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Guest Editorial: Understanding and preparing for disasters and catastrophic emergencies

2009; Wiley; Volume: 11; Issue: 4 Linguagem: Inglês

10.1111/j.1442-2018.2009.00494_2.x

1442-2018

Paul Arbon,

Viral Infections and Outbreaks Research

Many people associate the health response to a disaster with emergency care, surgery, and the urgent treatment of life-threatening injury. For most of us, our experience of disaster, and disaster health care, is limited to the images and stories that we see in the mainstream media. Television footage is usually focused on the work of surgical teams and at the site of temporary field hospitals. However, the surgical and emergency care response to disasters has a relatively limited impact on the health and recovery of affected communities, except, of course, at the level of those fortunate enough to receive life-saving treatment in a timely way. Surgical teams generally arrive a little too late to save life and generally cease to have much influence on survival and longer-term recovery a few days or weeks after the impact of a disaster. The real work in preparing for and recovering from disaster is done by community members and health practitioners. They have an important role to play in developing the capacity and resilience of communities so that they are well prepared and, when disaster strikes, in re-establishing health-care services and providing the rehabilitation and ongoing care that is required by survivors. It is these inputs that have the greatest impact on the survival and recovery of affected populations. As a result, the role of nurses and other health-care professionals across a broad range of specialties and during all phases of a disaster should not be underestimated. There is no widely accepted definition of disaster. For example, a study by Debacker et al. (1999) found > 100 definitions in general use. In the context of health-care planning and response, the definition provided by the International Federation of the Red Cross (IFRC, 2009) is appropriate: A disaster is a sudden, calamitous event that seriously disrupts the functioning of a community or society and causes human, material, and economic or environmental losses that exceed the community's or society's ability to cope using its own resources. Though often caused by nature, disasters can have human origins. All disasters are related to specific hazards and have been categorized as: (i) natural; (ii) mixed (natural and human-induced); and (iii) human-induced (WADEM, 2003). It was estimated by the Centre for Research on the Epidemiology of Disasters (CRED, 2007) that in the past 50 years, > 10 000 disasters have occurred, > 5 billion people have been affected, and > 12 million persons were killed, at an economic cost of > $US4 trillion. Disasters continue to occur and the frequency of these catastrophic occurrences is increasing (CRED, 2007). In addition, the impact of disasters is becoming more severe as more people live in close proximity to possible impact zones (such as "sea change" locations near to the coast), in more crowded situations, and with greater reliance on the community for essential services. In many countries, population transitions and growth have not been accompanied by adequate development of the infrastructure and degradation of the environment has increased the impact of disasters. These statistics amplify the importance of sound disaster planning and mitigation efforts. Included in these efforts is the preparation of the health workforce and the communities in which we live to respond effectively in time of a disaster. Though it is clear that we have much work to do to develop the science of disaster relief, we do know that the best response lies in the development of the level of preparedness of a community. It is likely that efforts to build the capacity and capability of communities to withstand the impact of a disaster will make the greatest contribution to the ability of that community to survive well, or at least relatively well, through a disaster impact. To understand why this is so, it is useful to consider how disasters develop and what influences the scale and the degree of damage and consequent harm to society. A disaster represents a level of damage that overwhelms normal societal functions and threatens one or more of the basic functions of society such as public safety, health, transport and logistics, food and water supplies, and other essential utilities such as power (WADEM, 2003). However, the level of damage is determined by the interaction between our understanding of the hazards and risks confronting the community, our efforts to strengthen our protection from these potential events, the size or strength of the impact when it does occur, and the effectiveness of our response and recovery work. A variety of current and emerging threats can be identified in any community. Threats, such as bushfire and flood, would be considered to be most significant in some communities, while other emerging threats, such as pandemic influenza and terrorist attacks, also might be important. Comprehensive risk assessments assist health-care organizations to identify those threats that have the greatest likelihood of occurrence and the greatest risk of significant harm in their community or region. The identified threats should underpin the development of specific plans that will assist health-care organizations in undertaking work to prevent or mitigate the impact, to prepare and plan for a response, and ultimately, in assisting the recovery of the community. To deal with disaster, we need to plan and prepare adequately to confront the hazards identified in our environment, respond effectively, provide relief when our community or our neighbors are impacted, and be ready to assist in the recovery and redevelopment of the community after disaster. It is argued that these phases may overlap; for example, the recovery effort may begin at the same time as the relief effort and may be understood as a cycle, or feedback loop, in which development supports future preparedness in an ongoing fashion. As a result, during community development, we hope that we have learned lessons from past experience of disaster and that new structures and arrangements are built up to better protect the community from any future disaster. A further key concept relates to building social (community) resilience. Hazards, once identified, lead to risk-modification activities. Hazards can be modified or "treated" to reduce the likelihood that they will "occur". Should they occur, an event might produce less damage if the absorbing capacity of the community has been strengthened. The absorbing capacity is defined as the ability to absorb the free energy of an event without sustaining damage. In fact, this means that actions taken before the event, such as building levees or reforestation, will work to reduce the level of damage that otherwise might have resulted from a specific impact. The damage might result in more or less change (loss) of function and buffering capacity will reduce the effect of the loss of function. Buffering capacity is defined as the ability of a society (community) to cope with damage and to function despite damage. For example, should the local power grid fail due to damage arising from an event, the operation of on-site generators would be considered to be buffering capacity. Finally, changes in function not able to be ameliorated by risk modification, and the steps taken to bolster the absorbing capacity and buffering capacity, might result in a disaster and require response capacity. The response capacity is defined as the capacity to provide extra and/or external aid to provide or sustain essential services and to respond to the effect of the damage caused by the disaster. These concepts lead us to the conclusion that a disaster is the endpoint of a process and that planning, preparation, and community development might defeat, or at least minimize, the damage caused to the community. In a simple example, a community that has built levees to withstand a serious rise in river levels might not sustain any damage at all when the 100 year rainstorm occurs. Another community, perhaps further downstream, where such preparations have not been taken, might experience a truly disastrous flood. Disasters will overwhelm the capacity of public safety and health-care agencies, at least in the short term, and it will be necessary for communities to have some capability to manage through these situations until other services can recover their ability to respond. Frequently, individuals will need to look out for themselves and for each other until the situation has stabilized. It is recognized that the heath-care workforce is generally poorly prepared to work in disaster situations. There is little understanding of the health impacts of disaster, of roles, of response coordination, or of the context and situation in which the response must occur. Internationally, access to, and the uptake of, basic education to increase health workforce capability is poor and there is an urgent need for accessible, basic, and relevant education and resources. Learning about the health effects of disasters and the clinical practices used during a disaster response are likely to be hampered by severe misconceptions about disasters. Our understanding of the true effects of a disaster on populations often is influenced by a pervasive set of myths about the health effects of a disaster. Among the myths associated with disasters is the idea that disasters bring out the worst in human behavior; in fact, although people are shocked and wonder why they survived and others died, their resilience is generally extraordinary and the stories of goodwill and support that arise from disasters demonstrate the very best of the human spirit. Another myth is that donations will arrive quickly and that donations of food, clothing, and household goods constitute an effective response to relief in disaster-affected communities. Not all donations are helpful and, at times, large amounts of donated goods can worsen, or at least complicate, the disaster response effort. Donations of items, such as blankets, shoes, or clothing, can cause a secondary disaster. Resources, such as food, shelter, and clothing, usually can be purchased effectively within the affected region or country and this assists local and regional economies in their recovery. Another common myth is the conclusion that dead bodies are a major cause of disease and that diseases that are not present usually in the affected area will arise because of dead bodies. Even if the dead are carriers of disease, they are probably much less of a risk to others dead than they were when they were alive. Frequently, the risk of disease is the first myth to emerge in media reporting of disasters. Unfortunately, this has resulted in the rapid and unceremonious disposal of corpses, often without proper efforts to identify them or inform their loved ones. This, of course, adds to the suffering of the survivors and uses resources that could be used to help those survivors. When considering the possible impact of a disaster on the health of a population, it is important to think about the changes that have occurred, and that are continuing to occur, in the population and the various factors that could be contributing to changes in health status or could be challenging health services delivery in a community. This understanding of the current and evolving health status of the population helps us to plan and respond and survive through (or recover from) disaster more effectively. Groups that might require special consideration, regardless of the levels of preparation of the community as a whole, include the elderly, those living alone, and persons suffering from a mental illness. This special edition of the Journal provides an understanding of many of these issues and challenges, providing insights from personal experience and disaster reports, discussion of the implications of research findings for practice, and introducing operational and educational tools to assist us in preparing to confront disaster.