The floods in the American Midwest in March 2008; the tornadoes that spun their way down the Virginia Peninsula on April 29, 2008; the tornadoes that struck the American Midwest on May 4, 2008; and Cyclone Nargis, which devastated Myanmar on May 4, 2008, reiterated how destructive Mother Nature can be. PAs were and are involved at some level in the responses to disasters in the United States, including the continuing efforts to recover from Hurricane Katrina (see Figure 1). Although some PAs may hesitate to volunteer their services following a disaster because they feel they lack proper skills, all PAs possess the basic medical skills that are needed during a natural disaster response. This article is a beginner's point of reference for exploring the vast and fascinating field of disaster medicine.
DISASTER EPIDEMIOLOGY
Natural disasters can occur in remote areas where medical care is already limited. Transportation infrastructure is often impaired or destroyed and inclement weather frequently hampers relief efforts. Affected communities may have to rely on existing resources for days to weeks before outside help arrives.1 Injuries and illnesses will occur far more often than fatalities. For example, CDC data show that for every tornado-induced fatality, approximately 44 survivors require some level of medical attention.2 This underscores the importance of medical support for both response and recovery operations. The incidences of respiratory and gastrointestinal illnesses may increase after a disaster. However, a disease needs to be already present in a community for it to appear in the aftermath of a disaster. A mass population movement after a disaster significantly increases the risk of enteric disease, which is exacerbated by poor sanitation and reduced public health services.3,4
Many injuries occur during the recovery phase when people are repairing and rebuilding damaged infrastructure. Musculoskeletal injuries related to overuse, overloading, or trauma—usually incurred while using power tools—occur most often. In addition to physical injuries, health care providers must be sensitive to the psychological impact of disasters and include mental health professionals in patient care when indicated. Posttraumatic stress disorder and depression are commonly found in disaster survivors, especially if they are displaced from their communities.5
Floods are the most common natural disaster. In the United States, floods cause more deaths than any other natural disaster, and most of these deaths occur during flash floods.6 Most flood-related injuries are lacerations and abrasions, which are frequently heavily contaminated with bacteria. The need for emergency medical care is rare and ranges from 0.2% to 2.0%.1 A flood in Missouri during the summer of 1993 is a good example of the prevalence of flood-related injuries. In a 50-day period during and after the flood, 524 flood-related conditions were reported; 250 of them were injuries including muscle sprains or strains, lacerations, and abrasions or contusions.5 The 233 reported cases of illness included GI problems, rashes or dermatitis, and heat-related illnesses.6 Hypothermia can also be prevalent in flood-water immersed victims (see Figure 2).
Floods also increase the risk for both waterborne and vectorborne illnesses. Waterborne diseases may appear within hours or days after the disaster and are likely to be diarrheas of varied etiologies. A waterborne disease that can manifest as late as 1 month after a flooding event is leptospirosis.
Caused by the bacteria leptospira interrogans, leptospirosis is associated with poor sanitation and the presence of rodents, dogs, cattle, and pigs. These animals can serve as reservoirs for the bacteria.7,8 Outbreaks of leptospirosis were recorded after floods in Nicaragua (1995), Brazil (1996), Krasnodar, Russia (1997), Santa Fe, New Mexico (1998), Orissa, India (1999), and Thailand (2000).3 Leptospirosis should be in the differential diagnosis for all febrile illnesses in a flood-impacted population.
Vectorborne diseases such as mosquito-borne diseases (malaria, West Nile fever, yellow fever, dengue, Saint Louis encephalitis) usually begin appearing roughly 6 to 8 weeks after flood waters recede. The increased incidence of these diseases stems from the favorable breeding conditions for mosquitoes created by flood waters.9