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Training and education should include the basics of sheltering and evacuation, updated plans based on lessons learned, and regular drills. The disaster in Joplin emphasizes how important preparation and planning can be. The United States Forest Service reports an average of 73, wildfires yearly, clearing about 7. There are, however, four notable exceptions in modern history, and they all involve firefighters:. Lessons learned from these disasters are beyond the scope of this paper, but are well-known to the men and women who risk their lives to fight these fires.

Heat waves generally do not overwhelm local resources, but are nonetheless an all-too-common cause of urban mortality, disproportionately affecting the old, the infirm, and the poor. Three events provide examples of contemporary heat wave disasters. Semenza et al 63 thought that the single biggest impact on mortality reduction is the provision of air-conditioned facilities to those at risk. The summer of was unusually hot in Europe.

Evacuation of the Sick and Wounded, WWII

Reports from Italy confirmed heat-related deaths, 64 and from France a catastrophic 14, heat-related deaths. In France, the greatest increase in mortality resulted from heat-related events: dehydration, hyperthermia, and heat strokes. Secondary increases were related to medical conditions such as urinary and respiratory conditions. Climate change and potential solutions are still the source of public debate. Identifying those at risk and providing them with heat relief is the key to prevention.

Hospitals should work in their communities to assist public health as appropriate. Winter Storms. Winter weather — including cold, heavy snow, ice, and flooding — is another cause of morbidity and mortality in the United States. Winter storms include blizzards, which have winds of 35 miles per hour or more, along with blowing snow reducing visibility to less than 0.

Measurement of cold-related mortality can be inconsistent, in part due to a lack of uniform diagnostic criteria. Among the primary conditions associated with cold weather are hypothermia and frostbite. Frostbite is tissue freezing as a result of crystal formation in the extracellular space. Another cause of morbidity and mortality in winter storms is CO poisoning. Avalanches masses of snow that slide, tumble, or flow down an incline are an infrequent cause of mass casualties but lead to an average of 29 deaths per year in the United States, most from asphyxia and a smaller number from trauma.

Tsunamis are ocean waves caused by seismic activity such as earthquakes or underwater landslides. A tsunami is a series of waves that can propagate at speeds up to miles per hour in the open ocean. Waves that hit land can be up to feet high, and can inundate and destroy the affected coastline several hundred feet inland. Because waves propagate outward in any direction, essentially any coastline facing the epicenter is at risk.

According to NOAA, there have been 41 major tsunami events since Although there have been no recent events on American soil, aside from a small non-seismic tsunami on the East Coast in June , the coastal areas remain at risk. In Hawaii, tsunamis accounted for more deaths people than all other natural disasters combined. Although the East Coast is typically not at risk, the Grand Bank earthquake near Newfoundland resulted in a wave that reached as far south as South Carolina.

The most destructive tsunami in this century, which killed more people than any other tsunami in recorded history, occurred on December 26, A massive earthquake Richter 9. There were two pre-event hospitals in the area, of which one was destroyed and the other left functional; however, the disaster shrank the supply of medical personnel from doctors and nurses pre-event to 30 post-event. Because of the destruction and limited access, this HASG was the first medical team deployed to the area a week following the event.

The team treated patients and performed 24 surgeries. The few severe trauma patients who survived long enough to reach care could not be successfully treated due to a lack of blood and critical care resources. Gastrointestinal disease was anticipated but did not occur. Tetanus, on the other hand, was not anticipated but occurred in five patients.

Although the property destruction cannot be prevented, it can be anticipated, especially on coastlines more remote to the event, providing an opportunity to prevent mortality. In the United States, a robust system of watches and warnings can provide time to evacuate. Storm Surge and Flood. Storm surge associated with tropical storms is discussed in the section about hurricanes. Floods often result from excess rain or snowmelts, as well as breaches of man-made structures.

Aeromedical Evacuation: Configuring the Hospital

They are a common and often cyclic cause of death and disaster worldwide. The second costliest flood in U. Much of the health care work force must have been affected either directly or indirectly. The Federal Emergency Management Agency FEMA and others provide some insight for public health mitigation strategies; 81 however, it is clear from the Katrina experience that hospital resilience in the face of direct impact to its resources and staff is integral to preparation.

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This concept will be discussed in greater detail below. Rural hospitals pose a special circumstance. Their often isolated geography, limited capacity and reserve, and reduced availability of services typical in urban settings can make these institutions vulnerable. Unfortunately, a recent national survey of rural hospitals by Manley and colleagues 7 points to a number of weaknesses.

Clearly there is an opportunity to integrate regional, state, and federal response with special attention to the rural hospital. Infectious epidemics following a natural disaster are common. The risk for communicable diseases is related to the size of the population displaced, the availability of safe water and sanitation, the level of immunity to vaccine-preventable diseases, and access to basic health care. Natural disaster is not only physically stressful, but socially and psychologically stressful.

The mental health consequences for health care providers often go beyond their personal loss during the disaster. Mild transient distress may manifest as sleep disturbance, fear, anger, sadness, and an increase in tobacco and alcohol use. Effective triage is essential to optimize limited resources.


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The immediate category of patients requires prompt institution of life support and resuscitative measures. The delayed group of patients has emergent injuries, which can wait. Minimal patients often reach the hospital first because they are not transported by EMS and are typically not scene triaged.

The Medical Department: hospitalization and evacuation, zone of interior

They can quickly overwhelm valuable ED and hospital resources. The expectant patients have signs of life, such as spontaneous breathing or pulse, but have sustained such severe injuries that survival, even with advanced measures, is not expected. The dead category is self-explanatory.


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  • These last two categories require the greatest adjustment from routine care, because they should be given minimal treatment comfort care or quickly pronounced dead. There is an unavoidable tension between standard of care and sufficiency of care. A frank discussion at the hospital level of the nature and quality of care to be provided in the case of a disaster should occur as part of the planning process. Under normal circumstances, trauma triage is performed at the scene and hospital with a low threshold for provision of advanced assessment.

    This is done to have a high sensitivity for serious injury and to reduce the chance of missing a patient who would benefit. This over-triage, by design, typically has only a modest specificity, and a number of patients without serious injury are processed through the high-resource utilization pathway. In a disaster situation with more victims than can be handled with the available resources, the triage level for high-resource utilization should be raised to preserve their availability for the more seriously ill and injured.

    Despite efforts to reduce scene and hospital over-triage, the walking wounded, who typically arrive before functioning triage is in place or may bypass it once it is set up, can rapidly overwhelm a facility, and broad geographic disruption, search and rescue, and cleanup activities, combined with the loss of basic health care services, result in an increase in non-trauma post-disaster ED volume.

    Hospital triage should be provided by the most experienced clinicians available. Initial interventions should include only lifesaving procedures, and the victims moved in one direction to successive hierarchies of care. All of the surgical and medical specialties may eventually be needed, depending on the type of disaster; however, Alson et al, 36 in describing their response as a field hospital during Hurricane Andrew, found that most of their time and resources were spent on general medical care, and not injury. This experience is mirrored in multiple reports following earthquakes, tornadoes, hurricanes, floods, landslides, and wildfires.

    Once a disaster is identified in the community or by the media and volunteer staff begin to arrive to assist, establishing a staging area to vet these volunteers and assign them to appropriate tasks may be beneficial. Natural disasters are uncommon and episodic; multiple competing priorities often usurp precious resources, and as a consequence, disaster planning may suffer.

    Published after action reports credit education, planning, training, and drilling with saving lives. The Incident Command System ICS provides a standardized hierarchy, logistic scaffold, operational units, and job assignments necessary to manage a disaster and should be part of any regional disaster plan. This plan must be flexible, as natural disasters have a geographic scale that often encompasses health care facilities and health care workers.

    When this coordination fails, the results are a natural disaster compounded by the man-made disaster of system failure. Farmer et al 94 outline five common shortfalls in hospital disaster preparedness:. Planning and preparedness for natural disasters needs to be resilient. For example, storage in a basement is very appropriate for a tornado-prone area, but not for a flood-prone area. The New Orleans hospitals were well supplied in preparation for Hurricane Katrina, but flooding rendered most of those supplies stored in basements useless, and the backup generators inoperable.

    In addition, communication beyond line of sight was almost impossible, and interagency cooperation difficult.

    Latest available findings on quality of and access to health care

    The Memorial Medical Center experience following Katrina is especially illustrative. The hospital leased space on the seventh floor to a long-term acute care LTAC facility for critically ill elderly patients. These patients were sheltered in place; however, flooding led to the loss of electricity, communications, cooling, sanitation, water, and supplies.

    A small staff stranded and isolated by the storm surge worked for four days in this primitive environment to care for critically ill patients. More than 34 of these patients died. A grand jury declined to indict, but civil claims persist. Evacuation planning should include the evacuation of difficult patients with limited personnel and services.

    Alternatives for complex machinery needed for life support must be identified and prepared. Robust communication trees need to account for the possibility of the total absence of communication networks and power. Mutual aid, state, and federal aid resources should be understood and the logistics of deployment developed well in advance of a disaster. Because natural disaster is geographic in distribution, many health care workers will often be directly affected.

    Staff who are injured, homeless, or searching for family and friends may not be willing to report for work. For example, wildfires in the San Diego area in burned almost , acres and displaced , people. A report from one hospital documented that on the first day of the disaster, there was a Preemptive education has been cited as the single most important tool to mitigate the effects of disaster, 94 and multiple authors advocate for formal education and simulation. The assumptions on which disaster planning is predicated need to be interrogated to explore the multitude of effects that may occur.

    Resilience in preparing for natural disaster seeks to mitigate risk with natural and human resilience to catastrophe.


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    • For example, natural resilience to a water event might include porous soil to allow drainage or vegetation to absorb it; and human resilience might include cohesive social networks that can provide resources and support. Now when they become unfit, evacuation from the field of operation is needed as quickly as possible. The number of sick and wounded who are present proves to be a ball and chain to a Commander, and since his missions will be handicapped and compromised because he will be compelled to carry a number of unfit men, all efforts are utilized to remove them to the lines of communication.

      Normandy summer of ; a Litter-patient is being painstakingly evacuated amidst difficult terrain. Note the enormous variety of Geneva Convention helmet markings. Medics are lifting a wounded doughboy to a waiting Ambulance, for further evacuation, the Bulge, Belgium, January-February The number of missions she has flown are entirely visible by the presence of the painted red crosses just underneath the cockpit. Picture taken in Germany by spring of An "Associated Press" photograph showing wounded American and German soldiers awaiting transport to England following savage fighting in Europe.

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      RAMC: Royal Army Medical Corps WW1

      The litter bearer treads cautiously in the mud, as the casualty is taken to the Receiving Ward. American soldiers await evacuation by ambulance going to the next echelon on medical care. A French civilian hands out cigarettes and matches to the G. Picture dated July 10, These patients onboard are on the first leg of a long trip home from the Pacific…. Allied casualties evacuated by American landing craft to a Hospital Ship.

      Picture taken after Operation Husky Invasion of Sicily. Wounded crew members of a B "Liberator" bomber are being transferred from the aircraft. Medical troops evacuated a wounded comrade in a Jeep designed with Red Cross Markers. The wounded man and medical personnel pertain to the 36th Infantry Division. This image was taken March, , near Haguenau, France. Picture taken in December A d Infantry Regiment Separate casualty is transferred to the rear.

      Photo captured 10 April during the fighting for Massa. The d Inf R. Mid June within Omaha Beach. Wounded Marines are being evacuated by LST. The vessel's tank deck has been converted into a hospital ward for casualties, with designated operating room and sick bay. Medics load a wounded serviceman into the rear of a light aircraft for evacuation. Note the use of the Stokes Litter Item No. The plane being used here seems to be a military version Piper J-3 with the designation of L Army Litter party carrying a casualty.

      Picture taken in Germany during winter. Wounded soldiers are being evacuated to General Hospitals stateside. Picture taken in August Toggle navigation. Share On Facebook. John Titor. Embrace Cultural Discoveries. Reimagine Iconic Events.