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.