Management of Diabetic Surgical Patients in a Deployed Field Hospital: A Model for Acute Non-Communicable Disease Care in Disaster

Abstract

Sudden onset disasters (SODs) have affected over 1.5 billion of the world's population in the past decade. During the same time, developing nations have faced a sustained increase in the burden of non-communicable disease (NCD) with extra pressure placed on health systems. The combined increase in SODs and the NCD epidemic facing the world's most disaster-prone nations will present new challenges to emergency medical teams (EMTs) during disaster response. This report details the experience as an EMT during the Typhoon Haiyan disaster of 2013, with particular reference to the challenges of diabetic management in a surgical field hospital. The incidence of diabetes in this surgical cohort exceeded that of the population by a factor of four. The steps to prepare for and treat diabetes in the field provide a useful model for the management of NCD in the deployed field hospital environment after a disaster. McDermott KM , Hardstaff RM , Alpen S , Read DJ , Coatsworth NR . Management of diabetic surgical patients in a deployed field hospital: a model for acute non-communicable disease care in disaster. Prehosp Disaster Med. 2017;32(6):657-661.

The patient safety practices of emergency medical teams in disaster zones: a systematic analysis

“…While this is being addressed by the WHO Global NCD Action Plan,56 there is little guidance in the literature for EMTs to manage NCDs and chronic disease in a disaster setting. Presentations of acute exacerbations of chronic cardiovascular disease, stroke, uncontrolled diabetes and stunted weight in malnourished children increase during or following a variety of disasters 55 58–61. WHO-registered EMTs are categorised mainly on their surgical capacity and provision of specialty surgical services 14.…”

Australasian general surgical training and emergency medical teams: a review

“…From a surgical perspective, injuries are most commonly encountered in the impact phase . Care for patients with non‐communicable diseases and acute non‐trauma‐related surgical emergencies is also required, in part due to the chronic shortages of surgical infrastructure and the disruption of local health infrastructure . Few EMTs arrive in the impact phase, with the majority arriving in the post‐impact and recovery phases.…”

“…EMTs may be run by governmental organizations, with models including civilian teams, military teams and mixed teams. The Australian Medical Assistance Team (AUSMAT) is the Australian Government's health emergency response capability and is coordinated by the National Critical Care and Trauma Response Centre (NCCTRC) . The Australian Defence Force has also previously deployed military EMTs to SODs .…”

“…The Australian Medical Assistance Team (AUSMAT) is the Australian Government's health emergency response capability and is coordinated by the National Critical Care and Trauma Response Centre (NCCTRC). 15 The Australian Defence Force has also previously deployed military EMTs to SODs. 17 EMTs may also be sent by non-governmental organizations (NGOs), with prominent examples being Médecins sans Frontières (Doctors without Borders, MSF) and the International Committee of the Red Cross.…”

“…21 More recently, government and military EMTs have deployed with multi-surgeon teams. 22 Although there is no single consensus on the prerequisite training and experience of general surgeons before they deploy with an EMT, it has been suggested that broad surgical skills including experience in emergency general surgery, surgery for non-communicable diseases such as diabetes, 15 basic orthopaedic and plastic surgery 23,24 and emergency obstetrics and gynaecology 4 would be useful.…”