PM2ch42.pdf

Military and Public Health Aspects of Natural Disasters

Chapter 42

MILITARY AND PUBLIC HEALTH

ASPECTS OF NATURAL DISASTERS

JOSE L. SANCHEZ, MD, MPH AND STEVE HOROSKO III, P H D

INTRODUCTION

MILITARY ROLE AND RESPONSIBILITIES

TYPES OF NATURAL DISASTERS

Windstorms

Floods

Earthquakes and Tsunamis

Volcanic Eruptions

IMPACT OF DISASTER PREPAREDNESS PLANS

SURVEILLANCE

Immediate Assessment

Short-term Assessments

Ongoing Medical Surveillance

EPIDEMIOLOGIC ASSESSMENT TEAMS

DISEASE CONTROL

Communicable Diseases

Malnutrition

Psychological Effects

Long-term Illnesses

DEATH AND INJURY

Patterns and Mechanisms

Human and Socioeconomic Factors

Physical, Environmental, and Geographic Factors

ENVIRONMENTAL HEALTH

Initial Environmental Health Assessment

Water

Human Waste

Waste Water

Solid Waste and Dust

Hazardous Substances and Medical Waste

Management of the Dead

Shelter

Food Sanitation

Personal Hygiene

Insect and Rodent Control

SUMMARY

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Military Preventive Medicine: Mobilization and Deployment, Volume 2

J.L. Sanchez , MD, MPH, Colonel, Medical Corps, US Army; Medical Epidemiologist and Military Chief, Department of Global

Epidemiology and Threat Assessment, US Military HIV Research Program, 13 Taft Ct. Suite 200, Rockville, MD 20850; Formerly:

Manager, Epidemiology Services Program, US Army Center for Health Promotion and Preventive Medicine, Aberdeen Proving

Ground, MD 21010-5403

S. Horosko III , P H D, Lieutenant Colonel, Medical Service Corps, US Army; Preventive Medicine Staff Officer, Office of the Surgeon

General, XVIII ABN Corps, Fort Bragg, NC 28310

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Military and Public Health Aspects of Natural Disasters

INTRODUCTION

The involvement of the US military in providing

disaster relief is an original intent of the Constitu-

tion and is defined in Titles 10 and 32 of the US

Code. 1 Humanitarian disaster relief efforts date

back to the pre–Civil War era, when Congress in

1847 approved the loan of naval vessels for trans-

port of supplies to the victims of the Irish potato

famine. 2 Army troops were subsequently used in

the administration and maintenance of stockpiles

of food, clothing, and tents during domestic relief

operations. After the turn of the 20th century, the

Army also assumed a role in the conduct of sanita-

tion and vaccination programs in the United States

and its territories. 2 Since 1972, the military has been

actively involved in conducting medical, logistic,

operational, and command and control functions

during emergency humanitarian relief after major

natural disasters. Examples include earthquakes

(Peru, 1970; Nicaragua, 1972; Guatemala, 1976),

floods (Sudan, 1988; Venezuela, 1999), windstorms

(Bangladesh, 1970, 1991; Sri Lanka, 1978; Florida,

1992, 1995; Hawaii, 1992; Central America 1998-

1999), and volcanic eruptions (Philippines, 1990). 3,4

Since the Persian Gulf War in 1991, the US mili-

tary has deployed smaller contingents more fre-

quently in peacekeeping operations and civilian

assistance missions. For example, on a typical day

in April 1996, as many as 41,000 US Army soldiers

were deployed on temporary duty to as many as 59

separate locations in the United States and overseas

in support of foreign humanitarian assistance mis-

sions. 5 Clearly, there is an ever-increasing need for

military preventive medicine and other medical

personnel to know about the specific needs that

arise in domestic or international natural disaster

relief operations.

MILITARY ROLE AND RESPONSIBILITIES

In the event of a natural disaster, the military may

be tasked to provide assistance (Figure 42-1). In ei-

ther a domestic or international scenario, military

support to civil authorities is the responsibility of

the Department of Defense, not the individual ser-

vices. In international scenarios, the Department of

State will request assistance through its coordinat-

ing agency, the Office of Foreign Disaster Assis-

tance, which coordinates all military and civilian

operations. 1 Military forces will be under the com-

Fig. 42-1. The military is unique in its ability to get rapidly deployable medical systems to the site of a disaster

quickly. After Hurricane Andrew struck southern Florida in August 1992, destroying hospitals and clinics as well as

homes and schools, military units responded by moving needed medical infrastructure to the area. ( a ) This is a front

line ambulance (FLA) that was driven to southern Florida by members of the 82 nd Airborne Division, Fort Bragg,

North Carolina. It transported victims to medical treatment facilities such as ( b ) this Air Force Air Transportable

Hospital, which was set up close to the previously existing military hospital of Homestead Air Force Base. This

transportable hospital was set up within a few days of Hurricane Andrew’s landfall. US Army photographs.

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Military Preventive Medicine: Mobilization and Deployment, Volume 2

mand of the Commander in Chief (CINC) respon-

sible for the US military units’ activities within that

theater of operations. The CINC may establish a

Joint Task Force (JTF) to provide the necessary re-

sponse in the disaster area. The JTF Commander will

have the responsibility, in turn, to deploy US forces

to the area. The JTF Commander will rely on the JTF

Surgeon to direct and coordinate the medical re-

sponse. Routinely, all military preventive medicine

(PVNTMED) assets will be subordinate to the JTF

PVNTMED structure and will report to the JTF Sur-

geon. On occasion, however, PVNTMED personnel

or teams will provide direct assistance to a civilian

lead agency, usually local public health officials.

The JTF Surgeon will first focus on immediate

lifesaving efforts and distribution of emergency

resources through host-nation and international

relief organizations, as well as through the host-

nation’s military. A Humanitarian Assistance Sur-

vey Team is normally deployed within 12 hours of

the CINC’s notification. The team’s mission is to

assess mortality, injury and illness, dislocation or

displacement of persons, and disruption of govern-

mental and national infrastructure. Within 48 to 72

hours, direct relief operations will start in the af-

fected area. At the same time, a Civil–Military Op-

erations Center directed by the US military will be

established to provide security and humanitarian

assistance in the field in coordination with the

United Nations (UN), non-governmental and pri-

vate volunteer organizations, and the local military. 1

See Chapter 45, The International Humanitarian

Response System, for a further explanation of the

roles of these organizations in disaster relief.

In the absence of a large-scale military PVNTMED

deployment or when military PVNTMED profession-

als are involved in a disaster response only as con-

sultants, the chain of command is not as clear. It is

essential, however, that one individual, preferably

the senior military officer present, coordinate the

military response with the local government agency

responsible for the relief effort. 6

TYPES OF NATURAL DISASTERS

Disasters are catastrophic events that overwhelm

a community’s emergency response capability and

threaten the public health and the environment. 7

Natural disasters are a major cause of premature

death, impaired health status, and diminished

quality of life. 8 It is estimated that between 1977

and the mid-1990s, 3 million people have been

killed by natural disasters, 820 million others have

been adversely affected, and property worth $25

billion to $100 billion has been damaged. 9,10 It was

estimated that the US government spent an average

of $1 billion per week in 1994 as a result of natural

disasters. 11

The natural disasters to be considered in this

chapter can be subdivided into ( a ) climatological

(ie, weather-related) disasters, such as windstorms,

tornadoes, and floods (including associated land-

slides and avalanches), and ( b ) geophysical disas-

ters, such as earthquakes, tsunamis, and volcanic

eruptions (Table 42-1). These two types of disasters

are generally of sudden onset and pose unforeseen,

serious, and immediate threats to public health.

Other disasters requiring external assistance but

that are predictable and slowly developing in na-

ture will not be considered here. 9,12 These include

droughts, which are often associated with famine

and desertification, and wildfires, which can some-

times be caused by natural forces such as lightning,

extreme heat, earthquakes, or volcanic eruptions.

Windstorms

Windstorm-related events cause an average of

30,000 deaths and $2.3 billion in damages world-

wide each year. 9 Severe tropical storms (called hur-

ricanes if they are located in the Atlantic Ocean,

Caribbean Sea, and eastern Pacific Ocean; typhoons

in the western Pacific; and cyclones in the Indian

Ocean), tornadoes, blizzards, and other storms af-

fect man-made structures and agricultural areas in

every country of the world (Figure 42-2). About 15%

of the world’s population is at risk from tropical

storms. Tornadoes are notorious in the midsection

of the United States, with some reaching wind

speeds of 500 kph (300 mph). As many as 700 to

1,000 strike that area every year, causing an aver-

age of 80 deaths per year. 9,13

Floods

Flooding, generally the result of torrential rains

and other factors such as poor farming practices,

deforestation, and urbanization, was responsible

for more than 63% of the federally declared disas-

ters in the United States from 1965 to 1985. Floods

are the most commonly occurring natural disaster

worldwide. In the United States alone they cause an

average of 140 deaths per year. Their impact is long-

term because of ( a ) damage to human settlements,

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Military and Public Health Aspects of Natural Disasters

TABLE 42-1

MAJOR NATURAL DISASTERS AND ASSOCIATED MORTALITY

Type

Country (Yr)

No. of Deaths

Climatological

Windstorms

East Pakistan (1970)

300,000

Bangladesh (1991)

140,000

East Pakistan (1963–1965) *

10,000–30,000

India (1971)

10,000–25,000

India (1977)

20,000

Bangladesh (1988)

15,000

Hong Kong (1906)

10,000

†

‡

USA—Galveston, Texas (1900)

> 6,000

USA—Florida; Louisiana (1992)

Tornadoes

USA—Illinois; Indiana; Missouri (1925)

689

Floods/Landslides

China (1887)

900,000

China (1969)

> 50,000

USA—9 Midwest states (1993)

Geophysical

Earthquakes

China (1556)

830,000

India (1737)

300,000

China (1976)

240,000

China (1920)

200,000

Japan (1923)

143,000

USSR (1948)

100,000

Italy (1908)

75,000

China (1932)

70,000

Peru (1970)

70,000

Iran (1990)

40,000

Armenia (1988)

25,000

Iran (1978)

25,000

Guatemala (1976)

23,000

USA—Anchorage, Alaska (1964)

131

USA—Loma Prieta, California (1989)

USA—Northridge, California (1994)

Tsunamis

Indonesia (1883)

36,000

Japan (1933, 1946, 1983, 1995) *

1,000–5,000

Volcanic eruptions

Martinique (1902)

38,000

Colombia (1985)

25,000

Sicily (1669)

20,000

Guatemala (1902)

6,000

Indonesia (1919)

5,200

* Four separate events are shown

† Deadliest natural disaster in US history

‡ Costliest hurricane disaster, Hurricane Andrew, in US history ($32 billion)

§ Costliest flood disaster in US history ($10 billion)

¶ Costliest natural disaster in US history ($40 billion)

Data sources: (1) Sharp TW, Yip R, Malone JD. US military forces and emergency international humanitarian assistance: observa-

tions and recommendations from three recent missions. JAMA . 1994;272:386–390 (2) Sidel VW, Onel E, Jack Geiger H, Leaning J,

Foege WH. Public health responses to natural and human-made disasters. In: Last JM, Wallace RB, eds. Maxcy-Rosenau-Last Public

Health and Preventive Medicine . 13th ed. Norwalk, Conn: Appleton & Lange; 1992: 1173–1186 (3) National Research Council Advi-

sory Committee on the International Decade for Natural Hazard Reduction Report . Confronting Natural Disasters: An International

Decade for Natural Hazard Reduction . Washington, DC: National Academy Press; 1987: 1–60 (4) Lechat MF. Disasters and public

health. Bull World Health Organ . 1979;57:11–17 (5) National Geographic Society. Raging Forces: Earth in Upheaval . Washington, DC:

National Geographic Society; 1995 (6) Disasters. The World Book Encyclopedia. Chicago: World Book Inc.; 1988: D225.

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