INTRODUCTION AND EPIDEMIOLOGY
Natural disasters continue to be an unpredictable source of worldwide morbidity and mortality and present unique challenges for practitioners of emergency care. The 2002 to 2011 annual average worldwide mortality rate was 107,000 deaths/year from natural disasters, with an average of 268 million worldwide victims per year during the same time period and an economic cost of $143 billion in 2012.1 With the increase in rapidly mobilized recovery teams, emergency physicians are at the forefront of patient care following a natural disaster. It is here that we can have the greatest impact in treating survivors and minimizing secondary morbidity and mortality, often in the setting of a significantly impaired healthcare system. Research suggests that the burden of natural disasters is likely to rise in the coming years, due to increasing population density in high-risk areas and risks associated with expanding technology (e.g., fires or earthquakes in larger and taller buildings or critical infrastructure).2
Although the mechanics, warning period, and impact vary widely between types of natural disasters, there is a predictable pattern of events that occur and may be used to maximize the subsequent response. Natural disasters result in a combined loss of resources—infrastructure, economic, social, and health. While this may be tempered by pre-event preparedness and infrastructure strength, this combination of resource loss has a synergistic impact on the health of and the delivery of health care to the affected population. Another commonality is the predictable pattern of pathology, seen in the progression from the impact of the event itself, through the acute aftermath, to the immediate postdisaster phase, into the recovery phase (Table 6-1). Perhaps most salient for emergency practitioners, relief efforts can be implemented based on data from previous disaster experience, while simultaneously being tailored to the type of disaster (e.g., hurricane, earthquake, tornado, flood, tsunami, or snow) and region affected. Finally, disaster responders should be prepared to face the duty of management of dead bodies, on a scale otherwise only seen in the setting of combat.
TABLE 6-1Timing of Disease Presentation ||Download (.pdf) TABLE 6-1 Timing of Disease Presentation
|Timing of Onset ||Presentation |
|Acute phase ||Trauma ||Stress reactions ||Drowning ||Inhalational injury ||Burns || || |
|Immediate postevent phase ||Infectious complications of trauma ||Exacerbation of chronic disease ||Acute stress disorder ||Burns ||Inhalational injury || || |
|Recovery phase ||Trauma ||Communicable disease ||Infectious complications of trauma ||Soft tissue infections ||Exacerbation of chronic disease ||Vectorborne disease ||Posttraumatic stress disorder |
Most natural disasters—whether by water, wind, fire, or snow—cause some disruption of power, communication, and transportation systems. In developed and developing nations, entire cities can be destroyed instantly, overwhelming nearby healthcare facilities and personnel. In such cases, the traditional triage system may not be effective.3 A Centers for Disease Control and Prevention posthurricane assessment in 2012 determined that most of the resulting public health emergencies ...