“EXTREME SITUATIONS AND DISASTERS THEIR INFLUENCE ON
THE POPULATION”
THE PLAN
1. Introduction. ES and their influence on a ability to live of the people.
2. Classification and the notions of the Extreme Situations (ES) and
catastrophes.
3. The tasks and organization of state service of Medicine of Catastrophes
(MC).
4. Basic features of a service MC in ES.
5. Basic divisions of a service MC.
1. Introduction.
ES and their influence on a ability to live of the people
The present-day century has aggravated the contradiction of interrelations of a
human society and nature to the extreme. Shift of ecological equilibrium to the crisis
edge observed everywhere has reduced buffer possibilities of nature and has
weakened its natural protective mechanisms. Since the prolongation of negative
economic cause and effect ties has a stable character, the possibility of human
involvement has increased. The new objective factor of increase of potential damage
in extreme situations is deepening of transforming activity of the man himself. And
now we can realize the thoughts of V.I.Vernadsky about the planetary character of
human activity to full extent: ”Created during the whole geological time and
established in its equilibrium, biosphere starts to change more and deeper under the
influence of the scientific thought of humanity. The scientific thought changes the life
phenomena, geological processes, planet power engineering. It is obvious that this
way of the human scientific thought is the natural phenomenon".
The main medical consequences of catastrophes are a large number of
casualties, mental disorders in people in the disaster area, disorganisation of
management of local public health services, material and human losses. As a result
there is a discrepancy between urgent need of medical aid and possibilities of
medical service in rendering it.
Natural disasters have the most severe consequences. 3 million people have
died due to catastrophes for the last 20 years, the number of injures makes about 800
million, the total cost of damage is estimated in 100 billion dollars.
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The catastrophes where international forces participate in its eradication are
registered on an average weekly. The analysis shows, that 90 % of them constitute:
floods 40 %, typhoons 20 %, earthquakes and droughts on 15%. The rate and the
range of technological disasters are comparable with natural ones. The events at
Chernobyl Nuclear Electric Power Station (NEPS) caused the death of 30 men,
hospitalization even more than 200 men with the diagnosis of radiation disease,
material damage is estimated to be 8 billion rubles, but medico-social, ecological and
other consequences are still serious problems. Sinking of passenger vessel "Admiral
Nakhimov" carried away more than 400 human lives. As a result of railway accidents
of 1988 more than 120 men were lost and more than 500 were hospitalized. On the
3rd of June, 1989 at 23 hours there was gas escape from the pipeline of the liquefied
gas due to the accident near the railway of Chelyabinsk – Ufa. A powerful explosion
and fire occurred in collision of two counter trains resulting in death of over 300
people (there were a lot of children among them) and more than 700 people were
hospitalized.
In contrast to disasters, the sources of which are uncontrollable by a man,
technological accidents can be regulated. Therefore it is of great importance to work
out scientifically grounded complex of measures not only for liquidation of
consequences of technological accidents, but also concerning the analysis of the
reasons of their origin.
The extreme situation can be a consequence not only of catastrophe. It may be
a conclusion of long-term evolutionary development of negative processes and
phenomena resulting in crisis. So crisis medico-ecological situation in area of the
Aral sea have been developing for 20 years. To our mind, significant signs of an
extreme situation are also considerable spatial - territorial characteristics,
involvement of large mass of the people in destructive processes and as a result the
sharp increase of need in medical aid for a long period of time.
Thus, there are bases to consider the notions "medicine of catastrophes" and
"medicine of extreme situations" to be close in their contents, though they are not
identical.
WHO suggests four main groups of catastrophe classification (meteorological;
topological; tellurian and tectonic accidents).Several decades ago we might speak
with certainty about prevalence of the natural phenomena as a cause factor resulting
in death and injury of people. Lately, the significance of antropogenic catastrophes
(technological accidents, crashes, etc.) has increased considerably. Due to risk
increase of emergency situations it was necessary to organize and prepare special
structures capable of functioning and giving medical aid to the population in the
disaster area.
The last two decades are characterized by active development of synthesis of
new chemical compounds and by now over 7 million names have been registered in
the world. They are actively introduced into industry, agriculture. According to the
World Health Organization a man utilizes about one million of chemical substances
and their number is growing by 200-1000 new substances annually. Over 53
thousands of them are considered to be toxic and potentially dangerous to a man.
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The most dangerous are chemical compounds used in national economy,
having high toxicity and capable to pollute an environment for a long time. They are
called highly active toxic agents (HATA). Their number exceeds several hundred and
their production per head in the world exceeds on thousand tons per year (WHO,
1988). Only in the countries of Western Europe the number of annually produced
common toxic chemical products – phosgene, ammonia and hydrocyanic acid is 100
billions of lethal doses, and the number of chlorine production is 100 times more.
The world experience of the analysis of chemical accidents gives evidence that
damage of chemical plants, stores and other objects and the emission of different
toxins into the environment may lead to serious consequences. The similar situations
can develop both in disasters (earthquakes, fires, floods), and at industrial failures.
The tragedy of Indian city Bhopala, located 600 km to the south of India’s capital of
Delhi illustrates this. On December 2, 1984 from 23 o'clock till 1 o'clock one of the
greatest as to the number of the dead and injured industrial accidents happened at the
chemical plant on production of pesticides of the American corporation “Union
Carbide”. As a result of escape of 30 tons of poisonous gas methylizocyanate(MIC),
toxicity of which is 10 times higher than that of phosgene, more than 2500 people
died and over 170000 people were in need of medical aid.
The same year has become tragically for Mexico, where the explosion of
storehouse of liquefied hydrocarbon in Sun-Juan-Iksyatake has resulted in death of
500 and injury of over 5000 men. The largest chemical catastrophe in the former
USSR for last years was the accident at industrial association "NITROGEN" in
Ionava (Lithuania) in March, 1989. The destruction of isothermal storehouse has
resulted in emission in an atmosphere more than 7000 tons of ammonia and fire in a
warehouse of nitrophosk, where there were about 15000 tons of this substance.
During the accident 7 men were lost, 64 men have received lesions of bodies of
breath and chemical burns.
The real analysis and correct evaluation of processes occurring in nature and
society speaks about the growing role of medicine of catastrophes in general system
of knowledge and practical activity of the people and public health services.
Therefore, the medicine of accidents may be defined as scientific discipline
interrelated with practically all medical specialties (organization of public health
services, surgery, therapy, radiology, toxicology, pediatrics, psychiatry etc.). It
studies problems of organization of rendering urgent medical aid to casualties directly
in the disaster area.
2. Classification and the notions of extreme situations and catastrophes.
There are several scores of definition of catastrophes in the world and native
literature. According to «Temporary criteria of the information about extreme
situations», (1990), criterion of an extreme situation of technogenic and natural
character is the casualty number of 10-15 persons, 2-4 dead, and also group acute
infectious diseases in 50 men, of the unknown ethiology in 20 persons and feverish
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diseases of the unknown ethiology in 15 persons, and also, if the mortality and
morbidity rate exceeds the average statistic in three and more times. Situation is also
considered to be extreme in “external unexpected abrupt states of emergency in
industrial accidents and catastrophes, ecological and other disasters characterized by
indefinite and difficult solutions, considerable economic damage, human casualties,
and, therefore, large human, financial and time expanses on realization of
evacuation-rescue works and liquidation of consequences of these accidents,
catastrophes and disasters”. For Health Service organization it is the number of
casualties including the dead that is the main criterion for this definition.
The extreme situation is a situation caused by natural or technological
disaster, at which arises a sharp disproportion between the need for the medical help
and opportunity of its maintenance by available forces and means of health service
while using the everyday forms and methods of work.
In emergency situation there is practically always the necessity to protect the
inhabitants from the factors, dangerous for life, to do rescue work and render urgent
medical aid to the victims.
The literature gives common signs of the notion catastrophe or disaster, such as
unpredictable and unexpected situation arising suddenly or somewhat extended in
time and accompanied by serious threat for health and life of separate groups or large
quota of the population and even of all society as a whole, as well as disturbance of
routine way of life, integrity of an environment.
In this case catastrophe is the sharpest form of a social pathology in general
and medico-social problem in particular.
Catastrophe or disaster is an extreme situation caused by forces of a nature or
human activity and accompanying by mass affection of the people with all
peculiarities of a pathology, damage of some part of medical institutions, liquidation
of which consequences need the help of forces and means from the outside of area of
disaster with use of the special forms and methods of their work.
The main medical consequences of the catastrophes are the transient
appearance of considerable quantity of injured, mental disorders in people in the
disaster area, human and material losses. As a result of the factor of suddenness of the
catastrophe there can be a discrepancy between urgent need of medical aid to a large
number of injureds and possibilities of the forces and means of health services in its
rendering.
Therefore, by mass losses of population it is expedient to consider an extreme
situation, in which the number of the injured persons requiring the medical help,
exceeds the possibility of rendering it by health service forces and means in the
disaster area.
The World Health Organization suggests the classification of disasters
(catastrophes) according to their origin (meteorological, topological, telluric,
tectonic, accidents).
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While classifying the catastrophes it is expedient to divide them into:
1. Natural disasters:
Meteorological (storms, hurricanes, tornadoes, cyclones, snowstorms, frosts,
unusual heat, drought etc.),
Topological (the floods, mud-flows, avalanches, landslides, etc.),
Tectonic (earthquake, eruption of volcano’s, etc.).
2. Technological accidents: explosions, destruction’s, fires, outflow of HATA
(including the railway, on water, on highways, on an air transportation), mine and pit
collapses, buildings and tunnel fallings, emissions of radioactive substances, damage
of technical constructions.
3.Social, specific catastrophes: epidemics, famine, terrorism, rioting, war,
epizootic and ecological disasters.
4. Transport accidents: automobile, railway, air, on water transport.
3. The tasks and organization of a state service of medicine of
catastrophes.
The medicine of catastrophes is a branch of medicine. The State Service of
Medicine of catastrophes (approved by the decision of the Cabinet of Ministers of
Ukraine from April 14, 1997 № 343) consists of medical forces, means and medical
establishments regardless the forms of property, kind of activity and branch
belonging on state and territorial levels appointed by Ministry of Health Services
(MHS) of Ukraine for rendering the medical help in extreme situations. The
appointment of medical forces and means is made in agreement with Ministry of
Emergency Situations, Ministry of Defense, Ministry of Internal Affairs, Ministry of
Transport, National guards, Ministerial Council of Independent Republic Crimea,
regional, Kiev and Sevastopol municipal state administrations.
In extreme situations (disasters, catastrophes, accidents, mass poisonings,
epidemics, epizooties, radiation, bacteriological and chemical pollution) the medical
help to the citizens appears free-of-charge.
On the state level Service of Medicine of Catastrophes (SMC) is organized in
the system of MHS of Ukraine.
On the territorial level SMC is organized in the system of MHS of the Crimea
Autonomic Republic, departments of health services regional, Kiev and Sevastopol
municipal state administrations.
The coordination of SMC work at a state level is carried out by a Central
Coordination Council of Health Services of Ukraine.
The coordination of SMC work at a territorial level is carried out by
corresponding Coordinator Councils of Autonomic Republic of the Crimea, regional,
Kiev and Sevastopol municipal state administrations.
The status of Central and territorial Coordination Councils is sanctioned by a
Cabinet of Ministers of Ukraine.
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The management of SMC during liquidation of medico-sanitary consequences
of the emergency situations is entrusted to MHS of Ukraine on the state level, and to
MHS of Autonomic Republic of Crimea, departments of Health Services of regional,
Kiev and Sevastopol municipal state administrations on the territorial level.
The main tasks of SMC are:
1.
Interaction of medical forces, means and medical institutions
correspondingly on the state and territorial levels in the sphere of medical
protection of the population on the territory of Ukraine in case of extreme
situations.
2.
Prognosis of medico-sanitary consequences of emergency
situations and working out recommendations to carry out specific coordinated
measures to decrease their negative influence.
3.
Eradication of medico-sanitary consequences of the extreme
situations by medical forces and means, firstly by forces of specialized teams
of urgent medical aid of SMC.
4. Basic features of a service MC in ES.
According to its tasks, SMC
 Gives free-of-charge urgent medical aid to the casualties at the prehospital
and hospital stages, firstly by the forces of specialized teams of urgent medical aid of
SMC.
 Organizes and carries out a complex of sanitary-hygienic and antiepidemic
measures in the disaster area.
 Coordinates work directed at preparation of Health Services, medical
institutions, the system of communication and notification, medical and specialized
formations and institutions of SMC to act in extreme situations.
 Carries out collection, analysis, registration and gives information about
medico-social consequences of extreme situations according to the Temporary
Regulations of providing the information by state power organs within Government
infomational-analytical system on problems of extreme situations.
 Provides health protection of the personnel, which takes part in the
liquidation of consequences of extreme situations;
 Provides creation and rational use of a reserve of material and technical
resources for realization of SMC measures accordingly at central and territorial
levels;
 Takes part in preparation of the medical and paramedical staff, who are to
give medical aid by law in case of emergency.
 Carries on scientific research work connected with perfection of the forms
and methods of organization urgent medical help to casualties in extreme situations;
 Takes part in international cooperation on problems of medicine of
catastrophes.
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5. Basic divisions of a service of MC.
On the state level SMC is composed of:
- Ukrainian Science and practice centre of the urgent medical aid and
medicine of catastrophes,
- Medical formations, institutions appointed by Ministry of Health Services
of Ukraine.
- Specialised teams of urgent medical aid organized on the basis of these
health service institutions.
On the territorial level SMC is composed of:
 The territorial centres of the urgent medical aid,
 The specialized teams of urgent medical aid,
 Medical formations and institutions ascribed by MHS of Ukraine to this
level,
 Specialized teams of urgent medical aid organized on the basis of these
health service institutions.
According to the order of Minister of Defense the following formations are
created on the basis of working medical institutions in the armed forces:
 Mobile doctor-nurse teams for rendering the first medical assistance: 1-2 in
the regiment;
 Mobile doctor-nurse teams for rendering the qualified medical help: in
separate medical company, separate medical battalion, military hospitals,sanatoria,
garrison and central clinics.
 Mobile detachment of medicine of catastrophes for rendering the qualified
medical help: in district and garrison hospitals (Odessa, Lvov, Kharkov,
Dnepropetrovsk). Into structure of group enters surgical and therapeutical groups.
 Teams of the specialized medical help: formed on the basis of Main military
clinical hospital (up to 18 teams)
The staff of the specialized medical teams and their ability on rendering first
medical aid for 12 hours is given in table 1.
The Central Board includes the plenipotentiary representatives of MHS of
Ukraine, medico-sanitary services of SCM, Ministry of Defence, Ministry of Internal
Affairs, Ministry of Transport, National guards and Ukrainian scientific - practical
centre of urgent medical aid and medicine of catastrophes as well as representatives
appointed by Ministerial Council of Independent Republic Crimea, regional, Kiev
and Sevastopol municipal state administrations.
The work of a Central commission is supervised by its chairman, and in case of
absence - on its comission one of his assistants.
The chairman of a Central commission is the minister of public health services
of Ukraine.
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Table 1. The specialized medical brigades.
Speciality
STAFF
(number of specialists,
ability to give aid 12 hours)
Surgical
Senior
surgeon-1;
surgeon-2;
anesthesiologist(9 persons, 10 operations)
reanimathologist-1; nurses: surgical-2; anesthetist-2;
driver-orderly-1.
Traumatological
Senior
traumatologist-1,
traumatologist-2,
(9 persons, 10 operations)
anesthesiologist-reanimathologist-2,
nurse-2,
nurseanesthetist-2, driver-orderly-1.
Neurosurgical
Senior neurosurgeon-1, neurosurgeon-1, nurse-2, driver(5 persons, 10 operations)
orderly-1
Stomatological
Maxillofacial surgeon-2, surgical nurse-2, nurse-2, driver(7 persons, 10 operations)
orderly-1
Burn (10 persons, 30 Senior combustologist-1, surgeon (combustologist)-1,
casualties)
anesthesiologist-reanimathologist-2,nurses:surgical2,anesthetist-2,treatment-1, driver-orderly-1.
Transfusional (12 persons, Senior
physician(anesthesiologist-reanimathologist)-1,
50 casualties)
surgeon-1, physician, stockpiling blood-1,nephrologist1,nurses:anesthetics-1,hemodialysis-1,plasmodialysis1,stockpiling of blood-1, doctor’s laboratory assistant-1,
attendant-1, driver-orderly-1.
Radiology-therapeutic(8
Senior
physician(radiologist)-1,
pediatrician-1,
persons, 100 casualties)
neurologist-1, nurses-3, doctor’s laboratory assistant-1,
driver-orderly-1.
Toxic
therapeutic
(6 Senior
physician(anesthesiologist-reanimathologist)-1,
persons, 25 casualties)
toxicologist-1, therapeutist-1, nurses-2, driver-orderly-1.
Psychotherapeutic
(5 Senior physician (psychotherapeutist)-1, psychiatrist-1,
persons, 100 patients)
nurses-2, driver-orderly-1.
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