Injury (1990) 21, 15-16 Printed in Great Britain 15

Discussion: Day One ‘Major disasters abroad’

Morning session chairman: Mr William Rutherford OBE FRCS

Open discussion following papers on the experiences of relief workers abroad. Papers presented but not published included:

Oscar Davis, Head of International Aid, British Red Cross

The Effects of a Disaster - The Needs Created - The Red Cross Response.

Whilst the characteristics of a disaster may vary, the effect on people, communication and public services problems are common to many major accidents. To be of benefit the response of Government and non-government organi- zations to the needs created must be rapid, effective and appropriate.

Howard Baderman MRCP, Accident and Emergency Consultant, London

The British Response to Disasters Abroad

As adviser to the DHSS and WHO on Accident and Emergency Services, Dr. Baderman has been extensively involved in many discussions for overseas emergency medical relief. The current UK provision was outlined, arguments for future developments were discussed.

Open Discussion

Dr Judith Fisher: The World Association for Emergency and Disaster Medi- cine, originally known as the Club of Mainz, formed in 1976, was cofounded with the WHO. Dr Baskett, Chairman Elect, and I have been giving advice to them on international planning. Among the suggestions is an international register of doctors, and international agreement over the use of permanent visas. There are five working groups, one of which is concerned with ‘international response’.

Brigadier W. E. I. Forsythe-Jauch: With major disasters you either take the doctor to the patient or vice versa. I feel we should be receptive to patients from overseas tragedies. I have personal experience in this way of the Islamabad explosion.

0 1990 Butterworth & Co (Publishers) Ltd 0020-1383/90/010015-02

Dr John Seaman: Unfortunately most people do not even receive basic healthcare. We have to decide why it is we think that injuries that occur after certain kinds of arbitrary events have a special category which means that we do not have to discuss the cost associated with them.

Dr Howard Baderman: It is important that we consider the aspect of cost, but I think we should not obstruct the basic wish to help; even though the cost of major disasters is very high.

Dr C. A. Perez-Avila: As a Salvadorian I have experience of events in that country. The Civil War has lasted for ten years and there was an earthquake three or four years ago. The earthquake affected the capital, which has 750 000 inhabitants. Two of the major hospitals were destroyed. There was no need for medical assistance because many well qualified doctors survived. There was, however, a desperate need for equipment. The idea of a ‘site medical officer’ coordinating the medical requirements is very appealing. Also, the so-called ‘first world often forgets what has happened to the ‘third world one month after the event. In El Salvador we were inundated with blankets and corrugated iron, which are still being used, but the hospitals have still not been rebuilt. The French Government has negotiated for the rebuilding of one of the main hospitals.

Dr John seaman: A great deal of so-called ‘disaster aid is politically and economically motivated. Ten years ago the British Govem- ment gave ‘disaster aid to Saudi Arabia. This helped the trade balance between the two countries.

Dr V. Gautam I am an Indian training in the UK in A & E medicine. There is a need for training in the native countries so that they can deal with their own problems in an appropriate way.

h4r William Rutherford: The ‘international medical community’ should share the experience of training so that the knowledge is available to countries to deal with their own disasters.

16 Injury: the British Journal of Accident Surgery (1990) Vol. 2l/No. 1

Mr Tony Redmond: After the Armenian relief operation, I was invited to a meeting in Moscow. It was felt that medically qualified personnel could have got involved at an earlier stage, and the military doctors certainly felt that they could have contributed more. I feel that even though it is diHicult to help because we are often far removed from the incident, we should not abandon any attempts as doctors.

The rescue workers in Armenia who had previous experience wanted doctors to become involved at an early stage. They need medical assistance to save the lives of any survivors; they often need medical help when they them- selves are injured; and they find it reassuring to work with people with experience of tragedy, illness, and injury.

Anonymous speaker: Countries should be better prepared for disasters them- selves. It should not be the responsibility of countries such as the UK to answer all the problems in any particular country.

Mr Tony Redmond: This raises the question of where do you place the ‘local response’? In disasters such as Armenia there was a delay in the medical response. Such a response is difficult to organize.

Anonymous speaker: ‘Information’ is one of the most important resources. Reports from the media are filtered before they are released. It is a shame that selected reports of the medical requirements cannot be made available.

The BBC World Service helps with training by broad- casting programmes on topics such as rehydration.

It is important to be aware of ‘low-tech solutions to problems. While in Afghanistan we found that by stretching a drip tube it became flexible and could be used as a paediatric nasogastric tube.

Dr John Seaman: The vast majority of disasters do not get reported in the media at all, because most occur in places with difficult access. There is a body of literature, much of which is from the UN, that people with a scientific background should read.

Mr Howard Baderman: Once the UK medical fraternity and the relevant govem- ment agencies are properly organized, we should look to the military and the media for the use of communications networks.

Mr Christopher Rudge: The aspect of cost is .Iportant. The media do not need to justify their costs i- .neir efforts to report a story. It would require a large investment to match their resources.

Mr Oscar Davies: Expense is not the only barrier. The British Red Cross procured telecommunications equipment to send to Armenia, and due to the bureaucracy of the UK it has still not left1

Mr William Rutherford: The basic humanity of good medicine is important. We are talking about events that we fail to respond to at our own peril as human beings and doctors.

/

Medicine for Disasters Edited by Peter Baskett BA MB BCh BAC FFARCS Consultant Anaesthetist, Frenchay Hospital, Bristol and Bristol Royal Infirmary, UK; Honorary Secretary of the World Association of Emergency and Disaster Medicine Robin Weller MB BS FFARCS DA Consultant Anaesthetist, Department of Anaesthetics, Frenchay Hospital, Bristol, UK

+ describes the fundamental principles of disaster management - medical and organisational

* gives detailed coverage of specific types of disaster whether natural or man-made + contributions from authors worldwide * aimed at doctors, nurses, paramedical staff, civil and military defence professionals

Contents l Foreword * History * Assessment and triage l Resuscitology and the management of severe trauma (to include bums) * Anaesthesia and analgesia in the field (to include bums) l Disaster planning in developed countries * Disaster planning in developing countries * Assessment of disasters in the developing world * The co-ordination of governments and the relief agencies - communications and legal aspects l Personnel and their training - Emergency supplies for disasters in developing countries l Patient evacuation and dispersal - The media and public relations l Communications l Identification of the dead - Nursing aspects of disasters l Psychiatric problems including mass grief. Environmental problems - heat and cold and shelter * Communicable diseases including measures for sanitation and immunisation * Famine l Earthquakes - Floods and hurricanes - Volcanoes * Road - Rail l Aircraft and airports - Shipwreck and exposure l Chemical accidents l Terrorism - aetiology and pathology * Terrorism - management and forensic - Nuclear accidents l A directory of organisations related to emergency and disaster medicine

March 1988 Sl2pages 234x 166mm Hardcover Bstrated 0 7236 0949 7 E60.00

For details of other Butterworth Scientific titles, please contact the appropriate office. Orders should be sent to the appropriate office listed below.

The UK headquarters serves all UK and overseas markets except where there IS a local Butlerworlhs office

\

United Kingdom Cuatomora in Ask mey order through: USA L Cenada Burterwonh Publtshers Butferworths. Borough Green Bulterworfh 6 Co (Asia) Pte Ltd

Sevenoaks. Kent TN15 BPH England

30 Robinson Road, Unit 12-01 Tuan Sing Towers 80 Monrvaie Avenue Singapore 0104. Repubkc of Singapore Stoneham. MA 02180,USA

Aurtnlla & Papua Now Quinr Naw Zoahnd Buaerwonhs Pty Lid. PO Bow 345 Butferwonhs of New Zealand Lid North Ryde. New South Wales 2113 33-35 Cumberland Place Australia Wellmgton 1, New Zealand