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In accordance with the 1973 Emergency Medical Services Systems Act in the United States, one of the 15 functions to be performed by every EMS (Emergency Medical Services) system is disaster planning. The predicate of success in remediating such a macrosystem challenge as regional disaster planning requires the consensus of multidisciplinary health care and public safety human resources prior to the effective cataloging of physical resources. As the emergency physician is the medical leader of EMS system design and implementation, it is important that he explore newly developing disaster planning methodologies to facilitate consensus disaster planning.
Fluorocarbons, which strictly speaking should perhaps be termed perfluorocarbons or perfluorochemicals (PFCs), are organic compounds produced by extensive fluorination of relatively simple alphatic and aromatic chemicals. They have, over the last thirty or forty years, been used for a wide variety of purposes in both industrial and domestic fields. As a consequence of one of their physical properties, namely their high solubility for respiratory gases, they are being developed as constituents of oxygen transporting plasma substitutes. Preliminary trials are being carried out in Japan and the United States and PFCs may well be on the verge of entering routine clinical medicine.
Many disaster plans are based on the presence of a physician at the scene to perform triage. This requirement originated when there were no trained paramedical personnel in the field and may actually delay care in rural areas where a physician may not be readily available or may be the only physician at the hospital.
It is our hypothesis that properly trained Advanced Emergency Medical Technicians (AEMT's) may serve as triage officers for rural disasters with little difference, and perhaps improvement, in the outcomes of medical care. AEMT's are among the first responders to arrive at scenes of accidents and often triage from three to five trauma patients in multiple victim accidents on the highway. They are on duty, available and strategically located both day and night. The AEMT's are familiar with working under field conditions, i.e. at night by headlight, in rain, snow, and darkness, and know extrication procedures. They are aware of environmental hazards. They have radio and telemetry communication with a physician when needed.
Although road accidents account for about 17% of hospital emergencies, they are the third commonest cause of death. Polytrauma is the main cause of death below the age of 40 years. Legislative action and safety measures (i.e. speed restriction, safety belts, safety helmets) and improvement in the hospital emergency care system in Germany resulted in a continuous reduction in road accident victims from about 19,000 in 1979 to about 12,000 in 1983. Additionally, the fall in personal injury resulted in savings of about 7,900 DM (US $3,000) in cases of minor injury, 79,000 DM (30,000 US$) in cases of severe injury and about 685,000 DM (280,000 US$) in cases where lives were saved.
Health planning for disasters builds on an awareness of ways in which the disaster affects health and on anticipation of tasks to be performed by the health sector.
In view of the possibility of an earthquake of significant magnitude in Israel, and in the absence of previous earthquake experience, published data of earthquake health effects were studied, such as causes of death and injury, casualty rates and factors influencing these, distribution of injuries and their severity, effect on health care facilities and on physical, social and psychological environments. Implications of the studied data were applied to relevant conditions in Israel and to an earthquake there. A predisaster vulnerability assessment was thus obtained, pointing to the nature, size, and space and time distribution of tasks the health sector would be expected to perform should an earthquake occur in Israel.
On the basis of this assessment some recommendations for the preparation and preparedness of the health sector for such an occurrence are submitted.
On the night of April 11, 1984, the cyclone “Kamisy” struck the northern part of Madagascar. Because of the alarming reports from the disaster area, the League of Red Cross and Red Crescent Societies decided to send a disaster stand-by team. The results of the survey of the disaster area and the medical assistance are discussed. Attention is also given to the objectives of the disaster stand-by team.
In 1979, Eisenberg et al. evaluated the survival rate after an out-of-hospital cardiac arrest in a population of approximately half a million people. It was concluded that the survival rate definitely depended on the time before the initiation of cardiopulmonary resuscitation (CPR) and the time the definitive care was received. Both were equally important. The time limits found were four minutes for initiation of CPR and eight minutes for definitive care.
The various disorders resulting from heat stress can be understood and treated from an understanding of the underlying pathophysiology. Broadly speaking, they can arise as a result of excessive heat production from the body, or impairment of heat loss to the environment. The normal responses of the body to attempt to lose heat, peripheral vasodilation and sweating, are the root causes of the main disorders. In the tropics, the high environmental heat load leads to a spectrum of illnesses ranging from chronic exhaustion to acute and lethal heat stroke. Cooling and correction of fluid and electrolyte disturbances are the key to their treatment. In temperate climates, variants seen commonly occur in those imposing a metabolic heat load by endurance exercise. In these cases, there is some evidence that hyperventilation plays a role in their development, and this merits paper-bag rebreathing in addition to cooling and rehydration, during treatment. Those assisting at sporting events should attempt to stop competitors as soon as they show signs of heat exhaustion, and must be aware that almost all competitors will be hyperthermic towards the finish, and should be cooled and rehydrated as soon as possible.
Under the auspices of the Organization for Civil Defence, the Netherlands Red Cross and the National Union for Lifesaving and First Aid “The Orange Cross”, a training course in First Aid under Disaster Conditions was started in 1979.
This training course is meant for laymen, who, after having obtained their First Aid certificate, will participate in the medical care of disaster victims. The contents of the training course are discussed. In order to obtain a clear insight into the training course, attention is also paid to the Medical Disaster Relief Organization.
Fluorocarbons, or more strictly perfluorochemical (PFC) containing plasma substitutes have a high solubility for the respiratory gases, a desirable feature for a plasma substitute. This was dramatically demonstrated by their ability to sustain life for many hours in rats almost completely devoid of red cells. The ability of PFCs to carry oxygen exceeds that of other hemodilutents and they have been shown to produce better oxygenation under conditions of hemodilution than hydroxyethyl starch, dextran solutions or stroma-free hemoglobin solutions.