Changes in the Functions for Continued Healthcare Services during a Disaster

Abstract

of each organization, and their relation to each other, by creating a matrix of the functions and organizations. Background: When a natural disaster or mass-casualty inci-dent occurs, a large number of injured people visit hospitals. During these times, hospitals need to provide additional services. Thus, it is necessary for various related organizations such as hospitals, municipalities, medical associations, and trade associations, to collaborate. There is a pressing need to establish an Area Disaster Resilience Management System for Health-care (ADRMS-H) to increase medical resilience. It is necessary to identify the functions of, and coordination between, organizations needed to develop ADRMS-H. Methods: We identified the medical care requirements during a disaster and the functions that guarantee ongoing health care by investigating disaster records and interviewing several doctors who provided health care services during the Great East Japan Earthquake. In addition, we analyzed the changes in the functions by the hour, and divided the phases based on the changes. Furthermore, we identified the organizations that are needed to fulfill each function and created a matrix between the functions and organizations of each phase. Results: We created the matrix based on each of the seven phases. The functions included those that must be fulfilled by hospitals, such as providing treatment, and those that must be fulfilled by municipalities, and so on, such as establishing aid stations. Some functions are fulfilled in cooperation with various organizations. Conclusion: When large earthquakes occurred in Japan, it was difficult to understand the functions needed to ensure con-tinued health care services. Creating the matrix of each phase enables us to understand the changing roles of each organiza-tion by the hour. This facilitates in the establishment of ADRMS-H. Study/Objective: The objective of this review was to elucidate the health problems over time, following flood and storm disasters. Background: The health care response to a flood or storm disaster should be guided by the expected health needs of the affected population, for both existing conditions and those caused by the disaster. It is essential to know how the burden of disease varies during different phases after the disaster, but there are few studies on the quantifiable changes in health, or in comparing the difference between floods and storms. Methods: A literature search of the databases Medline, Cinahl, Global Health, Web of Science Core Collection, Embase, and PubMed was conducted in June 2015, for English-language research articles on morbidity or mortality and flood or storm disasters. Articles on mental health, interventions, and health care workers were excluded. Data were extracted from articles that met the eligibility criteria and analyzed by narrative synthesis. Results: The review included 113 studies. Poisonings, wounds, gastrointestinal infections, and skin or soft tissue infections all increased after storms. Gastrointestinal infections were more frequent after floods. Leptospirosis and diabetes-related com-plications increased after both. The majority of changes occurred within four weeks of floods or storms. Conclusion: Health changes differently after floods and after storms. There is a lack of data on the health effects of floods alone, long-term changes in health, and the strength of the association between the disaster and health problems. An ana-lysis of how contextual factors affect health problems would be a useful complement to the results. The review highlights areas of consideration for medical response, and the need for high quality, systematic research in this area. The study was funded by the Swedish National Board of Health and Welfare.