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Definition of Disaster Disaster medicine and epidemiology

Graduate School of Medicine, Kyoto Univ. Satoko MITANI
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an occurrence of a severity and magnitude that normally results in deaths, injuries, and property damage and that cannot be managed through the routine procedures and resources of government. It requires immediate, coordinated, and effective response by multiple government and private sector organizations to meet human needs and speed recovery. (FEMA,1984)
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Preventable Trauma Death (PTD)

The purpose of disaster medicine

Death without access to appropriate treatment Lives, which need not have been lost if common treatment (ex., airway control, release of tension pneumothorax) have been taken

is to eliminate preventable death

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Disaster cycle

The warning phase

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Tsunami warning on 3.11, 2011

Tsunami TEN DEN KO

Miracle on KAMAISHI

Disaster cycle

The impact phase

To help yourself by yourself

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Disaster cycle

The emergency phase

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The wall of 72 hours

Probability of survival of buried victims
rescued within 24 hours : 60% after 72 hours: around 10 %.

Disaster cycle

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Sub-acute phase
Two or three weeks after the event For patients with chronic disease
hypertension, diabetes, cardiac disease, mental disorder A patient with kidney disease who requires dialysis treatment should be transported to outside of the affected area Psychological issues: ASD, PTSD Infectious diseases
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Psychological issues
grief, distress, insomnia, hopelessness, and intrusive re-experience are normal responses under the abnormal situation like a disaster.

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Vulnerable people in sub-acute phase

The disability persons Patients with chronic disease Pregnant female Children The aged persons Foreigners, travelers

The Great East Japan Earthquake

Occurred on 11th March, 2011 At 10th July 2013
Death and missing: 18550 persons Refuge : over 400,000 persons

Issues in regard to rough existence of shelters

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Latrine one for every twenty displaced persons

A Shelter

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Water

Foods
The appropriate diet for a person per a day : 1,900 to 2,500 kilo calorie Attention to the special needs
the aged the disabled Sugar for diabetes patients Salt for hypertension patients

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Disaster cycle

The reconstruction or rehabilitation phase

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Conclusion about disaster medicine

Emergency phase/Acute phase
the wall of 72 hours Emergency medicine : injured, crush syndrome

CSCATTT

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Sub-acute phase
Chronic diseases, infectious disease Public health issues Psychological care

Chronic phase
Psychological care Reconstruction of community health care

C: command and control S: safety C: communication A: assessment T: triage T: treatment T: transport

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Ts
Triage Treatment Transport
urgency and severity

Triage
To define the priority of treatment according to the degree of

Death or non-treatment The highest priority Non-emergency treatment Minor injury

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Emergency phase
To eliminate preventable death Not to aim to help all victims Care first a man who will be able to be rescued under limited medical resources To define a priority is the most important Triage is a way to define a priority
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Triage tagsurface

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Triage tagreverse

Used triage tags

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Black tag Death or non-treatment 1. Already died 2. No chance of successful resuscitation even with cardiopulmonary resuscitation 3. The last order of transport, of non-transport However, black tag does not confirm a death in medical diagnosis
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Red tag The highest priority

Patients who need emergency care to life-saving Patients who have risk of asphyxia, severe hemorrhaging, and shock
<examples> impaired consciousness, airflow obstruction, breathing difficulty, shock, severe hemorrhage, open wound of chest, pneumohemothorax, intra-abdominal hemorrhage, multiple born fracture, crush syndrome, multiple trauma, extensive burn, burn of the respiratory tract
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Yellow tag non-emergency treatment

Patients with no risk of lives, even with being late for taking care Patients who need hospital treatments, however, who show comfortable vital signs Patients who need operations, however, within six to twelve hours

Green tag minor injury

Non-need for medical treatment by specialist physician Sufficient to be treated at outpatient department Patients who can walk by themselves
Examples: Born fracture of four limbs, abarticulation, bruise, sprain, abraded wound, incision wound, slight burn, hyperventilation syndrome

Even if being triaged to green tag, do not send them home right away, but gather them to one place, and re-triage them, to avoid a miss of under-triage and changes in the condition.
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Used triage tags

Goal of triage
Right Patient Right Place Right Time Create priorities assess the degree of urgency
MIMMS Advanced Course
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Report
Describe about the systems of disaster medical response in your country, which you think the most important and emergency to prepare. Express your opinion.

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