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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 (United Nations) 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.
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.
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.
Standardized, validated training programs for teaching administrative decision-making to healthcare professionals responding to weapons of mass destruction (weapons of mass destruction) incidents have not been available. Therefore, a multidisciplinary team designed, developed, and offered a four-day, functional exercise, competency-based course at a national training center.
Objective:
This report provides a description of the development and initial evaluation of the course in changing participants' perceptions of their capabilities to respond to weapons of mass destruction events.
Methods:
Course participants were healthcare professionals, including physicians, nurses, emergency medical services administrators, hospital administrators, and public health officials. Each course included three modified tabletop and/or real-time functional exercises. A total of 441 participants attended one of the eight course offerings between March and August 2003. An intervention group only, pre-post design was used to evaluate change in perceived capabilities related to administrative decision-making for weapons of mass destruction incidents. Paired evaluation data were available on 339 participants (81.9%). Self-ratings for each of 21 capability statements were compared before and after the course. A 19-item total scale score for each participant was calculated from the pre-course and post-course evaluations. Paired t-tests on pre- and postcourse total scores were conducted separately for each course.
Results:
There was consistent improvement in self-rated capabilities after course completion for all 21 capability statements. Paired t-tests of pre- and postcourse total scale scores indicated a significant increase in mean ratings for each course (all p <0.001).
Conclusion:
The tabletop/real-time-exercise format was effective in increasing healthcare administrators' self-rated capabilities related to weapons of mass destruction disaster management and response. Integrating the competencies into training interventions designed for a specific target audience and deploying them into an interactive learning environment allowed the competency-based training objectives to be accomplished.
Although the need for on-site physicians at mass gatherings has been investigated in developed countries, it has not been studied in a developing country, where resources are limited, paramedical services are unavailable, and transportation and other facilities are inadequate.
Hypothesis:
The presence of on-site physicians would result in the effective management and prehospital care of casualties at mass gatherings or major sporting events in a developing country.
Methods:
A retrospective review of the planning procedures and medical records of the 19th Nigerian University games was conducted. Data from demographic profiles of visitors presenting to the on-site, secondary, and tertiary medical centers and the treatments used were extracted from log-books and processed and interpreted.
Results:
The Games hosted 6,000 accredited athletes and officials, and an estimated 80,000 spectators. Medical coverage was provided by 54 doctors and other healthcare staff at on-site, secondary, and tertiary medical centers. No trained paramedics were available. A total of 494 visits were made to the medical centers (medical usage rate of 2.1/1,000, patient presentation rate of 0.08). Forty-six percent of the visitors were evaluated by a physician on-site. Ninety percent of the visits were managed on-site, while 5% and 3% were referred to secondary and tertiary medical centers, respectively.
Conclusion:
The presence of on-site physicians at a major sporting event resulted in the majority of injuries and complaints being effectively treated on-scene. This reduced the number of hospital referrals and saved time and money for treatment.
With a huge, climactically hostile catchment area, limited retrieval options and finite resources at the only adult burns unit in South Australia, this paper discusses the case for the establishment and maintenance of a Burns Assessment Team in South Australia. The composition and role of the team and its relationship with other retrieval services, the primary care unit, and the proposed National Burn Coordinator also are discussed.
This is a summary of the presentations and discussion of Health Protection and Disease Prevention of the Conference, Health Aspects of the Tsunami Disaster in Asia, convened by the World Health Organization (WHO) in Phuket, Thailand, 04–06 May 2005. The topics discussed included issues related health protection and disease prevention as pertaining to the responses to the damage created by the Tsunami. It is presented in the following major sections:(1) key questions; (2) national perspectives; (3) an international perspective; (4) laboratory aspects in disease surveillance; and (5) partnership.
This is a summary of the presentations and discussion of Panel 2.15, Civil-Military Cooperation in Humanitarian Health Action of the Conference, Health Aspects of the Tsunami Disaster in Asia, convened by the World Health Organization (WHO) in Phuket, Thailand, 04–06 May 2005. The topics discussed included issues related to civil-military collaboration in humanitarian health actions as pertain to the responses to the damage created by the Tsunami. It is presented in the following sections: (1) how effective civil-military cooperation can help health responses, including; (a) needs assessment; (b) coordination; (c) filling gaps; and (d) capacity (2) what was done well, and what could have been done better better; and (3) conclusions and recommendations. Conclusions and recommendations included: (1) the best coordination mechanisms for civil-military cooperation; and (2) suggested additions and improvements.
This is a summary of the presentations and discussion of Panel 2.18, Logistics, Information Technology, and Telecommunication in crisis Management of the Conference, Health Aspects of the Tsunami Disaster in Asia, convened by the World Health Organization (WHO) in Phuket, Thailand, 04–06 May 2005. The topics discussed included issues related to logistics, information Technology (IT), and crisis communication pertaining to the responses to the damage created by the Tsunami. It iss presented in the following major sections: (1) issues; (2) lessons learned; (3)what was done well; (4)what could have been done better; and (5)conclusions and recommendations. Each major section is presented in four sub-sections: (1) needs assessments; (2) coordination; (3) filling the gaps; and (4) capacity building.
This is a summary of the presentations and discussion of Session 1.2 of the Conference, Health Aspects of the Tsunami Disaster in Asia, convened by the World Health Organization (WHO) in Phuket, Thailand, 04–06 May 2005. The topics discussed included issues related national health perspectives as pertaining to the responses to the damage created by the Tsunami. It is presented in the following major sections: (1) key questions; (2) discussion; (3) what was done well?; (4) what could have been done better?; and (5) what can be done to prepare for the future?.
This paper outlines each aspect of coordination as it relates to the responses made by various organizations in the disaster-affected areas. It is a synthesis of the presentations and discussions pertaining to coordination during the Conference, Health Aspects of the Tsunami Disaster in Asia, convened by the World Health Organization (WHO), in Phuket, Thailand, 04–06 May 2005. Coordination is defined, and two important questions are answered: (1) What coordination was done well?; and (2) What coordination could have been done better?.
This is a summary of the presentations and discussion of Panel 2.14, Contribution of Non-Governmental Actors, of the Conference, Health Aspects of the Tsunami Disaster in Asia, convened by the World Health Organization (WHO) in Phuket, Thailand, 04–06 May 2005. The topics discussed included issues related to the role of media and communication as pertaining to the responses to the damage created by the Tsunami. It is presented in six sections: (1) Background; (2) Key questions; (3) Discussion; (4) What have we learned?; (5) Conclusions; and (6) Recommendations. The what have we learned section is presented in the categories of: (1) needs assessments; (2) coordination; (3) filling gaps; and (4) capacity building.
This is a summary of the presentations and discussion of Panel 2.6, Mental and Psychosocial Effects of the Tsunami on the Affected Populations of the Conference, Health Aspects of the Tsunami Disaster in Asia, convened by the World Health Organization (WHO) in Phuket, Thailand, 04–06 May 2005. The topics discussed included issues related to mental and psychological aspects as pertaining to the damage created by the Tsunami. It is presented in the following major sections: (1) responses; (2) needs assessment; (3) coordination; (4) gap filling; (5) capacity building; (6) stakeholder agreement; and (7) conclusions and recommendations. In the responses discussion, issues included: (1) psychosocial support services; (2) mental health services; and (3) the Thai respoonse. Subsections in the stakeholder agreement section include: (1) public-private partnerships; and (2) preparedness.
This is a summary of the proceedings of the Conference on the Health Aspects of the Tsunami Disaster in Asia that was convened by the sunami World Health Organization in Phuket, Thailand from 04–06 May 2005. It contains reviews of the experiences of the health sector and early recovery fol following the Earthquake and Tsunami with emphasis onwhat was done well and what could have been done better and the lessons learned that can be incorporated into actions that will mitigate the damage created by future events. It outlines the national and international responses and recovery and the actions taken and not taken by the international community in support of the countries affected. Specific issuesaddressed include: (1) needs assessments; (2) coordi- coordination; (3) filling gaps in essential services, and (4) capacity building at the country level. Each of these aspects is analyzed as to its: (1) appropriateness; (2) adequacy; (3) effectiveness; (4) efficiency; and (5) connectedness.
Much of what occurred provided benefits to the stricen population, but there is substantial room for improvement through implementation of the lessons learned. These lessons must be converted into actions in order to mitigate the damagesustained and to enhance our responses to the damage from future
This is a synthesis of the presentations and discussions pertaining to Needs Assessments of the Conference, Health Aspects of the Tsunami Disaster in Asia, convened by the World Health Organization (WHO), in Phuket, Thailand, 04–06 May 2005. The topics discussed included: (1) Needs assessments; (2) Coordination; (3) Effectiveness of needs assessments; (4) Needs assessments change; (5) Qualifications for conducting needs assessments; (6) Dissemination; (7) Emergencies overlay background needs assessments; (8) Need for standards; and (9) Conclusions and recommendations.