Course Disasters and their Effects ​on the Population: Key Concepts

Coordinating Disaster Response Activities

Coordinating the activities of all these organizations poses a tremendous challenge. Following a natural disaster the host nation’s government/agencies and military are likely to have operational command. Most nations now have defined governmental authorities responsible for global disaster planning and response, as well as coordinators for individual sectors such as health. External agencies or governments play a supportive role in providing technical assistance and resources. PAHO has developed a number of technical manuals and training activities to assist nations in the planning of coordinated disaster responses at the regional and national level.

Medical Volunteering

Following a disaster many pediatricians and other health professionals volunteer for a limited time. During the initial response phase, the greatest pediatric needs include air transport teams, surgical teams (a surgeon, OR nurse, anesthesiologist, and critical care pediatrician), as well as pediatricians with training and experience in emergency medicine and critical care. Volunteers may have to be self sufficient for a period of time in terms of food, water, and shelter. Volunteers should work through an established NGO or governmental agency rather than simply “show up” to help. Volunteers should be prepared to respond quickly, as the quicker the response teams can provide appropriate care, the more effective they can be at saving lives and limiting morbidity.

Part of preparation is anticipating the types of injuries that will be seen with different types of disasters. When sending a response team into a disaster during the acute response phase, it is important to have the personnel with the ability to treat the most likely injuries seen with the specific type of disaster. In a major earthquake like the one in Haiti in January 2010, one would expect the majority of the casualties to be secondary to traumatic injuries related to collapsed buildings.

Therefore, a team should be prepared to have personnel and supplies that can be used to treat crush injuries, a large number of open wounds, along with a variety of orthopedic injuries. In a disaster involving an explosion (large industrial accident or terrorist attack), the pattern of injuries would include many of the same traumatic injuries as seen in an earthquake, but would also include a large number of burns and blast injuries such as blast lung. Personnel required in this type of disaster should include those with training in caring for burns as well as experience with other traumatic injuries.

Table 4 provides a list of pediatric equipment that, if possible, should be brought in if not available on site.

Among the recommended equipment, elements for proper airway management in children are crucial. A major challenge of any disaster response is gathering, organizing, and moving supplies to the affected area. Resource management within the hospital and other facilities or agencies may prove to be a decisive factor in whether a mass casualty event can be handled.

Communication

Communication in a disaster situation is essential between disaster relief team members as well as with coordinating groups and logistical support personnel in home countries. Modern technology has provided many different types of communication devices, which have different advantages and disadvantages. Communication networks and contingency plans are an essential part of the disaster preparedness phase. Radios are useful for short range communications when a disaster relief team is separated. However, they are limited by range and will not allow communication with the other teams or organizations that are a long distance away.

Mental health considerations

Disaster response providers are often thrust in to a high stress situation with exposure to situations they may have never experienced before. The degree of destruction and death will likely be much greater than what the health care providers are accustomed to dealing with in their daily lives. Local first responders and medical providers thrust in to the role of the initial emergency response phase may be faced with the additional stress of personally knowing many of the victims (or their family members) that they are caring for.

The emotional impact of large scale destruction, suffering, and death will elicit different responses in different people, but all volunteer providers should recognize how their experiences can affect their wellbeing both emotionally and physically. The emotional stress experienced by disaster response providers has been well documented after events such as 9/11 and Hurricane Katrina. The effect of stress is amplified by the long hours of intense work experienced during the response to a disaster. Environmental conditions (such as extreme heat/cold/rain/flooding), lack of sleep, and inadequate nutrition impair a provider’s ability to deal with the stressful situation.

Crisis response workers and managers, including first responders, public health workers, construction workers, transportation workers, utilities workers and other volunteers, are repeatedly exposed to extraordinarily stressful events. This places them at higher than normal risk for developing stress reactions (Pan American Health Organization [PAHO], 2001). It is important for all disaster response providers to recognize the potential emotional stress they will be entering before arriving on scene. Stress prevention and management needs to be considered and addressed from the start of the deployment in order to prevent problems. By anticipating stressors and individual's responses to these stressors, the response team and individuals can potentially prevent a crisis within the team of care providers.

The US Department of Health and Human Service, Substance Abuse and Mental Health Services Administration (SAMHSA), and Center for Mental Health Services (CMHS) have published a guide focusing on general principles of stress management and offers simple, practical strategies that can be incorporated into the daily routine of managers and workers. It also provides a concise orientation to the signs and symptoms of stress.