The public health response to the Chi-Chi earthquake in Taiwan, 1999

2018 Taiwan Hualien Earthquake-Disaster Lessons We Learned in the Emergency Department of a Tertiary Hospital

Background

On February 6, 2018, a magnitude-6.2 earthquake on the Richter scale struck Hualien, and that disaster killed 17 people and injured more than 300 people. Our hospital, the only tertiary hospital in eastern Taiwan, responded to a mass casualty incident (MCI) in two hours. Such a devastating earthquake infl uenced the health of the general population and the mental health of hospital staff. Thus, we aimed to analyze the medical problems in earthquake victims, the MCI response's operation, and the prevalence of post-traumatic stress disorder (PTSD) among healthcare providers.

Methods

We reviewed the medical records to investigate the information on the medical requirement of victims. Questionnaires were collected from emergency department staff regarding the operation of the MCI and the effect of regular MCI drills. For a survey of PTSD among healthcare providers, we used the Chinese version of the Davidson Trauma Scale for the psychiatric assessment.

Results

Among the 113 victims who entered the emergency room, almost 90% had a minor injury. The results of the operation of the MCI revealed that 71.5% of them knew the response process of the MCI and performed well. The hospital staff's mental health assessment showed 17.5% met the diagnostic criteria for PTSD one month after the disaster, and 3.2% met the criteria seven months after the earthquake. Personal psychiatric histories were the only risk factor for PTSD.

Conclusions

Most earthquake victims presented to the emergency room with trauma injuries. Thus, we need to prepare more resources to manage surgical problems. To be well prepared for mass casualty events, the annual exercises play a signifi cant role. Besides, we can't ignore the mental health condition of healthcare providers after the disaster. We record this tragic earthquake's valuable experience and lessons and share them with others.

Disaster preparedness and response improvement: comparison of the 2010 Haiti earthquake-related diagnoses with baseline medical data

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Objectives

Disaster medicine research generally lacks control groups. This study aims to describe categories of diagnoses encountered by the Belgian First Aid and Support Team after the 2010 Haiti earthquake and extract earthquake-related changes from comparison with comparable baseline data. The hypothesis is that besides earthquake-related trauma, medical problems emerge soon, questioning an appropriate composition of Foreign Medical Teams and Interagency Emergency Health Kits.

Methods

Using a descriptive cohort study design, diagnoses of patients presenting to the Belgian field hospital were prospectively registered during 4 weeks after the earthquake and compared with those recorded similarly by Médecins Sans Frontières in the same area and time span in previous and later years.

Results

Of 7000 triaged postearthquake patients, 3500 were admitted, of whom 2795 were included and analysed. In the fortnight after the earthquake, 90% suffered from injury. In the following fortnight, medical diseases emerged, particularly respiratory (23%) and digestive (14%). More than 53% developed infections within 3 weeks after the event. Médecins Sans Frontières registered 6407 patients in 2009; 6033 in 2011; and 7300 in 2012. A comparison indicates that postearthquake patients suffered significantly less from violence, but more from wounds, respiratory, digestive and ophthalmological diseases.

Conclusion

This is the first comparison of postearthquake diagnoses with baseline data. Within 2 weeks after the acute phase of an earthquake, respiratory, digestive and ophthalmological problems will emerge to the prejudice of trauma. This fact should be anticipated when composing Foreign Medical Teams and Interagency Emergency Health Kits to be sent to the disaster site.

The evidence base of primary research in public health emergency preparedness: a scoping review and stakeholder consultation

BACKGROUND

Effective public health emergency preparedness and response systems are important in mitigating the impact of all-hazards emergencies on population health. The evidence base for public health emergency preparedness (PHEP) is weak, however, and previous reviews have noted a substantial proportion of anecdotal event reports. To investigate the body of research excluding the anecdotal reports and better understand primary and analytical research for PHEP, a scoping review was conducted with two objectives: first, to develop a thematic map focused on primary research; and second, to use this map to inform and guide an understanding of knowledge gaps relevant to research and practice in PHEP.

METHODS

A scoping review was conducted based on established methodology. Multiple databases of indexed and grey literature were searched based on concepts of public health, emergency, emergency management/preparedness and evaluation/evidence. Inclusion and exclusion criteria were applied iteratively. Primary research studies that were evidence-based or evaluative in nature were included in the final group of selected studies. Thematic analysis was conducted for this group. Stakeholder consultation was undertaken for the purpose of validating themes and identifying knowledge gaps. To accomplish this, a purposive sample of researchers and practicing professionals in PHEP or closely related fields was asked to complete an online survey and participate in an in-person meeting. Final themes and knowledge gaps were synthesized after stakeholder consultation.

RESULTS

Database searching yielded 3015 citations and article selection resulted in a final group of 58 articles. A list of ten themes from this group of articles was disseminated to stakeholders with the survey questions. Survey findings resulted in four cross-cutting themes and twelve stand-alone themes. Several key knowledge gaps were identified in the following themes: attitudes and beliefs; collaboration and system integration; communication; quality improvement and performance standards; and resilience. Resilience emerged as both a gap and a cross-cutting theme. Additional cross-cutting themes included equity, gender considerations, and high risk or at-risk populations.

CONCLUSIONS

In this scoping review of the literature enhanced by stakeholder consultation, key themes and knowledge gaps in the PHEP evidence base were identified which can be used to inform future practice-oriented research in PHEP.

Surveillance and epidemiology in natural disasters: a novel framework and assessment of reliability

OBJECTIVE

To create a framework and methodology for organizing relevant disaster epidemiology literature. The target audience for the framework is local public health practitioners conducting emergency surveillance in the setting of preparedness or response to natural disasters.

METHODS

The approach to developing the framework involved utilizing the public health and emergency management literature. It was created along four axes. The first was the type of natural disaster; second was according to phase of disaster cycle; third was the impact of the disaster (health, infrastructure, economic); and fourth was related to the main outcome of the study (ie. injuries or infectious diseases). A literature review was conducted and subsequently the current literature was utilized to perform a reliability test of the established framework, using two independent reviewers.

RESULTS

Using existing disaster classification systems and risk analysis tools, a framework was developed along the four axes. The final literature search resulted in 85 articles on surveillance in natural disaster settings. The majority of studies are on the subject of hurricanes with a catastrophic impact rating. The phase of testing reliability of the framework resulted in percent agreement of 74%.

CONCLUSIONS

A reliable framework was developed that enables local public health practitioners to easily access appropriate and previously utilized surveillance methods for a natural disaster emergency. This framework contributes to an evidence-informed approach to surveillance in natural disasters with public health impacts.

Taiwan's medical response to the 921 'Chi-Chi' earthquake

OBJECTIVE

The objective of this study was to identify and review literature relevant to the medical response to the 921 earthquake in order to analyse Taiwan's immediate and long-term management of the medical issues arising from the disaster.

METHODS

Pubmed and Google Scholar searches were conducted in June 2008 to identify papers relevant to the topic. These were reviewed and the findings of each collated to develop a critical review of Taiwan's response to the earthquake. Pubmed and Google Scholar searches were conducted again in March 2010 to verify the currency of the literature reviewed.

RESULTS

A total of 14 papers were identified and reviewed. Many concluded that while disaster response efforts were initiated quickly, the inexperience of the authorities, the timing and location of the earthquake, and the associated destruction of vital infrastructure, meant much of the initial rescue planning and coordination was improvised. This resulted in poor response times by emergency teams, inefficient mobilisation of military and medical resources, poor cooperation between authorities and a failure to fully utilise international assistance when it arrived.

CONCLUSION

Taiwan was unprepared for a disaster of the magnitude of the 921 earthquake. The government has since taken initiatives to ensure Taiwan is better prepared for any future large scale disaster, including the establishment of the National Institute for Disaster Management. There is a paucity of literature on the medical response to the disaster. Only one new paper of relevance to the topic has been listed on Pubmed or Google Scholar in recent years.

Disasters and perinatal health:a systematic review

BACKGROUND

The empirical literature on the effects of disaster on pregnancy and the postpartum period is limited. The objective of this review was to examine the existing evidence on the effect of disasters on perinatal health.

METHODS

A systematic review was conducted by searching electronic databases (MEDLINE, EMBASE, Cinahl, PsycInfo), including literature on disasters and pregnancy outcomes (e.g., preterm birth, low birth weight, congenital anomalies), mental health, and child development. A total of 110 articles were identified, but many published reports were anecdotes or recommendations rather than systematic studies. The final review included 49 peer-reviewed studies that met inclusion criteria.

RESULTS

Studies addressing the World Trade Center disaster of September 11 and other terrorist attacks, environmental/chemical disasters, and natural disasters such as hurricanes and earthquakes were identified. Disasters of various types may reduce fetal growth in some women, although there does not appear to be an effect on gestational age at birth. Severity of exposure is the major predictor of mental health issues among pregnant and postpartum women. After a disaster, mental health of the mother may more strongly influence on child development than any direct effect of disaster-related prenatal stress.

CONCLUSIONS

There is evidence that disaster impacts maternal mental health and some perinatal health outcomes, particular among highly exposed women. Future research should focus on understudied outcomes such as spontaneous abortion. Relief workers and clinicians should concentrate on the most exposed women, particularly with respect to mental health.

TARGET AUDIENCE

Obstetricians & Gynecologists.

LEARNING OBJECTIVES

After completion of this educational activity, the obstetrician/gynecologist should be better able to compare and contrast the effects of different types of disasters (hurricanes, earthquakes, chemical spills) on pregnant and postpartum women in order to prepare for patient care in the aftermath of such disasters; differentiate the birth outcomes likely to be affected by disaster, in order to identify patients likely to be at high risk; and assess the extent to which pregnant and postpartum women are a uniquely vulnerable population after disaster, to assist in organizing care under such circumstances.

Rapid Health and Needs assessments after disasters: a systematic review

Background

Publichealth care providers, stakeholders and policy makers request a rapid insight into health status and needs of the affected population after disasters. To our knowledge, there is no standardized rapid assessment tool for European countries. The aim of this article is to describe existing tools used internationally and analyze them for the development of a workable rapid assessment.

Methods

A review was conducted, including original studies concerning a rapid health and/or needs assessment. The studies used were published between 1980 and 2009. The electronic databasesof Medline, Embase, SciSearch and Psychinfo were used.

Results

Thirty-three studies were included for this review. The majority of the studies was of US origin and in most cases related to natural disasters, especially concerning the weather. In eighteen studies an assessment was conducted using a structured questionnaire, eleven studies used registries and four used both methods. Questionnaires were primarily used to asses the health needs, while data records were used to assess the health status of disaster victims.

Conclusions

Methods most commonly used were face to face interviews and data extracted from existing registries. Ideally, a rapid assessment tool is needed which does not add to the burden of disaster victims. In this perspective, the use of existing medical registries in combination with a brief questionnaire in the aftermath of disasters is the most promising. Since there is an increasing need for such a tool this approach needs further examination.

The burden of acute respiratory infections in crisis-affected populations: a systematic review

Crises due to armed conflict, forced displacement and natural disasters result in excess morbidity and mortality due to infectious diseases. Historically, acute respiratory infections (ARIs) have received relatively little attention in the humanitarian sector. We performed a systematic review to generate evidence on the burden of ARI in crises, and inform prioritisation of relief interventions. We identified 36 studies published since 1980 reporting data on the burden (incidence, prevalence, proportional morbidity or mortality, case-fatality, attributable mortality rate) of ARI, as defined by the International Classification of Diseases, version 10 and as diagnosed by a clinician, in populations who at the time of the study were affected by natural disasters, armed conflict, forced displacement, and nutritional emergencies. We described studies and stratified data by age group, but did not do pooled analyses due to heterogeneity in case definitions. The published evidence, mainly from refugee camps and surveillance or patient record review studies, suggests very high excess morbidity and mortality (20-35% proportional mortality) and case-fatality (up to 30-35%) due to ARI. However, ARI disease burden comparisons with non-crisis settings are difficult because of non-comparability of data. Better epidemiological studies with clearer case definitions are needed to provide the evidence base for priority setting and programme impact assessments. Humanitarian agencies should include ARI prevention and control among infants, children and adults as priority activities in crises. Improved data collection, case management and vaccine strategies will help to reduce disease burden.

Prevalence of HCV and HIV infections in 2005-Earthquake-affected areas of Pakistan

Background

On October 8, 2005, an earthquake of magnitude 7.6 hit the Northern parts of Pakistan. In the post-earthquake scenario, overcrowding, improper sewage disposal, contamination of food and drinking water, hasty surgical procedures, and unscreened blood transfusions to earthquake victims most likely promotes the spread of infections already prevalent in the area.

Objective

The objective of the study reported here was to determine the prevalence of Human Immunodeficiency and Hepatitis C viruses (respectively, HIV and HCV) in the earthquake-affected communities of Pakistan. The samples were analyzed 2 months and then again 11 months after the earthquake to estimate the burden of HIV and HCV in these areas, and to determine any rise in the prevalence of these viral infections as a result of the earthquake.

Methods

Blood samples were initially collected during December, 2005 to March 2006, from 245 inhabitants of the earthquake-affected areas. These samples were screened for HCV and HIV, using immunochromatography and Enzyme-Linked Immuno-Sorbent Assay (ELISA).

Results

Out of 245 samples tested, 8 (3.26%) were found positive for HCV, and 0 (0.0%) for HIV, indicating the existence of HCV infection in the earthquake-stricken areas. The same methods were used to analyze the samples collected in the second round of screening in the same area, in September, 2006 – 11 months after the earthquake. This time 290 blood samples were collected, out of which 16 (5.51%) samples were positive for HCV, and 0 for HIV.

Conclusion

A slightly higher prevalence of HCV was recorded 11 months after the earthquake; this increase, however, was not statistically significant. None of the study participants was found HIV-infected.

Negligible risk for epidemics after geophysical disasters

After geophysical disasters (i.e., earthquakes, volcanic eruptions, tsunamis), media reports almost always stress the risk for epidemics; whether this risk is genuine has been debated. We analyzed the medical literature and data from humanitarian agencies and the World Health Organization from 1985 to 2004. Of >600 geophysical disasters recorded, we found only 3 reported outbreaks related to these disasters: 1 of measles after the eruption of Pinatubo in Philippines, 1 of coccidioidomycosis after an earthquake in California, and 1 of Plasmodium vivax malaria in Costa Rica related to an earthquake and heavy rainfall. Even though the humanitarian response may play a role in preventing epidemics, our results lend support to the epidemiologic evidence that short-term risk for epidemics after a geophysical disaster is very low.

The devastation of Bam: an overview of health issues 1 month after the earthquake

The appalling earthquake in the ancient city of Bam on December 27th 2003 was one of the worst disasters since the last century in Iran. Further to the chilling statistics of human loss, essential services including water supply, power, telephone, health care services, main roads, and the city's only airport were crippled. From the 'public health' and 'health emergency' perspectives, the initial priorities were to minimise avoidable further mortality and morbidity. This required prompt evacuation of the injured, defining catchment areas, establishment of efficient systems for disease control, organising a disaster management plan, out patient management, co-ordination of international aid, and re-organising the current PHC network in the district. The second stage, each department planning health delivery for the subsequent year, was rapidly initiated. This paper discusses these strategies, which were designed specifically for Bam but are likely useful in similar situations.