( By A Working Guide (WHO - OMS, 1989) )

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Chapter 2.Emergency care

In many cases the local health personnel do not have available the specialists and resources needed after a disaster to treat all emergency cases on the spot. Often they are forced to confine their efforts to screening the victims and providing care for those who are able to survive without major medical assistance. In every instance the local personnel must be trained to receive the following medical emergencies:

· haemorrhages,
· cardiovascular failure,
· respiratory distress,
· states of shock,
· skull injuries,
· fractures,
· dislocations,
· burns,
· exposures to toxic substances,
· electrocution,
· drownings,
· cases of accidental hypothermia.

The types of emergency vary according to the kind of disaster and how and when it strikes.

In earthquakes there is a high level of mortality as a result of people being crushed by falling objects. The risk is greatest inside or near dwellings but is very small in the open. Consequently earthquakes at night are more deadly. There are large numbers of injuries. During the night fractures of the pelvis, thorax and spine are common because the earthquake strikes while people are lying in bed. In the daytime injuries to the arms and legs, the collarbone and the skull frequently occur. There may be people in a state of shock and people suffering from burns (particularly in areas where electricity and gas are installed). Afterwards there may be surgical complications of fractures or infections of wounds.

In volcanic eruptions mortality is high in the case of mudslides (23 000 deaths in Colombia in 1985) and glowing clouds (30 000 deaths at Saint-Pierre in Martinique). There may be injuries, bums and suffocations.

In floods, mortality is high only in the case of sudden flooding: flash floods, the collapse of dams or tidal waves. Fractures, injuries and bruising may occur. If the weather is cold, cases of accidental hypothermia may arise.

In cyclones and hurricanes mortality is not high unless tidal waves occur. The combined effect of wind and rain may cause houses to collapse. A large number of objects may be lifted in the air and carried along by the wind. This may give rise to injuries, fractures, cuts and bruises.

In droughts, mortality may increase considerably in areas where the drought causes famine, in which case there may be protein-calorie malnutrition (marasmus, kwashiorkor) and vitamin deficiencies (particularly vitamin A deficiency leading to xerophthalmia and child blindness). In famine conditions measles, respiratory infections and diarrhoea accompanied by dehydration may bring about a massive increase in infant mortality. When people migrate and settle on the outskirts of towns and villages, poor hygiene and overcrowding may facilitate the spread of endemic communicable diseases (diarrhoeas, tuberculosis, parasitic diseases and malaria).

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