Disaster Response in Europe




The important goals of disaster and mass casualty incident (MCI) response are to protect and to save life. When a disaster strikes a population, people expect that leaders, local authorities, and the national government will take actions to respond immediately and in an appropriate manner, restoring order as quickly as possible.


Starting with the establishment of the European Union (EU), and in particular over the last 20 years, state members and European institutions have committed to mutual support in response to disasters. As a consequence of this commitment, the EU founded a specific institution, recognized by all state members, exclusively dedicated to humanitarian aid, supporting or supplementing national policies in the field of mutual civil protection assistance, and facilitating coordination of assistance interventions. , This institution is called the European Community Humanitarian Office (ECHO).


Historical perspective


From Ancient Times to the Middle Ages


Since ancient times, Europe has been stricken by multiple disasters. Examples include tsunami and earthquakes (Helike tsunami and earthquake 373 bc ), fires (Great Fire of Rome 64 bc ), volcanic eruptions (Minoan eruption 1628 bc ), and bubonic plague (Justinian’s Plague 541 ad ), to mention a few.


Ancient civilizations believed that disasters are events due to the intervention of the gods or fate, and this belief was perpetuated even into modern times. Indeed, the word disaster appears to have been derived from the ancient Greek word “dus-aster” or the Latin “dis-aster” that means “bad-star” in English. Despite this belief, primitive responses, often ineffective and in some cases bizarre, were provided at the local level. The first fire brigade service was established in Ancient Rome during the second century bc . Its name notwithstanding, this service did not protect against all the fires that frequently occurred in the city, but was a profit-making business protecting private interests. Marcus Licinius Crassus became one of the wealthiest men in Ancient Rome because he imagined and organized a private fire brigade service with several hundred slaves. When notified, they rushed to the location of a fire. Once on site, they negotiated a fee with the property owner to extinguish the fire. In the event no agreement was reached, the fire brigade did not intervene. If the fire resulted in the complete destruction of the property, Crassus made an offer to buy the land at a favorable price.


Another example of ancient European disaster response is reported in the Latin literature, when Pliny the Younger described the operation of search and rescue provided by his uncle, Pliny the Elder, to save his friends and his family in Pompeii during the Vesuvius eruption of 79 ad .


With the spread of Christianity in the Mediterranean basin and throughout Europe, religious congregations provided the bulk of disaster response, particularly during epidemics. Groups organized themselves to help the infirm, usually with minimal success due to lack of medical knowledge. Medical practice at that time was largely based on the use of herbs, astrology, and local superstition, often with the consequence of spreading the outbreak among healthy people.


The plague known as the “Black Death” that spread from Central Asia to Europe in the middle of the fourteenth century ad was one of the largest pandemics in history, with an estimated 75 to 200 million deaths. Monks and priests provided care for the ill, and victims of the plague were often abandoned by their families and expelled from the community. Saint Roch from Montpellier (canonized as the special patron against contagious diseases) is still venerated for the great aid and support given during the plague. The religious orders also provided strong support during the famine that struck Europe during the Middle Ages. Another frequent type of disaster in Europe during these times was war (e.g., the Hundred Years’ War 1337 to 1453 ad ). Early European responses to nearly all large-scale disasters were ineffective, and it was not until the modern era that the first transformations and innovations in the disaster response system were to be seen.


Modern Era


Disaster management in the modern era witnessed many important improvements. Concepts of mitigation and preparedness were combined into disaster management; the epidemiology of disaster was investigated, and a number of improvements were instituted in triage, treatment, and transport of casualties. Although disaster management was often viewed as a local issue, the nineteenth century witnessed the founding of numerous nongovernmental organizations (NGOs) created to provide assistance throughout Europe. The twentieth century marked the development of agreements between nations, national policies and laws regarding disaster response, and civil protection.


The start of the modern era in disaster preparedness and response can be considered to be the year 1755 during the Lisbon earthquake. Immediately after the first earthquake hit Lisbon and caused more than 30,000 victims, King Jose Manuel I of Portugal named the Prime Minister Marquis of Pombal as the Incident Commander to manage the disaster response and recovery. The Marquis’s first innovation was to collect information from the population, and in particular from priests, regarding the tremors and the collapsed buildings, certain that these phenomena could be studied as natural events and therefore mitigated. He also established a program of disaster relief for the population with shelter and food centers, fire brigades, and mass burials to avoid disease outbreaks. He started an urban plan to rebuild the city that was based on the information collected regarding the buildings, proposing and actuating the construction of more solid structures—thus developing the first mitigation plan for a city. ,


Another important milestone in disaster response occurred shortly thereafter. At the end of the eighteenth century, a French surgeon of the Napoleonic Army, Dominique Jean Larrey, after years as chief surgeon on the battlefield, took inspiration from military medicine. He established the first ambulance service to evacuate and provide aid to the wounded on the battlefield and invented the first method of triage (the word is derived from the French “trier,” “sorting”). Before this ambulance service, staffed by a team of surgeons and nurses who provided some care on-scene and transported patients in a light two-wheeled carriage, casualties not able to walk often stayed on the battlefield for days before being moved to a field hospital. Many died in agony, waiting for care. Larrey also introduced several changes in the medical practice of that period, including performance of immediate rather than delayed amputations as life-saving measures and the field use of positive pressure ventilation and hypothermia. A few decades later, a cholera outbreak spread across London in 1854, causing more than 600 deaths. A physician, John Snow, determined that the outbreak was due to contaminated water supplied by a pump in a specific neighborhood of the city. His approach to solving this medical mystery was revolutionary. Snow analyzed data from the population and information about the water supply network and demonstrated the cause of the outbreak, how the disease was spread, and how to control spread. He applied methodologies now referred to as epidemiology. In the same year, Florence Nightingale, an English woman born in Italy, instituted some of the first organized disaster relief efforts. Despite coming from a rich British family, she wished to commit her efforts to the care of the sick. During the Crimean War she led a group of 38 women who treated the injured. During this war the medical facilities were very poor, and mortality rates were 10 times higher than on the battlefield. , Florence Nightingale reorganized British hospital practices by cleaning the rooms, promoting good hygiene, creating nutritional and water sanitation programs, improving health standards, and reducing mortality by two thirds. She introduced a new model of care, shaping the future of modern nursing. After her experience in the field, she established a school of nursing at Saint Thomas Hospital in London. Her efforts and work resulted in major changes regarding medical care, public health, sanitations, and military health.


In the same year, Jean Henry Dunant, a Swiss businessman, impressed with the violence of the Battle of Solverino of 1859 and the resulting number of deaths and casualties (more than 20,000), organized a medical support system for the casualties utilizing the local population, in particular young women. A few years later in 1863 he founded the International Committee of the Red Cross (ICRC). , The ICRC was the first organization that provided support to victims of war and other disasters. It was also the first internationally recognized organization that provided humanitarian relief in agreement with the principles of neutrality, independence, and impartiality. Through the efforts of the ICRC, in 1864 12 European states signed the “Convention for the amelioration of the condition of the wounded in armies in the field.” Signatory states committed to provide aid to the injured from war of any nationality, the field identification of health care personnel involved in medical support by displaying a red cross, and the inviolability and neutrality of persons involved in the performance of humanitarian relief and assistance. Despite initial challenges, including bankruptcy in 1867, the ICRC’s commitment to humanitarian relief was enormous and remains active today, ensuring decent conditions and humane treatment of prisoners, aiding populations affected by all forms of conflict and disaster, providing assistance for family reunification, supporting the poor, promoting the improvement of living conditions and a sustainable environment, and providing basic health care assistance. The ICRC played an important role as a provider of medical support, humanitarian activities, and service on the battlefield and in prisoner of war camps during the First and Second World Wars. These important efforts were internationally recognized, with the ICRC being awarded the Nobel Peace Prize in 1917, 1944, and 1963.


In 1927 several European and outside nations signed the convention establishing the International Relief Union (IRU), which became operational in 1932. The objectives of the IRU were to give first aid and support to populations stricken by disasters and to coordinate the disaster response. The IRU was active in response to several disasters until 1982, when several nations invoked the withdrawal clause of the convention and ceased their support.


During and between World Wars I and II, the international response to war, and ensuing complex humanitarian disasters such as famine or displaced populations, was provided by international or local humanitarian agencies such as ICRC and Oxfam.

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Aug 25, 2019 | Posted by in EMERGENCY MEDICINE | Comments Off on Disaster Response in Europe
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