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  1. Home
  2. Books
  3. Koenig and Schultz's Disaster Medicine
  • Cited by 15
Publisher:
Cambridge University Press
Online publication date:
August 2011
Print publication year:
2009
Online ISBN:
9780511902482
DOI:
https://doi.org/10.1017/CBO9780511902482
Subjects:
Emergency Medicine, Medicine
Information

Book description

As societies become more complex and interconnected, the global risk for catastrophic disasters is increasing. Demand for expertise to mitigate the human suffering and damage these events cause is also high. A new field of disaster medicine is emerging, offering innovative approaches to optimize disaster management. Much of the information needed to create the foundation for this growing specialty is not objectively described or is scattered among multiple different sources. Now, for the first time, a coherent and comprehensive collection of scientific observations and evidence-based recommendations with expert contributors from around the globe is available in Koenig and Schultz's Disaster Medicine: Comprehensive Principles and Practices. This definitive work on disaster medicine identifies essential subject matter, clarifies nomenclature, and outlines necessary areas of proficiency for healthcare professionals handling mass casualty crises. It also describes in-depth strategies for the rapid diagnosis and treatment of victims suffering from blast injuries or exposure to chemical, biological, and radiological agents.

Reviews

'There are so many exceptional chapters in this text that it is almost unfair to single out selected ones for praise … Even those who consider themselves experienced will learn a lot in studying from this compilation … meticulously researched and exhaustive … Disaster Medicine: Comprehensive Principles and Practices is just that:comprehensive. Students, seasoned practitioners, health systems organizations, and academic institutions will find it a most welcome and invaluable addition to their reference libraries.'

Source: Annals of Emergency Medicine

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Contents

Page 2 of 2

Contents
  • 22 - Crisis and Emergency Risk Communication
    pp 326-344
  • View abstract

    Summary

    Health risk communications are an important and necessary component of disaster management. Many predictable and harmful individual and community behaviors can be mitigated with effective Crisis and Emergency Risk Communication (CERC). CERC tools are critical disaster resources and CERC uses sound psychological and communication research in its approach to the selection of message, messenger, and method of delivery. A complicating phenomenon is the reality that one's messages compete with many others for credibility with the public before, during, and after the disaster occurs. Communication experts and leaders who have faced disasters have discovered that certain approaches cripple or even destroy the success of their disaster response operations. Stakeholders may be able to help communicate messages for the organization. There are vital areas of emergency risk communication that require urgent consideration and research such as those related to vicarious rehearsal and outreach to special populations.
  • 23 - Telemedicine and Telehealth Role in Public Health Emergencies
    pp 345-360
  • View abstract

    Summary

    Telemedicine is a subset of telehealth. The role for telehealth in providing healthcare services in public health emergencies should be considered within the context of a changing social environment created by emerging technologies. The current state of the art with respect to the use of telehealth in public health emergencies is varied and somewhat rudimentary. Although the current role of telehealth in public health emergencies is limited and variable, there are several telehealth modalities in use, including real-time clinical videoconferencing, home telehealth, store-and-forward, public telephone systems, amateur radio, and web-based information. There is increasing use of informal telehealth modalities to provide support in emergency and disaster situations. With technologic advances, heightened emphasis on efficient allocation of scarce resources and cost-effectiveness, and protection of emergency responders, telehealth become an increasing important tool for the emergency managers of the future.
  • 24 - Complex Public Health Emergencies
    pp 361-376
  • View abstract

    Summary

    This chapter focuses on the prototypical public health emergency commonly referred to as complex humanitarian emergencies (CHEs). CHEs are confined within nation-state borders and result in massive numbers of internally displaced populations (IDPs). The humanitarian community relies on use of specific direct and indirect indices to assess consequences including severity of the conflict, measure the impact or outcome of interventions in declining mortality and morbidity, and identify the most vulnerable of populations requiring care. In CHEs, deaths from the complications of a simple and preventable childhood disease highlight the inherent threat to the immune system that results from malnutrition and micronutrient diseases. Immediate psychosocial interventions focus on supporting public health activities aimed at reducing mortality and morbidity, mitigating the burden on the community of managing the seriously mentally ill who need specialized psychiatric care, and mobilizing community-based resiliency and adaptation to new circumstances affecting people during the emergency.
  • 25 - Patient Identification and Tracking
    pp 377-388
  • View abstract

    Summary

    This chapter focuses on the considerations that should be given for tracking victims who are not already easily located and identified through existing systems. There are two components of a patient-tracking system. The first part is the initial collection of data and entry into a system. The second component is the data portal that receives, aggregates, and disseminates data that emergency medical services (EMS) or healthcare personnel collect. The regional/state/national data portal must allow patient tracking by unique identifiers regardless of where they are physically located. The science of patient tracking is in its infancy and suffers from ambiguity over the very concept of patient tracking. The tracking systems currently under development have not been tested under actual disaster conditions. Nevertheless, their ongoing development and refinement should be encouraged as it is likely to improve future disaster management.
  • 26 - Explosive Events
    pp 393-422
  • View abstract

    Summary

    Explosive events occur in many settings. They can have a variety of etiologies, which can be accidental or intentional. The effects of explosive events on local healthcare systems have been more frequently reported. Mechanisms of internal organ injury following blast exposure are multifactorial but stress and shear on biological tissues may result in irreversible work being applied. Some explosive events may necessitate additional considerations for local responders. Specialized teams with subject matter expertise and problem-specific training exist in many countries to assist local authorities and respond when requested. The rapid determination of infrastructure dysfunction and initial resource needs is critical to avoiding an ineffective response, and beginning the process of recovery from an explosive event. Security, public safety, protection of critical infrastructure, and preservation of medical capacity must be immediate considerations following an explosive event.
  • 27 - Burn Patient Management
    pp 423-429
  • View abstract

    Summary

    This chapter focuses on the principles of disaster management to highlight the key features of a regional burn disaster plan. It highlights typical injuries that are best treated in the burn center facility. As with any mass casualty situation, casualty triage is an initial action with a burn disaster. One well-described method consists of combining the Simple Triage and Rapid Treatment (START) system with the Age/Total Body Surface Area (TBSA) Survival Grid from the American Burn Association. The next higher level of care should have personnel experienced with burn surgery and postoperative burn care. There should also be blood-banking and microbiological testing capabilities. At the burn center, the work begun at the initial patient care site should continue with greater emphasis on three injury types unique to burns: inhalation injury, chemical injury, and electrical injury. Future comprehensive emergency management plans must account for burn patients.
  • 28 - Clinical Aspects of Large-Scale Chemical Events
    pp 430-453
  • View abstract

    Summary

    This chapter explores various clinical aspects of large-scale exposures to chemical agents, and presents several examples of both intentional and accidental events. It demonstrates the importance of rapid identification and treatment of those individuals with early acute respiratory failure. Several examples of events are followed by commentaries that include perspectives on the mitigation, preparedness, response, or recovery efforts for each event. Chemical agents used in a large-scale terrorist attack fall into four categories of compounds: pulmonary intoxicants, cyanides, vesicants, and nerve agents. Medical review of large-scale chemical events is necessary for purposes of quality improvement and to provide a database record to assist in validation of current medical practice and development of novel medical interventions. Federal Emergency Management Agency (FEMA) is responsible for developing preparedness plans, upgrading response capabilities, and conducting training for these civilian communities. These obligations were integrated into program called the Chemical Stockpile Emergency Preparedness Program (CSEPP).
  • 29 - Biological Events
    pp 454-476
  • View abstract

    Summary

    Biological warfare has been a threat to humanity since ancient times and crude attempts at bioterrorism have been a growing concern for several decades. In June of 1999, U.S. public health experts met at CDC headquarters and used this rationale to develop a list of critical biological agents for health preparedness. Category A agents are those that, if released effectively, would be expected to have a high overall public health impact. Category B agents present a somewhat lesser requirement for preparedness, whereas category C agents require vigilance to guard against their future development as threat agents, but can be adequately managed within the framework of the existing public health infrastructure. To understand current biological warfare medical countermeasures research strategy and progress within the United States, it is useful to review weapons of mass destruction (WMD) medical countermeasure research programs led by Department of Defense, and the Department of Homeland Security.
  • 30 - Nuclear and Radiological Events
    pp 477-510
  • View abstract

    Summary

    Mass exposure to radiation does not occur frequently but such events, when they do occur, present tremendous challenges to affected communities. With the concerns of recent years about nuclear or radiological terrorism, it would also appear that the risk of deliberate mass exposures to radiation has increased. Nuclear power plant accidents leading to the release of radioactive materials could cause widespread environmental contamination with a variety of radionuclides. This chapter summarizes the prompt and delayed effects of fission explosions in the range of energy yields expected from an improvised nuclear device. The acute radiation syndrome (ARS) encompasses a set of complex pathophysiological processes precipitated by exposure to high doses of radiation. The major determinant of clinical outcome following an acute radiation exposure is the dose received by the affected individual. Estimating this dose (in a process termed biodosimetry) thus becomes a critical part of clinical management of such individuals.
  • 31 - Hazardous Material, Toxic, and Industrial Events
    pp 511-526
  • View abstract

    Summary

    Hazardous material (HazMat) incidents are increasingly prevalent due to the continuing rapid growth and globalization of the chemical industry. Industrial accidents can be described by the initiating event, which can be one or more of the following: human error, environmental conditions, and container or equipment failure. To recognize a HazMat event, emergency medical services and fire department personnel responding to a motor vehicle collision or structure fire must have a high index of suspicion. Measures to mitigate, prevent, and manage toxic HazMat incidents are closely interconnected and can be similar in both execution and goals. When responding to an acute HazMat incident, the protocols and procedures that are planned during the preparation phase are followed and executed. A well-developed research agenda provides the evidence-based science to guide community risk management and enforcement of high safety standards in the chemical industry.
  • 32 - Floods
    pp 529-542
  • View abstract

    Summary

    Floods may be caused by natural processes that are either fluvial or coastal in origin. Generalized food shortages, severe enough to cause nutritional problems, usually do not occur after disasters but may arise among low-income nations. Displacement is a key risk factor for morbidity and mortality among disaster-affected populations. Flooding may directly damage healthcare facilities or it may hinder public access to these facilities by closing transportation routes. The number of deaths associated with flooding is closely related to the life-threatening characteristics of the flood and by the behavior of the victims. Causes of flood-related morbidity reported in high-income nations during the first 6 weeks after the disaster are frequently equally divided between injuries and illnesses. Sustainable flood risk management seeks to reduce risk at all stages of the disaster cycle giving preference to more cost-effective disaster risk reduction activities such as prevention, preparedness, and mitigation.
  • 33 - Cyclones/Hurricanes/Typhoons
    pp 543-552
  • View abstract

    Summary

    This chapter focuses on the impact of tropical cyclones on human societies. This includes public health; the mortality and morbidity resulting from these events; intervention measures such as evacuation; medical preparedness for the affected population; and mitigation, prevention, and response strategies for the medical community drawn from a global perspective. Recent large cyclonic storms such as Hurricanes Katrina and Rita in the U.S. and Typhoon Nari that caused devastation in Taiwan reaffirmed the need to meet the complex challenge of public health planning, especially for those with special needs. Typically, hospitals experience a lull in emergency department visits around the time the tropical cyclone makes landfall and in the storm's immediate aftermath. Part of disaster planning is deciding which medical supplies should be stockpiled for a tropical cyclone and its aftermath. Supplies of tetanus toxoid, oral and parental antibiotics, hypoglycemics, and others are needed in the aftermath of a cyclone.
  • 34 - Tornadoes
    pp 553-561
  • View abstract

    Summary

    Tornadoes occur with very little or no advanced warning, causing considerable structural damage, traumatic injury, and death. This chapter reviews risk factors for injury and death, injury patterns, and mass casualty scenarios by using modeling and real event reports. Risk of injury or death has been associated with storm strength, victim age, type of material used for dwelling construction, shelter location, income level, and time of day. Injury patterns can be categorized by the time at which they occur in relation to the storm. This approach may affect treatment strategies. Initial emergency medical services (EMS) transports could then attempt even distribution of the victims to appropriate medical centers, avoiding overloading one facility as much as possible. Research is necessary to develop best practices that guide strategies for designation and management of off-site facilities that can rapidly be converted to temporary shelters for some group of victims.
  • 35 - Earthquakes
    pp 562-577
  • View abstract

    Summary

    Earthquakes are considered as one of the most destructive disasters. Several theories exist that attempt to explain earthquake behavior. The concept accepted by seismologists is the Tectonics Plate Theory. The persistent threat of seismic events and the difficulties involved with mitigating their effects highlight the importance of disaster preparedness. A review of pertinent literature reveals that up to 20% of the patients hospitalized after earthquakes suffer from nontrauma-related conditions. The conditions commonly seen are acute exacerbations of chronic conditions such as diabetes, chronic obstructive pulmonary disease, acute coronary syndromes and myocardial infarctions, end-stage renal disease, anxiety, hypertension, and the onset of spontaneous abortions, among others. Although investigators examining the medical consequences of seismic events have made significant progress, additional work is necessary to further improve the care and outcomes of earthquake victims. These endeavors require a true transdisciplinary approach involving participation by individuals from multiple medical, health, and nonmedical specialties.
  • 36 - Tsunamis
    pp 578-585
  • View abstract

    Summary

    Tsunamis can cause severe damage to coastal areas as they run-up onshore and dissipate wave energy caused by the massive displacement of ocean water. Drowning is the obvious risk for humans and animals when a tsunami strikes an inhabited shoreline. Many persons survive the initial effects of an oncoming rolling wave but are swept to sea to drown in open ocean waters that are churning as tsunami waves strike. In addition to drowning, death occurs by blunt force injury as heavy objects are thrown against persons and structures as the advancing waves hit the shore. The immediate public health concerns with tsunami events include loss of shelter, food, water, and clothing supplies. Starvation and hypothermia or sunburn and sun exposure are common public health concerns immediately after a tsunami strike. The development of safe and effective maneuvers for avoiding personal injury from tsunamis represents a significant future research opportunity.
  • 37 - Winter Storms
    pp 586-608
  • View abstract

    Summary

    This chapter discusses the problems winter storms pose, and how they fit into the continuum from minor annoyance to major disaster. It explores what can be done to prepare for future events that threaten the welfare of those in their paths. Understanding the human impact of catastrophic events, so that society can be better prepared for future challenges, is the primary mission in the fields of emergency management and disaster medicine. Establishing an incident command structure, regardless of size, should bring together the resources officials need to determine the security and safety of affected areas, identify hazards to responders, and coordinate the support necessary to begin rescue and recovery efforts. Rapid assessments for identifying immediate challenges created by a winter storm and determining potential resources required to mount an effective response are necessary to avoid a dysfunctional approach.
  • 38 - Extreme Heat Events
    pp 609-631
  • View abstract

    Summary

    This chapter addresses the medical and public health implications of extreme heat events (EHEs) and the associated mortality and morbidity. It provides a background to understanding EHEs as disasters. Increasing global warming, urbanization, and population numbers require improvement in effective EHE planning and response activities. The long-established concept of the Urban Heat Island is pervasive in the American and the European literature on EHEs, and applies, to a lesser extent, to urban areas in developing countries. Urban EHE response planning has developed into a unique policy area with its own literature that is scattered among larger disciplines. It is supported by a growing public awareness constantly reinforced by heat wave alerts. The Chicago Heat Wave of 1995 was a relatively short, but intense event that resulted in deaths within vulnerable populations and damaged the reputation of the political system that was slow in recognizing and coping with its consequences.
  • 39 - Volcanoes
    pp 632-642
  • View abstract

    Summary

    This chapter describes the key elements of volcanic disaster planning for health sector workers. A simplified way to approach volcanoes and their hazards is to learn whether they are mainly explosive or effusive (a nonexplosive outpouring of fluid lava) in behavior. The main eruptive hazards can be divided into fall and flow processes. Pyroclastic flows and surges, lahars and debris flows, and lava flows can, for emergency planning purposes, be envisaged by thinking visually or intuitively, but their behavior belongs to the world of flow, or fluid dynamics, on which the understanding of the blood circulation, meteorology, and aeronautics is based. Although mitigation of human casualties by timely evacuation is the main goal in emergency management of volcanic threats, disaster planners must also be familiar with rescue and emergency treatment measures and prepare for unique conditions associated with volcanic eruptions.

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