Healthcare

Caring for the Body

In most disasters, no one can estimate the number of persons who will need clinical care or how long the need for such care will last. Generally, those rescued alive will be extracted from the scene by local emergency workers or by family members or neighbors within the first 72 hours after the event. But the rescue of earthquake victims in the Philippines and Haiti two weeks after a disaster serves as notice that nothing can be taken for granted in situations far removed from normal. Fatalities are a grim reminder that people will die within minutes of the event, but experts agree that many, possibly up to 40 percent, of those with life-threatening injuries can be saved if they receive basic medical care in the first hours following a disaster. Triage, an approach first applied on battlefields, is a strategy for sorting victims when resources are limited and time is of the essence, and classifies injuries on the basis of how well the patient will respond to simple, immediate treatment. With the highest-priority patients, treatment or transportation can make the difference between survival or death; second-priority patients are transported or treated once all the highest-priority patients have been attended to; third-priority patients are able to wait longer, and are sometimes taken to a secondary treatment center; and patients in the lowest category are either dead or moribund. Patients requiring hours of intensive surgery may not be priority cases, as more patients could be saved using summary methods.

In practical terms, this means that those with blocked airways or excessive bleeding and those in shock receive [Page 265]attention first, and the walking wounded receive delayed treatment. In some disasters, large numbers of the latter group will have managed to get themselves to the nearest emergency room or will have been transported there by others. In settings with few resources, trained medical personnel may be severely limited, but basic first aid and resuscitation can still save many lives.

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