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 Skin and soft tissue disruption (MRSA) Muscle/tissue necrosis Toxin production disease Burns Waterborne Gastroenteritis Cholera Non-cholera dysentery Hepatitis Rare diseases California Preparedness Education Network

Post-impact Phase Infections Vectorborne 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: 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: Available Accessible Acceptable Adaptable

Other basic needs to be addressed Provide solutions for vulnerable groups: 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