Type of Disaster Scenario

In order to prepare to respond to a disaster event, one must consider the type of disaster. Is it a one-time event, the result of weather, seismic activity, or a technological/transportation mishap? Is it an acute occurrence in a chronically affected area? What is the scale: large scale (widespread) vs limited in scope? The spectrum of medical and surgical disease that you will likely treat and approximate numbers of patients influences both preparation and logistics. Always count on a disproportionate number of children. The age spectrum is usually shifted to the left in developing countries, kids have a higher likelihood of being injured than adults, but they are often more resilient. When will you arrive? The first 48 hours will see mainly acute injuries. Only local resources that survive the event will be available. As time passes, acute injuries will decrease and more secondary effects will emerge, along with common acute and chronic surgical disease. After about 2 weeks, the usual spectrum of surgical disease will predominate, along with re-operation of injuries, wound revisions, new acute injuries (especially of relief workers), and possibly reconstructive surgeries.

Who will you be deploying with? One should never self-deploy. Always go with an established, experienced group. Will you be part of an organized, self-contained surgical team joining an existing hospital or part of a deploying surgical hospital? The core of a surgical hospital consists of a preop/ER, at least one OR, a PACU/ICU, and a surgical ward. Additional support functions such as central sterile equipment, radiology, lab, and pharmacy are needed. There should be more nurses than physicians (two to three times), sufficient support personnel to move patients, supplies, and perform non-medical tasks. In general, there is at least one non-medical staff member for every medical one. Consider if lab, X-ray, blood bank, or mortuary services will be organic or provided by another entity. When considering deploying with a group, their level of preparation and experience in disaster relief should be considered. A good way to gain personal experience is to deploy with organizations like Operation Smile, Médecins Sans Frontières (MSF, Doctors Without Borders), etc. doing charity work under less stressful (non-disaster) circumstances.

It is critical to know, before leaving, how you will be fed and who is providing logistical support. You must bring with you whatever you will need. The best assumption is that nothing will be available. Even if guaranteed support, it should be expected that you will take the basic means for subsistence along with you. You should not deploy unless you have a reasonable exercise tolerance and no acute or chronic diseases that require specialized support (e.g. orthopedic injuries, diabetes requiring insulin, coronary artery disease requiring medication, obstructive sleep apnea requiring CPAP.) It goes without saying that you should bring an adequate supply of personal medications and hygiene items.

Reconnaissance and Intelligence

Before agreeing to deploy, a detailed country study of the disaster area and adjacent geography must be performed. A Google search is a good place to start, but more specific (and reliable) information can be had from other sources (http://www.country-studies.com/). Trip Advisor (http://www.tripadvisor.com/) and other travel sites like Lonely Planet (http://www.lonelyplanet.com/) can provide general information, but should not be relied upon for disaster situations.

Topics covered should include climate and weather, terrain, transportation infrastructure, economics, customs, culture, religion, demographics, languages, and common foods found in the area. The CIA World Fact Book provides an additional overview (https://www.cia.gov/library/publications/the-world-factbook/geos/vm.html). The US Department of State (http://www.state.gov/p/) provides guidance for US citizens. Maps of the affected area and adjacent, non-affected areas should be obtained and studied. Google Maps, Google Earth, Bing, and Yahoo Maps are reasonable places to start, but often are not up to date. It is wise to download digital maps to carry with you since the Internet is unlikely to be available. Paper maps should also be carried as a backup. ESRI sells a high-end mapping product called ArcGIS® (www.arcgis.com/). While it is expensive software, intended for professional use, they also have a low-cost home license and a free trial. ESRI provides free support to relief organizations, including disaster maps, data, and technical support (http://www.esri.com/services/disaster-response). There is usually a posting of current disaster maps soon after an occurrence.

The World Health Organization () and Centers for Disease Control (http://wwwnc.cdc.gov/travel/destinations/list/) provide current disease data. One must understand the pre-disaster burden of medical and surgical disease and the normal level of medical care available to the population. It is wise to consult a tropical medicine text to brush up on endemic diseases in the target country like malaria, schistosomiasis, and helminthiasis. Vaccinations should be up to date for the intended travel itinerary. Visit a travel medicine clinic well before deploying to be sure all immunizations are current.

Attention should be given to the bottom levels of Maslow’s hierarchy of needs and essential infrastructure: air, water, shelter, clothing, food, security, sanitation, transportation, communications, energy, and medical care – both for those deploying and for those you intend to serve.