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