Principles and practice of disaster relief: lessons from Haiti

'I can see clearly now': clarifying the role of psychiatry in global disaster

OBJECTIVE

First, to review the principles and practice of disaster psychiatry, in light of recent global events. Second, to identify opportunities for research.

METHOD

A literature review of the MEDLINE database, UpToDate and the Cochrane Library was conducted. Reference lists were also reviewed.

RESULTS

Psychiatrists are well-positioned to contribute to positive outcomes at all stages of the disaster response. These contributions derive from their roles as doctors, mental illness specialists and clinical leaders.

CONCLUSION

A novel framework for the psychiatrist's contributions was proposed. Specific knowledge of disaster psychiatry may be worthwhile, and establishment of a public disaster psychiatry centre is reasonable. Research should further examine the role of tele-psychiatry and pursue a best practice for community and front-line employee psychological preparedness.

Civil-Military Coordination (CIMIC) Model in Natural Disasters in Iran

Objective:

The present study aimed at codifying a native model of civil-military coordination (CIMIC) in natural disasters in Iran.

Methods:

This manuscript is a part of a larger study. The present cross-sectional study was conducted in 2019 using a two-stage Delphi technique. The factors confirmed by the technique were prioritized via a pairwise questionnaire. In doing so, 24 elites and experts in civil-military coordination were presented with the indicators in the course of classic Delphi technique and pairwise comparison. At the end, the nationalized model was finalized by sending the model to ten experts and asking their ideas.

Results:

The results obtained from the two rounds of Delphi indicated that 36 coordination factors could be classified into three primary classes of staff, stuff, and system. All factors were confirmed by the experts. Considering the weight of each class, “staff” and “stuff” classes were considered to be the highest and lowest priorities, respectively.

Conclusion:

Application of the coordination factors in the context of military and civil organizations leads to a better response to natural disasters. The organizations in charge of responding to disasters should be obliged to apply this model in the highest organizational commitment level as the final goals of disaster management. The results of the present study can be applied for codification of a comprehensive plan for assessing the civil-military coordination in natural disasters.

Physiological Capabilities of Cryoconite Hole Microorganisms

Cryoconite holes are miniature freshwater aquatic ecosystems that harbor a relatively diverse microbial community. This microbial community can withstand the extreme conditions of the supraglacial environment, including fluctuating temperatures, extreme and varying geochemical conditions and limited nutrients. We analyzed the physiological capabilities of microbial isolates from cryoconite holes from Antarctica, Greenland, and Svalbard in selected environmental conditions: extreme pH, salinity, freeze-thaw and limited carbon sources, to identify their physiological limits. The results suggest that heterotrophic microorganisms in cryoconite holes are well adapted to fast-changing environmental conditions, by surviving multiple freeze-thaw cycles, a wide range of salinity and pH conditions and scavenging a variety of organic substrates. Under oxic and anoxic conditions, the communities grew well in temperatures up to 30°C, although in anoxic conditions the community was more successful at colder temperatures (0.2°C). The most abundant cultivable microorganisms were facultative anaerobic bacteria and yeasts. They grew in salinities up to 10% and in pH ranging from 4 to 10.5 (Antarctica), 2.5 to 10 (Svalbard), and 3 to 10 (Greenland). Their growth was sustained on at least 58 single carbon sources and there was no decrease in viability for some isolates after up to 100 consecutive freeze-thaw cycles. The elevated viability of the anaerobic community in the lowest temperatures indicates they might be key players in winter conditions or in early melt seasons, when the oxygen is potentially depleted due to limited flow of meltwater. Consequently, facultative anaerobic heterotrophs are likely important players in the reactivation of the community after the polar night. This detailed physiological investigation shows that despite inhabiting a freshwater environment, cryoconite microorganisms are able to withstand conditions not typically encountered in freshwater environments (namely high salinities or extreme pH), making them physiologically more similar to arid soil communities. The results also point to a possible resilience of the most abundant microorganisms of cryoconite holes in the face of rapid change regardless of the location.

Returning to normalcy in the short term: a preliminary examination of recovery from Hurricane Harvey among individuals with home damage

This study focuses on coastal counties in Texas, United States, affected by Hurricane Harvey in 2017 to gauge the influence of individual and contextual characteristics on people's ability to return to normalcy in the short term. Data from a survey conducted by the Kaiser Family Foundation and the Episcopal Health Foundation between October and November 2017 were utilised in the analysis. The paper observes, based on the results of an ordered logistic regression, and contrary to previous work, that age, gender, levels of poverty, and social capital are not significant predictors of a return to normalcy. However, indicators such as whether a person evacuated, if he/she identified as Hispanic/Latino, the extent of damage sustained to one's home, and if one's automobile was damaged or destroyed are shown to affect recovery. A discussion of the potential reasons for these findings is provided as a means of informing future research on disaster recovery.

Consideration of Medical and Public Health Coordination - Experience from the 2016 Kumamoto, Japan Earthquake

OBJECTIVE

The aim of this study was to identify disaster medical operation improvements from the 2016 Kumamoto Earthquake (Kumamoto Prefecture, Japan) and to extract further lessons learned to prepare for future expected major earthquakes.

METHODS

The records of communications logs, chronological transitions of chain of command, and team registration logs for the Disaster Medical Assistant Team (DMAT), as well as other disaster medical relief teams, were evaluated.

RESULTS

A total of 466 DMAT teams and 2,071 DMAT team members were deployed to the Kumamoto area, and 1,894 disaster medical relief teams and 8,471 disaster medical relief team member deployments followed. The DMAT established a medical coordination command post at several key disaster hospitals to designate medical coverage areas. The DMAT evacuated over 1,400 patients from damaged hospitals, transported medical supplies to affected hospitals, and coordinated 14 doctor helicopters used for severe patient transport. To keep constant medical and public health operations, DMAT provided medical coordination management until the local medical coordination was on-track. Several logistic teams, which are highly trained on operation and management of medical coordination command, were dispatched to assist management operation. The DMAT also helped to establish Disaster Coordination and Management Council at the prefectural- and municipal-level, and also coordinated command control for public health operations. The DMAT could provide not only medical assistance at the acute phase of the disaster, but also could provide medical coordination for public health and welfare.

CONCLUSION

During the 2016 Kumamoto Earthquake, needs of public health and welfare increased enormously due to the sudden evacuation of a large number of residents. To provide constant medical assistance at the disaster area, DMAT, logistic teams, and other disaster medical relief teams must operate constant coordination at the medical headquarter command. For future expected major earthquakes in Japan, it will be required to educate and secure high enough numbers of disaster medical assistance and health care personnel to provide continuous medical and public health care for the affected area residents.Kondo H, Koido Y, Kawashima Y, Kohayagawa Y, Misaki M, Takahashi A, Kondo Y, Chishima K, Toyokuni Y. Consideration of medical and public health coordination - experience from the 2016 Kumamoto, Japan Earthquake. Prehosp Disaster Med. 2019;34(2):149-154.

Improving Disaster Preparedness of Families With a Parenteral Nutrition-dependent Child

OBJECTIVES

Disruption in the care of special healthcare needs children may lead to life-threatening situations or preventable secondary conditions. California averages more than 100 earthquakes per week. Subsequent power outages, damage to utility systems, and road damage after an earthquake can have grave consequences for families with parenteral nutrition (PN)-dependent children. The purpose of the study was to demonstrate that we could improve disaster preparedness of families with PN-dependent children utilizing individualized family education and distribution of personalized disaster survival toolkits.

METHODS

We administered a baseline survey to assess disaster preparedness of our families with PN-dependent children followed by individualized disaster survival toolkit distribution and education. We followed up with these families with phone call surveys at 2 and 4 months. A generalized estimating equation with both logistic and linear regression was used to analyze data over the follow-up period.

RESULTS

We found statistically significant improvements in developing a family emergency plan (P < 0.0001), having a basic emergency supply kit (P < 0.0001), having a completed emergency information form from the child's provider (P < 0.0001), and the confidence level or readiness for a disaster (P < 0.0001). All participants had extra batteries for PN infusion pumps. Having alternative power sources, such as a generator, did not significantly change over time.

CONCLUSIONS

Individualized disaster education helped families with PN-dependent children not only to prepare for a possible earthquake, but also to feel more confident in their ability to handle a natural disaster.

Effective International Medical Disaster Relief: A Qualitative Descriptive Study

Purpose

The aim of this study was to assist organizations seeking to develop or improve their medical disaster relief effort by identifying fundamental elements and processes that permeate high-quality, international, medical disaster relief organizations and the teams they deploy.

Methods

A qualitative descriptive design was used. Data were gathered from interviews with key personnel at five international medical response organizations, as well as during field observations conducted at multiple sites in Jordan and Greece, including three refugee camps. Data were then reviewed by the research team and coded to identify patterns, categories, and themes.

Results

The results from this qualitative, descriptive design identified three themes which were key characteristics of success found in effective, well-established, international medical disaster relief organizations. These characteristics were first, ensuring an official invitation had been extended and the need for assistance had been identified. Second, the response to that need was done in an effective and sustainable manner. Third, effective organizations strived to obtain high-quality volunteers.

Conclusion

By following the three key characteristics outlined in this research, organizations are more likely to improve the efficiency and quality of their work. In addition, they will be less likely to impede the overall recovery process.

BrobyN, LassetterJH, WilliamsM, WintersBA. Effective international medical disaster relief: a qualitative descriptive study. Prehosp Disaster Med. 2018;33(2):119–126.

Terremotos y salud: lecciones y recomendaciones

Los terremotos, además de los múltiples efectos que producen, ponen en evidencia la vulnerabilidad de los sistemas de salud y crean la necesidad de adoptar una política de Estado que ponga en práctica un plan de contención y mitigación de daños a la salud. Asimismo, el comportamiento de las personas durante un terremoto es un factor importante de predicción de su supervivencia, por lo tanto, la educación de la comunidad acerca de cómo comportase durante un evento es primordial...

Basic educational needs of midwifery students for taking the role of an assistance in disaster situations: A cross-sectional study in Iran

BACKGROUND

After disasters, the disaster medical assistance team composed of skilful healthcare staff should be available at the disaster site for providing care to disaster's victims. It is believed that midwives are at the front line of the disaster management team and should be prepared for providing care to mothers and children.

OBJECTIVES

To investigate the midwifery students' basic educational needs for taking the role of an assistant in disaster situations.

DESIGN

A cross-sectional study was conducted in an urban area of Iran, in year 2015.

PARTICIPANTS

Two hundred and thirty-one final-year midwifery students with bachelor and master degrees in midwifery participated in this study.

SETTING AND SAMPLES

The samples were chosen using a census method from four nursing and midwifery schools affiliated with four medical sciences universities in Tehran, Iran.

METHODS

The informed consent form was signed by the samples before data collection. The samples were asked to fill out the researcher's made questionnaires consisting of the demographic data form and the basic educational needs for taking the role of an assistant in disaster situations. The later was consisted of two parts: 'coping with disaster situations' and 'performing the triage'. The data were analysed using descriptive and inferential statistics via the SPSS software for Windows.

RESULTS

The mean score of coping with disaster situations was 31.3±8.2 (out of 45). Also, the mean score of performing the triage was 14.6±11.8 (out of 20). It was found that 68.8 and 74% of the students in coping with disaster situations and performing the triage, respectively had high and very high educational needs. The highest educational need was reported in the areas of 'time management' and 'the use of equipment in disaster situations'. About 86.8% of the students declared that academic education did not prepared them for taking roles in disaster situations. Only 10.6% passed educational courses about disasters before and 11.5% had the work experience in disaster situations. There was a statistically significant relationship between the students' age (P=0.01), participation in educational courses (P=0.005) and the work experience in disaster situations (P=0.04) and educational needs.

CONCLUSIONS

Our findings showed that the midwifery students had high needs for education regarding disaster situations. Therefore, the incorporation of disaster management content in the midwifery degree curricula is suggested.

Natural disaster management: experience of an academic institution after a 7.8 magnitude earthquake in Ecuador

OBJECTIVES

This case study describes the implementation of an academic institution's disaster management plan.

STUDY DESIGN

Case study.

METHODS

USFQ's Medical School developed a six-phase disaster relief plan consisting of: induction, establishing a base camp, crisis management and mental health aid, creation of multidisciplinary teams and multi-agency teams, and reconstruction. Each phase uses a community-oriented approach to foster survivor autonomy and recovery.

RESULTS

Our methodology facilitated the successful implementation of multidisciplinary interventions to manage the earthquake's aftermath on the personal, community and regional levels, treated and prevented psychological and physical morbidity among survivors and promoted healthy living conditions and independence.

CONCLUSIONS

A multidisciplinary response team that addresses medical needs, mental health, education, food, nutrition and sanitation is highly effective in contributing to timely, effective relief efforts. The short- and long-term solutions we describe could be applicable to other academic centres' interventions in future disaster scenarios around the world.

Of timelines and timeliness: lessons from Typhoon Haiyan in early disaster response

Typhoon Haiyan struck the Philippines on 8 November 2013 with maximum sustained winds of 235 kilometres per hour, adversely affecting at least 11 million people and displacing some 673,000 in the central regions of the country. The disaster clearly overwhelmed the Philippine government despite its seemingly well-crafted disaster management plan. Using timelines of different organisations, this paper identifies gaps in the government's response, mainly due to its failure in coordinating and managing relief operations, which adversely affected its effectiveness and efficiency in the delivery of critical goods and services following the disaster. The paper also demonstrates how non-governmental organisations (NGOs), the United Nations, foreign governments and other organisations provided assistance, mainly through aid niching, to cover the government's shortcomings. The paper recommends a paradigm shift in the government's disaster response by integrating collaborative arrangements between government agencies and NGOs, and giving local governments the lead role, with the national government as support, in disaster planning and response.

Haitian and international responders' and decision-makers' perspectives regarding disability and the response to the 2010 Haiti earthquake

BACKGROUND

Following disasters, persons with disabilities (PWD) are especially vulnerable to harm, yet they have commonly been excluded from disaster planning, and their needs have been poorly addressed during disaster relief. Following the 2010 Haiti earthquake, thousands of individuals experienced acute injuries. Many more individuals with preexisting disabilities experienced heightened vulnerability related to considerations including safety, access to services, and meeting basic needs.

OBJECTIVE

The objective of this research was to better understand the perceptions of responders and decision-makers regarding disability and efforts to address the needs of PWD following the 2010 earthquake.

DESIGN

We conducted a qualitative study using interpretive description methodology and semistructured interviews with 14 Haitian and 10 international participants who were involved in the earthquake response.

RESULTS

Participants identified PWD as being among the most vulnerable individuals following the earthquake. Though some forms of disability received considerable attention in aid efforts, the needs of other PWD did not. Several factors were identified as challenges for efforts to address the needs of PWD including lack of coordination and information sharing, the involvement of multiple aid sectors, perceptions that this should be the responsibility of specialized organizations, and the need to prioritize limited resources. Participants also reported shifts in local social views related to disability following the earthquake.

CONCLUSIONS

Addressing the needs of PWD following a disaster is a crucial population health challenge and raises questions related to equity and responsibility for non-governmental organizations, governments, and local communities.

Plastic Surgery Response in Natural Disasters

Disasters cause untold damage and are often unpredictable; however, with proper preparation, these events can be better managed. The initial response has the greatest impact on the overall success of the relief effort. A well-trained multidisciplinary network of providers is necessary to ensure coordinated care for the victims of these mass casualty disasters. As members of this network of providers, plastic surgeons have the ability to efficiently address injuries sustained in mass casualty disasters and are a valuable member of the relief effort. The skill set of plastic surgeons includes techniques that can address injuries sustained in large-scale emergencies, such as the management of soft-tissue injury, tissue viability, facial fractures, and extremity salvage. An approach to disaster relief, the types of disasters encountered, the management of injuries related to mass casualty disasters, the role of plastic surgeons in the relief effort, and resource management are discussed. In order to improve preparedness in future mass casualty disasters, plastic surgeons should receive training during residency regarding the utilization of plastic surgery knowledge in the disaster setting.

Resource-poor settings: response, recovery, and research: care of the critically ill and injured during pandemics and disasters: CHEST consensus statement

BACKGROUND

Planning for mass critical care in resource-poor and constrained settings has been largely ignored, despite large, densely crowded populations who are prone to suffer disproportionately from natural disasters. As a result, disaster response has been suboptimal and in many instances hampered by lack of planning, education and training, information, and communication.

METHODS

The Resource-Poor Settings panel developed five key question domains; defining the term resource poor and using the traditional phases of the disaster cycle (mitigation/preparedness/response/recovery). Literature searches were conducted to identify evidence to answer the key questions in these areas. Given a lack of data on which to develop evidence-based recommendations, expert-opinion suggestions were developed, and consensus was achieved using a modified Delphi process.

RESULTS

The five key questions were as follows: definition, capacity building and mitigation, what resources can we bring to bear to assist/surge, response, and reconstitution and recovery of host nation critical care capabilities. Addressing these led the panel to offer 33 suggestions. Because of the large number of suggestions, the results have been separated into two sections: part I, Infrastructure/Capacity in the accompanying article, and part II, Response/Recovery/Research in this article.

CONCLUSIONS

A lack of rudimentary ICU resources and capacity to enhance services plagues resource-poor or constrained settings. Capacity building therefore entails preventative strategies and strengthening of primary health services. Assistance from other countries and organizations is often needed to mount a surge response. Moreover, the disengagement of these responding groups and host country recovery require active planning. Future improvements in all phases require active research activities.

International aid and natural disasters: a pre- and post-earthquake longitudinal study of the healthcare infrastructure in Leogane, Haiti

The reconstruction of healthcare systems in developing countries after natural disasters is poorly understood. Using data collected before and after the 2010 Haiti earthquake, we detail the response of aid agencies and their interaction with local healthcare providers in Leogane, the city closest to the epicenter. We find that the period after the earthquake was associated with an increase in the total number of healthcare facilities, inpatient beds, and surgical facilities and that international aid has been a driving force behind this recovery. Aid has funded 12 of 13 new healthcare facilities that have opened since the earthquake as well as the reconstruction of 7 of 8 healthcare facilities that have been rebuilt. Despite increases in free, aid-financed healthcare, private Haitian healthcare facilities have remained at a constant number. The planned phase-out of several aid-financed facilities, however, will leave Leogane with fewer inpatient beds and healthcare services compared with the pre-earthquake period.

Characteristics, determinants and perspectives of experienced medical humanitarians: a qualitative approach

OBJECTIVE

To explore the characteristics, motivations, ideologies, experience and perspectives of experienced medical humanitarian workers.

DESIGN

We applied a qualitative descriptive approach and conducted in-depth semistructured interviews, containing open-ended questions with directing probes, with 44 experienced international medical aid workers from a wide range of humanitarian organisations. Interviews were coded and analysed, and themes were developed.

SETTING

International non-governmental organisations (INGOs) and United Nations (UN).

RESULTS

61% of participants were female; mean age was 41.8 years with an average of 11.8 years of humanitarian work experience with diverse major INGOs. Significant core themes included: population's rights to assistance, altruism and solidarity as motives; self-identification with the mission and directives of INGOs; shared personal and professional morals fostering collegiality; accountability towards beneficiaries in areas of programme planning and funding; burnout and emotional burdens; uncertainties in job safety and security; and uneasiness over changing humanitarian principles with increasing professionalisation of aid and shrinking humanitarian access. While dissatisfied with overall aid operations, participants were generally satisfied with their work and believed that they were well-received by, and had strong relationships with, intended beneficiaries.

CONCLUSIONS

Despite regular use of language and ideology of rights, solidarity and concepts of accountability, tension exists between the philosophy and practical incorporation of accountability into operations. To maintain a humanitarian corps and improve aid worker retention, strategies are needed regarding management of psychosocial stresses, proactively addressing militarisation and neo-humanitarianism, and nurturing individuals' and organisations' growth with emphasis on humanitarian principles and ethical practices, and a culture of internal debate, reflection and reform.

Using the military in disaster relief: systemising challenges and opportunities

Purpose

– The purpose of this paper is to contribute to a greater understanding of the challenges of civil military logistical cooperation, coordination and collaboration in humanitarian relief logistics.

Design/methodology/approach

– Systematic literature review of academic journals.

Findings

– This paper has four main findings. First, a categorisation of humanitarian logistics literature is achieved through a systematic review. Second, a classification of military involvement in humanitarian relief logistics is presented. Third, the research substantiated systematic differences in the kinds of military cooperation not only due to stage of operations but also depending upon whether the disaster is “natural” or “manmade”. Fourth, the research identifies the challenges of civil military logistical cooperation, coordination and collaboration and posits recommendations to overcome the identified challenges.

Research limitations/implications

– This paper represents an exploratory study and provides the basis for further research on cooperation, coordination and collaboration between military and civilian agencies in humanitarian operations. The paper sets a research agenda for academics.

Practical implications

– This paper is the first to offer practical guidance to military commanders and managers of humanitarian agencies on solutions and recommendations to overcome the challenges to civil military logistical cooperation/coordination in humanitarian operations.

Originality/value

– The area of civil military logistical cooperation/coordination has received limited consideration within the humanitarian aid logistics literature to date. This paper is designed to redress this shortfall. As a result, it is hoped that it will act as a catalyst for further research and to widen and deepen the resultant debate with a view to improving the outcome for those affected by current and future disasters.

Wilderness medicine

BACKGROUND

Human activity in wilderness areas has increased globally in recent decades, leading to increased risk of injury and illness. Wilderness medicine has developed in response to both need and interest.

METHODS

The field of wilderness medicine encompasses many areas of interest. Some focus on special circumstances (such as avalanches) while others have a broader scope (such as trauma care). Several core areas of key interest within wilderness medicine are discussed in this study.

RESULTS

Wilderness medicine is characterized by remote and improvised care of patients with routine or exotic illnesses or trauma, limited resources and manpower, and delayed evacuation to definitive care. Wilderness medicine is developing rapidly and draws from the breadth of medical and surgical subspecialties as well as the technical fields of mountaineering, climbing, and diving. Research, epidemiology, and evidence-based guidelines are evolving. A hallmark of this field is injury prevention and risk mitigation. The range of topics encompasses high-altitude cerebral edema, decompression sickness, snake envenomation, lightning injury, extremity trauma, and gastroenteritis. Several professional societies, academic fellowships, and training organizations offer education and resources for laypeople and health care professionals.

CONCLUSIONS

THE FUTURE OF WILDERNESS MEDICINE IS UNFOLDING ON MULTIPLE FRONTS: education, research, training, technology, communications, and environment. Although wilderness medicine research is technically difficult to perform, it is essential to deepening our understanding of the contribution of specific techniques in achieving improvements in clinical outcomes.

Critically assessing the Haiti earthquake response and the barriers to quality orthopaedic care

BACKGROUND

Although numerous authors have described surgical experiences following major disasters, little is known regarding the needs of and barriers to care faced by surgeons during such disasters.

QUESTIONS/PURPOSES

We therefore (1) identified and compared recurrent interview themes essential to the disaster response following the 2010 Haiti earthquake; (2) determined the difference in reported disaster equipment management task difficulty between disaster-trained and untrained volunteers; and (3) approximated the quantity of various procedures performed.

METHODS

We conducted 14 interviews with selected orthopaedic surgeon volunteers. We also invited the 504 members of the American Academy of Orthopaedic Surgeons (AAOS), who registered as Haiti earthquake volunteers, to complete an online survey; 174 (35%) completed the survey and 131 (26%) were present in Haiti during the 30 days after the earthquake. Recurrent interview themes were identified, quantified, and compared using Poisson regression analysis. The difference in disaster equipment management difficulty scores was determined with a Wilcoxon rank-sum test.

RESULTS

Of 10 recurrent interview themes, group organization (31 occurrences) was mentioned much more often than all but two of the remaining nine themes. Compared with disaster-untrained respondents, equipment management tended to be less challenging for disaster-trained respondents. Transporting to the treatment site and security during storage at the site were less challenging (19.5% and 16.5% decreases, respectively). Revision surgeries, guillotine amputations, fasciotomies, and internal fixations, suggestive of inappropriate disaster care, were frequently reported.

CONCLUSIONS

Organizational and training barriers obstructed orthopaedic care delivery immediately after the Haiti earthquake. Disaster training and outcomes require further study to improve care in future catastrophes.

Emergency Surgery Data and Documentation Reporting Forms for Sudden-Onset Humanitarian Crises, Natural Disasters and the Existing Burden of Surgical Disease

Following large-scale disasters and major complex emergencies, especially in resource-poor settings, emergency surgery is practiced by Foreign Medical Teams (FMTs) sent by governmental and non-governmental organizations (NGOs). These surgical experiences have not yielded an appropriate standardized collection of data and reporting to meet standards required by national authorities, the World Health Organization, and the Inter-Agency Standing Committee's Global Health Cluster. Utilizing the 2011 International Data Collection guidelines for surgery initiated by Médecins Sans Frontières, the authors of this paper developed an individual patient-centric form and an International Standard Reporting Template for Surgical Care to record data for victims of a disaster as well as the co-existing burden of surgical disease within the affected community. The data includes surgical patient outcomes and perioperative mortality, along with referrals for rehabilitation, mental health and psychosocial care. The purpose of the standard data format is fourfold: (1) to ensure that all surgical providers, especially from indigenous first responder teams and others performing emergency surgery, from national and international (Foreign) medical teams, contribute relevant and purposeful reporting; (2) to provide universally acceptable forms that meet the minimal needs of both national authorities and the Health Cluster; (3) to increase transparency and accountability, contributing to improved humanitarian coordination; and (4) to facilitate a comprehensive review of services provided to those affected by the crisis.

BurkleFMJr, NickersonJW, von SchreebJ, RedmondAD, McQueenKA, NortonI, RoyN. Emergency surgery data and documentation reporting forms for sudden-onset humanitarian crises, natural disasters and the existing burden of surgical disease. Prehosp Disaster Med.2012;27(6):1-6.

An ill wind? Climate change, migration, and health

BACKGROUND

Climate change is projected to cause substantial increases in population movement in coming decades. Previous research has considered the likely causal influences and magnitude of such movements and the risks to national and international security. There has been little research on the consequences of climate-related migration and the health of people who move.

OBJECTIVES

In this review, we explore the role that health impacts of climate change may play in population movements and then examine the health implications of three types of movements likely to be induced by climate change: forcible displacement by climate impacts, resettlement schemes, and migration as an adaptive response.

METHODS

This risk assessment draws on research into the health of refugees, migrants, and people in resettlement schemes as analogs of the likely health consequences of climate-related migration. Some account is taken of the possible modulation of those health risks by climate change.

DISCUSSION

Climate-change-related migration is likely to result in adverse health outcomes, both for displaced and for host populations, particularly in situations of forced migration. However, where migration and other mobility are used as adaptive strategies, health risks are likely to be minimized, and in some cases there will be health gains.

CONCLUSIONS

Purposeful and timely policy interventions can facilitate the mobility of people, enhance well-being, and maximize social and economic development in both places of origin and places of destination. Nevertheless, the anticipated occurrence of substantial relocation of groups and communities will underscore the fundamental seriousness of human-induced climate change.

The response of academic medical centers to the 2010 Haiti earthquake: the Mount Sinai School of Medicine experience

On January 12, 2010, Haiti was struck by a 7.0 earthquake which left the country in a state of devastation. In the aftermath, there was an enormous relief effort in which academic medical centers (AMC) played an important role. We offer a retrospective on the AMC response through the Mount Sinai School of Medicine (MSSM) experience. Over the course of the year that followed the Earthquake, MSSM conducted five service trips in conjunction with two well-established groups which have provided service to the Haitian people for over 15 years. MSSM volunteer personnel included nurses, resident and attending physicians, and specialty fellows who provided expertise in critical care, emergency medicine, wound care, infectious diseases and chronic disease management of adults and children. Challenges faced included stressful and potentially hazardous working conditions, provision of care with limited resources and cultural and language barriers. The success of the MSSM response was due largely to the strength of its human resources and the relationship forged with effective relief organizations. These service missions fulfilled the institution's commitment to social responsibility and provided a valuable training opportunity in advocacy. For other AMCs seeking to respond in future emergencies, we suggest early identification of a partner with field experience, recruitment of administrative and faculty support across the institution, significant pre-departure orientation and utilization of volunteers to fundraise and advocate. Through this process, AMCs can play an important role in disaster response.