Disasters and PCPsDisasters and PCPs

Is Failing to Prepare Preparing to Fail?

Disaster EffectsDisaster Effects

Supply shocks: diminished staff levels, staff capacity, damaged buildings and supplies

Demand shocks: increased injury, disease, distress

PCP OpinionsPCP Opinions

35-40% of family physicians disagree or aren’t sure they or medical community could respond effectively to a natural disaster (wild overest.)*chen

Redlener peds studyHeldring study

DefinitionDefinition

Medical perspective: A destructive event that causes extraordinary disruption of well-being (social, economic, physical, mental)

Types of disasters in the Types of disasters in the literatureliterature

Natural Disasters—Hurricanes Floyd, 1999; Andrew; Hugo; floods in England and Australia; Northridge earthquake; Hurricane Katrina

Terrorism—September 11th, Anthrax attacks, Aum Sharikyo

Epidemics—SARS

Social ConsequencesSocial Consequences

Flooding from Hurricane Floyd: 14% lost homes among PC population; 10% households lost work at 3 months

Increased outpatient, ER, pharmacy use up to 1 year later

Norris—family conflicts, occupational/financial stress

Health ConsequencesHealth Consequences

Orthopedic/soft tissue injuries, dermatitis and diarrhea from water borne pathogens, asthma (moldy homes), febrile illnesses, animal bites, exacerbations of chronic illnesses

Depression, PTSD, anxiety disorders, somatoform disorders, violence, suicide attempts, substance abuse, family conflicts

Children/adolescent behavior problems, stomach aches

Health Consequences—Floyd Health Consequences—Floyd FloodFlood

26% Loss of medical devices (oxygen tanks, wheelchairs) & medicines; access to dialysis

20%-25% new/worsened health problem in household

High Risk Populations—High Risk Populations—Disabled/ElderlyDisabled/Elderly

Higher rates of physical injury/illnessFunctional limitations (mobility,

communication, orientation)Economically underprivileged (live in more

vulnerable structures, unable to rapidly increase preparedness)

Socially isolated

High Risk Populations—High Risk Populations—ChildrenChildren

Higher rates of psychological problems

Other Vulnerable PopulationsOther Vulnerable Populations

Chronically illPrevious psychiatric disordersImmigrants/refugeesLower socioeconomic status

PCP RolePCP Role

Prevent, treat, alleviate health and social problems of disaster victims

Ethical responsibility

PCP RolePCP Role

Knowledge and Skills– Risk factors for psychological disorders– Psychological First Aid: turn off the tv!– PTSD, Bereavement

Resources– Office and staff plan– Family plan

Identify At-Risk Patients– Discuss disaster preparedness