Managing anaesthetic provision for global disasters

Abstract

The numbers of people affected by large-scale disasters has increased in recent decades. Disasters produce a huge burden of surgical morbidity at a time when the affected country is least able to respond. For this reason an international disaster response is often required. For many years this disaster response was not coordinated. The response consisted of what was available not what was needed and standards of care varied widely producing a healthcare lottery for the affected population. In recent years the World Health organisation has initiated the Emergency Medical Team programme to coordinate the response to disasters and set minimum standards for responding teams. Anaesthetists have a key role to play in Level 2 Surgical Field Hospitals. The disaster context produces a number of logistical challenges that directly impact on the anaesthetist requiring adaptation of anaesthetic techniques from their everyday practice. The context in which they will be working and the wider scope of practice that will be expected from them in the field mandates that deploying anaesthetists should be trained for disaster response. There have been significant improvements in recent years in the speed of response, equipment availability, coordination and training for disasters. Future challenges include increasing local disaster response capacity, agreeing international standards for training and improving data collection to allow for future research and improvement in disaster response. The goal of this review article is to provide an understanding of the disaster context and what logistical challenges it provides. There has been a move during the last decade from a globally uncoordinated, unregulated response, with no consensus on standards, to a globally coordinated response through the World Health Organisation (WHO). A classification system for responding Emergency Medical Teams (EMTs) and a set of agreed minimum standards has been defined. This review outlines the scope of the role of the anaesthetist in a Level 2 field hospital and some of the challenges that this scope and context present. It focuses mainly on natural disasters, but also outline some of the differences encountered in responding to other global disasters such as conflict and infectious outbreaks, and concludes with some of the challenges for the future.

Redeployment and training of healthcare professionals to Intensive Care during COVID-19: a systematic review

“…Challenges faced by redeployed staff during the COVID-19 pandemic overlapped with previous studies assessing experiences of junior staff in Emergency Departments, or staff redeployed to disaster and war zones (see Table 2 ) (Brewer & Ryan-Wenger, 2009; Craven, 2017; Marion, Charlebois, & Kao, 2016). Theyyunni et al (2013) analysed reflections from medical students after their emergency medicine rotation.…”

Emergency Preparedness in Ambulatory Surgery Centers and Office-Based Anesthesia Practices

“…Natural disasters can include earthquakes, tornadoes, hurricanes, floods, or tsunamis. Natural disasters generally affect a large number of people and can require coordination of both local and national resources to respond to healthcare needs [1]. The earthquake and subsequent tsunami that struck Japan in 2011 as well as Hurricane Katrina and the subsequent flooding in Louisiana in 2005 are examples of the widespread destruction that can be caused by natural disasters.…”

“…In the past ten years, natural disasters and other emergencies have highlighted the shortcomings of healthcare systems to protect patients and healthcare team members during emergencies [1][2][3]. Ambulatory Surgery Centers (ASC) and Office Based Anesthesia Practices are unique healthcare environments that necessitate specific emergency planning for disasters and other emergencies.…”

Anaesthesia care providers employed in humanitarian settings by Médecins Sans Frontières: a retrospective observational study of 173 084 surgical cases over 10 years

“…Low-income and middle-income countries (LMIC) are disproportionately affected by gaps in healthcare provision, with an estimated 90% of patients in these countries unable to access basic surgical care 1. The burden is increased and access further reduced in crisis situations, caused by conflict or natural disasters 2. To address these imbalances, Médecins Sans Frontières (MSF, also known as Doctors without Borders) provide humanitarian surgical assistance based on the needs of affected populations through one or more of their five operational centres, one of which is Operational Centre Brussels (MSF-OCB).…”