Disaster Management
Definition
- A disaster is any event (man-made or natural) that causes enough devastation or destruction that it cannot be managed by the usual resources.
- FEMA definition: An occurrence of a severity and magnitude that normally results in deaths, injuries, and property damage that cannot be managed through routine procedures and resources.
- A disaster is not defined by the number of injuries or deaths or by its destructive damage. If the resources are overwhelmed, it is a disaster.
- “Disaster Management” is the activities before, during, and after a disaster, which attempt to maintain control, lessen the impact, and aid in recovery.
Types of Disasters
Natural
- Weather (hurricane, drought, typhoon, cyclone)
- Topographic (landslide, avalanche, flood, mud slide)
- Underground (earthquake, tsunami, volcanic eruption)
- Biological (communicable disease outbreak)
Man-Made
- Warfare (nuclear/biologic/chemical terrorism, terrorism and weapons of mass destruction, blockade, siege)
- Civil disturbance (riot, demonstration)
- Accidental:
- Transportation accident (airplane crash, train wreck, sinking ship, traffic accident)
- Structural collapse (building, mine, dam)
- Explosion, fire, hazardous materials release, nuclear accident
- Biological (inadequate sanitation)
- Disaster Levels
- Level I: local resources adequate
- Level II: requires regional aid
- Level III: requires Federal aid
- Objectives of Disaster Management
- To reduce or avoid human suffering and loss
- To reduce or avoid physical and economic losses
- To speed recovery back to normal (or as close to normalcy as possible)
- These objectives are best accomplished through preparation before the disaster.
Three Stages of Disaster Management
Preparedness
- This includes having equipment and supplies in place and having a well thought-out, rehearsed plan. Teaching disaster response and basic first aid to the public is invaluable.
- Hazard mitigation: building stability and safety, code enforcement, safety measures (e.g., bolting down bookcases in earthquake areas) and possession of insurance policies to cover disaster-related damage
Response
- Provision of emergency medical care (basic first aid or more advanced care depending on the number of injuries and the availability of staff and supplies)
- Provision of psychological support
- Provision of basic needs including food, water, and shelter
Recovery
- Getting things back to normal (continued medical care, cleanup, and rebuilding).
Field Treatment Following a Disaster
The Goals of Field Medical Care
- Maintenance of an open airway
- Control of bleeding
- Most external hemorrhage will stop with direct pressure. If not, elevate the affected area and/or compress the nearest pressure point.
- Cover all open wounds. The sight of blood after a disaster increases anxiety among the public. If dressing supplies are inadequate, bed sheets (or other material) can be cut into strips for use.
- Irrigate all wounds prior to closing. Use forceps to remove all obvious foreign material in the wound.
- Immobilization of suspected fractures
- Use cardboard, magazines, or padded pieces of wood.
- Another option is to splint two body parts together (“buddy splint”). Make sure that there is adequate padding in between the extremities Once the extremity is splinted, elevate it and apply a cold pack, if available.
- Always check distal nerve and circulatory function before and after splinting. If distal circulation is compromised after splinting, remove the splint and start over. If distal circulation is compromised prior to splinting, a closed reduction is indicated.
- Recognizing and treating shock
- Pain relief
- Recognition of crush injury
- Crush syndrome occurs secondary to prolonged (>4 h) continuous compression of the extremities and can lead to rhabdomyolysis, life-threatening myoglobinuria, renal failure, hyperkalemia, and disseminated intravascular coagulation.
- Prehospital care begins before the victim is removed. After extrication, the hemodynamic status of the injured victim may rapidly deteriorate and the victim may develop severe hypovolemia (extremity edema develops and upon release of the extremity, a redistribution of body fluid occurs). Treatment prior to removal of the
trapped extremity includes bolus intravenous hydration using normal saline.
Albuterol via hand-held nebulizer will help mitigate hyperkalemia. Also consider calcium chloride (1 g IV push) and sodium bicarbonate (1 mEq/kg added to a liter of normal saline).
Disaster Triage
- The primary goal of disaster triage is to do the most good for the most number of victims. This triage is designed to give maximal medical results with available resources.
- The main function of the triage team is to SORT the victims, not treat them. Therefore, the triage team should not spend an inordinate amount of time on any single victim.
- Disaster triage consists of two phases:
- The first phase is to initially categorize the victims (“immediate”, “delayed”, “dead”, or “walking wounded” as defined below).
- If treatment is to begin immediately on scene, a second triage will be needed to determine which of the “immediate” victims will be seen first, then which “delayed” patients will be seen first, etc.
Triage Categories
- Immediate
- Airway compromise
- Suspected internal bleeding
- Severe uncontrolled external bleeding
- Serious fractures (pelvis, femur, neurovascular compromise)
- Delayed
- Stable fractures
- Spinal cord injuries
- Minor burns
- Dead/Expectant
- Obvious dead
- Severe burns (80-100% full thickness)
- Cardiac arrest
- Severe head injury (brain matter showing or evidence of increased ICP)
The START System
|
