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PubMedDate not supplied

Coordination and resource maximization during disaster relief efforts.

INTRODUCTION: In the aftermath of the Earthquake and Tsunami in Southeast Asia, many relief organizations sent medical aid to affected areas. OBJECTIVE: The aim of this paper is to examine the mix of healthcare workers resulting from an influx of aid to Meulaboh, Indonesia, and how they met local healthcare needs. METHODS: Data were collected from the registration center for relief organizations in Meulaboh and daily hospital meetings on healthcare needs and available workers. RESULTS: Prior to the Tsunami, there were 14 doctors and 120 nurses in the hospital. By the third week after the Tsunami, there were 21 surgeons performing 10 surgeries daily, and >20 non-surgical doctors in the 90-bed hospital. There were <70 nurses available during the month after the Tsunami, which was insufficient for the needs of the hospital. In the town of Meulaboh, the number of doctors exceeded the number of nurses, while public health workers comprised <5% of the healthcare workers. CONCLUSION: An initial disaster-coordinating agency, formed by the United Nations (UN) in conjunction with affected countries, should link actively with relief organizations. This will optimize help in meeting local needs, and direct relief to where it is needed most.

Cross-Sectional Studies↗
PubMedDate not supplied

Barriers to disaster coordination: health sector coordination in Banda Aceh following the South Asia Tsunami.

Ecological disasters impact large populations every year, and hundreds of nongovernmental organizations, thousands of aid workers, and billions of dollars are sent in response. Yet, there have been recurring problems with coordination, leading to wasted efforts and funds. The humanitarian response to the December 2004 Earthquake and Tsunami in Asia was one of the largest ever, and coordination problems were apparent. The coordination processes and attempts at coordination are discussed in this paper. Specific barriers to cooperation are discussed, such as weak leadership, the absence of accountability, the lack of credentialing, the diverse goals of the responding agencies, and the weaknesses in the coordination process itself.

Altruism↗
PubMedDate not supplied

Team Echo: observations and lessons learned in the recovery phase of the 2004 Asian tsunami.

The 26 December 2004 Tsunami resulted in a death toll of >270,000 persons, making it the most lethal tsunami in recorded history. This article presents performance data observations and the lessons learned by a civilian team dispatched by the Australian government to "provide clinical and surgical functions and to make public health assessments". The team, prepared and equipped for deployment four days after the event, arrived at its destination 13 days after the Tsunami. Aspiration pneumonia, tetanus, and extensive soft tissue wounds of the lower extremities were the prominent injuries encountered. Surgical techniques had to be adapted to work in the austere environment. The lessons learned included: (1) the importance of team member selection; (2) strategies for self-sufficiency; (3) personnel readiness and health considerations; (4) face-to-face handover; (5) coordination and liaison; (6) the characteristics of injuries; (7) the importance of protocols for patient discharge and hospital staffing; and (8) requirements for interpreter services. Whereas disaster medical relief teams will be required in the future, the composition and equipment needs will differ according to the nature of the disaster. National teams should be on standby for international response.

Australia↗
PubMedDate not supplied

Response of Thai hospitals to the tsunami disaster.

The disaster caused by the tsunami of 26 December 2004 was one of the worst that medical systems have faced. The aim of this study was to learn about the medical response of the Thai hospitals to this disaster and to establish guidelines that will help hospitals prepare for future disasters. The Israeli Defense Forces (IDF) Home Front Command (HFC) Medical Department sent a research delegation to Thai hospitals to study: (1) pre-event hospital preparedness; (2) patient evacuation and triage; (3) personnel and equipment reinforcement; (4) modes used for alarm and recruitment of hospital personnel; (5) internal reorganization of hospitals; and (6) admission, discharge, and secondary transfer (forward management) of patients. Thai hospitals were prepared for and drilled for a general mass casualty incident (MCI) involving up to 50 casualties. However, a control system to measure the success of these drills was not identified, and Thai hospitals were not prepared to deal with the unique aspects of a tsunami or to receive thousands of victims. Modes of operation differed between provinces. In Phang Nga and Krabi, many patients were treated in the field. In Phuket, most patients were evacuated early to secondary (district) and tertiary (provincial) hospitals. Hospitals recalled staff rapidly and organized the emergency department for patient triage, treatment, and transfer if needed. Although preparedness was deficient, hospital systems performed well. Disaster management should focus on field-based first aid and triage, and rapid evacuation to secondary hospitals. Additionally, disaster management should reinforce and rely on the existing and well-trusted medical system.

Disaster Planning↗
PubMed2006

Recovery after the tsunami: timeline for rehabilitation.

In the aftermath of the Asian tsunami, there is potentially a large, traumatized population in need of psychosocial support, but determining which individuals require psychological intervention and knowing how and when to treat them may be the key to positive long-term outcomes. The early identification of people at high risk of developing subsequent psychiatric disorders from among those experiencing a transient stress reaction following trauma is often the initial step in the recovery process. Clinical instruments for screening and/or predicting those most at risk are available and require validating for cultural and linguistic sensitivity. Timely treatment is essential, since inappropriately targeted therapy can compromise recovery and may even exacerbate posttraumatic stress symptoms, particularly if treatment is initiated before grief reactions have subsided. Finally, appropriate treatment interventions, which incorporate cognitive-behavioral therapy and prolonged exposure, offer the best current therapeutic options for the treatment of posttraumatic stress disorder and associated comorbid conditions such as anxiety, depression, and grief. However, since most of the supportive data for the psychosocial consequences of trauma were obtained from small-scale studies of discrete trauma events in Western countries, it may not be possible to extrapolate these findings to a large-scale natural disaster in Asia, such as the Asian tsunami. More data are required to assist in the development of strategies for the effective management of the psychological consequences of trauma worldwide, with emphasis on creating mental health strategies that are culturally sensitive and valid for various trauma events and disaster scenarios.

Anxiety Disorders↗
PubMed2006

Lessons in posttraumatic stress disorder from the past: Venezuela floods and Nairobi bombing.

Identification and treatment of posttraumatic stress disorder (PTSD) are important following a disaster. Insights into how these aims can be achieved may be obtained from previous disasters. This article describes mental health initiatives following the 1999 flooding in Vargas State, Venezuela, and the 1998 U.S. Embassy bombing in Nairobi, Kenya. Following the Vargas State floods, a specialist mental health center devoted to the diagnosis, treatment, and follow-up of PTSD was established. Awareness and acceptance of the clinic was promoted by media campaigns and community-based activities. After 18 months, approximately 5000 people had been screened, of whom 62% were diagnosed with PTSD and treated. Moreover, the clinic's activities had expanded to include treatment of other medical conditions and assistance with nonmedical needs. Following the Nairobi bombing, a mass media campaign was initiated to create awareness of PTSD symptoms and help victims come to terms with their experience. This campaign was found to be well received and helpful. In addition, counselors were trained to support people living or working close to the blast. These examples show that mental health initiatives are feasible after a disaster and highlight a number of issues: (1) The intervention should be tailored to the needs of the target population; (2) Communication should be simple and appropriate; (3) Community-based activities are valuable in promoting awareness and acceptance of mental health initiatives; (4) Reducing the stigma often associated with mental health problems is important; and (5) The mass media can be helpful in promoting awareness of mental health issues following major trauma.

Community Mental Health Centers↗