Medical relief in earthquakes

Protecting worker and public health during responses to catastrophic disasters-learning from the World Trade Center experience

Despite incremental lessons learned since 9/11, responder and community health remain at unnecessary risk during responses to catastrophic disasters, as evidenced during the BP Deepwater Horizon spill and Hurricanes Katrina, Rita, and Sandy. Much of the health harm that occurs during disaster response, as distinct from during the disaster event itself, is avoidable. Protection of public health should be an integral component of disaster response, which should "do no additional harm." This commentary examines how challenges and gaps the World Trade Center response resulted in preventable occupational and environmental health harm. It proposes changes in disaster response policies to better protect the health of rescue and recovery workers, volunteers, and impacted worker and residential communities.

Coping with the Challenges of Early Disaster Response: 24 Years of Field Hospital Experience After Earthquakes

Objective

To propose strategies and recommendations for future planning and deployment of field hospitals after earthquakes by comparing the experience of 4 field hospitals deployed by The Israel Defense Forces (IDF) Medical Corps in Armenia, Turkey, India and Haiti.

Methods

Quantitative data regarding the earthquakes were collected from published sources; data regarding hospital activity were collected from IDF records; and qualitative information was obtained from structured interviews with key figures involved in the missions.

Results

The hospitals started operating between 89 and 262 hours after the earthquakes. Their sizes ranged from 25 to 72 beds, and their personnel numbered between 34 and 100. The number of patients treated varied from 1111 to 2400. The proportion of earthquake-related diagnoses ranged from 28% to 67% (P < .001), with hospitalization rates between 3% and 66% (P < .001) and surgical rates from 1% to 24% (P < .001).

Conclusions

In spite of characteristic scenarios and injury patterns after earthquakes, patient caseload and treatment requirements varied widely. The variables affecting the patient profile most significantly were time until deployment, total number of injured, availability of adjacent medical facilities, and possibility of evacuation from the disaster area. When deploying a field hospital in the early phase after an earthquake, a wide variability in patient caseload should be anticipated. Customization is difficult due to the paucity of information. Therefore, early deployment necessitates full logistic self-sufficiency and operational versatility. Also, collaboration with local and international medical teams can greatly enhance treatment capabilities. (Disaster Med Public Health Preparedness. 2013;0:1–8)

Remote mobile health service utilization post 2005 Kashmir-Pakistan earthquake

AIMS

Limited published studies have examined patient characteristics and disease patterns served by mobile clinics in remote areas post natural disaster. By comparing users of a remote mountainous stationary clinic and a mobile helicopter outreach clinic in Neelam Valley, 4 months post Pakistan-Kashmir earthquake, this study aims to: (i) compare the demographic and disease profile of health service users, (ii) examine how acute and chronic disease patterns vary with clinical settings, and (iii) discuss the potential implications to mobile emergency clinical service planning acute phase of natural disaster in remote areas.

METHODS

Cross-sectional, retrospective record-based study in two remote clinical settings in Neelam Valley, Kashmir-Pakistan. Patients who presented to clinics from 21 January to 20 February, and whose diagnoses were available, were included in the study. Descriptive statistics and chi significance tests were conducted.

RESULTS

Different users and disease profiles were found between mobile and stationary clinics. While older age, female sex, living further way from clinics, earthquake-related trauma, wound and gastrointestinal infections were found to be more significantly associated with mobile clinic users, stationary clinics patients tended to be younger, living closer to the clinic site, and disease profiles were predominantly chronic in nature.

CONCLUSION

In addition to the provision of acute and chronic medical clinical service, mobile clinics operating during post acute emergency phase of natural disaster in remote areas should be sex sensitive, with highly trained and experienced staff as well as the capacity to provide trauma care.

Disaster epidemiology and medical response in the Chi-Chi earthquake in Taiwan

STUDY OBJECTIVE

We examine the mortality and morbidity associated with earthquakes in the Chi-Chi earthquake in Taiwan in 1999.

METHODS

Crude casualty data were collected from the reports of the government, local health bureaus, and 97 hospitals. The demographic data from the annual report of the Department of Interior were also employed for data analysis. Cross tables showing incidence of deaths and injuries by age, sex, time, and geographic distribution were generated to compare the mortality among different subgroups. Multiple regression models were established to explore the risk factors related to the mortality caused by earthquakes.

RESULTS

The following results were found: the mortality rate increased with proximity to the epicenter, mortality was higher among the elderly than among young people, 30% of the victims died from head injuries caused by the collapse of dwellings, and the peak of medical demand was 12 hours after the earthquake and significantly increased demand for care lasted as long as 3 days. Furthermore, the regression model indicated that 78.5% of the variation of locality-age-sex-specific mortality was explained by the intensity of the earthquake, age, population density, distance to epicenter, medical beds per 10,000 people, and physicians per 10,000 people.

CONCLUSION

The results implied that fragile minorities, specifically the elderly and children, require special consideration and attention in regard to disaster rescue and emergency medical care allocation. Epidemiologic analysis can guide disaster response and preparation.