Natural Disasters

Natural Disasters Tintinalli Chap. 7

Impact • 3,197 events worldwide between 1995-2004 • 1500-2.5 million deaths per event • Burden likely to rise • Increasing population in high-risk areas • Expanding technology • Loss of resources is uniformly present • Economic, social, health

Loss of Resources • Most natural disasters cause some disruption • Power • Communication • Transportation • Medical planning must include practical, simple alternatives • Runners

Disease Burden • Traumatic Injury • Infectious Disease • Chronic Medical Conditions • Mental Health Issues • Handling of Dead Bodies

Trauma • Occurs in Acute Phase • Direct trauma • Second spike during Recovery/Clean-up Phase • Surgical management may not be available

Infectious Disease • Most due to diseases common to the region • Combination of communicable disease and malnutrition • Most occur in Acute Phase • Risks heightened by mass population movement/resettlement, overcrowding, poverty, sanitation issues, absence of shelter, food, and health care • Respiratory, GI, skin/soft tissue, and vectorborne

Respiratory Illness • Causes • Direct aspiration of contaminated water • Airborne droplet transmission • Inhalation injury • Most are mild but may account for 20% of deaths in children < 5 • Most emerge several weeks postdisaster • Disaster victims and rescue workers are at risk

GI Illness • Diarrhea • ~ 40% of deaths in Acute Phase (80% children) • Peaks several weeks post-disaster • Generally mild

Skin and Soft Tissue Infections • Traumatic abrasions/lacerations • Acute Phase and Clean-up phase

Vectorborne Illness • Water-based disasters • Up to 8 weeks postdisaster • Occur in regions where disease is endemic • Yellow fever, malaria, dengue fever

Chronic Medical Conditions • May be the biggest unanticipated health threat to a postdisaster population • “Medication refill” or “chronic medical problem” is among the top 5 diagnoses made in disaster relief clinics • Separation from medications or health technology products • Removal from usual sources of care • Disruption of health care infrastructure

Mental Health • Often overlooked • Result of destruction of community/property, witnessing terrifying events, and disruption of normal life for days to years postdisaster • PTSD rose 10-fold after Hurricane Katrina • Psychological disorders may be exacerbated by physical illness/injury • Suicide rates may be elevated for years after a significant disaster

Hurricanes • Catastrophic Destruction • Wind forces • Water (storm surge or flooding) • More injury and death occur during recovery period than in the acute phase • Infections • Chronic medical conditions • Wounds and lacerations • Musculoskeletal injury and trauma • Rashes

Earthquakes • Inability to detect or provide a warning • Destroy water, electric, communication, gas/sewage lines, and cause structural instability • Most common injuries are fractures and crush injuries • Most fatalities occur within 3 hours • Citizens with special needs are at increased risk

Tornadoes • 800 tornadoes are sighted annually in U.S. • Annual human toll is 80 deaths and 1500 injuries • Unusual to lose entire region of power, communications, or medical infrastructure • Tornado warning systems have dramatically reduced injury and loss of life • Injuries • Commonly multisystem • Fractures and soft tissue trauma are most common • Head injuries are most common cause of death

Floods and Tsunamis • Extremely Destructive • Short, if any, warning • Acute injuries • Sheer force of water • Drowning • Trauma from falling objects • Illnesses • Respiratory illness is most common • Can be severe – “tsunami lung” • GI illness is rare • Infection of skin wounds

Blizzards and Snow Disasters • ED volumes do not significantly increase • Shift in presenting complaints • Injuries • Slipping on ice • Clearing snow • Falling off ladders • Carbon monoxide poisoning • Kerosene/propane heaters in basement, attached porch/garage • MI and angina

Natural Disasters