Previous SAQs Flashcards
Relief (humanitarian) agencies usually classified under 4 broad headings. List any two of them.
International
National or Governmental
Non Governmental (NGO)
Military
List 4 leading NGOs involved in relief work
MSF Doctors without Borders MERLIN RedR Save The Children CAFOD CARE OXFAM (vital needs) MdM War Child Leonard Cheshire Mercy Corps (rebuild capacity, employment, economy)
In 2005 the United Nations introduced a new disaster response initiative aimed at enhancing international relief efforts following disasters and complex humanitarian emergencies. What was this initiative?
The United Nations Cluster Systems.
Extra: Aimed to eliminate gaps in the humanitarian response, improving efficiency. Each cluster is a minisector that operators during a humanitarian disaster, lead by a cluster lead who acts as the provider of last resort and is responsible for policy setting and ensuring readiness by building technical capacity e.g. WFP may take lead for food and nutrition.
Specifically what was the 2005 United Nations disaster response initiative intended to achieve. List three improvements.
- Improved liaison and co-ordination with Government of affected country
- Allocation of responsibilities to named agencies agreed in advance
- Named agencies to be “providers of last resort”
- Prevention of duplication of effort by expatriate relief agencies
- Cluster leads responsible for improving training and preparedness for future disasters
Describe briefly the elements of an ‘‘initial assessment’’ as part of MSFs ‘‘Top 10 priorities for intervention’’.
This involves establishing health priorities based on a rapid collection and analysis of data concerning population at risk, age ranges, endemic and emerging health threats and needs in terms of human and material..
What are MSF’s ‘‘top 10 priorities for intervention’’, during an emergency..
Measles immunization Water and sanitation Food and nutrition Shelter and site planning Health Care Control of communicable disease and epidemics Public health surveillance Human resources and training Coordination of effort
List some life threatening communicable diseases commonly observed during an emergency.
Measles
Diarrhoeal diseases
Acute respiratory infections
Malaria
During the MSF Top 10 priorities for intervention, there is a requirement for an urgent mass vaccination programme. What is the most likely disease, and which age group should be vaccinated?
Malaria - 6 months to 15 years.
What vitamin is commonly given with a measles vaccination?
Vitamin A.
During the initial phase of a crisis what is the recommended absolute minimum water volume required by an adult for survival? As agencies differ on this a range is accepted
The range varies from 3 to 7 litres per day (WHO recommends 5 litres)
As the crisis develops there will be an additional need for water for food preparation, personal hygiene and clothes washing. What is the water volume range recommended for this?
The range now is from 7 to 20 litres (Sphere suggests 7 to 15 litres)
With time water needs will rise almost exponentially during a disaster or conflict. There are many situations and places causing this rise in need. List three.
Medical Centres Hospitals (Operating theatres and ITUs make huge demands) Cholera and diarrhoea treatment areas Public Laundries Public toilets – hand washing and cleaning Feeding (Malnutrition) Centres Farms and livestock Perineal cleaning
In crises local water supplies are often contaminated and water requires to be treated. List 3 ways in which may be treated to make it safe for drinking.
Sedimentation in a tank or large container
Exposure to UV rays
Filtration
Added chemicals – typically use of halogens
Boiling
Reverse osmosis
What are the legal consequences of failing to identify the dead, during a disaster?
Inheritance of property/money – 1 mark
Relatives unable to claim compensation - 1 mark
Life insurance not paid – 1 mark
Marital state of surviving next of kin – I mark
If foreigners involved – there will be repatriation and diplomatic issue – I mark
Are there health implications surrounding dead bodies in sudden impact disaster? Write two short sentences to support your answer
In most situations the answer is no.
Few pathogenic microorganisms survive death of the host person
Decay and smell from cadavers due to non-pathogenic bacteria.
Those most at risk are those handling the deceased (body handlers)
Most risk of disease comes from the living
What precautions should body handlers take during a disaster?
List 3 measures taken to reduce risk
Hepatitis B vaccination
Wearing of Gloves
Wearing of Gowns
Use of Eye protection
Disposal/disinfection of gloves, gowns and eye protectors
Hand washing after handling and before eating
Wash down/disinfection of vehicles and equipment
There is a generally agree code of practice when handling dead bodies
List any two of the recommendations
Treat the dead with dignity and respect
Work within local religious and cultural mores
Where possible use body bags
Do not use disinfects (Lime for example)
New burial sites sited at least 250 m from drinking water sources and 0.7 m above saturated zone
what is the goal of fluid resuscitation for trauma?
The goal of fluid resuscitation for trauma is to restore cellular and organ
Perfusion [3 marks]
List four commonly used resuscitation fluids.
Isotonic or Normal Saline [1 mark]
Hartmann’s Solution or Lactated Ringers solution [1 mark]
Gelatin solutions – (Haemaccel for example) [1 mark]
Dextrans [1 mark]
Starch solutions [1 mark]
Albumin [1 mark]
Fresh Frozen Plasma[1 mark]
Fresh whole blood [1 mark]
Stored packed red blood cells (PRBC) [1 mark]
It is common practice to give a shocked trauma victim an initial fluid bolus of warmed (if possible) isotonic electrolyte solution such as Ringer Lactate or Normal Saline. What is the initial dose range for an adult? What is the usual dose for a child?
For an adult the initial bolus is one or two litres [2 marks]
For a child the amount of initial bolus is calculated by the formula 20 ml per kilogram body weight [2 marks
List five considerations in choosing between alternate sources for water supply for the refugees [5 marks]
Volume available [1 mark] Reliability of supply [1 mark] Quality of supply [1 mark] Contamination risk [1 mark] Water rights of local people [1 mark] Speed at which supply can be made operational (ready for use) [1 mark] Simplicity of technology needed [1 mark] Ease of maintenance [1 mark] Cost [1 mark]
List three potential sources of water in the refugee setting [3 marks]
Rainwater [1 mark] Spring water [1 mark] Surface water [1 mark] Dug wells [1 mark] Bore holes [1 mark] Municipal supplies [1 mark] Private supplies [1 mark] Commercially available bottles water [1 mark]
List 2 methods you might use to ensure water is safe for drinking {2 marks]
Pre-chlorination [1 mark] Filtration [1 mark] Disinfection [1 mark] Aeration [1 mark] Sedimentation [1 mark]
What is the definition of a refugee in international law?
A refugee is someone who has been forced to flee his or her country because of persecution (e.g. race, religion, nationality, political views), war, or violence – and is unable to return based on these factors
What is definition of an Internally Displaced Person (IDP) in international law?
Persons or groups of persons who have been forced or obliged to flee or to leave their homes or places of habitual residence, in particular as a result of or in order to avoid the effects of armed conflict, situations of generalized violence, violations of human rights or natural or human-made disasters, and who have not crossed an internationally recognized border.
Why is the distinction between refugee and internally displaced person important, under international law?
IDP have no protection under the 1951 Refugee convention
Which UN Organisation is charged with maintaining the rights of refugees?
UNHCR – UN high commissioner for refugees
Please define triage.
Triage is the prioritization process of patients for transport, medical treatment and management, based on and in proportion to need, but also on prognosis and resources required.
What does triage have as its main aim?
Triage aims to do the most for the most, by providing the right care to the right person at the right time
What do the following triage allocations mean?
- yellow or orange label
- delayed group
- white or black label
- T1 or P1
Yellow or orange label – urgent patients or major injury, but can tolerate a moderate delay in treatment (2 hours)
Delayed group- minor injuries who can tolerate a indefinite delay on treatment
White or black label – deceased patient
T1 or P1 – patients who require immediate life and limb saving treatment
In the context of triage what is the difference between a ‘Multiple Casualty’ and a ‘Mass Casualty’ situation’? Please describe in one sentence
Multiple casualty is when the resources of the health care system can cope, while mass casualty is when the hospital is overwhelmed and resources are saturated due such high numbers of patients.
Viral Haemorrhagic Fever (VHFs) are not frequently encountered in disaster settings and are widely feared. WHFs encompass a wide range of different diseases. List any three.
Lassa Fever, Rift Valley Fever, Yellow Fever.
What vectors can transport Viral Haemorrhagic Fevers? Give two examples.
Mosquito’s and Monkeys
A lethal triad of pathologies is present in severe cases of Viral Haemorrhagic fevers. List the three aspects of this triad.
- Impaired cardiac function
- capillary permeability
- impaired coagulation
What are the five preventative measures used to prevent or control/mitigate an outbreak of Viral Haemorrhagic Fever?
- Isolation of patients
- Vaccination (yellow fever)
- Hygiene and health education
- Control of reservoirs/vectors
What sequence of activities comprise the primary survey?
A - Airway B - Breathing C - Circulation D - Disability E - Environment
Following a successfully completed Primary Survey and concurrent resuscitation activities management continues by performing a Secondary Survey. List the sequence of activities that comprise this survey.
Full history, full physical examination, full neurological exam, Event/mechanism of injury, other examinations such as CT, re-evaluation of patient
There are many factors which predispose to an outbreak of GI disease. List three of them.
Infrastructure damage – water/sanitation/health, contamination of water supplies, overcrowding, break down of hygiene
Medical staff working during an outbreak of GI disease refer to the big three – Cholera, Dysentery and Typhoid (Also called Enteric fever). What is the cause of Cholera, what are its main symptoms and what is the cornerstone of therapy for most victims?
Cause of cholera is a bacteria called Vibrio. Main symptoms is sudden onset profuse diarrhoea, N V, and cramps. Therapy is based on rehydration, then in severe cases antibiotics.
How is Cholera transmitted?
Through feco-oral route, e.g. contaminated food/water, or unclean environment
How is Cholera diagnosed in a refugee/IDP camp?
Acute watery diarrhoea leading to severe dehydration or death
What measures can be taken to prevent mosquito bites?
Long sleeved shirt between dusk and dawn
Long trousers as above
Anti mosquito screens for doors and windows
Use of impregnated bed nets
Accommodation well clear of water sources
Insect repellents
What measures can be taken to reduce mosquito numbers?
Residual spraying Fogging (Swing fog) Physical destruction of breeding sites Larvicides Stocking water sources with fish
Is there any additional measure an expatriate humanitarian volunteer can use to prevent malaria?
Chemoprophylaxis treatment
The area or region deployed will determine which medication is used.
The Private Military and Security Companies (PMSCs) are involved in a wide range of activities in the current operational environment. List two of them.
specialist security provision and close protection capabilities
provision of advice and training packages,
training of local police forces,
logistical support, including medical provision,
specialist advice with de-mining and monitoring roles in peace keeping.
PMSCs broadly breakdown into 2 groups – Private Military Companies and Private Security Companies. Provide a short definition for each
Private military companies (PMCs) – corporate entities providing offensive services designed to have a military impact in a given .situation that are generally contracted by governments (2 marks)
Private security companies (PSCs) – corporate entities providing defensive services to protect individuals and property, frequently used by multinational companies in the extractive sector, humanitarian agencies and individuals in situations of conflict or instability (2 marks)
There are compelling reasons who Governments employ PMSCs rather than use their Military Forces. List 2 reasons.
Use of PMSCs is cheaper that employing soldiers
Dead and injured PMSCs provoke little or no outcry from the media and the public
Using PMSCs lowers overall mortality and morbidity among the Military
Use of PMSCs creates economic opportunities in war afflicted countries
PMSCs are growing in number and size. List any 2.
Executive outcomes Blackwater Aegis DynCorp Sandline Kellog, brown and root
List 3 major threats to women’s health in conflicts and catastrophes.
- Female genital mutilation or female circumcision
- Early marriage
- Early age at childbirth/first pregnancy
- Multiparity
- Vulnerability to abduction and rape
Malnutrition (lack of food/water)
Childbirth is particularly dangerous during in conflicts and catastrophes. List three common complications likely to be seen by carers?
- Obstetric fistula
- Perineal injury/tears
- Uterine prolapse
- Incontinence
- Puerperal infection/sepsis
- Unrecognised hypertension
- Death from haemorrhage
- Depression/suicide
List two factors related to increased maternal mortality in conflicts and catastrophes?
- Violence
- no access to ante-natal care
- Lack of access to education
- no access to general health care
- early marriage and adolescent pregnancy
Obstetric fistula is a very common finding in conflict and catastrophe settings. Please list 2 particular features of this obstetric complication?
- Urine and or faeces per vagina
- 2 million women live with fistula
- early death
- readily treatable by gynaecologists
- 20:1 morbidity to death ratio
- social exclusion ‘better off dead’
- limited or no access to healthcare
Acting as a leader in Disaster Medicine you are asked to prepare a brief on the topic. You should use authoritative sources of information. List two of these sources.
UK Foreign and Commonwealth Office Travel Warnings
US State Dept Travel Advice
ICRC handbook on Staying Alive
Aid workers Network guide to field security
National Travel Network and Centre
RedR’s Safety & Security Advice
Trainers in the field of Disaster Medicine use the seven ‘P’s in the planning process. The first three are Prior Preparation Planning.. list the next four.
Prevents Pathetically Poor Performance
