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Disaster coordination and management: summary and action plans.

INTRODUCTION: Disaster is a collective responsibility requiring coordinated response from all parts of society. This theme focused on coordination and management issues in a diverse range of scenarios. METHODS: Details of the methods used are provided in the preceding paper. The chairs moderated all presentations and produced a summary that was presented to an assembly of all of the delegates. Although the main points developed in Themes 1 and 4 were different from each other (as reported in the Results section), their implementation was similar. Therefore, the chairs of both groups presided over one workshop that resulted in the generation of a set of Action Plans that then were reported to the collective group of all delegates. RESULTS: The main points developed during the presentations and discussions included: (1) the need for evidence-based assessments and planning, (2) the need for a shift in focus to health-sector readiness, (3) empowerment of survivors, (4) provision of relief for the caregivers, (5) address the incentives and disincentives to attain readiness, (6) engage in joint preparation, response, and training, (7) focus on prevention and mitigation of the damage from events, and (8) improve media relations. There exists a need for institutionalization of processes for learning from experiences obtained from disasters. DISCUSSION: Action plans presented include: (1) creation of an Information and Data Clearinghouse on Disaster Management, (2) identification of incentives and disincentives for readiness and develop strategies and interventions, and (3) act on lessons learned from evidence-based research and practical experience. CONCLUSIONS: There is an urgent need to proactively establish coordination and management procedures in advance of any crisis. A number of important insights for improvement in coordination and management during disasters emerged.

Continuity of Patient Care↗
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Principles of disaster management lesson. 12: structuring organizations.

This lesson discusses various structures for organizations that have functional roles in disaster responses, relief, and/or management activities. It distinguishes between pyramidal and matrix structures, and notes the advantages and disadvantages of each in relation to disasters. Span of control issues are dissected including the impact of the "P" factor on the performance of disaster managers and workers including its relationship to the coordination and control function. The development of a Table of Organization and how it relates to departmentalization within an organization also is provided.

Decision Making, Organizational↗
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Emergency health surveillance after severe flooding in Louisiana, 1995.

INTRODUCTION: In disaster situations, timely surveillance systems that provide illness, injury, and mortality information to public health officials and hospitals are essential for planning and evaluating interventions. OBJECTIVES: To describe flood surveillance methodology, the impact of the event on hospitals, and the number of daily patient visits due to selected illnesses and injuries before, during, and after severe flooding in southeastern Louisiana in May 1995. METHODS: Survey of disaster-area hospitals regarding flood impact. Emergency department surveillance of injuries and illnesses for the week before, the two days during, and the week after the flood. RESULTS: There occurred an increase in the number of persons who drowned or were injured that presented to the moderately affected hospitals during the storm, but there was no increase in visits for gastroenteritis to any group of hospitals. Services were disrupted in more than half of hospitals. The severely affected hospitals had the least variation in the average number of daily visits. None of the drownings were reported by those hospitals that reported severe service disruption. CONCLUSIONS: Data should be collected from all hospitals in or near disaster areas, even if they were not directly affected by the disaster. Public education about the danger of drowning during flash flooding must be improved. The Louisiana experience emphasizes the need for a disaster-preparedness plan for rapid surveillance of illnesses and injuries.

Disasters↗
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The effects of Hurricane Mitch on a community in northern Honduras.

INTRODUCTION: Hurricane Mitch was an event described as one of the most damaging recent natural disasters in our hemisphere. This study examined its effects on a community of 5,000 residents in northern Honduras. METHODS: Survey responses of 110 attendants at an ambulatory clinic 4 months after the event were analyzed. Correlates were established between demographic and housing characteristics and morbidity and mortality. RESULTS: The availability of food, water, and medical care decreased significantly immediately after the hurricane, but by four months afterward returned to baseline values. Residents reported emotional distress correlated with the loss of a house or intrafamilial illness or mortality. Diarrheal illnesses more commonly were found in households with poor chronic access to medical care. The use of cement block housing correlated with availability of food or running water, with access to medical care and vaccinations, and with a reduced frequency of diarrhea or headaches in the immediate post-hurricane phase. CONCLUSIONS: Improvements in housing construction appear to be the most effective preventive measure for withstanding the effects of future hurricanes in tropical regions similar to northern Honduras.

Communicable Disease Control↗
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The need for a global health disaster network.

When a disaster occurs, a major difficulty is knowing where to find accurate information, and how to help coordinate efforts to share accurate information in a quick and organized manner. The establishment of a global information network, that is in place before a disaster occurs, could link all the communication efforts for relief. We propose that a Global Health Unit for Disaster and Relief Coordination be set up as part of the Global Health Network, utilizing the Internet as its backbone. This Unit would establish the links for the disaster information mosaic.

Computer Communication Networks↗
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The flight from Rwanda in 1994: what were (are) the priorities?

EXTENT OF THE CATASTROPHE: More than 2 million refugees, 2-3 million displaced persons internally, thousands of unaccompanied children, and a total number of reported fatalities of 48,347 in Goma, Zaire. PRIORITIES FOR INTERNATIONAL RELIEF: International relief support started with coordination provided by the United Nations High Commissioner for Refugees (UNHCR). In the first phase, availability of potable water was the highest priority. Current priorities are to intensify repatriation of Rwandan refugees under conditions that will guarantee human rights and allow for dignified daily living. CONCLUSIONS: Education beginning at childhood, to overcome conflicts, social inequality, and overpopulation should be promoted by assisting governments, instead of pursuing policies aimed largely at forwarding their own national interests.

Democratic Republic of the Congo↗
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Mission to Sarajevo.

Explore the source record for details and available documents.

Bosnia and Herzegovina↗
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Emergency medical services during the siege of Sarajevo, Bosnia and Herzegovina: a preliminary report.

BACKGROUND: The siege of Sarajevo is a long-term, human-made, medical disaster of international significance. The delivery of emergency health care provided to the large civilian population held captive in that war zone for an extended time was studied. METHODS: In May 1993, a humanitarian and fact-finding visit to Sarajevo was conducted. Physicians, administrators, and public health officials were interviewed; epidemiological data were acquired--the resuscitation of war casualties at the two largest hospitals were observed; and local published reports and videotaped footage on the organization and delivery of prehospital and hospital care were reviewed. The videotapes also served to document war crimes. RESULTS: Daily bombardment and sniper fire directed at civilians have caused a steady stream of casualties (64,130, or an average of 119 killed or injured per day in 18 months). Eighty percent of the victims were civilian. Despite hazardous conditions from direct shelling, disruption of vital lifelines, and shortage of supplies, medicines, oxygen, and anesthetics, the physicians continue to provide at least a minimum standard of resuscitative care. Seventy percent of all war victims were transported to hospitals in private vehicles. Most casualties (93%) received some form of prehospital, basic first-aid from lay bystanders or first responders. From November 1992 to February 1993, 27,733 patients were treated in hospitals, resulting in 2,139 major surgical procedures. The primary cause of death in 71 of 273 victims was prolonged hemorrhagic, hypovolemic shock. Sixty-one percent of these victims died within 24 hours of injury. CONCLUSIONS: Continuous needs assessment of a civilian population in a war zone should be accompanied by rapid delivery of outside aid. International "peacekeeping" forces should protect hospitals and their staffs, and ensure the entry of supplies and evacuation of some patients. A public trained in life-supporting first-aid, and physicians and paramedics with experience in advanced life support may have enhanced lifesaving efforts in Sarajevo.

Adolescent↗
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Complex, humanitarian emergencies: I. Concept and participants.

Complex, humanitarian emergencies, the result of civil strife and armed conflict affecting large populations at the brink of extinction, represent the most compelling of disaster relief challenges. They require the coordination of the United Nations agencies, the International Committee of the Red Cross, international nongovernmental relief organizations, and military forces. An increasing number of civilian and military health-care providers find themselves involved in the planning, coordination, and direct patient-care aspects of these emergencies, often without proper initiation and understanding of the unique nature of these disasters. This article provides a primer on the concept of complex, humanitarian emergencies and the contributions, characteristics, capabilities, and limitations of each major participant.

Disaster Planning↗
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Complex, humanitarian emergencies: II. Medical liaison and training.

In complex, humanitarian emergencies, professional liaison roles are just one of many that evolve from the coordination of United Nations agencies, the International Committee of the Red Cross, international and national non-governmental relief organizations, and coalition military forces. Liaison is crucial to the humanitarian relief process. Decision makers benefit from liaisons' professional experience, their knowledge of the characteristics, missions, and capabilities of each major participant in the relief process, and in their ability to coordinate and clarify professional issues in meeting the goals of a mission. Medical liaison roles develop from the awareness that complex emergencies primarily are catastrophic public-health emergencies. Unfortunately, education and training of the medical liaison currently are ill-defined. However, limited experience suggests that skills should be broadly based in principles of disaster epidemiology, assessment and management, knowledge of contributing relief resources, agencies and the military, and international humanitarian law and the Geneva Conventions.

Continuity of Patient Care↗
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Complex, humanitarian emergencies: III. Measures of effectiveness.

Complex humanitarian emergencies lack a mechanism to coordinate, communicate, assess, and evaluate response and outcome for the major participants (United Nations, International Committee of the Red Cross, non-governmental organizations and military forces). Success in these emergencies will depend on the ability to accomplish agreed upon measures of effectiveness (MOEs). A recent civil-military humanitarian exercise demonstrated the ability of participants to develop consensus-driven MOEs. These MOEs combined security measures utilized by the military with humanitarian indicators recognized by relief organizations. Measures of effectiveness have the potential to be a unifying disaster management tool and a partial solution to the communication and coordination problems inherent in these complex emergencies.

Disaster Planning↗
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The use of intraperitoneal infusion for the outpatient treatment of hypovolemia in Somalia.

INTRODUCTION: The civil war in Somalia has destroyed the medical system and left hundreds of thousands of people without access to medical care. Samaritan's Purse and World Medical Missions, two relief organizations, developed mobile medical teams to provide health care to urban and rural Somalia. Gastroenteritis with severe dehydration was encountered frequently, and difficult intravenous (i.v.) access presented a challenging dilemma for patients who were unable to tolerate oral or nasogastric fluid administration. HYPOTHESIS: Intraperitoneal (i.p.) fluid infusion may be used to treat dehydration in patients with poor venous access and ongoing fluid losses. METHODS: Two mobile medical teams treated patients from 1 January to 1 April 1993. Intraperitoneal fluid infusions were given to 16 patients with severe dehydration in whom i.v. access was unobtainable. Children received approximately 80 ml/kg of 0.45% normal saline, and adults received 40 ml/kg of 0.9% normal saline. Patients were reexamined at one and seven days. RESULTS: A total of 25,659 patients were seen in the mobile medical clinics during a 3-month period. Dehydration was diagnosed in 1,833 (7.1%) patients, and 1,203 (4.7%) patients were found to be malnourished. Sixteen patients were treated with i.p. fluid infusions, 14 patients (87.5%) survived, and two patients (12.5%) died, both within 24 hours. In one patient (6.3%), subcutaneous infiltration occurred without subsequent adverse effects. CONCLUSION: This case series found that in the mobile clinic setting in Somalia, i.p. fluid administration improved the hydration status in patients with significant dehydration. Although i.v. infusion remains the treatment of choice when oral or nasogastric fluid administration is not possible, i.p. infusion is easily performed and may be an important alternative in disaster settings.

Adolescent↗