Health and Medical Aspects of Disaster Preparedness

187 Pages·1990·7.288 MB·English

by  John C. Duffy (eds.)

Health and
Medical Aspects
of Disaster
Preparedness
NATO • Challenges of Modern Society
A series of edited volumes comprising multifaceted studies of contem
porary problems facing our society, assembled in cooperation with NATO
Committee on the Challenges of Modern Society.
Volume 1 AIR POLLUTION MODELING AND ITS APPLICATION I
Edited by C. De Wispelaere
Volume 2 AIR POLLUTION: Assessment Methodology and Modeling
Edited by Erich Weber
Volume 3 AIR POLLUTION MODELING AND ITS APPLICATION II
Edited by C. De Wispelaere
Volume 4 HAZARDOUS WASTE DISPOSAL
Edited by John P. Lehman
Volume 5 AIR POLLUTION MODELING AND ITS APPLICATION III
Edited by C. De Wispelaere
Volume 6 REMOTE SENSING FOR THE CONTROL OF MARINE POLLUTION
Edited by Jean-Marie Massin
Volume 7 AIR POLLUTION MODELING AND ITS APPLICATION IV
Edited by C. De Wispelaere
Volume 8 CONTAMINATED LAND: Reclamation and Treatment
Edited by Michael A. Smith
Volume 9 INTERREGIONAL AIR POLLUTION MODELING: The State of the Art
Edited by S. Zwerver and J. van Ham
Volume 10 AIR POLLUTION MODELING AND ITS APPLICATION V
Edited by C. De Wispelaere, Francis A. Schiermeier, and
Noor V. Gillani
Volume 11 AIR POLLUTION MODELING AND ITS APPLICATION VI
Edited by Han van Dop
Volume 12 RISK MANAGEMENT OF CHEMICALS IN THE ENVIRONMENT
Edited by Hans M. Seip and Anders B. Heiberg
Volume 13 AIR POLLUTION MODELING AND ITS APPLICATION VII
Edited by Han van Dop
Volume 14 HEALTH AND MEDICAL ASPECTS OF DISASTER PREPAREDNESS
Edited by John C. Duffy
Health and
Medical Aspects
of Disaster
Preparedness
Edited by
John C. Duffy
Assistant Surgeon Oeneral
Olllis W. Long Hansen's Disease Center
Carville, Louisiana
Published in cooperation with
NATO Committee on the Challenges of Modern Society
PLENUM PRESS • NEW YORK AND LONDON
Library of Congress Cataloging in Publication Data
Health and medical aspects of disaster preparedness I edited by John C. Duffy.
p. cm.-(NATO challenges of modern society; v. 14)
"Published in cooperation with NATO Committee on the Challenges of Modern
Society."
"Report of a four·year pilot study on health and medical aspects of disaster
preparedness, held between 1985 and 1989 in Washington, D.C." -T.p. verso.
Includes bibliographical references.
ISBN-13: 978-1-4612-7880-1 e-ISBN-13: 978-1-4613-0589-7
DOl: 10.1007/978-1-4613-0589-7
1. Disaster relief-Congresses. 2. Disaster medicine-Congresses. 3. Emergency
medical services-Congresses. I. Duffy, John C. (John Charles), 1934- . II.
North Atlantic Treaty Organization. Committee on the Challenges of Modern
Society. Ill. Series.
[DNLM: 1. Disaster Planning. 2. Emergencies. 3. Emergency Medical Services. 4.
Public Health. WB 105 H434 1989)
RA645.9.H43 1990
362.1'8-dc20
DNLM/DLC 90-6789
for Library of Congress CIP
Proceedings of a four-year pilot study on
Health and Medical Aspects of Disaster Preparedness,
held in Washington, D.C.
© 1990 Plenum Press, New York
Softcover reprint of the hardcover 1s t edition 1990
A Division of Plenum Publishing Corporation
233 Spring Street, New York, N.Y. 10013
All rights reserved
No part of this book may be reproduced, stored in a retrieval system, or transmitted
in any form or by any means, electronic, mechanical, photocopying, microfilming,
recording, or otherwise, without written permission from the Publisher
To my wife, Franc;oise
PREFACE
The study of Health and Medical Aspects of Disaster Preparedness was
approved by NATO/CCMS in 1985 with the first pilot study meeting in June of
that year. The pilot study, under the leadership of the United States and
Belgium, focused on the current status of disaster preparedness in partici
pating nations. An objective look was taken at the availability or
resources to cope with disasters from an international standpoint. The
types of disaster settings that were reviewed in the study included the
following:
(1) Earthquakes, floods, hurricanes, avalanches
(2) Nuclear power plant accidents or spills
(3) Water and aircraft accidents
(4) Building fires, building collapses
(5) Contamination by hazardous chemicals or biological waste
(6) Civil disturbances
A disaster can strike anywhere at any time. Some nations and local
communities have well-developed disaster plans with which to meet
catastrophic situations. The fact is that most communities are without
written and coordinated disaster plans which offer their citizens the most
effective and comprehensive protection in these unexpected and often
critical situations.
Disaster has been defined as a sudden event which involves large numbers
of people and results in loss of life, serious injury and property loss.
together with a severe disruption of community organization and services.
In the United States, thousands of people are killed and injured in
disasters every year. Thus, disasters constitute a serious problem in both
individual and public health terms in this country alone.
Disasters can be classified as natural and man-made. Natural disasters
include earthquakes, floods, tsunamis, hurricanes, avalanches, epidemics,
droughts, and famines. Those which are considered man-made include explos
ions, fires, civil riots and disturbances, major transportation accidents,
chemical and radiological pollution. Clearly, the industrialization which
has occurred in so many countries throughout the world contributes to many
disasters and potential disasters.
In many areas of the world, natural events produce a constant threat of
disaster such as in earthquake, flood, hurricane and avalanche prone areas.
One would expect that in these areas, fairly well developed and coordinated
disaster plans would exist that could cope with these events, should they
occur. However, the problem with disaster preparedness plans is that
preparedness requires that plans be prepared, coordinated, tested or
exercised, and updated in order to be ready for any event, including those
which may never occur. Unless a national disaster strategy is designed to
accommodate and coordinate existing organizations which may have other
primary missions, the cost of preparedness becomes prohibitive. The
organizational aspects of disaster planning emerge as areas of prime
importance. It becomes necessary to engage all relevant existing organiza
tions in disaster planning efforts with the assignment of clear role
designations and clear lines of authority, along with the declaration of
lead agencies.
Increased industrialization and technological advances have brought
nations closer together. Interdependency and sociologic ties make it
expedient for emergency planning to account for the potential assistance
which nations might provide to one another in connection with potential and
actual mass disasters. This dictates the need for a national plan which
accommodates international activities.
The many organizations and people involved in providing assistance to
victims of a disaster must be cognizant of the fundamental principles
involved in disaster management. These include preventing the occurrence of
the disaster; prevention of occurrence of additional casualties after the
initial impact; rescue of individuals; provision of emergency care to the
injured; evacuation of the injured to appropriate medical installations or
aid stations; the provision of definitive medical care for the seriously ill
and injured; relocation of residents of the disaster area; and the promotion
of the reconstruction of the disaster area and lives of the victims.
Successful disaster planning must impact on several factors which are
relevant to operations in disaster settings. Good communications (manage
ment and medical) are essential to successful disaster rescue operations.
Triage, the classifying and prioritizing of casualties in order that each
victim is assured the medical attention which is required, will be
facilitated by a standardized tagging or sorting system. Categorization of
hospital facilities assures that victims are transported to facilities which
are capable of providing medical care as required. Immediate and
coordinated transportation is imperative for those victims who have life
threatening injuries and require institutional emergency medical care.
Also, these procedures will be required for many of the victims with
injuries which may not be as serious. Adequate disaster planning includes
arrangements for needed manpower, such as professional medical and nursing
personnel, paraprofessionals, and volunteers who have the knowledge and
skills required to provide care for victims of a disaster. These inter
related and interdependent activities require an organization for management
of all resources at the disposal of a community if its residents are to have
the most effective system available for coping with disasters. Local,
state, regional, national and international cooperation will assure that
most individuals in stricken countries receive the care and services needed
in these emergency situations.
Both member and non-member nations have sent representatives to pilot
study meetings over the three year history of this study. Among the most
frequent countries who contributed to the pilot study were:
Canada
United Kingdom
viii
Italy
Greece
Germany
Portugal
France
Netherlands
Spain
Kuwait
In addition, there have been representatives from the Pan American
Health Organization.
Two pilot study meetings were exceptionally valuable in terms of their
contribution to the final report. In July 1986, pilot study members
participated in the first full scale national disaster exercise in the
United States. The second meeting, hosted by the Belgians in the spring of
1987, was in Antwerp. There the participants toured major industrial plants
and installations and reviewed their disaster response plans.
It is clear that disaster planning at the national level is sparse and
almost non-existent between contiguous nations. This publication looks at
examples of disaster plans; hypothetical models fer investigation of health
and medical aspects of disaster preparedness; data collection; the role of
stress in the disaster scenario; joint civil/military contributions, among
the more important topics.
One of the very important contributions of NATO/CCMS is the support
provided by their Fellowships program. Three contributors to this book were
supported by Fellowship grants: Doctors Lund, Baxter, and Antonini.
The exceptional effort required to communicate with authors, organize
and prepare manuscripts for publication was carried out by my secretary,
Laurie Bourgeois. Without her dedication and commitment, this book could
not have been finished.
Appreciation must also be given to all the participants who shared their
expertise with us. We are particularly grateful to Alan Sielen, United
States Coordinator for NATO/CCMS Activities, and NATO/CCMS for providing the
mechanism and support for the study.
Finally, a special thank you to the Belgians who, as co-leaders of this
pilot study, have given generously of their time and resources. In this
regard, special mention must be given to Daniel Van Daele, Director General,
and Etienne L. Pelfrene, Ministry of Public Health and The Family, Brussels,
Belgium
John C. Duffy, M.D., FAPA, FAsMA
Assistant Surgeon General
U.S. Public Health Service
CONTENTS
Disaster Medicine - An Overall Response to Disaster Situations • •• 1
NATO - Joint Civil/Military Group
Teaching and Training In Emergency and Disaster Medicine • • • • •• 19
C. Manni, M.D.
A Planning Model for Disaster Response • • • • • • • • • • • • • •• 31
H.R. Champion, M.D.
The French Armed Services Health Department : Its Role Facing
Natural Disasters 41
L.J. Courbil, M.D.; P. Chevalier, M.D.; and
J.L. Belard, M.D.
Veterans Administration Health Care System Experience With • • • •• 63
Natural Disasters
M.W. Wolcott, M.D.
Chemical Hazards on Ships, Especially Tankers: • • 75
Toxicargo in General and Chemical Tankers
Chemical Hazards on Board
H. Goethe, Prof. Dr. med. (ret)
Veterinary Services in Disasters and Emergencies • • • • • • • • •• 79
A.V. Tennyson, VMD
Disaster Planning that Addresses the Preservation of Cultural. • • • 87
Property
The Getty Conservation Institute
A Review of Medical Response to Disaster Casualties. • • • • • • • • 101
D.A. Rund, M.D.
Common Psychological Themes in Societies' Reaction To •••••••• 123
Terrorism and Disasters
J.C. Duffy, M.D.
Psychological Training of Disaster Workers • • • • • • • • • • • • • 131
F. Antonini, Ph.D.
Role and Function of Antipoison Centers in Toxicological
Emergencies and Disasters • • • • • • • • • • • • • • • • • 145
S.I. Magaline, M.D.
XI
Injury Patterns Associated with Earthquakes. • • • • • • • • • • • • 153
D.A. Rund, M.D.
A Multidisciplinary Approach to the Medical Management of
Man-Made and Natural Toxic Disasters. • • • • •• • • • 161
P.J. Baxter, M.D.
The Aircraft Disaster .•.••••••••••••••••.•••• 175
J.e. Duffy, M.D.
INDEX. • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 181