disaster medicine and epidemiology

8/13/2019 Disaster Medicine and Epidemiology

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Disaster medicine and

epidemiology

Graduate School of Medicine,

Kyoto Univ.

Satoko MITANI

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Definition of Disaster

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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The purpose of disaster medicine

is

to eliminate preventable death

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Preventable Trauma Death (PTD)

Death without access to appropriate treatment

Lives, which need not have been lost if

common treatment (ex., airway control,

release of tension pneumothorax) have beentaken

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Disaster cycle

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The warning phase

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Tsunami warning on 3.11, 2011

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Tsunami TEN DEN KO

Miracle on KAMAISHI

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Disaster cycle

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The impact phase

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To help yourself by yourself

Disaster cycle

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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 %.

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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

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Issues in regard to rough existenceof shelters

The Great East Japan Earthquake

Occurred on 11th March, 2011

At 10thJuly 2013

Death and missing: 18550 persons

Refuge : over 400,000 persons

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Triage tagreverse

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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

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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

Yellow tag

non-emergency treatment

Patients with no risk of lives, even with being late for takingcare

Patients who need hospital treatments, however, who showcomfortable vital signs

Patients who need operations, however, within six to twelvehours

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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 avoida miss of under-triage and changes in the condition.

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Used triage tags

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Goal of triage

Right Patient

Right Place

Right Time

Create priorities

assess the degree of urgency

MIMMS Advanced Course 38

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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disaster medicine and epidemiology

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