1. Natural Disasters & Health Care Konstantinos Holevas Civil Engineer, MSc. Nicosia, 2011

2. Managing Natural Disasters In this course as well as in major emergencies, disasters and crises the aim is to know and be able to make the distinction between:  WHAT is IMPORTANT  WHAT is URGENT based on a diagnosis and the circumstances. 2

3. THE distinction IMPORTANT: We should NEVER forget it. URGENT : We should START with it. Examples: –Protect your own life. –Stop a bleeding. –The safety of rescuers. –Start triage (?) –Operations center on site (?) ……………….. 3

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32. Earthquakes: What is/are the priority action/s? Flash Floods: How to manage it? Preparation? Tsunamis: Is it a real threat for us, here? The health protection measures are quite similar. The Basic Questions 32

33. 33 Urban Agglomeration in 2025 Source: FAO

34. Mainly of a sudden onset. Priority action: Stay where you are! Then move to a safer place. Minimize panic. Start triage. Health and Safety Concerns: Crush Injuries & Crush Syndrome. PTSD. 1. Geological Risks and Disasters Tectonic Faults activation Major Earthquakes Landslides & Mudslides Volcanic eruptions 34

35. 35 Tectonic plates in SE Mediterranean

36. Landslides occur when masses of rock, earth, or debris move down a slope. Debris flows, also known as mudslides, are a common type of fast-moving landslide that tends to flow in channels. Landslides are caused by disturbances in the natural stability of a slope. They can accompany heavy rains or follow droughts, earthquakes, or volcanic eruptions. Mudslides develop when water rapidly accumulates in the ground and results in a surge of water-saturated rock, earth, and debris. Mudslides usually start on steep slopes and can be activated by natural disasters. 36 Landslides & Mudslides

37. 37 Building collapse that can result in deaths or injuries; Infrastructure failures (bridges, roads, etc) Rapidly moving water and debris that can lead to trauma; Broken electrical, water, gas, and sewage lines (networks) that can result in injury or illness; and Disrupted roadways and railways that can endanger motorists and disrupt transport and access to health care. Panic and anxiety that can lead to psychological effects. Related Health threats

38. 2. Hydro-Meteorological Disasters Floods: Flash floods (sudden) - Plain floods (slow) Extreme/adverse weather conditions Hurricanes Tornadoes Avalanches Lightening Over the last 40 years the average number exposed to floods every year increased from 32.5 to 69.4 million people. Global physical exposure to tropical cyclones tripled between 1970 and 2010. The number of people living within 100 km of the coast increased up to 39% of the world's population. Climate change is a reason hypothesis. 38

39. Flash floods, a real threat 39

40. Health Care Guidance Evacuation Centers and procedures. Some highlights: If evacuating, take your prescription medicines with you. Prevention from Carbon Monoxide (CO) poisoning. Get medical care if you are injured, sick, or having trouble coping with stress. Stay cool and drink plenty of fluids to prevent heat- related illness. Clean up, disinfect, and practice good hygiene to avoid illness from bacteria, viruses, mold and mildew. After floods: To prevent illness, disinfect and dry buildings and items in them.

41. Tsunamis in the Mediterranean 41 Map depicts the Mediterranean Sea (green) and the degree of sea-level displacement caused by a tsunami like the one that wracked the region in A.D. 365. A new study suggests that such tsunamis are relatively frequent in the region, striking perhaps as often as every 800 years. Source : Nature Geoscience.

42. Health Effects of Tsunamis Immediate health concerns After the rescue of survivors, the primary public health concerns are clean drinking water, food, shelter, and medical care for injuries. Flood waters can pose health risks such as contaminated water and food supplies. Loss of shelter leaves people vulnerable to insect exposure, heat, and other environmental hazards. 42

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44. Health Effects of Tsunamis The majority of deaths associated with tsunamis are related to drownings, but traumatic injuries are also a primary concern. Injuries such as broken limbs and head injuries are caused by the physical impact of people being washed into debris such as houses, trees, and other stationary items. As the water recedes, the strong suction of debris being pulled into large populated areas can further cause injuries and undermine buildings and services. Medical care is critical in areas where little medical care exists. 44

45. Long-lasting effects The effects of a disaster last a long time. The greater need for financial and material assistance is in the months after a disaster, including: surveying and monitoring for infectious and water- or insect-transmitted diseases; diverting medical supplies from nonaffected areas to meet the needs of the affected regions; restoring normal primary health services, water systems, housing, and employment; and assisting the community to recover mentally and socially when the crisis has subsided. 45

46. Health/Safety Concerns for All Disasters Prevent IllnessPrevent Illness - Injury - Food & Water -InjuryFood & Water Animals & InsectsAnimals & Insects - Returning Home After a DisasterReturning Home After a Disaster - Carbon MonoxideCarbon Monoxide - Environmental ConcernsEnvironmental Concerns - CleanupCleanup - Mold - Power OutagesMoldPower Outages Coping with a Disaster or Traumatic Event Source: http://emergency.cdc.gov/disasters/alldisasters.asp

47. Recommendations To improve the quality of response to the medical problems encountered immediately after a sudden onset disaster and during the first days/weeks that follow, focus on : Crush injuries, crush syndrome (quakes) Limb salvage Skin cover, Psychological support and The question of whether or not to amputate.

48. From Haiti earthquake 48

49. Recommendations Strong emphasis must be given on local conditions, ethical questions and the difficulties of decision making under very stressful situations, which can be additionally aggravated by extreme environmental or weather conditions.

50. Recommendations For more info you may visit: http://emergency.cdc.gov/ The Centers for Disease Control & Prevention http://crisis.med.uoa.gr/index.php The site of this Master Course Thank you! 50