disaster medicine and epidemiology
TRANSCRIPT
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Disaster medicine and
epidemiology
Graduate School of Medicine,
Kyoto Univ.
Satoko MITANI
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Definition of Disaster
an occurrence of a severity and magnitude
that normally results in deaths, injuries, and
property damage and that cannot be
managed through the routine procedures and
resources of government. It requires
immediate, coordinated, and effective
response by multiple government and private
sector organizations to meet human needs
and speed recovery. (FEMA,1984)
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The purpose of disaster medicine
is
to eliminate preventable death
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Preventable Trauma Death (PTD)
Death without access to appropriate treatment
Lives, which need not have been lost if
common treatment (ex., airway control,
release of tension pneumothorax) have beentaken
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Disaster cycle
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The warning phase
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Tsunami warning on 3.11, 2011
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Tsunami TEN DEN KO
Miracle on KAMAISHI
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Disaster cycle
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The impact phase
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To help yourself by yourself
Disaster cycle
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The emergency phase
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The wall of 72 hours
Probability of survival of buried victims
rescued within 24 hours : 60%
after 72 hours: around 10 %.
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Disaster cycle
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Sub-acute phase
Two or three weeks after the event
For patients with chronic disease
hypertension, diabetes, cardiac disease, mental
disorder
A patient with kidney disease who requires
dialysis treatment should be transported to
outside of the affected area
Psychological issues: ASD, PTSD
Infectious diseases
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Psychological issues
grief, distress, insomnia, hopelessness, and
intrusive re-experience are normal responses
under the abnormal situation like a disaster.
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Vulnerable people in sub-acute phase
The disability persons
Patients with chronic disease
Pregnant female
Children
The aged persons
Foreigners, travelers
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Issues in regard to rough existenceof shelters
The Great East Japan Earthquake
Occurred on 11th March, 2011
At 10thJuly 2013
Death and missing: 18550 persons
Refuge : over 400,000 persons
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Triage tagreverse
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Used triage tags
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Black tag
Death or non-treatment
1. Already died
2. No chance of successful resuscitation even
with cardiopulmonary resuscitation
3. The last order of transport, of non-transport
However, black tag does not confirm a death in
medical diagnosis
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Red tag
The highest priority
Patients who need emergency care to life-saving
Patients who have risk of asphyxia, severe
hemorrhaging, and shock
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impaired consciousness, airflow obstruction, breathing
difficulty, shock, severe hemorrhage, open wound of chest,
pneumohemothorax, intra-abdominal hemorrhage, multiple
born fracture, crush syndrome, multiple trauma, extensive
burn, burn of the respiratory tract
Yellow tag
non-emergency treatment
Patients with no risk of lives, even with being late for takingcare
Patients who need hospital treatments, however, who showcomfortable vital signs
Patients who need operations, however, within six to twelvehours
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Green tag
minor injury
Non-need for medical treatment by specialist physician
Sufficient to be treated at outpatient department
Patients who can walk by themselves
Examples: Born fracture of four limbs, abarticulation, bruise, sprain,
abraded wound, incision wound, slight burn, hyperventilation
syndrome
Even if being triaged to green tag, do not send them home right
away, but gather them to one place, and re-triage them, to avoida miss of under-triage and changes in the condition.
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Used triage tags
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Goal of triage
Right Patient
Right Place
Right Time
Create priorities
assess the degree of urgency
MIMMS Advanced Course 38
Report
Describe about the systems of disaster
medical response in your country, which you
think the most important and emergency to
prepare.
Express your opinion.
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