Emergency Health Services Lecture 3 PDF

Ahfad University for Women 2021 Emergency health services Lecture ( 3 )  Key competencies 􀂃 To understand the consequences of disasters and the role of health services in disasters; 􀂃 To recognise the staffing required for managing large numbers of casualties; 􀂃 To...

Ahfad University for Women 2021 Emergency health services Lecture ( 3 )  Key competencies 􀂃 To understand the consequences of disasters and the role of health services in disasters; 􀂃 To recognise the staffing required for managing large numbers of casualties; 􀂃 To design appropriate facility-based and community-based health services; 􀂃 To understand the importance of supporting community health services;  Key competencies 􀂃 To understand how to implement emergency health services in the acute phase; 􀂃 To recognise and address special health issues in emergencies; 􀂃 To design a drug supply system; and 􀂃 To organise an information system for monitoring and evaluating health services  Introduction The type of health services provided depends on whether the emergency situation is a natural disaster, a complex emergency or protracted refugee health; but it must guarantee basic physical and mental care as well as prevention. In all emergency situations, the prioritisation of health services must focus on meeting both the short-term and long-term needs of the victims.  Introduction The priorities for health services in the emergency phase should focus on treating common health conditions such as trauma injuries, acute infections and acute exacerbation of chronic diseases. It should also involve all available health providers including community health workers. An ongoing health information system for monitoring the health status of the affected population can be integrated into the existing national health information system.  Effects of disasters The effects of disasters on health depend on the disaster’s type and time of onset. Sudden onset disasters such as earthquakes pose greater threats to health than slow onset disasters. The actual and potential health problems resulting from the disaster are multi- faceted and do not all occur at the same time. The resulting health problems might be related to food and nutrition, water and sanitation, mental health, climatic exposure and shelter, communicable diseases, health infrastructure and population displacement.  Consequences of disasters on health services Disasters, whether natural or human-made, create particular problems for health services. Damage to health infrastructure: ❑ Disasters can cause serious damage to health facilities, water supplies and sewage systems. The damage can severely limit health systems’ provision of medical care to the population in the time of the greatest immediate need. ❑Structural damage to facilities poses a risk for both health care workers and patients;  Consequences of disasters on health services The supply chain (medical equipment and pharmaceutical supplies) for the health facilities is often temporarily disrupted; 􀂃 Limited road access makes it at least difficult for disaster victims to reach health care centres. 􀂃 Pre-hospital coordination and communication is crucial in emergency situations. Disrupted communication systems lead to a poor understanding of the various receiving facilities’, military resources’ and relief organisations’ actual capacity.  Increased demands for medical attention 􀂃 Climatic exposure because of rain or cold weather puts a particular strain on the health system; 􀂃 Inadequacy of food and nutrition exposes the population to malnutrition, particularly in the vulnerable groups; and 􀂃 If there is a mass casualty incident, health systems can be quickly overwhelmed and left unable to cope with the excessive demands.  Population displacement ❖A mass exodus from the emergency site places additional stress and demands on the host country, its population, facilities and health services, particularly. ❖ Depending on the size of the population migration, the host facilities may not be able to cope with the new burden, and ❖Mass migration can introduce new diseases into the host community.  Major outbreaks of communicable diseases ❖ While natural disasters do not always lead to massive infectious disease outbreaks, they do increase the risk of disease transmission. The disruption of sanitation services and the failure to restore public health programmes combined with the population density and displacement, all culminate in an increased risk for disease outbreaks. ❖The incidence of endemic vector-borne diseases may increase due to poor sanitation and the disruption of vector control activities  The role of emergency health services in disasters Disasters call for a coordinated response between curative and preventive health services, including food supply, water and sanitation. To minimise mortality and morbidity, it is also necessary to organise the relief response according to three levels of preventive health measures  Primary prevention The ultimate goal of preventive health care to prevent the transmission of disease to generally healthy population by using the following actions: Promoting healthy practices; Implementing public health measures that reduce a population’s exposure to risk factors such as ensuring a safe drinking water supply to prevent diarrhoea, Conducting medical interventions such as chemo-prophylactics against malaria and measles immunisation.  Secondary prevention Identifies and treats as early as possible diseased people. This is done using the following: Alleviating symptoms of diseases such as giving OR S early to a child with diarrhoea to prevent dehydration and possible death; and Curing patients with diseases through early detection and treatment of TB, dysentery, etc. Tertiary prevention Reduces permanent damage from disease such as a patient being offered rehabilitative services to lower the effects of paralysis due to polio or land mine injuries. Planning emergency health services Assess Priority Implement Setting Detailed Set Goals planning & Ob.  Assessment and priority setting Emergency health care must focus on the most urgent health problems. These may vary depending on the nature and magnitude of the disaster on and whether there is a long term population displacement. Any interventions recommended after the assessment must prevent excess mortality and morbidity as well as anticipate future health problems from the evolving emergency situation.  Setting goals and objectives The goals of establishing emergency health care for large displaced populations can be defined as: o Reducing excess mortality and morbidity; and o Targeting the health problems that are causing the excess mortality. The goals for reducing excess mortality and morbidity can be reached by providing the appropriate medical care to those with: Acute injuries resulting from trauma or acute exacerbation of chronic medical diseases in a disaster’s aftermath; and Clinical illnesses from communicable diseases.  Detailed planning The following steps can be used to develop a plan: ❑Identify the priority health services needed and when they should be established; ❑ Define the level of health care that will be provided; ❑Define the strategy for providing health services; and ❑ Set standards for health services. Defining the strategy for establishing health services There are two basic strategies for providing emergency health care to a large displaced population: Facility-based health care; and Community-based health care  Facility-based health care Facility-based health care can be established by augmenting the local health care system, setting up a separate health care system or setting up mobile or satellite clinics.  Facility-based health care Augmenting local services has many advantages because: Resources are not wasted by duplicating existing services; Local health authorities are directly involved with the problems faced by the displaced population; and Both the host and displaced populations receive equal medical attention, thereby reducing resentment from the host pop. Setting up a separate health care system Sometimes local services are inaccessible, overloaded or short- staffed. If setting up new facilities is the only option, seek approval from the national health authorities at the beginning. Policies of the host country health system should be adopted for the following: ▪Clinical diagnosis and therapeutic protocols; ▪ Essential drugs and drug supply; ▪ Patient flow and referral system; Setting up a separate health care system ▪ Health information system; ▪ Training curriculum for health workers including health workers from the displaced population; ▪ Minimum staffing levels per facility including expatriates; and ▪ Coordinating health care and relations with the national health care system  Field hospitals and clinics The Pan American Health Organisation cites three basic criteria for setting up a field hospital: ▪ Be fully operational within twenty-four hours of the disaster; ▪ Be able to provide services that coincide with medical needs; and ▪ Allow for national health personnel to operate the technology contained within. Field hospitals and clinics More specifically, a field hospital should have the following features: ▪ A secure location; ▪ Easy access for the population to be served; ▪ Several access routes for transport of patients and supplies; ▪ Adequate water supply: 150-200 litres per patient per day including laundry; ▪ Access to local staff and translators; Field hospitals and clinics ▪ An organised supply chain; ▪ Sanitation system with latrines, drainage and waste disposal; ▪ Covered waiting areas for protection from the weather; and ▪ Several generators for a reliable electricity supply. Diagram of a ready-made system  A ready-made system Often, ready-made systems are not available. They have to be created one or parts of them on the ground. The initial step is to set up a health centre for 10,000 to 30,000 beneficiaries supported by a network of home visitors and a referral system to a tertiary care hospital. This enables active case finding and the integration of beneficiaries into the health system. Maintain a triage system throughout this process so that serious yet easily treatable diseases are immediately taken care of such as diarrhoea that might lead to severe dehydration.  Setting up mobile or satellite clinics Outreach services are appropriate for delivering preventive care such as immunisations or antenatal care. Outreach clinic supervisors should be encouraged to visit health workers based in the community such as Community Health Workers, Traditional Birth Attendants (TBAs) and auxiliaries to assess and build the capacity of the community-based health workers. Outreach clinics are not the appropriate facility for treating serious medical conditions that require a more frequent follow-up.  Facility-based health care The aim of establishing an emergency health system should be to strengthen the local health system. Whichever strategy is adopted, to achieve the following: Comprehensive care :looking for other conditions that a patient may not report such as depression with persistent headaches or abdominal pain (somatisation); Continuity of care : following up referrals, defaulters of TB treatment or immunisation; and Integrated care : linking curative with preventive care at every opportunity such as combining child immunisation with antenatal clinic days.  Community-based health care Strengthening local health facilities does not guarantee that everyone will use them. Possible barriers to seeking health care include the lack of: Awareness of available services; Access due to various problems such as being too far, inconvenient hours of operation, health workers’ poor attitudes, no money for drugs, ethnic-based or politically-based discrimination and inadequate security; and Health care resources such as drugs, materials, staff and services.  Setting up a community health worker programme There are two ways of establishing community-based health care: 1. Setting up a community health worker programmes; and 2. Integrating alternate health providers.  Community Health Workers (CHW) During the acute emergency phase, initial training should focus on simple priority tasks that address immediate health needs such as: ✓ Identifying cases of disease as early as possible; ✓Referring the seriously ill as early as possible; ✓ Identifying vulnerable groups; ✓Information, Education and Communication about disease prevention and control , and ✓ Data collection on all the above activities. Integrating alternate health providers ‘Modern’ health practitioners. Non-government organisation (NGO). Other service providers: Elders, Religious leaders, Teachers, and Social service organisations  Setting standards for emergency health care Advantages from standardising emergency health care include: ❑ Easier integration of new staff members; ❑Regulating patient referrals to higher levels of care; ❑ Improving management of drugs and equipment; and ❑ Preventing competition between facilities that provide the same care.  The incident command system Incident command system is a hierarchical structure that commands, controls and coordinates an effective emergency response among all the agencies and organisations in a disaster. The incident command system Incident command system is composed of five major components: 1. Incident command; 2. Operations; 3. Planning; 4. Logistics; and 5. Finance  Expected injury patterns by disaster Type of disaster Expected injury pattern Drought Heat exhaustion, stroke, dehydration, renal failure, malnutrition and starvation Earthquake Fractures, blunt trauma, wounds, crush syndrome Wildfire Severe burns, respiratory complications Temperature Hypothermia, hyperthermia, frostbite, heat stroke extremes Volcano Severe burns, crush injuries, respiratory infections/complications Wave/surge/flood Drowning, hypothermia, waterborne communicable diseases Windstorm Blunt/penetrating trauma to head/chest (caused by flying debris), crush