The role of Public Health Physician In Disaster Management

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The role of Public Health Physician In Disaster
Management

• By
• Prof. Mahi Al-Tehewy
• Ain Shams University

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Definition

• Disaster is a destructive event that results in
  the need for a wide range of emergency resources
  to assist and ensure the survival of the stricken
  population

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Classification

• Natural Disasters
• Technological disasters
• NA-TECHs
• Conflict-related disasters (complex emergencies)

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Natural Disasters

• In the past 20 years natural disasters have
  affected 800 million people and caused 3 million
  deaths
• Sudden onset e.g. Earthquakes, Fires. It
  needs urgent and massive relief efforts.
• Slow onset e.g. Famine of 1977 in Ethiopia
  which followed successive years of droughts

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Technological disasters

• Due to unregulated or unsafe use of industrial
  technologies.
• e.g. radio nuclear release at Chernobyl in 1986
• Acute effect
• Indirect effect

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Na-Tech

• Natural disaster can be an important factor in
  precipitating a tech.disaster e.g. Gasoline fires
  that killed over 500 persons in Durrunka, Egypt,
  in 1994 as a result of flash flooding that
  ruptured a fuel storage tank and carried burning
  petroleum into the nearby town.

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Conflict-related disasters (complex emergencies)

• Due to social, economic and political problems
  and always involve armed confrontation.
• There is extensive destruction in public health
  infrastructure, population displacement, epidemic
  disease, and food shortage.
• Ex. humanitarian crises in Iraqi, Darrfour,
  Somalia, Palestine and Aphghanistan.

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Public Health ToolsFor Disaster Response

• Initial Assessments
• Public health surveillance
• Targeted investigation and surveys

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Public Health Tools1-Initial Assessments

• Purpose
• To rapidly obtain information about the
  immediate needs (emergency relief services)
• of the stricken population and their supporting
  public health infrastructure.

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Initial Assessments (cont.)

• The assessments should identify
• - The extent of the needed response
• - Technical areas where assistant is needed
• It should Suggest other areas where more focused
  health survey or surveillance should be conducted
  

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Initial Assessments (cont.)

• Within 24-48 hours
• Representative sample
• Knowledge about geographic distribution and size
  of the pop. Through
• - Census - Aerial photos - Rapid Surveys
• Slow-onset disasters like famines require
  repeated emergency health assessments

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Public Health Tools 2- Surveillance

• Purpose
• To monitor the health of the population
• To gauge the effectiveness of ongoing relief
  programs

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Surveillance (cont.)

• It should be established in sentinel sites such
  as clinics.
• Critical events for surveillance include
• - Deaths
• - Vaccine preventable diseases
• - Malnourished diseases.

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Public Health Tools3- Targeted investigations
and surveys

• Purpose
• To complement initial assessment and
  surveillance.
• For example
• - Investigation of outbreaks
• - Survey of vaccine coverage
• - Assessment of nutritional status

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Public Health InterventionIn Disasters

• Environmental Health Control
• Communicable Diseases Control
• Nutritional Rehabilitation

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Public Health Intervention In Disasters 1-
Environmental Health Control

• Potable water 15-20 liter/person/day increase in
  heat stress or physical activity
• Proper management of human waste
• Shelter particularly in cold weather
• Control of insect vector
• Others in Tech. Disaster in case of chemical
  contamination of water/soil

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Public Health Intervention In Disasters 2-
Communicable Diseases Control

• Usually come on top of endemic diseases.
• New disease may occur if people move to a new
  location where an unfamiliar disease is endemic

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Communicable diseases control (cont.)

• Following conflicts related disasters Measles,
  Diarrhea, ARI and Malaria.
• This is due to Poor environ. condition,
  crowding, malnutrition, lack of immunization
  activities, inadequate case finding and limited
  curative services
• Following natural disasters Less common e.g.
  Malaria. Due to damage of public health
  infrastructure

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Communicable diseases control (cont.)

• Fundamental public health strategies
• Emergency Measles Vaccination
• Administration of vitamin A
• Basic Environmental measures
• Rapid case finding
• Aggressive treatment (e.g. Rehydration,
  appropriate antibiotics)

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Public Health Intervention In Disasters 3-
Nutritional rehabilitation

• Poor nutritional status increases susceptibility
  to communicable diseases
• The immediate cause of death in most malnourished
  persons is not usually starvation per se but
  infectious diseases

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Emergency feeding program

• The program may focus on
• - Wide spread distribution of general food
  rations
• - Targeting specific food supplement to selected
  high risk group e.g. pregnant and lactating women
• - Preparing food for consumption on-site in
  feeding centers

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Points to be considered

• The food must be culturally acceptable and
  nutritionally balanced
• Long term relief program may cause micronutrient
  deficiencies
• Sound program decisions must be based on
  information from rapid nutritional surveys as
  well as analysis of economic indicators

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• Emergency Famine relief
• Short Term solution
• Emergency feeding program
• Long term solution
• Restoring an endogenous food economy
• (dealing with the the root causes such as
  economic collapse, disruption of production,
  inadequate distribution and other socioeconomic
  conditions)

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Challenges in Disaster Relief Today

• Coping with violence
• Many relief workers have been killed
• Q How to adequately protect them?
• Improving emergency response
• In 1994 50,000 persons of Rwanda refugee died
  from cholera in a matter of one week
• Q- Effectiveness of emergency relief programs
• - Failure to Implement programs early enough
• - Shortage of training program

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Challenges in Disaster Relief Today (cont.)

• Vulnerable population
• Identifying and focusing on
• population with special needs
• after disasters is a critical issue
• Land Mines
• More than110 million land mines in about 60
  countries caused 15,000 fatalities/year

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Challenges in Disaster Relief Today (cont.)

• Terrorism
• The release of Sarin gas in the Tokyo subway
  system illustrate the emerging threat from such
  weapons. There is a need for
• Rapid characterization of offending agent
• Mass decontamination
• Ready access to antidotes
• Specialized medical training
• Proper protective equipment for emergency
  responders

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Challenges in Disaster Relief Today (cont.)

• Mental Health
• It may predominate the health concern during the
  acute phase of disaster response.
• Emergency response personnel are also subject to
  short-and long term effects as a result of
  stress. There is a need for specialized
  psychological triage and treatment program for
  victims

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Thank You