Steve Berman MD, FAAP, Professor of Pediatrics and Director,

Center for Global Health,School of Public Health,

University of Colorado Denver

Understand what makes a disasterRecognize the components of disaster responseUnderstand the need for disaster preparedness and trainingLearn about the AAP/PAHO “Pediatrics in Disaster” training program

Disaster:A disaster is an event that most often occurs suddenly and

unexpectedly, causing trauma to people and/or severe

damage to the environment, and exceeds or overwhelms the

response capacity of the affected community.

Risk = Hazard x Vulnerability/Capacity

NATURAL FORCES

TECHNOLOGICAL

• Industrialaccidents

• Conflict / Civil war• Displaced population• Severe infrastructure

losses• Significant securityproblems

Climatic / Geological

COMPLEX EMERGENCY

TRIGGERING EVENTS

MASSIVE REPRESSION OR TERRORISM

• Massive destructionweapons

• Chemical orbiological weapons

• Attacks on civilianpopulation

HUMAN ORIGIN

ChildrenWomenElderly Disabled

Their developmental statusLack of experience and knowledge about how to seek helpLack of insight regarding their own distress.

The psychological and emotional needs of children are often neglected following disasters, particularly when parents and other adults in their lives are having trouble coping with the event themselves.

Physical victimization• Rape• Torture• Robbery

Exploitation• Child labor• Child trafficking and sex trade• Soldiering

Destroyed roads, lack of electricity, inoperable telephone communications, difficult terrain, high altitudes and harsh weather make it difficult to know what is happening in the affected areasYou serve as a consultant helping to organize and coordinate the emergency response

What is your first recommendation?

Within 48 hours rapid assessment teams are flown into the affected areas by military helicopter Doctors, nurses, surgeons, kidney specialistsPsychologistsSocial workersLogisticiansWater and sanitation expertsFlight-transport specialists

Tens of thousands of people are affected and are sleeping outside with little shelter from cold and rainThousands have severe wounds including fractures, spinal cord injuries, crush injuries, lacerations, and infectionsMost hospitals have been destroyed

What do you recommend?

Organize the transport of supplies to the affected areas by helicopterShelter materials• blankets• sleeping mats• winterized tents

Water Tanks and PumpsFood supplies

Set up field hospitals and medical tents to relieve partially functioning hospitalsArrange transport of critical patients from affected areas to out of area hospitalsObtain additional dialysis machines to handle large numbers of patients with renal failure secondary to “crush” injuries Provide mental heath services and counseling (psychologists)

1. Prevention/ Mitigation

2. Preparedness

3. Emergency response

4. Recovery

PHASES OF DISASTER MANAGEMENT

Address vulnerabilities

Minimize risks

Manage disaster

Do a rapid assessment of the affected population

USA Guatemala

1. Local assessment teams trained and in place

Fail Fail

2. External assessment teams able to quickly respond

Fail Fail

3. Secure communications system in place and used

Fail Fail

4. Secure transportation system available and used

Fail Fail

USA Guatemala

2. Provide adequate shelter and clothing

Pass Pass

3. Provide adequate food Fail Fail

4. Provide elementary sanitation and clean water

Fail Fail

5. Institute a diarrhea control program

Pass Pass

USA Guatemala

6. Immunize against Measles when appropriate

Pass Pass

7. Re-establish and improve primary care medical treatment

Fail Fail

8. Establish disease surveillance and a health information system to monitor effectiveness of health interventions and realign priorities

Pass Pass

USA Guatemala

9. Organize human resources Fail Fail

10. Coordinate Activities Fail Fail

Overall Fail Fail

Disaster response training at the local level should be a community process involving the health sector (physicians, nurses, hospital, health clinics, private physicians), municipal agencies (fire department , police, sanitation and garbage)) disaster response agencies (CONRED, red cross) schools, churches, and community groups such as the Rotary and Lions clubs).

Educate Pediatricians, physicians, nurses, other health care

personnel, rescue teams and community workers about the

needs of children in disaster preparedness and emergency

response.

Establish national and regional PEDS training centers to carry

out “train the trainer” activities.

Facilitate collaborations among professional societies, PAHO,

hospitals, medical schools, and local, regional, and national

governmental agencies related to pediatric disaster

preparedness and response.

American Academy of Pediatrics (AAP)Pan American Health Organization (PAHO) and World Health OrganizationLatin American Pediatric Society (ALAPE)Association for Health Research & Development (ACINDES)Project VietnamHealth ministries Johnson and Johnson Pediatric InstituteCase Western program and faculty

Disasters and their effects upon the population: Key conceptsPreventive medicine in humanitarian emergenciesPlanning and triage in the disaster scenarioPediatric traumaManagement of prevalent infections in children following a disaster

Diarrhea and dehydrationDelivery and immediate neonatal careNutrition and malnutritionThe emotional impact of disasters in children and their familiesToxic exposures

Training manualLecture slidesFacilitator guideStudent workbook of exercisesPretest and posttest examinationsEvaluations of lectures, exercises, and overall course6 month post survey

Training manual provided prior to the courseLectures Problem based small group learning• Scenarios appropriate for training site

Technical skills training (toxic exposures, trauma and newborn care)Final simulation and integration exercises

China (2 courses), Vietnam (2), Qatar (1), Mexico (2), Panama (3), Peru (1) and Ecuador (1)• Planning phase: Philippines, Nicaragua, Haiti

Course materials are now available in English, Spanish, Chinese, and Vietnamese• In process: French and Creole

A little useful15%

Somewhat

useful39%

Very useful46%

some what useful25%

very useful75%

not at all 

useful10%

very useful90%

USAChina

Vietnam

ORGANIZATION AT THE SITE OF A DISASTER

FIELD MASS CASUALTY MANAGEMENT

Access

• Strictly restricted

• Restricted / reserved

• Patient flow

•Transport resource flow (“conveyor belt” management)

Hos

pit

al

Impact zoneTriage

Command post

AMP

Collecting zoneCollecting zone

Evacuation

Decisions made based on saving lives and the availability of resources

Primary triage concerned only with clinical condition regardless of age

Quick and limited assessment of victims

Examine all victims in a short period of time

Categories:

Immediate: Respiratory rate (RR) <15 or >45 rpm, after airway positioning and/or rescue ventilations

Delayed: Alert or responsive to voice, and RR: 15-45 rpm

Minimal: Able to walk

Deceased: No breathing nor pulse after airway positioning

JumpSTART©

Impact ZoneTriage

Collection Zone

Green Yellow/Red

Decontamination Zone

Waiting Area

Advanced Medical Post

Evacuation Area

Hospital Emergency Department

Ambulance

HOT

Warm

PERSONAL NEEDED23 Total:1. Command Post=22. Impact Zone=53. Decontamination Zone=44. Advanced Medical Post=5

• Triage (1)• Coordinator (1)• Doctors (3)

5. Evacuation Area=36. Hospital Emergency 

Department=4

Triage

Triage

Triage

Command Post

COLD

You are working as a local emergency dispatch worker when you are notified that a bomb has gone off at a nearby outside crowded market place. There appear to be fatalities and some survivors are complaining of nausea with and without vomiting. You and your team proceed to the scene where it is determined that there is radiation exposure from a dirty bomb.

1. With the given history, what are some things you should be worried about?

2. What protective gear should you wear?3. How should your ambulance approach

the scene?4. What dangers are you personally at risk

for?

You enter the market place and find several people standing around looking dazed and one person is vomiting. You identify close by a hysterical young mother with a crying infant in her arms; a man, around 20 years old, and a pre-school age girl are lying on the ground with obvious injuries and bleeding, but they both appear conscious. One woman looks badly injured, she is not responsive and without a detectable pulse.

5. What are the next actions to be taken now and why?6. Who do you tend to first and why? 7. What other things should you consider while providing aid to the victims in the hot zone?

8. Do you decontaminate the victims in the hot zone?9. How should the victims be decontaminated?10. What should be done with open wounds? 11. What should you do at the end of your shift to protect yourself and the rest of your crew from secondary contamination?

12. How do you assess and stabilize and transport the victims

13. What clinical clues are useful to determine the extent of the radiation exposure?14. What is the most likely clinical course of victims of radiation exposure?15. What are the indications for the use of potassium iodide therapy in children’s radiation exposure?