1. Disasters and PCPs
Is Failing to Prepare Preparing to Fail?

2. Disaster Effects
 Supply
shocks: diminished staff levels,
staff capacity, damaged buildings and
supplies
 Demand shocks: increased injury, disease,
distress

3. PCP Opinions
 35-40%
of family physicians disagree or
aren’t sure they or medical community
could respond effectively to a natural
disaster (wild overest.)*chen
 Redlener peds study
 Heldring study

4. Definition
 Medical
perspective: A destructive event
that causes extraordinary disruption of
well-being (social, economic, physical,
mental)

5. Types of disasters in the
literature
 Natural
Disasters—Hurricanes Floyd,
1999; Andrew; Hugo; floods in England
and Australia; Northridge earthquake;
Hurricane Katrina
 Terrorism—September 11th, Anthrax
attacks, Aum Sharikyo
 Epidemics—SARS

6. Social Consequences
 Flooding
from Hurricane Floyd: 14% lost
homes among PC population; 10%
households lost work at 3 months
 Increased outpatient, ER, pharmacy use up
to 1 year later
 Norris—family conflicts,
occupational/financial stress

7. Health Consequences
 Orthopedic/soft
tissue injuries, dermatitis and
diarrhea from water borne pathogens, asthma
(moldy homes), febrile illnesses, animal bites,
exacerbations of chronic illnesses
 Depression, PTSD, anxiety disorders,
somatoform disorders, violence, suicide attempts,
substance abuse, family conflicts
 Children/adolescent behavior problems, stomach
aches

8. Health Consequences—Floyd
Flood
 26%
Loss of medical devices (oxygen
tanks, wheelchairs) & medicines; access to
dialysis
 20%-25% new/worsened health problem in
household

9. High Risk Populations—
Disabled/Elderly
 Higher
rates of physical injury/illness
 Functional limitations (mobility,
communication, orientation)
 Economically underprivileged (live in more
vulnerable structures, unable to rapidly
increase preparedness)
 Socially isolated

10. High Risk Populations—
Children
 Higher
rates of psychological problems

11. Other Vulnerable Populations
 Chronically
ill
 Previous psychiatric disorders
 Immigrants/refugees
 Lower socioeconomic status

12. PCP Role
 Prevent,
treat, alleviate health and social
problems of disaster victims
 Ethical responsibility

13. PCP Role
 Knowledge
and Skills
– Risk factors for psychological disorders
– Psychological First Aid: turn off the tv!
– PTSD, Bereavement
 Resources
– Office and staff plan
– Family plan
 Identify
At-Risk Patients
– Discuss disaster preparedness