Disaster medicine - High altitude emergencies, Cold related emergencies, Crush syndrome Flashcards
Define ‘disaster’
WHO definition:
A serious disruption of the functioning of a
community or a society causing widespread
human, material, economic or environmental
losses , which exceed the ability of the affected
community or society to cope using its own
resources.
CRED definition:
“a situation or event, which overwhelms local capacity, necessitating a request to national or
international level for external assistance; an
unforeseen and often sudden event that
causes great damage, destruction and human
suffering”.
List types of disaster
Natural:
* Earthquake, landslide, tsunami, cyclones, flood or drought.
* Biological: epidemic disease, infestations of pests.
Man-made:
* Technological: chemical substance, radiological agents, transport crashes.
* Societal: conflict, stampedes, acts of terrorism.
Most prevalent reported disasters
Subtotal climato-, hydro-, meterological disasters
Floods
Transport accidents
Windstorms
Industrial accidents
Outline the disaster management cycle
Define the Sphere project minimum standard for basic disaster relief
Water, sanitation and hygiene promotion
- 2-4 gallons of portable water per person (including intake, hygiene and cooking needs)
- Maximum of 20 persons per toilet
- Handwashing and personal hygiene
- Avoiding mosquito exposure
- Solid waste management
Shelter
- Minimum space of 38 sqft per person
- Comfortable bedding
- Proper access for disabled
Define the sphere project minimum standard for medical relief
Health services
- Trauma care
- Mental health care
- Chronic illness care
- Handling remains of the dead
Outline the variation of needs and priority during acute phase of a disaster
List some communicable diseases associated with natural disasters
- Water-related communicable diseases
(diarrheal diseases, cholera, leptospirosis,
hepatitis A and E). - Diseases associated with overcrowding
(measles). - Vector-borne diseases (e.g., malaria, dengue).
- Other diseases (e.g., tetanus, fungal infections).
Healthcare provided at acute and recovery phase of disaster management
Disaster medical response in acute phase
- Search and rescue
- Triage and initial stabilization
- Definitive medical care
- Evacuation
Recovery phase:
Primary care
– Children: nutrition, immunization
– Women: child birth etc
– Chronic illnesses
Public Health
– Mental health
– Disease surveillance
– Prevent/Control outbreaks of infectious ds
Examples of mental health problems a/w disasters
Anxiety disorder/ Acute stress (ACU)
Moderate-severe Depression disorder (DEP)
PTSD
Psychosis
Epilepsy/Seizures
Intellectual disability
Suicide
Harmful substance abuse
Define the HK three tier emergency response system
- Tier 1: isolated events such as rescuing a
person from a car crash - Tier 2: an event with many casualties e.g. fire
in a high rise building - Tier 3: events having severe and widespread
consequences such as effects of a typhoon.
Parties involved in the rescue phase of HK emergency response system
- FSD (Ambulance): on-site rescue and transport of
casualties - The Police: establish a Command Post at the scene and
secure the outer cordoned zone surrounding the site. - Hospital Authority: provision of hospital services,
dispatch medical teams for on site triage and treatment - HAD: coordinate relief items with Social Welfare
Dept.(SWD), Housing Dept. and other agencies - EMSC: update Government senior officials
Structure within HA:
EEC = Emergency Executive Committee
CCC = Central Command Committee
MICC = Major Incident Control Centre
Is international support always needed for disaster relief
Issues with international response
- Depends on any unmet immediate needs after assessment
- The local population almost always covers immediate lifesaving needs
- Only medical personnel with skills not available in the affected country may be needed
e.g. foreign military support or resource support
Problems:
- Duplication of resource
- Fragmentation of support
- Inco-ordination
- Lack of relevant experience/ competence/ capacity
Foreign medical team (FMT) basic requirement
FMT trained using competency-based curriculum to provide care in austere environments
Sterilization: Basic steam autoclave or disposable equipment
Logistics: Self-sufficient team +/- OPD facility self sufficient
FMT size:
- At least 3 doctors specialists trained in emergency and primary care
- 1:3 doctor: nurse ratio
- Staff skilled in emergency and trauma care, maternal and child health, knowledge of endemic disease management
- FMT capacity: 100+ OP consultation per day for 2 weeks
Roles of foreign medical team
High altitude illness
Define high altitudes associated with altitude sickness
High: 2500-3500m, altitude sickness common when individual ascend rapidly
Very high: 3500-5800m, Altitude sickness common
Physiological changes at high altitude
- Hypobaric hypoxia (ambient PO2 decreases with lower barometric pressure at high altitude)
- Acute mountain sickness (AMS) S/S: Headache, Loss of appetite, Dizziness, Fatigue on minimal exertion, increasing tiredness, vomiting
- High altitude cerebral edema (HACE): Altered mental status (confusion, drowsiness, ataxia)
- High altitude pulmonary edema: Dyspnea at rest, moist
cough, rales, severe exercise limitation, cyanosis, tachypnea, tachycardia, desaturation
Diagnosis of acute mountain sickness
Treatment
Lake Louise AMS score: assesses severity of illness by questionnaire of symptoms during ascent
AMS Diagnosis:
- Altitude gain + Headache + Total symptoms score ≥ 3
Mild AMS:
* Descend ≥ 500m
* Acclimatization x 1-2/7
* Avoid ascent till s/s subsided
* Acetazolamide 125-250mg bd
Moderate AMS:
* Descend
* O2 (1-2L/min)
* Portable hyperbaric therapy (2-4psi) x 6hr
* Acetazolamide 125-250mg bd
* Dexamethasone 4mg Q6H IM/PO
Diagnosis of High Altitude Cerebral Edema (HACE)
Treatment
Lake Louise Criteria for HACE
- AMS + Altered mental status or Ataxis
or
- Altered mental status + Ataxia
Treatment
* Immediate descent/evacuation ≥ 1000m
* O2 to keep SpO2 ≥ 90%
* Dexamethasone 8mg stat IV/IM/PO, then 4mg Q6H
* Portable HBT if cannot descend
Examples of protable hyperbaric therapy
MoA
Gamow Bag Inflation
MoA: Positive pressure inflation into sealed body bag, increasing local pressure and relieving hyperbaric hypoxaemia
Pathophysiology of high altitude pulmonary edema
Define hypothermia and severity grades
Method of diagnosis
S/S
Hypothermia: Core body temperature
< 35C (or 95F)
Method of diagnosis: Low reading thermometer, Rectal temperature, Clinical S/S
Mild 32-35: Tachypnea, Tachycardia, Dysarthria, Shivering
Moderate 28-32: Loss of shivering, diminished consciousness
Severe <28: Coma, Loss of reflexes, Ventricular fibrillation
S/S when body temperature is between 37 - 33/ Mild hypothermia
S/S when body temperature is between 32-29/ Moderate hypothermia
S/S when body temp is below 28/ Severe hypothermia
Methods of active external rewarming
Methods of active core rewarm
Common injuries in victims trapped under collapsed structures
