, League of Red Cross & Red Crescent Societies, Case Postal 372, CH-1211, Geneva 19, Switzerland.

UNHCR Conference on Refugees

The U.N. High Commissioner for Refugees and the United Nations Development Program organized an International Conference on Refugees in Central America. The Conference, held 28 May-l June in Guatemala, was attended by the Secretary-General of the U.N., high-level delegations from Central American countries, Mexico and Belize and representatives of developed countries that traditionally support activities in this area (US, Canada, EEC, Nordic countries.) Countries faced with the problems associated with refugees and displaced populations submitted project proposals to fundung agencies on areas such as repatriation or integration. Some technical areas could be strengthened by the active participation of technical departments in key ministries. For more detailed information on proposals of this meeting contact Emergency Unit, United Nations High Commissioner for Refugees, CH- 1211, Geneva 10, Switzerland.

Delft Center Holds Documentation Meeting

Two dozen information specialists from development organizations, international agencies and universities met at the Disaster and Emergency Reference Center of the Delft University of Technology in the Netherlands on 28-89 May to discuss documentation and disaster studies. At the close of the meeting, the Delft Declaration was issued and a collaborative exchange network has been established. DEMIN, the Disaster and Emergency Management Information Network, will assist research, information and training centers in developing countries to establish basic libraries and databases. A working group is studying database formats under development or in use and examining the potential for the electronic exchange of information through these databases. DEMIN will communicate through information bulletins and newsletters of supporting organizations and through UNDRO's electronic mail network, UNIENET. DEMIN has begun work on the development of a global directory of research and documentation centers that deal with disasters. For information on joining DEMIN or for a copy of the Delft Declaration, write Disaster and Emergency Reference Center, PO. Box 5048, 2600GA, Delft, Netherlands.

FEMA Produces Earthquake Teaching Materials

The U.S. Federal Emergency Management Agency has produced a comprehensive teaching plan to help primary school children learn about the dangers of earthquakes and how to cope with them. The plan consists of lessons that provide basic information about earthquakes and features hands-on classroom activities. The package contains teacher background material, masters for reproducing transparencies, handouts and worksheets, and lists of materials and resource. This material can serve as a model for developing similar packages for other types of disasters. Write FEMA, Earthquake Programs, 500 C Street S.W. Washington, D.C. 20472, USA.

Member countries

Colombia: National Disaster System Organized

The presidential decree number 919 of I May 1989 organizes the Colombian National System for the Prevention of and Attention to Disasters which was created by law last year. The decree also classifies all current norms relating to disaster prevention and attention, including the aforementioned law (see issue No. 38 of this Newsletter.) The articles of this decree are clearly written and would serve as an excellent model for other countries to organize similar plans. For a copy of the complete decree write Dr. Camilo Cardenas, Director, Oficina de Emergencias, Presidencia de la República, Carrera 8, 7-26, Bogotá, Colombia.

Costa Rica: Latin American Disaster Meeting

Officials responsible for national health sector disaster preparedness programs, directors of civil defense systems and national emergency committees, and represenatives of Foreign Affairs met in San Jose, Costa Rica from 22-26 May at the Latin American Meeting on Disaster Preparedness with Emphasis on the Health Sector and other Social Sectors. Experts from U.N. agencies, bilateral agencies, the Red Cross and other international institutions also attended. The meeting was convened to evaluate the progress of national health sector preparedness programs. The complete text of the recommendations from the health sector, Civil Defense, Foreign Affairs and NGO working groups, as well as recommendations concerning international health assistance, women and disasters and the International Decade on Natural Disaster Reduction put forth at this important meeting have been published (in Spanish only) and are available from the Editor of this Newsletter.

Caribbean: Health Coordinators Meet

Twenty one Caribbean health disaster coordinators met from 25-28 April in Kingston, Jamaica. For the first time this annual meeting was held concurrently with the meeting of National Disaster Coordinators. The two groups met together at an opening technical session where Jamaica's health sector and civil defense, among others, discussed lessons learned from Hurricane Gilbert. At the health sector coordinators' meeting participants discussed:

- lessons learned from Hurricane Gilbert: plans should be written, tested, disseminated and tested annually; personnel should know clearly what they are to do; mechanisms should be in place to turn on and off the relief effort: major constraints to implementing certain activities: political priorities, inadequate resources and competing responsibilities of national health coordinators;

- recommendations: Ministries should prepare and submit a budget for allocating health preparedness programs; health disaster coordinators should be authorized to allocate at least 20% of their time to disaster preparedness activities in smaller states; larger countries should have a full time coordinator to coordinate and elaborate a health sector plan by April 1990. A report of this meeting, including the recommendations of participants and many important lessons learned from last year's hurricane, is available from Dr. Jean Luc Poncelet, Emergency Preparedness Adviser. PCDPPP, P.O. Box 1399, St. John's, Antigua.

Dominica: National Red Cross Society Recognized

The International Committee of the Red Cross has recognized the Dominica Red Cross. The Dominica Red Cross began in 1958 as a branch of the British Red Cross. Today it has seven local committees one for each of the island's administrative districts. Its principal activities are first aid, disaster relief, and assistance to the disabled and elderly. Contact Dominica Red Cross, Rosseau, Dominica, West Indies.

Guadeloupe: Nursing Curriculum Includes Disaster Preparedness

The School of Nursing in Guadeloupe has included disaster preparedness in their curriculum. This will include eight lectures during the first year and the same number during the second year.

Jamaica: A Note on Hurricane Gilbert

A solar-powered vaccine refrigerator installed in the Kingston area survived Hurricane Gilbert and saved the country's main vaccine supplies. While the storm immediately disrupted electrical services throughout the country - and some health centers in particularly hard-hit areas were months without power - solar vaccine refrigeration continued. Solar refrigerators get electricity from photovoltaics. These solar energy collectors convert sunlight directly to electricity. Because the solar powered refrigerator has a large battery bank that continues to supply power at night and during storms. the system worked admirably both during and after the hurricane. For more information contact Mr. Peter Carrasco. Expanded Program on Immunization, Pan American Health Organization, 525 23rd Street N.W.. Washington, D.C. 20037, USA.

Mexico: Hospital Preparedness Course

The Secretary of Health sponsored a multisector course on hospital preparedness for hospital directors, administrators, architects and engineers. It is interesting to note that this is the first course that has had a large number of participants from other health sector institutions. This indicates a growing interest in emergency preparedness and a demonstrated commitment on the part of the health sector to prepare its institutions for those disasters that require a hospital response. For more information write Dr. Ignacio Guzmán Gorduño, Director, Direccion Prevencion de Accidentes y Atención a Desastres, Secretaría de Salud, San Luis Potosí 199, 5 piso, Mexico, D.F., Mexico.

Peru: Disaster Seminar in Ica

Peru's National Institute of Civil Defense carried out a seminar on the Operational Management of Disasters for the Permanent Committee for International Support in the city of Ica from 26-29 April. This meeting gathered together the principal non governmental agencies that carry out projects in Peru, representatives of bilateral agencies such as the U.S. Office of Foreign Disaster Assistance and the Canadian International Development Agency, and the embassies of donor countries. The purpose was to determine the type of aid that could be best offered before, during and after a disasters. For a complete report write General E.P Jorge Ferreyros Seguin, Instituto Nacional de Defensa Civil, Esquina Calle 1 y 21, CORPAC, Lima, Peru.

Computerized Management of Medical Supplies Representatives of bilateral agencies, NGOs and national disaster offices met with representatives of PAHO to establish the scope of a computerized management system to monitor medical relief supplies in the immediate aftermath of sudden-impact disasters. The meeting in Mexico City, from 11-12 May, was attended by the Japan International Cooperation Agency (JICA), the Office of U.S. Foreign Disaster Assistance (OFDA/AID), Jamaica's Office of Disaster Preparedness, the American and Colombian Red Cross, Volunteers in Technical Assistance (VITA), and Americares. Following are highlights of their recommendations: Requests for medical supplies · countries should have a pre-approved list of priority medical items. · workshops should be organized to brief Foreign Affairs Offices on the problems related to unsolicited relief and the importance of pre-arranged mechanisms to handle incoming supplies. · disaster-stricken countries should schedule frequent meetings with the donor community to improve coordination and avoid duplication of requests for assistance. · countries should place a high priority on establishing bilateral agreements for disaster response with neighboring countries. Donor countries · donors should agree on a labeling/numbering system to ensure that relief supplies are properly handled and distributed by priority. · donor countries should encourage the print and broadcast media in their countries to initiate public education campaigns on what constitutes an appropriate international response. · where applicable, donors should prompt airlines to adopt a policy for transporting priority medical supplies to the Ministry of Health of affected countries. · liaison with the NGO community, especially those working in the medical field, should be strengthened. Points of entry · a data entry system should be in place at the most important point of entry as soon as possible to track all entering medical relief supplies. In those cases where a warning period exists, such as in severe floods or hurricanes, this system should be in place beforehand. · funding must be identified to develop database software, procure portable IBM-compatible equipment and field test and train users. -^-^ · the database should include guidelines and checklists of steps and procedures for customs clearances. In-country distribution · to insure efficient distribution and accountability, all incoming medical supplies should be centrally controlled and managed. · experience has shown that fewer problems occur when supplies are recorded at the airport or other point of entry immediately upon arrival and dispatched directly to the designated consignee.

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 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.

International Decade for Natural Disaster Reduction. Earthquake Engineering Research Institute. 40 slides and notes. (English)

The Continuing Education Committee of the The Earthquake Engineering Research Institute has produced a 40 slide program that will facilitate discussions or presentations on natural hazards: floods, volcanos, tsunamis, earthquakes, to name a few. It also includes mitigation strategies for the different types of disasters. These scientific and technical activities are required to achieve the overall goals of the International Decade for Natural Disaster Reduction. The program also includes slides on the opportunities for research and mitigation during the Decade and on assessing the chance and the magnitude of potential losses due to disasters. EERI has many other slide sets including a new one on the Armenia earthquake. Contact them for a complete listing.

- US$50 for members of EERI, $60 for non-members. EERI, 6431 Fairmount Avenue, Suite 7, El Cerrito, California, 94530, USA.

Shared Vulnerability: The Media and American Perceptions of the Bhopal Disaster. Lee Wilkins, Greenwood Press, New York, 161 pp., 1987 (English)

It is difficult the underestimate the influence of the mass media when it comes to shaping public opinion and changing attitudes. This book is part of a series on the Study of the Media and Mass Communications, and explores the coverage given to the Bhopal disaster by the written and electronic media, using criteria such as topics of coverage, sources cited and the difference in coverage among the media. Of particular interest is a discussion of the mass media's contribution to what is called the "doomsday mythology surrounding science" and the author's emphasis on the role of the media in stimulating public debate and promoting efforts to reduce industrial or environmental hazards. While this sound analysis deals with one specific case, it is, nonetheless, food for thought about a trend that is becoming increasingly important to the international management of disasters.

- US$29.95. Greenwood Press Inc., 88 Port Road West, Westport, Connecticut, 06881, U.S.A.

Upcoming meetings

September

10-15 The World Association for Emergency and Disaster Medicine will hold the 6th World Congress on Emergency and Disaster Medicine in Hong Kong. The program will emphasize both the specialized and interdisciplinary aspects of emergency and disaster medicine. Plenary sessions will review and evaluate recent developments; workshops will give priority to the analysis of problem issues in organization and delivery of services and will make recommendations for future strategies. Registration fees approximately US$345. For further information write Dr. Michael Moles, Chairman 6WCEDM, Anaesthetic Unit, Prince Philip Hospital, 34 Hospital Road, Hong Kong.

October

24-26 An international meeting on Catastrophes and Society will be held in Madrid, Spain to analyze the social and economic problems caused by natural disasters, to discuss ways in which educational and preventive systems can be established and to improve the relationship between public and private institutions in setting up common international programs. Contact Meeting Secretariat, ITSEMAP, Paseo de Recoletos, 25, 28004 Madrid, Spain.

February 1990

7 The British Consultants Bureau will host a one-day conference on Disaster Relief and Mitigation two months after the commencement of the International Decade for Natural Disaster Reduction. The conference will bring together the users and the producers of scientific and technical information and management expertise in areas such as post-disaster field investigation; hazard and vulnerability assessment; community preparedness and development; and water supply and environmental health. For complete information contact Director, British Consultants Bureau, I Westminster Palace Gardens, 1-7 Artillery Row, London SH1P 1RJ, U.K.

Disaster preparedness training

Magnitude vs. Intensity From time to time, the words magnitude and intensity are used interchangeably in writings on earthquakes. Although both terms are used to express the severity of an earthquake, they refer to two different scales. The Richter Scale of magnitude measures an earthquake's energy at its source. This is the most commonly-used scale, but often the most misunderstood. The magnitude of an earthquake, as measured by the Richter scale, is expressed in whole numbers and decimals. Each whole number step of magnitude on the scale represents an increase of 10 times in the measured wave amplitude. Thus, an 8.3 magnitude earthquake is not twice as large as an earthquake of 4.3 magnitude, but 10,000 times as large. The Modified Mercalli Intensity Scale measures the intensity of an earthquake's effects in a given locale, and is perhaps much more meaningful to the layman because it is based on actual observation of earthquake effects in specific places. The scale contains 12 categories ranging from I (not felt except by a very few under especially favorable circumstances) to XII (total damage - practically all works of construction are greatly damaged or destroyed.) Waves are seen on ground surface and lines of sight and level are distorted. Objects are thrown upward into the air. It is difficult to compare magnitude and intensity because magnitude is a measure of the energy released at the focus of the earthquake while intensity is linked with the particular ground and structural conditions of a given area, as well as the distance from the epicenter of the earthquake. Adapted from UNDRO News

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 hare been reproduced and recently added to the collection of articles available from the Editor of this Newsletter. A complete list of reprints is available upon request. Please quote the reference code listed to the left of the publication title when requesting articles.

W.5 Role of a Hospital Team at an Industrial Explosion. Bruce E. Haynes, M.D., Alfred C. Emmel, M.D., MAJ, MC, USAF. American Journal of Emergency Medicine. Vol. 6, No. 3, May 1988.

W.8 International Solidarity for Armenian Quake Victims. N. Solomatine. UNDRO News, Nov./Dec. 1988.

W.9 Behavior of Building Occupants in Earthquakes. Michael E. Durkin. Earthquake Spectra, Vol. 1, No. 2, February 1985.

X.2 Evacuations due to Off-site Releases from Chemical Accidents: Experience from 1980 to 1984. Journal of Hazardous Materials, 14(1987) 247-257.

X.6 Characteristics of Extreme Rainfall Events in Northwestern Peru During the 1982-1983 El Niño Period. R.A. Goldberg. G. Tisnado, R.A. Scofield.

X.7 Afghan War Wounded: Experience with 200 Cases. Jorma Rautio, M.D., Pekka Paavolainen, M.D. The Journal of Trauma, Vol. 28, No. 4.

Requests for articles should be directed to: Pan American Health Organization Emergency Preparedness and Disaster Relief Coordination Program 525 Twenty-third Street, N.W. Washington, DC 20037, USA

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 for the Americas of the World Health Organization. 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 the 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, USA