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Il n'est pas d'hommes politiques ou de grands responsables qui ne souhaitent l'égalité du citoyen face aux agressions, chacun recherchant au travers d'une doctrine unique une réponse adaptée en tout point du territoire et chaque jour de l'année. Meme si les types de détresse ont évolué et le recours au centre d'appel est devenu habituel, demandant aux secouristes professionnels de s'adapter le vrai drame ou le chronomètre et les compétences sont essentiels, reste le challenge des services de secours. Mais comment, dans le panel des différentes formations techniques et des types de matériel, adapter dans une doctrine que l'on voudrait unique, une marche générale des opérations efficiente. Le secours á personnes que l'on pense réserver exclusivement aux professionnels de santé ne doit il pas être aussi la préoccupation du sauveteur citoyen. La premiùre minute reste essentielle, elle est quelque soit le type d'agression de la responsabilité du premier maillon de la chaine du premier témoin sur les lieux. Alors doctrine unique, difficile, utilisation des compétences, surement. Un code des bons gestes á effectuer au bon moment au bon endroit semble capital, un référentiel sur les responsabilités de chacun indispensable et l'égalité des chances un objectif.
China is one of the countries most affected by disasters caused by natural hazards. Disasters comprise an important restricting factor for economic and social development.
Methods
Retrospective analysis was performed based on the epidemiological data of disasters caused by natural hazards in recent two decades.
Results
The deadliest disaster that was reviewed was the Sichuan, Wenchuan earthquake on 12 May 2008 with a death toll of 88,928. Floods were the the primary natural hazard resulting in disaster in China. The economic loss caused by natural disasters was huge, the Sichuan earthquake alone resulted in an economic loss of 845.1 billion Chinese Yuan. However, psychosocial factors did not receive attention by Chinese Government and academics.
Conclusions
The characteristics and impact of disasters should be analyzed to scientifically provide useful information for natural disaster mitigation in China.
It is important to equip emergency department (ED) staff with skills to manage mass casualty incidents (MCI) as disasters strike without warning. Our hospital, Tan Tock Seng Hospital, has been the national screening centre for severe acute respiratory distress syndrome (SARS) and H1N1 outbreaks in 2003 and 2009. Furthermore, our ED has managed casualties from mass food poisoning in the community. We would like to share our experiences in training our staff for MCI. For the ED to operate smoothly in a MCI, comprehensive training of staff during “peace” time is essential. We have a selected team of doctors and nurses as the department disaster workgroup. This team, together with the hospital emergency planning department, prepare the disaster protocols using an “all hazard approach concept” and aim to minimise variations between different protocols (Conventional, Infectious disease, Hazmat, Radioactive MCI). These protocols are updated regularly, with new information disseminated to all staff. Next, all staff must be well-versed in the protocols. New staffs undergo orientation programmes to familiarize them with the work processes. Regular audits are conducted to ensure that the quality is well-maintained. Additionally, training also occurs at the inter-departmental and national levels. There are regular activation exercises to test inter-departmental response to MCI and collaborations with Ministry of Health to conduct disaster exercises e.g. the biennial Kingfisher Exercise in preparation for radiation-related MCI. Such exercises improve communication and working relationships within the ED and with other departments. The camaraderie developed can act as a pillar of support during stressful times of MCI. Lastly, the ED staffs attend local and international courses and conferences to update ourselves on the latest training and knowledge in the handling of MCI. This allows us to share our ideas and to learn from our local and international counterparts, and helps better prepare ourselves.
Since September 2009, the Warsaw Ambulance Service (WAS) has enabled 23 ambulances to carry out a 12-lead electrocardiograph (ECG) transmission to the specialist in the ECG transmission center, and in return received an interpretation of sent data along with guidelines concerning further treatment and transportation. This would allow patients with myocardial infarction (MI) eligible for PCI to be transported directly to the catheterization laboratory. The aim of this study was to present the results of the first four months of operation of the ECG transmission system in WAS, and assess the frequency of its use and the amount of MI it covered. Furthermore this study, attended to the main issues that might have had a negative impact on the surveyed system.
Methods
Since September 2009, each attempt of transmission was described by a number of factors by the staff attending to ECG transmission center. Documentation created from September to December 2009 was subjected to a thorough analysis.
Results
From September to December 2009, there was a total of 1,650 attempts of transmission, 292 (18%) of them were unsuccessful. Of 1,358 successfully transmitted ECGs, 39 (3%) suggested a ST-Segment Elevation Myocardial Infarction (STEMI) and 149 (11%) suggested a Non-ST-Elevation Myocardial Infarction (NSTEMI). The number of attempted ECG transmission carried out by individual ambulance teams per intervention was significantly different (p < 0.001) and showed a relation with a place of stationing. The proportion of unsuccessful attempts was significantly different for individual ambulance teams (p < 0.001) and was higher for ambulance teams with lower amount of attempts (p < 0.0001).
Conclusions
Prehospital 12-Lead ECGs help to reduce emergency medical services-to-Balloon times. It often was used as a support in case of patients without symptoms typical for MI. Motivation and personal opinion of individual ambulance teams about the system affected frequency of its use. More frequent use of the system by ambulance teams resulted in a lower percentage of unsuccessful attempts of ECG transmission.
Summary Apathy syndrome is the apathy attribution of persons, foundations, nations or global world against the preparations and arrangements to avoid progression of disaster. In this article, it is aimed to review the collected opinions of authors who are studying causes of apathy syndrome. The factors of avoiding to be prepared against natural disasters can be classified under three main topics; personal, social and cultural. The personal factors or the factors depending on persons are discussed in three sub topics, respectively emotional factors, mind-related factors and behavioral factors. Particularly “resistivity against changes” and “unwilling to abandon habits” are emphasized as the major reasons. The topic, social factors, can be sorted out as insufficient administrative/political volition acting against disaster and being undeveloped among the cultural factors preventing disaster preparations, believing and mystical meaning giving onto “disaster” expression have been reserving spectacular space. Individuals and society are perceiving disaster as a divine punishment and this perceive makes meaningless to get prepared. Consequently, it is evaluated that sensitive to country conditions, culture, sexual discrimination of society, age and special disability circumstances, and also versatile, deep and penetrating, keeping continuity, analytically approaching formal education can resolve disaster troubles of countries. Authors of this article have emphasized crucially to establish an academy of disaster contributed every kind of disciplines as soon as possible in the world.
On 12 January 2010, a powerful earthquake struck Port-au-Prince, Haiti. To help ensure outside assistance, information that describes and quantifies the severity of the disaster is needed urgently. Several studies have suggested that needs assessments are seldom performed, and that initial media images direct relief interventions rather than needs. This study sought to assess the extent of information on the situation that was available rapidly after the earthquake. The aim was to document and analyze information on severity and needs available on the Internet during the first week after the Haiti earthquake, and to compare the results with official severity data. Reliefweb is the most used information-sharing Internet portal following humanitarian disasters. All documents related to the Haiti earthquake published on Reliefweb during the first seven days after the earthquake were selected. Indicators that described the severity of the earthquake were searched for, including the number of affected and dead and the assumed needs of the population. Results were compiled and cross tabulated for frequency and compared with official outcome data. A total of 822 reports were posted. An estimate on the number of dead was available in 10% of the reports, ranging from 40,000 to 100,000. The most commonly reported number of affected was three million. The estimated numbers of dead and affected were similar to the official data. Not one posting described the method used for the estimates they provided. These results indicate that the severity of the earthquake was relatively well documented after four days. However, a striking finding was the lack of description of how the data had been collected. It remains difficult to determine the reliability of needs estimates, as they were done and posted by the relief organizations themselves. No independent attempt to estimate the needs was found.
The bushfires of February 2009 in Victoria, Australia resulted in the deaths of 173 people and caused injuries to 414. Furthermore, > 2,030 houses and 3,500 structures were destroyed. The role and experience of nurses in this environment are not well understood, and little is known about the clinical and education background of nurses in this setting. This presentation will provide an overview of the bushfires and report on two research projects. The aims of these projects were to explore participant demographics and various aspects of nursing activities in the prehospital environment. These projects used volunteer nursing members of St John Ambulance Australia who responded to the Victorian fires. The first project used a retrospective, descriptive postal survey, and the second was descriptive and exploratory, using semi-structured interviews as a means of data collection. The survey highlighted that nurses had varying clinical and educational backgrounds. Males were overrepresented when compared to the national average of nurses. Most participants had taken disaster-related education, however, this varied in type and duration. Similarly, most had participated in training or mock disasters; however this usually was not related to bushfire emergencies. The qualitative findings identified two main themes having expansive roles and being prepared. These highlighted that nurses maintained a variety of roles, such as clinicians, emotional supporters, coordinators and problem solvers, and they were well prepared for these roles. This research provided insight into the characteristics and level of preparedness of nurses who responded to the 2009 Victorian bushfires in the prehospital environment. Additionally, it highlights the need for more structured education and training for nurse that is aligned with their role and deployment environment.
Natural disasters challenge for Emergency and Rescue Services- lessons learned Przemyslaw Gula MD PhD, Edyta Szafran Institute for Emergency Medicine. Krakow, Poland.
In the period 2008–2010 Poland experienced series of natural disasters including 3 large scales flooding, 2 periods of extremely high snowfalls followed by low temperature periods and finally local flush flooding in different locations. The time of each disaster elapsed from several days up to 6 weeks. All of them had severe impact on local infrastructure by destroying road systems, communication as well as healthcare and fire brigade facilities. The rescue efforts required evacuation, Search and Rescue operations, providing medical care and shelter. The most problems occurred in following areas: - large scale evacuation - collapse of communication systems (including 112 dispatch) - inadequate number of specialized rescue equipment (helicopters, vehicles, boats, snowmobiles, etc.) - providing EMS in affected areas - necessity of evacuating hospitals. The lessons learned showed the need for following changes: - strong trans regional coordination in means of facilitation of utilizing civil protection and military recourses - unification of operative procedures for all actors of the response operation - improvement of communication systems and reducing their vulnerability on environmental factors - establishing regional crisis management and control centers, covering the emergency response activities in affected areas - need of large-scale use of HEMS as well as Police and military helicopters in natural disasters - need for better supply in specialized rescue equipment including recue motorboats, 4 wheels drive recue vehicles and ambulances, snowmobiles, quads in local response units. The main rule of commanding the entire operation is subsidiary. Local coordinating structures should be supported by regional and central governments by supplying necessary recourses. However the operational command should be unified and include all participating units and organizations.
Increase in the number of emergency situations (ES), technogenic accidents and disasters and terrorist threats defines the need for implementation of advanced medical technologies. One of these technologies is to deploy an airmobile hospital (AH) in emergency situation to provide skilled medical care in case of a large number of casualties. AH is equipped with inflatable modules, deployment of which takes no more than an hour. Each module is equipped with specialized departments. AH consists of triage department, OR, intensive care department, outpatient department, X-ray and diagnostic department and inpatient department as well. The station is equipped with modern intensive care unit including ALV apparatus, defibrillator-monitor with built-in pacemaker, as well as endovideosurgery complex, laboratory and telemedicine equipment, radiation control monitors, communication and global positioning units. One of the advanced technologies of emergency medicine is implementation of telemedicine equipment. EMERCOM of Russia on the basis of our institution has opened a telemedicine center that provides videoconferencing, any audio-visual information both text (extracts from case histories), and instrumental studies (radiographs, echograms, ECG, etc.). EMERCOM of Russia specialists use airmobile medicine technologies including specially equipped aviation facilities with airmobile medicine modules (aircraft, helicopter). In addition, we have developed a hardware system of individual monitoring the functional state of a rescuer. It is designed to transmit to the senior officer of the division the data about functional status of 10 rescuers (heart rate, respiratory rate, temperature), motor activity and the current coordinates to detect deterioration and freezing (immobilization) of the rescuer. The complex is equipped with an emergency radio-beacon to accelerate the search for a rescuer.
The organization of the medical emergency system in Poland has been revised substantially since 2007. Rescuers were able to perform certain life-saving procedures and to administrate some drugs without doctor's order.
Aim
The efficiency of advanced life support (ALS) performed by emergency medical service with paramedics (without doctor) was assessed for cases of cardiac arrest (CA) in prehospital conditions. It was correlated with quantity of basic life support (BLS) procedures undertaken by casual witnesses and with the knowledge of automated external defibrillation (AED) in people without medical training.
Method
Forty-eight cases of CA were analyzed, which took place in District Siedlce in the first three quarters of 2009. Data were collected retrospectively, from medical reports. Advanced life support procedures adhering to the guidelines of the European Resuscitation Council were investigated in terms of pharmaco-and electrotherapy. Additionally, the study of the knowledge of AED was conducted through a survey, in which 103 randomly selected persons without medical training took part.
Results
Adrenaline and amiodarone were given by paramedics correctly in 94% of patients. Defibrillation was performed in all patients with documented ventricular fibrillation or pulseless ventricular tachycardia valid values of energy. Cardiopulmonary resuscitation was successful in 33% of the cases. At the scene of the accident BLS was performed before the arrival of ambulance in only 7% of cases. Of the respondents, 41% (non-medic) could use the AED safely, but only 13% of them knew the guidelines for using defibrillators.
Conclusions
Paramedics were properly implementing ALS procedures for prehospital CA. The percent of effective cardiopulmonary resuscitations may improve the early implementation of BLS, including the use of AED. It is necessary to educate people without medical training in this field.
An unprecedented cholera outbreak affected Zimbabwe from August 2008 to July 2009 with 98,592 cases and 4,288 deaths, in 54 out of 62 districts. The main strategy used to overcome the outbreak was an integrated community-based interventions package. The present work is a case study to describe the strategy and lessons learned for future humanitarian crises and preparedness. The methodology was based on the review of epidemiological reports, assessment and surveys' reports, minutes of joint Health and Water Sanitation and Hygiene (WASH) Clusters' meetings, and direct observation as Health Cluster Coordinator. Epidemiological data showed an increasing number of cases in rural areas with community deaths representing 66% of the 1,948 deaths from 61,304 cases on 31 January 2009. Risk factors identified in communities were: lack of awareness about the disease, cultural and religious behaviors, lack of potable water with weak sanitation, lack and inappropriate use of water purification tablets, and lack of soap and water containers for effective behavior change. There also was late arrival to cholera to the few treatment centers by rural populations. In addition to treatment centers, a package of interventions was implemented by multi-sectoral stakeholders. The package included: health and WASH education tools and practice sessions for healthy and hygienic behavior change and for an effective use of oral rehydration salt as first aid measure; community-based surveillance with an early warning system and response teams; and distribution of containers and water purification tablets with drilling of water points. Epidemiological data showed a significant decrease of cholera cases where the full package was implemented. This work showed that an integrated package of interventions jointly targeting risk factors can be effective on public health threats in rural communities. Community-based preparedness and response should then take into account an integrated joint intervention package to mitigate public health threats.
In the US, a system has been developed to provide disaster sheltering for persons with special needs in what are now termed alternate care sites (ACS). As in many other developed countries, as the population ages, the rates of people with chronic diseases that require complex health care management in the home setting has increased. The aim of this study was to identify the key chronic diseases, conditions, and therapies that should be planned for in ACS operations.
Methods
A convenience sample (n = 402) of senior citizens (≥ 65) who resided in Honolulu, Hawaii were interviewed and completed a 15-item survey that asked about demographics, existing health conditions, activities of daily living abilities (ADL), and requirements for ongoing care.
Results
The mean age was 68 years; 56% were female. The most common health issues included: hypertension (53.4%), heart disease (24.6%), diabetes mellitus (23.3%), and asthma (15.1%); while 11% (n = 47) reported they required daily physical assistance ADLs, including: getting up from a chair (15.1%), walking (8.1%), taking medications (8.1%), dressing (5.2%), and toileting (4.2%). Of these 47 people, most (81%) had someone who would help them in a disaster shelter, while nine (19% of the total who required assistance) had no one to help them. On average, of the respondents who reported they took medication daily, 14% had less than a seven-day supply of medication for their chronic disease.
Conclusions
As the population ages, the burden of chronic disease in the population increases. During a disaster with large numbers of displaced persons, accommodations for such persons must be accounted for in order to prevent a second disaster related to de-compensation of those with chronic health problems in the ACS shelter. Understanding the population needs beforehand can mitigate the effects of displacement on this population.
To study advantages of external fixation in severe injuries of extremities in children.
Material and Method
305 children at the age from 3 to 17 years with polytrauma (ISS > 18) were studied. From them skeletal injuries took place in 198 patients, cranioskeletal trauma - 125, multiple bone fractures - 56, bone fractures + visceral trauma - 24. 44 children had open bone fractures or fractures accompained with vast defects of soft tissues. Operative interventions in polytrauma are divided into urgent, elective and delayded. Urgent intervention (according to vital indications) are conducted together with anti-shock therapy in massive blood losses (injury of spleen, liver), crushing of lungs, cardiac tamponade, intracranial compression. Elective interventions are prformed after stabilization of patient's state and after bringing him out of shock.
Results
Sets for external fixation were used in acute period of trauma, in early and late posttraumatic period. Tipe of sets depended on character of injury and followed steps of treatment. Indications for external fixation in acute period and catabolic phase of traumatic disease were: 1. multiple fragmental fractures, 2. defects of bones, 3. vast defects of soft tissues, 4. long bone fractures accompained with severe brain trauma. Indications for external fixation in late period were mulunion, in postpond – ununion, deformations and shortening of extremities.
Conclusion
The usage of external fixation was an effective approach in treatment of children with severe complicated injuries of extremities. Advantages of external fixation in conditions of polytrauma were undiscutable: management in force effects, absence of secondary dislocations, good conditions for debridment and follow restorative treatment, mobility of patients.
Training and education of healthcare and government workers has long been accepted as integral to disaster preparedness, although, up until recently, veterinarians and veterinary paraprofessionals have not participated in such practices. It is well documented that when disasters occur, there are dramatic increases in the occurrence and spread of zoonotic diseases, significant contamination of food, water and soil, and reductions in food supply for both humans and animals. These effects reflect the interdependence of humans, animals and their environment, and the importance of managing animal health and welfare after such disasters. Currently, animal welfare emergency management (AWEM) is neither evidence-based nor standardized. Most veterinary schools do not include AWEM in their curriculum, even though AWEM is an essential part of the veterinary professions obligations to both animals and humans. With this gap identified, research was undertaken to derive educational competencies and objectives in criteria-based preparedness and responses that were relevant to veterinarians and veterinary paraprofessionals involved in AWEM. The results have been used to inform the development of Animal Emergency Response training for inclusion in both veterinary and veterinary paraprofessional curriculums. A systematic evidence-based consensus building method was used to derive the educational competences and objectives. This included the following steps: (1) review of peer-reviewed literature on relevant content areas and educational theory; (2)a review of existing competences and training objectives within other sectors involved in disaster management; (3) a survey of international experts and responders which produced qualitative and (4) quantative results development of competencies and testable objectives. The qualitative results showed that veterinarians and veterinary paraprofessionals require core competencies in all three groups and the four basic components of disaster management: mitigation, preparedness, response/emergency relief and recovery. A curriculum should cover all animals, companion, production and wild.
Asian tsunami in 2004 had a tremendous impact on the health system of Sri Lanka leaving many healthcare institutions damaged in the costal provinces and destabilizing the healthcare delivery network. Immediately after the tsunami, health authorities in Sri Lanka realized, health workers should be prepared well if they are to face any future disasters successfully. In this background, the Ministry of Health set its agenda to train all levels of health cadres on disaster preparedness and mitigation whenever there are opportunities. Ministry of Health established the Tsunami Rehabilitation Unit (TRU), later renamed as Disaster Preparedness and Response Unit (DPRU) and mandated it to prepare the health sector for future disasters. During a disaster, well trained health cadre is an asset to any health manager facing the burden of the emergency at the ground level. Trained health personnel on disaster management become a human resource multiplier to fill the gaps of scarce skilled health staff in the field operations. We reviewed the Ministry of Health reports, plans, meeting minutes, reports of training institutions, routine reporting from Ministry of Health departments and reports from health sector partners to compile and then analyze to construct this case study. We provide an overview of how DPRU coordinated and used the opportunities following Tsunami 2004 and then during the humanitarian crisis at the end of 30 years of armed conflict in 2009 to train the health staff. This case study also describes how DPRU networked with government and non governmental organizations to train the different categories of government health staff.
War, conflict, and complex emergencies are major contributors to the crisis of human suffering with impacts on health, public health infrastructure, food security, economic viability, community infrastructure, and social fabric as well as the environment. Conflict mitigation and resolution are essential to the recovery and restoration of the community and health. Public health can serve as a mechanism to mitigate the impacts of conflict, serve as a bridge to resolve conflict and provide community resilience. The role of health care professionals as a “Bridge to Peace” is a critical component of conflict resolution. Health as a Bridge for Peace was formally accepted by the 51st World Health Assembly in May 1998 as a feature of the “Health for All in the 21st Century” strategy and has been demonstrated across a wide range of conflicts. Public health has attributes that make it a valuable platform for conflict resolution: it is broad, population-based, affects all parties, benefits both individuals and society, valued by recipients, and supports Universal Values. Public heath can be utilized in pre-conflict, conflict, and post-conflict situations and has been used in more than 20 conflict scenarios with Humanitarian Cease-fires, Days of Tranquility, and Safe/Peace Corridors supporting programs such as childhood vaccination days in Afghanistan to Guinea Worm Eradication in East Africa.
A systematic search and narrative review of existing literature on the medium- and long-term impacts of injuries was conducted to provide context for a primary research study.
Methods
Searches were undertaken in MEDLINE, CINHAL and Science Citation Index using a combination of free text and Medical Subject Heading (MeSH) terms. Studies were included if they assessed outcomes following injury at least six months post-injury and reported morbidity-related outcomes. A standardized data extraction form was developed, and studies were assessed for quality using standard quality assessment criteria. The main characteristics of included studies were presented in structured tables and synthesized using a narrative summary.
Results
The search strategy identified 4,969 abstracts and/or titles, of which 125 appeared relevant. Following a detailed reading of the material, 32 studies met the inclusion criteria of this review. Summarizing the results of the studies was difficult, as they were of moderate quality and used many different methods. The main findings were that at 12 months post-injury a proportion of injured patients continue to suffer from physical, psychological, and social problems and this proportion doesn't decline over the next few years. In the medium term (12 months–5 years) about 10–25% of casualties continue to report a variety of health problems associated with their injuries.
Conclusions
It is difficult to synthesize injury outcome studies because of the varying methodological approaches, study populations, follow-up periods, and outcome measures used. The evidence that exists suggests that many casualties demonstrate good early recovery but a significant proportion still show significant social, physical, and psychological sequelae one to five years post-injury.
There is one important aspect of hospital preparedness for disaster that has so far received minimum attention. It has been taken for granted that medical staff know best how to take care of themselves and are well prepared personally when there is a call for disaster. However, the reality is far from what is expected, and many staff tend to keep their personal needs as a second priority when it comes to patient care, especially during disasters and mass casualties. They may not show it, however, while attending to their duties and managing casualties of disasters.
Discussion
Medical staff continue to have personal concern regarding their family, properties, personal safety and in some instances their own health as well. The medical staff are not the only one to blame, as other parties, including their employers are involved. This presentation will discuss causes and consequences of ill prepared medical staff personnel to disaster or Mass casualty, including a brief illustration of a mini survey that was conducted immediately following a hospital disaster drill. The presentation will also elaborate on developing staff personal response plans and kits that will contribute in reducing the burden of concern for their own family and them and indirectly may help increase their performance and productivity during disaster or mass casualty situations.
Training Agricultural Emergency Responders by Paula L. Cowen, D.V.M., Director, Professional Development Staff, Veterinary Services, Animal Plant Health Inspection Service, United States Department of Agriculture
Background Emergency Response is a critical component of our Animal Agriculture infrastructure. The ability to deploy trained personnel to handle any kind of emergency is key to quickly containing any disaster and mitigating the effects. This training is provided by a number of federal agencies, universities as well as at the state and local level.
Body
Several training strategies are employed by a number of different entities. Training is available on-line, in the classroom, with wet labs using live animals, through exercises and case studies. An overview of training and education of Agricultural Emergency Response personnel across the United States will be covered with a more in depth look at the training provided by the Animal Plant Health Inspection Service.
Conclusion
The Professional Development Staff provides technical training in disease identification and control, emergency response, import/export, and other topics as needed. Protecting and promoting American Animal Agriculture is our core mission. Veterinary Services provides leadership at the intersection of Animal and Public Health concerns.
On February 27, 2010, a 8,8 MW earthquake struck the central and southern coast of Chile, that was followed by a tsunami that destroyed some cities such as Constitution, Ilaco, Talcahuando and Dichato. The national authorities reported 512 dead and 81,444 homes were affected. It was the one of the five most powerful earthquakes in the human modern history. The most affected regions were Maule (VII) and Bio (VIII).
Results
The impact of the quake in the health sector was enormous especially on the health care infrastructure. The preliminary evaluations showed that 18 hospitals were out of service due severe structural and no-structural damages, interruption of the provision of water or because they were at risk to landslides. Another 31 hospitals had moderate damage. The Ministry of Health lost 4249 beds including 297 (7%) in critical care units. Twenty-two percent of the total number of beds and thirty-nine surgical facilities available in the affected regions were lost in a few minutes due to quake. At least eight hospitals should be reconstructed and other hospitals will need complex repair.
Conclusion
The effect of the earthquake was significant on hospital services. It included damages to the infrastructure and the loss of furniture and biomedical equipment. The interruption of the cold chain caused loss of vaccines. National and foreign field hospitals, temporary facilities and the strengthening of the primary health care facilities had been important to assure the continuation of health care services. *Based on information from PAHO – Chile.