Roy Nobhojit
World Association of Disaster and Emergency Medicine.
Prehosp Disaster Med. 2006 Sep-Oct;21(5):310-5. doi: 10.1017/s1049023x00003939.
On 26 December 2004, an earthquake (9.0 Richter, 10 kilometers below the sea) near Sumatra, Indonesia, triggered a tsunami, which traveled at approximately 800 km per hour to strike the Indian coastline. The disaster response at a 100-bed hospital situated on the beach front (2,028 km from the epicenter) is described. This paper underlines the benefit of the Pan-American Health Organization (PAHO)/World Health Organization (WHO) Guidelines for Natural Disasters in the Indian setting.
The demand on the healthcare system in the affected study area (50 km2, 40,000 population) was assessed in terms of preparedness, response time, casualties, personnel, and resources. Other disaster issues studied included: (1) the disposal of the dead; (2) sanitation; (3) water supply; (4) food; (5) the role of the media; and (6) rehabilitation. Two hospital paramedics administered a disaster-related questionnaire in the local language to the victims (or an accompanying person) upon arrival at the hospital. Personal interviews with administrative officials involved in incident management, aid, volunteers, and response, also were conducted. The outreach programs consisted of medical camps, health education, re-chlorination of contaminated drinking water, and spraying bleaching powder on wet floor areas.
The total death toll in the area was 62 (with 56, four, and two bodies being recovered on Day 1, 2, and 3 respectively). There were 17 deceased males and 45 females. The bodies immediately were handed over to the relatives upon identification or sent to the mortuary. The attendance in the makeshift accident-and-emergency department on the day of the Tsunami was 219, surged to 339 patients on Day 2, and returned to baseline census on Day 7. Essentially, injuries were minor, and two children with pulmonary edema secondary to salt-water drowning recovered fully. The hospital was cleaned of debris and seaweed on Day 3 and the equipment was restored, but it remained only partially functional. This is because many staff members did not come to work because of rumors that another tsunami was imminent. There were no outbreaks of water-borne illnesses. Post-traumatic stress disorder (PTSD) symptoms such as panic attacks, nightmares, insomnia, fear of water, being startled by loud sounds, and palpitations were detected in 17% of the patients.
After an event, medical rescue personnel often are instructed by well-meaning authorities to conduct interventions and response, which have high visibility in the media. However, strictly adhering to the PAHO/WHO guidelines proved to be cost-effective in terms of resource allocations and disaster responses in the Tsunami-affected areas. Unnecessary mass vaccinations, mass disposal of dead bodies without identification, and an influx of untrained volunteers were avoided. Inappropriate aid by developed nations often is unmindful of the victims' needs and self-esteem. The survivors demonstrated natural coping mechanisms and resilience, which only required time and psychosocial support.
2004年12月26日，印度尼西亚苏门答腊附近发生地震（里氏9.0级，震源在海面以下10公里处），引发了海啸，海啸以每小时约800公里的速度冲击印度海岸线。本文描述了一家位于海滨（距震中2028公里）、拥有100张床位的医院的灾难应对情况。本文强调了泛美卫生组织（PAHO）/世界卫生组织（WHO）自然灾害指南在印度背景下的益处。
从准备情况、响应时间、伤亡情况、人员和资源等方面评估了受灾研究区域（50平方公里，4万人口）对医疗系统的需求。研究的其他灾害问题包括：（1）尸体处理；（2）卫生设施；（3）供水；（4）食品；（5）媒体的作用；（6）恢复。两名医院护理人员在受害者（或陪同人员）抵达医院时，用当地语言对其进行了与灾难相关的问卷调查。还对参与事件管理、援助、志愿者和应对工作的行政官员进行了个人访谈。外展项目包括医疗营地、健康教育、对受污染饮用水进行重新氯化处理以及在潮湿地面区域喷洒漂白粉。
该地区的总死亡人数为62人（第1天、第2天和第3天分别找到56具、4具和2具尸体）。其中男性死亡17人，女性死亡45人。尸体一经辨认便立即交给亲属，或送往停尸房。海啸当天临时事故和急诊科的就诊人数为219人，第2天激增至339人，第7天恢复到基线普查水平。基本上，受伤情况较轻，两名因海水溺水继发肺水肿的儿童已完全康复。医院在第3天清理了残骸和海藻，并恢复了设备，但仍仅部分功能可用。这是因为许多工作人员因有传言称即将发生另一次海啸而未前来上班。没有爆发水源性疾病。在17%的患者中检测到创伤后应激障碍（PTSD）症状，如惊恐发作、噩梦、失眠、怕水、被巨响惊吓和心悸。
事件发生后，善意的当局常常指示医疗救援人员进行干预和应对，这些干预和应对在媒体上具有很高的关注度。然而，在海啸受灾地区，严格遵守泛美卫生组织/世界卫生组织的指南在资源分配和灾难应对方面被证明是具有成本效益的。避免了不必要的大规模疫苗接种、未经辨认就大规模处理尸体以及大量未经培训的志愿者涌入。发达国家不恰当的援助往往忽视了受害者的需求和自尊。幸存者展示了自然的应对机制和恢复力，这只需要时间和社会心理支持。
