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Natural disasters continue to be an unpredictable source of worldwide morbidity and mortality, and present unique challenges for practitioners of emergency care. Mortality rates can be staggering: an analysis of natural disasters worldwide between 1995 and 2004 found 3,197 events, with a range of 1500 to 2.5 million deaths per event.1 With any natural disaster, the potential exists for severe loss of life. More important for the emergency physician is management of the immediate and prolonged postdisaster phase to minimize secondary mortality and further deterioration of the health care system. Research suggests that the burden of natural disasters is likely to rise in the coming years, due to increasing population density in high-risk areas and risks associated with expanding technology (e.g., fires or earthquakes in larger and taller buildings or critical infrastructure).2


Although the mechanics, warning period, and impact vary widely between types of natural disasters, there are commonalities that apply to each event and its subsequent response. A loss of resources—economic, social, and health—is uniformly present in a community immediately after a disaster; pre-event preparedness and infrastructure strength often determine a community’s response to and recovery from catastrophe. Furthermore, particular diseases may be anticipated based on familiarity with the local disease burden (Table 7-1). Perhaps most salient for emergency practitioners, relief efforts should be implemented based on data from previous disaster experiences while simultaneously being sensitive to the disaster and region currently affected.

Table Graphic Jump Location
Table 7-1 Timing of Disease Presentation 

Most natural disasters—whether by water, wind, fire, or snow—cause some disruption of power, communication, and transportation systems. In developing nations as well as the U.S., entire cities can be destroyed instantly, overwhelming nearby health care facilities and personnel. In such cases, the traditional triage system may not be effective.3 A Centers for Disease Control and Prevention posthurricane assessment in 2002 determined that most of the resulting public health emergencies were directly due to power outages, which limited access to food, water, and medical care.4 Because standard amenities, such as power, running water, and sanitation methods may be unavailable for extended periods of time, all medical disaster planning must include practical, simple alternatives to technologies that are likely to fail during a disaster.


Lack of communication is a common feature of both the impact and delayed phases of a disaster. Even the most sophisticated equipment may fail due to regionwide outages or loss of electricity for charging devices. In our experience during Hurricane Katrina, the only working means of communication for a ...

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