Disaster Response Safety and Security
Roman A. Hayda, MD and the OTA Disaster Management and Emergency Preparedness Committee
Disaster responders are often motivated with good intentions that are often fulfilled. However, if safety and security issues are ignored or underplayed, the opposite may occur with the volunteer becoming a casualty. Instead of helping they become a burden magnifying the disaster.
There are 3 areas of concern for the individual and the team in domestic and international response: physical security, physical health, and mental health. All of these must be considered in the preparation phase, response phase and during recovery.
In terms of physical security, the response team must be able to safely perform triage and care. These should be planned for in advance and maintained during response. For instance, in a natural disaster, care facilities should be close enough to the disaster to limit transit time but not in danger of injury from a collapsing building or flooding. In terror events, security personnel should be made available to assure that medical providers are not placed at undue risk from continued terror actions (second hit) or other threats such as kidnapping.
Physical health of responders is equally important. The personnel need to assess their ability to withstand the rigors of disaster response prior to the event. Stable and controlled medical conditions are not a contraindication to participation but providers should have an excess supply of medication since resupply may not be available. Endemic diseases should be considered, and ALL vaccinations should be up to date. When travelling internationally, checking websites for suggested vaccinations is valuable. During the response, appropriate rest, hydration, and nutrition is critical but often neglected. However, these can lead to significant degradation of performance. Anecdotally an unvaccinated responder to the recent Haiti disaster became seriously ill with COVID 19 where advanced care was not possible due to lack of ICU facilities risking their own health and degrading the response of the team who had to provide care for the individual.
Finally, mental health is critical during and after response due to the potentially extremely high stress levels. Providers and leaders must remain cognizant of and respond to the potential of severe mental stress during and after response in themselves and their teammates. Maintaining appropriate rest, nutrition and hygiene is a vital component of prevention but counselling and mental health support both during after response are critical. Debriefing during and after the event is an important means of identification and initiation of treatment measures.