Civilian-Military Cooperation after disaser

Civilian-military cooperation after disaster is too important for successfully response. Coordinating of general civilian-military actions and mutual support carry out through an exchange, joined planning and general estimation of situation, information which was folded, by the lead through of general conferences, meetings, etc like that. A success of Civilian-military mission on the whole depend of quality, amount and timeliness of the exchanged information.  Coordination and mutual support must be attained on all levels, beginning from the greatest State and concluding Local.

1.                  Civilian- military operative center (CMOC)  is a primary link, for co-ordinating of general actions of civil agencies, military forces and humanitarian government,  ungovernmental and volunteer  agencies and agencies.

2.                  Civilian military co-operation must be realizable through an exchange information and general planning.

3.                  Military component civilly military plays co-operations supporting function.

4.                  During response of disaster consequences must be inculcated unique for military and civil standards and protocols of grant of medicare.

     Establish of general Civilian-military operation centers (CMOC) is stipulated by creation and introduction of the unique for civil and military compatible standards and protocols  that application of international standards such as triage protocol and protocols for  emergency medical care. 

   # Good example and experience of International coordination is Civilian-military cooperation   under Euro-Atlantic Disaster Response Coordination Centre (EADRCC) (Ukrainian flood, Pakistan earthquake, etc)

Ukraine-International day for disaster reduction

Ukraine - International day for disaster reduction: United Nations focuses on engaging communities at the local level

• Date:13 Oct 2011
• Source(s):United Nations Development Programme - Ukraine (UNDP Ukraine)

Kyiv, Ukraine, 13 October 2011 – The United Nations calls on local governments and communities to increase their commitment to disaster prevention and preparedness on International Day for Disaster Reduction.

Observed annually on 13 October, the International Day for Disaster Reduction is an opportunity to raise awareness about how to make communities safer from disasters. This year’s theme is to engage children and young people in disaster risk reduction (DRR) efforts.

Since 1991, Ukraine has experienced at least 69 disasters, which have affected over 2.7 million people and caused over $2.5 billion in economic losses, according to EM-DAT, an international disaster database. Furthermore, the Ministry of Emergencies of Ukraine reports that mining accidents between January and July 2011 alone have led to over 100 casualties—an average of one casualty every two or three days.

The most prominent disasters in Ukraine are related to industrial pollution and flash floods. Last year, the Government of Ukraine declared an ecological emergency in Kalush, where obsolete mining facilities and toxic stockpiles of hexachlorobenzene (HCB) threatened to contaminate local soil and water sources. In July 2008, floods in the Carpathian Mountains affected over 224,000 people and caused around $650-870 million in losses.

“We need to shift our mindset from just responding to disasters to preventing disasters,” said Ricarda Rieger, Country Director of UNDP. She added, “The impact of disasters can be minimized—even prevented—if local governments, communities, and other relevant stakeholders work together to identify the risks and implement mitigation measures.”

In 2009, UNDP and Ministry of Emergencies of Ukraine signed a memorandum of understanding to cooperate on disaster risk reduction efforts. Among the activities to spur from that agreement include engaging communities and governments in disaster planning activities at the local level. For example, the United Nations is promoting a campaign called “Making Cities Resilient,” which encourages cities to implement a checklist of 10 practical actions to reduce disaster risk. The checklist includes activities such as preparing risk assessments and protecting natural buffers that mitigate floods and storm surges.

While there is much work to be done, the International Day for Disaster Reduction is a chance to raise awareness and mobilize communities toward building more resilient communities.

Principles of Disaster medicine

     Disaster strikes anytime and anywhere. It takes many forms – an act of nature disasters (such as a earthquakes, hurricanes, tornadoes, floods etc), a man-made disasters such as industrials (a nuclear and chemistry disasters, a fire or a hazardous spill, buildings collapse and etc.) and disaster on transport (a railways and a aircrafts disasters), and social disaster (a war and a terrorism for example). It builds over days or weeks, or hits suddenly, without warning. Millions people in whole world face disaster and its terrifying consequences every year.

     Disasters are disrupted normal community function, destroyed the life securing structure and generated the large number of victims. The providing of the Emergency Medical Aid for the large number of victims in the Disaster area is sophisticated. There are inadequate remedy and medical equipment, inadequate number of the ambulance cars or well equipment vehicle for victims’ evacuation and inadequate hospital space.

     The effects of each disaster are different. Considerations are given to the size of the area involved, the extent of damage, and the effect on community resources. The extent of damage includes the physical injury to persons and damage to property, especially destruction of infrastructure (roadways, bridges, and communication lines). The effects on community resources include the insufficient of public health, shelters; meal and water.  These problems are impossible to solve without adequate planning for emergency preparedness and managing. Adequate Emergency planning, managing and medical staffs training are the main task of the new branch of the medicine – Disaster Medicine.

      The Disaster Medicine is difficult to conceptualize:

1.     The World Health Organization defines a disaster as a “sudden ecological phenomenon of sufficient magnitude to require external assistance”;

2.     The definition of American College of Emergency Physicians: “when the destructive effects of man-made forces overwhelm the ability of a given area or community to meet the demand for health care”;

3.      or next definition “A disaster is an event that destroys property, includes injury and/or death, and affects a large population or area.”

4.      A disaster is a situation with an imbalance between the acute needs and the locally available resources. In these cases, special reinforcing and coordinating measures must be taken, in order to keep the quality of medical treatment as close to normal level as possible (Swedish National Board of Health and Welfare ) .

    Other definitions exist, but the common denominator calls for a disruption of such magnitude that the organization, infrastructure, and resources of a community are unable to return to normal operations following the events without assistance.

     The management of humanitarian assistance involves many more and different players today, and disasters are recognized as public health priorities in which the health system plays a significant role.

     The medical response on disaster first of all has been determined by the scales of disaster and the number of victims which needed it. At the Small-scale disaster the Local health services can provide medical aid by the local forces without external assistance. In cases of Large-scale disasters with great number of victims and destroyed hospitals the special approach for disaster mitigation are needed.

     The experience of the medical response on disaster testifies about necessity of implementation by several main steps:

Step N.1. Disaster  area investigations. 

Step N.2. Search and rescue.

Step N.3. The victims triage; initial stabilization and transportation to field hospital.

Step N.4. The medical aid providing to the victims.

Step N.5. The victims’ transportation outside the disaster zone.

     During the planning and management by the medical response is necessary to apply the following basic principles:

1.     The Succession.

2.     The Timeliness.

3.     The Sequence of operations.

The Succession Principle of the medical response is a provided a unique and obligate for whole medical teams medical protocols and the clear medical documents for the every victim. These documents could accompany him on all stages of medical response. The victim’s Medical Card is a basic document and it could be completed at the first medical contact. At the medical card the character of damage, diagnosis and volume of medical aid, that was given, could be fixed. During transportation a Medical Card could be sent together with the victim.

The Sequence of medical aid, that was given, are represents the medical manipulations for saving of vital functions and capacity of the victim. Its provided by the well training medical personnel on all stages of transportation.

The Timeliness of medical aid allows the life of most of the victims and to prevent development of complications. It achieved by adequate organization and management by the search of the victims, their initial stabilization and transportation from the disaster area.

The medical response is depend on phases of disaster and foresees the several stage system of the medical aid providing. This system has divided on the two (stage) levels - the first (prehospital) stage is a level jf the first medical aid, and if terms are allowed, with the elements of skilled. The second (hospital) stage is a a stage of the advanced  medical aid.

Nation and international coordination after disaster

AFTER HUGE DISASTER:
First of all needed National Health Authority (local Health Ministry) Coordination with UN family organization(OCHA, WHO, UNDP, UNICEF and etc) and EADRCC (Euro-Atlantic Disaster Response Coordination Centre, NATO).
This coordination helped to provide best results in all disaster areas.
Second- the collaboration with Medical Assistance Team  from other countries also brought good results.
 I have a good experience and good results after collaboration with DMAT from USA (Iran), Spainish and German medical teams under Red Cross.
Third - collaboration with goodwills philantropic organization. This collaboration provide good results in redistribution of patients and supplies in disaster area.

Own experience of Field hospital operation after earthquake

The increase of international help in natural disaster areas and tacit growing dissatisfaction of aid receiving countries has triggered the necessity to analyze the experience of previous missions in order to optimize the care by international aid groups . Previous experience shows, that in regions affected by a disaster, the health protection system can be considerably damaged if not completely destroyed and needed international assistance not only in emergency aid to the affected population but also the routine medical care, which foreign medical teams can provide by the selective medical services and specialists which are needed in an area. ―According to our findings, we strongly emphasize the imperative need for field hospitals in disastrous

countries, which can offer effective and efficient health care services for the injured people regardless of age or gender and especially cover the needs of fragile minorities. A multidisciplinary, field hospital must include orthopaedics, general surgery and plastic surgery, anaesthesiology, internal medicine, gynaecology and obstetrics, and paediatrics specialities with enough paramedical and support staff. However much researches testify that only 20% national medical teams can get to the disaster area during the first 24 hours, and foreign teams get to area during 7 days from the moment of event 3,4. Though it is possible to decrease the lethal consequences if medical team provide necessary care during the first 6 hours after a earthquake, and medical care to victims in a result of natural disaster is effective if it is given during the first 24 hours from the moment of catastrophe.

The Ukrainian Disaster Medicine Team (UDMT) has experience of providing medical aid to victims after four severe earthquakes. The mobile hospital was deployed to Turkey, Korfez, (August 17, 1999; measuring 7,4; 7,8 Richter scale; 17.127 deaths); in India, Gujarat, (January 26, 2001; measuring 6,9 Richter scale; 20.000 deaths); in Iran, Bam (December 26, 2003; measuring 6,7 Richter scale; 31000 dead); in 2005 – Pakistan, Muzaffarabad (October 8, 2005; measuring 7,6 Richter scale; 73.000 death).

The average time for beginning to see patients after arrival to disaster area was 1,5 hours; time to establish functional surgical department and operation theatre - 3 hours and laboratory - 2-3 hours.

The layout of hospital depended on the ground in the area. The first requirement was a suitably flat area and road access in all cases. Other necessary conditions for hospital site location were: 1. the absence in near-by location of potentially dangerous structures (buildings or other objects); 2. the maximum provisions for permanent function; 3. the security of medical team and patients; 4. Suitable epidemiologic situation.

UDMT deployment to disaster site occurred on third – fifth day. The Joint Ukrainian team was composed of Medical personal (physicians, nurses, laboratory assistants, X-ray technician) and rescue specialists. The hospital was equipped with inflatable tents and ordinary large (military or large family size) size tents. The UDMT supplies of the medical equipment and medicines is arranged in accordance to the list specified by Ukrainian government authorities in state act ―About Mobile hospital.  Rescue specialists were trained to provide first medical aid as first responder.

Advanced diagnostic facilities consist of: X-Ray; ultrasound, Bronchoscopy, Gastroscopy, Biochemical and Clinical laboratories.

References for Field Hospitals

1. Editorial Comments—Foreign Field Hospitals in Sudden-Impact Disasters (SID):

Editorial Comments Claude de Ville de Goyet, MD Consultant, Retired Director of the

Emergency Preparedness Program of the Pan-American Health Organization (PAHO),

Regional Office for the Americas of the World Health Organization Correspondence: Email:

cdevill@attglobal.net Web publication: 18 April 2008

2. Editorial The Field Hospital Setting in Earthquake M. Memarzadeh MD*; A.

Loghmani**; N. Jafari**Assistant Professor, Department of Surgery, Dean of AlZahra

Hospital, Isfahan University of Medical Sciences chairman of Health care team for

disaster preparedness in Isfahan province. Journal of Research in Medical Sciences

2004; 5: 199-204

3. Hsu EB, Ma M, Lin FY, Van Rooyen MJ, Burkle FM Jr: Emergency medical assistance

team response following Taiwan Chi-Chi earthquake. Prehosp Disaster Med. 2002;

17(1): 17-22.

4. Asari Y., Koido Y., Naramura Y., Ohta M.: Analysis of medical need on day 7 after

tsunami disaster in Papua New Guinea. Prehosp Disaster Med.2000; 15(2): 9-13.

5. Pretto EA, Angus DC, Adrams JI, Shen B, Bisell R., Ruiz Castro VM, Sawyer R,

Watoh Y, Ceciliano N, Ricci E.: An analysis of prehospital mortality in an earthquake.

Disaster Reanimatology Study Group. Prehospital Disaster Med.1992; 9 (2): 107-17.

6. Liang NJ, Shift YT, Shift FY, Wu HM, Wang HJ, Shi SF, Liu MI, Wang BB: Disaster

epidemiology and medical response in the Chi-Chi earthquake in Taiwan. Ann.Emerg.

Med 2001; 38(5): 549-555.

7. Ethical issues in Disaster Management ACUTE PHASE OF RESCUE Nobhojit Roy

Centre for Studies in Ethics and Rights Mumbai INDIAN JOURNAL OF MEDICAL

ETHICS

8. International Statistical Classification of Diseases and Related Health Problems 10th

Revision Version for 2007 - http://www.who.int/classifications/apps/icd/icd10online/

9. Noji EK: The public health consequences of disasters. Prehosp Disaster Med. 2000;

15(4):147-57.

10. Anthony D Redmond Needs assessment of humanitarian crises. BMJ 2005; 330 (4):

1320-1322.

11. Endrotomo Sunargono, Yoshitake Hayashi, Yumie Tamura, Naoki Nishinguchi,

Takeshi Yoshida, Atsushi Wada, Naotaka Shifuku, Masahiro Kurosaka, Sakan Maeda:

How to Help Acehnese Helping Themselves? A Note after a Visit with Kobe

University Medical Team Kobe J. Med. Sci 2005: 51 (2): 29-34.

12. Young Ho Kwak, Sang Do Shin, Kyo Seok Kim, Woon Yong Kwon, Gil Joon Suh:

Experience of a Korean Disaster Medical Assistance Team in Sri Lanka after the South

Asia Tsunami J Korean Med Sci 2006; 21:143-50.

13. Richard Aghababian: Lessons Learned of International Importance from Recent

Disasters. Prehosp Disast Med. 2000; 15(3): S79.

14. Jennifer Leaning Medicine and international humanitarian low. BMJ 1999. vol.319:

393-394.

15. Joachim Gardemann Primary Health Care in Complex Humanitarian Emergencies:

Rwanda and Kosovo Experiences and Their Implications for Public Health Training.

Crotia medical journal 2002; 43(2): 148-155.

16. O'Neill PA. The ABC's of disaster response. Scand J Surg 2005; 94(4):259-66.

17. Bremer R. Policy development in disaster preparedness and management: lessons

learned from the January 2001 earthquake in Gujarat, India. Prehosp Disaster Med

2003;18(4):372-84.

18. Bolster CJ Mobile hospital provides care when disaster strikes. Healthc Financ

Manage. 2006 Feb;60(2):114-6, 118.

19. A Multidisciplinary Field Hospital as a Substitute For Medical Hospital Care in the

Aftermath of an Earthquake: The Experience of the Israeli Defense Forces Field

Hospitalin Duzce, Turkey, 1999 Yaron Bar-Dayan,MD, MHA;1,2 Adi Leiba, MD;2

Pinar Beard, MD;3 David Mankuta, MD;1 Dan Engelhart, MD;1 Yftah Beer, MD;1

Mauryzio Lynn;1 Yuval Weiss, MD;1 Giora Martonovits,MD,MPA;1 Paul

Benedek,MD, MHA;1 Avishay Goldberg, PhD,MPH,MA2

20. Airborne Field Hospital in Disaster Area: Lessons from Armenia (1988) and Rwanda

(1994)Samuel N. Heyman, MD;1 Arie Eldad, MD;2 Michael Wiener, MD31.

Department of Medicine, Hadassah, Hospital, Mt. Scopus, The Hebrew University-

Hadassah Medical School, Jerusalem 2. The Israeli Defense

COMPARATIVE BETWEEN EUROPEAN AND UKRAINIAN DISASTER MEDICINE SERVICE

1. The management principles of  Ukrainian Disaster Medical Service and  Services of other European countries is same.

 2.   The Health protection system in Ukraine is a functional as subsystem for disaster response like as in other European countries .  

3.    In the Ukraine and other countries of EU medical planning, readines and medical response after disaster is jurisdiction of local authorities.

4.  In Ukraine and in EU at the disaster area a main value is played by EMS, disaster medicine assistance team and Field hospitals.

A Principles of medications providing for medical team at the disaster area.

The equipment list of Disaster Mdicine Team could be based on a «Essential Drug List” by WHO, in particular on the “New Emergency Health Kit”. A Basic List of equipment could be complement an Additional list depending on the type of Emergencies  in accordance with Epidemiology of Disaster.      Providing medications in accordance with recommendations by WHO pursuant to the Additional list of medications will allow to provide a medical aid for victims by different Disaster medicine teams from different countries with the observance of principles of heredity and sequence.