General Considerations After a
Disaster
Ricardo Castro MD
Pontificia Universidad Catolica de Chile, Department of
Intensive Care Medicine, Santiago, Chile
Research Scholar
University of Pittsburgh Medical Center
Department of Critical Care Medicine
CRISMA Laboratory
Pittsburgh, PA 15261
Myths associated with disasters
• Any kind of assistance needed in disasters
• A response not based on impartial evaluation contributes to chaos. It
must be coordinated
• Epidemics and plagues are inevitable after every disaster
• Epidemics rarely may occur after a disaster, but can be avoided
• Dead bodies will not lead to catastrophic outbreaks of exotic disease
• Proper resumption of public health services will ensure the public’s
safety (sanitation, waste disposal, water quality, and food safety)
• Disasters bring out the worst in human behavior
• The majority responses spontaneous and generous
• The community is too shocked and helpless
• Cross-cultural dedication to common good is most common response to
natural disasters
Patterns of mortality and injury
• Disaster events that involve water are the most
significant in terms of mortality
• Floods, storm surges, and tsunamis all have a higher
proportion of deaths relative to injuries
• Earthquakes and events associated with high winds
tend to exhibit more injuries than deaths, as in Haiti
• The risk of injury and death is much higher in
developing countries – at least 10 times higher
because of little preparedness, poorer infrastructure.
Disaster and Health
• In a major disaster water treatment plants,
storage and pumping facilities, and distribution
lines could be damaged, interrupted or
contaminated.
• Communicable diseases outbreak due to:
• Changes affecting vector populations (increase
vector),
• Flooded sewer systems,
• The destruction of the health care infrastructure,
and
• The interruption of normal health services geared
towards communicable diseases
Disaster and health
• Injuries from the event
• Environmental exposure after the event (no
shelter)
• Malnutrition after the event (feeding the
population affected)
• Excess NCD mortality following a disaster
• Mental health (disaster
syndrome)
The Phases of Disaster
• Mitigation:
• Lessen the impact of a disaster before it strikes
• Preparedness:
• Activities undertaken to handle a disaster when it strikes
• Response:
• Search and rescue, clearing debris, and feeding and
sheltering victims (and responders if necessary).
• Recovery:
• Getting a community back to its pre-disaster status
Mental wellness
• In any major disaster, people want to know
where their loved ones are, nurses can assist in
making links.
• In case of loss, people need to mourn:
• Give them space,
• Find family friends or local healers to
encourage and support them
• Most are back to normal within 2 weeks
• About 1% - 3% may need additional help
Special considerations for children
• A child may be afraid of recurrence, injury, or death after an
earthquake.
• They may also fear being separated from their family or being
left alone.
• Children may even interpret disasters as punishment for real
or imagined misdeeds.
• Children will be less likely to experience prolonged fear or
anxiety if they know what to expect before, during, and after
an earthquake.
• Talking to children openly will also help them overcome fears
Special considerations for children
• Talking to children openly will also help them
overcome fears
• Return of children to school as early as possible
• Ensure appropriate nutrition and evaluate
nutritional status
Dangers of Tropical Diseases
Outbreaks
• Historically, infectious disease epidemics have
high mortality
• Disasters have potential for social disruption
and death
• Epidemics compounded when infrastructure
breaks down
California Preparedness Education Network
Phases of a Disaster
(from an infectologic point of view)
• Impact Phase (0-4 days)
• Extrication
• Immediate soft tissue infections
• Post impact Phase (4 days- 4 weeks)
• Airborne, foodborne, waterborne and vector diseases
• Recovery phase (after 4 weeks)
• Those with long incubation and of chronic disease,
vectorborne
Current outbreak risks for Haiti
• Endemic organisms
• Post-impact phase
• Recovery Phase
Post-impact Phase Infections
• Crush and penetrating trauma
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Skin and soft tissue disruption (MRSA)
Muscle/tissue necrosis
Toxin production disease
Burns
• Waterborne
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Gastroenteritis
Cholera
Non-cholera dysentery
Hepatitis
Rare diseases
California Preparedness Education Network
Post-impact Phase Infections
• Vectorborne
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Malaria
WNV, other viral encephalitis
Dengue and Yellow fever
Typhus
• Respiratory
• Viral
• CAP
• Rare disease
• Other
• Blood transfusions
California Preparedness Education Network
Recovery Phase Infections
These agents need a longer incubation period:
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TB
Schistosomiasis
Lieshmaniasis
Leptospirosis
Nosocomial infections of chronic disease
California Preparedness Education Network
Other basic needs to be addressed
Protection of Specific Human Rights
• Protection of life, security and dignity
• Protection of rights related to basic necessities
• Protection of other economic, social and cultural
rights
• Protection of other civil and political rights
• Safety and security of women and girls
Other basic needs to be addressed
Provision of adequate food, water and sanitation,
shelter, clothing and essential health services:
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Available
Accessible
Acceptable
Adaptable
Other basic needs to be addressed
Provide solutions for vulnerable groups:
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Facilitating assistance
Assistance to women
Assistance to groups with particular needs
Food
Non-food items
Water and sanitation
Shelter and housing
Health (general)
HIV/AIDS