Chapter 58: Anesthesia for Humanitarian Relief Operations

INTRODUCTION

The World Health Organization (WHO) Centre for Research on the Epidemiology of Disasters (CRED) defines a disaster as “a situation or event which overwhelms local capacity, necessitating a request to a national or international level for external assistance; an unforeseen and often sudden event that causes great damage, destruction and human suffering.” Specific criteria include the following:

• 10 or more people reported killed

• 100 or more people reported affected

• Declaration of a state of emergency

• Call for international assistance

While natural disasters are categorized according to causality (tectonic events, flood, plague, etc.), many share similar patterns of increasing frequency, severity, and humanitarian impact (Figure 58–1).¹ Whether this is a result of improved data reporting or growing population and increased urbanization in susceptible areas, the result is a growing need for rapid and effective strategies to provide anesthetic care for trauma victims treated during the emergency medical relief scenarios of a collapsed medical infrastructure.

Much of the published data from medical humanitarian relief efforts comes from seismic events. Over 500,000 earthquakes are documented yearly, of which 3000 are perceptible. In the last 30 years, an annual average of 21 major earthquakes has been reported. Since 2005, however, this average has increased to more than 30 major events.² Since 1975, over 1.2 million deaths have been reported due to seismic events as per the U.S. Geologic Survey (USGS), with nearly half of all fatalities occurring within the last 10 years as a result of growing urban population density.³ According to the United Nations Environment Programme Global Resource Information Database (UNEP GRID), humanitarian disasters resulting from climatic and tectonic events demonstrate the greatest and most rapid impact on human health (Figure 58–2).⁴ Consequently, anesthetic strategies designed for these specific scenarios are of utmost importance from a healthcare perspective.

ANESTHESIA FOR DISASTER RELIEF FOLLOWING MAJOR NATURAL DISASTERS: EARTHQUAKES

Patient Injury Patterns: Presentation

In order for anesthetic medical relief to be effective, it must address the needs of the predominant injury pattern of those patients who are considered “salvageable.” Malish et al. conclude that the consideration of typical injury patterns helps establish early diagnosis and predict treatment requirements with the goal of stabilizing patients in the mass-casualty scenario.⁵ Based on various studies, early disaster surgical intervention focuses on surviving patients with limb injuries. In the proceedings of the WHO Symposium on Earthquakes and People’s Health,⁶ a global incidence of 51.2% was reported for limb injury based on earthquake data from 11 separate ...