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INTRODUCTION

Casualties from natural disasters can easily deplete available resources, and can cause issues with pre-existing healthcare systems.

TYPES OF INJURIES AFTER NATURAL DISASTERS

Natural disasters are classified as geophysical (earthquakes, volcano, dry mass movement such as landslide or avalanche), hydrologic (floods), meteorologic (storm, tornado), and climatologic (extremes in temperature).1–5 Certain disasters can lead to predictable injuries and illness patterns.5 Hurricane, a storm with winds > 74 mph, can cause traumatic injuries related to flying objects and wind pressure.5 Tornado, a violent rotating column of air, can have craniocerebral injuries, crush injuries from falling structures, fractures which may be open, contusion, abrasions, soft tissue injuries, and sepsis.5–7 Floods cause drowning and hypothermia.5,7 Landslides, a downward movement of soil, lead to submersion or immersion injuries. Earthquakes, the sudden violent shaking of the ground, can lead to crush injuries, fractures, lacerations, and fire related injury such as burns or smoke inhalation. Tsunami, a high wave caused by underwater disturbance, can lead to trauma and drowning.5 Forest fires can lead to burns, smoke inhalation injuries, hypovolemic shock, and sepsis. Heat waves can lead to heat exhaustion and heat stroke. On the opposite spectrum of temperature, winter storms can lead to automobile accidents with life threatening traumatic injuries, hypothermia, and carbon monoxide poisoning. Volcanoes can discharge air pollutants which can lead to new respiratory failure or exacerbation of pre-existing lung disease, conjunctivitis, arthralgias, burns, and cutaneous bullae.5

EVACUATION OF HOSPITAL DURING NATURAL DISASTER

Pre-Event ICU Evacuation planning should be in place as soon as possible.1,2 Strategies should include shelter in place, partial evacuation, or early evacuation.2 If possible, coordination with local government should be in place so there would be enough ground or flight support. Responders have suggested the following ICU-specific equipment: transport sleds (21%), oxygen tanks and respiratory therapy supplies (19%), flashlights (24%), portable ventilators and suctions (16%), and walkie-talkies (26%).1 These ventilators should be able to support patients on current power and with adequate oxygenation.2 Major stressors include lack of water, food, toilets, and concerns for family members.1

In time limited scenarios, patients who are less critical should be evacuated first to maximize the number of patients that can be moved out.2 If there is adequate time, all critical care patients can be moved in parallel. Another approach would be to transfer similar patients together as a group; allowing the other facility to cluster resources.

Preparation of patient for evacuation involves stabilization, finishing diagnostic procedures, and addressing the physiologic changes during transportation.2 Complete transfer of medical records, preferably electronically via the internet or with the patient using a USB flash drive and/or paper medical record, is key. Patient and supplies should be tracked.

ICU IN AUSTERE CONDITIONS

A make-shift ICU and/or ...

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