Cuban Medical Literature
Health Sector Preparedness
for Emergency or Disaster Situations

Hector Conde Rico, MD
Vicente Garcia Gomez, MD

INTRODUCTION

The degree to which the medical services of a country are prepared to face a disaster denotes the quality of those services and their capacity to provide agile and timely preventive medical care in normal conditions.

The level of preparedness of the National Health System depends on its organization and the capabilities of its staff, with the active participation of a trained community.

The Ministry of Public Health forms a part of the Civilian Defense system of our country, as stated in the National Defense Law (No.75, 1994), and Legal Decree No. 170 (May 1997).

Disaster plans are detailed in every unit of the National Health System and are incorporated into the national, provincial and municipal plans.

By law, leaders at every level are responsible for successfully carrying out the disaster plans.

Characteristics of Medical Assurance Plans Against Disasters

Action plans against disasters are designed by multidisciplinary groups of specialists at different levels and are coordinated with all sectors of the economy.

The disaster action plan is unique as it is designed according to terrain and territory, taking into account different hazards and/or threats which are then incorporated into the plan.

The action plans against disasters should be very well known by all workers; they should know their activities and responsibilities.

Plans should be continually updated and simulated annually via METEOR Exercises [annual national meteorological exercises], which are organized by the National High Command of the Civil Defense; these exercises make it possible for the Civil Defense to verify if any particular plan requires updating.

Preparedness for emergencies and disasters is part of the regular activities of the National Health System.

All action plans include prevention and mitigation measures.

The Structure of the Action Plan Against Disasters

The plan consists of:

• A textual part
• A graphic part
• Complementary documents (annexes)

Textual Part

The textual part consists of:

• Introduction
• Objectives
• Appraisal of the situation
• Preventive and mitigation measures
• Actions to take during different phases of the disaster (before, during and after)
• Organization of preventive medical assistance
• Organization of hygiene and epidemiological measures
• Evacuation of the sick and injured
• Assurances
• Organization of management and communication
• Education of the people and workers
• Cooperation with other economic sectors

Graphic Part

A topographic map or sketch shows:

• Health installations
• Housing for evacuated people
• Locations reinforced with medical brigades
• High risk zones for the population
• Warehouses, water supply sources, etc.

Complementary Documents

• Warning plan
• Calendar plan
• Maps on risk communities
• Transcripts of cooperation
• Periodic report tables

This methodology is intended to facilitate the planning process, maintaining the same order, format and structure, at every institutional level of the National Health System. It also takes into account all means through which the health of the population is secured, while preserving the strength of public health institutions.

GENERAL AIM

To guarantee preventive medical care, ensure hygienic-epidemiological measures and carry out the medical evacuation of casualties using the existing preventative assistance network in the most rational and effective way. This is achieved according to the territorial principle and under the leadership and control of the defense councils at each level.

SPECIFIC AIMS

To guarantee timely medical care in order to reduce fatalities among the hurt and injured through an immediate and effective response that saves lives, prevents complications and allows for a fast recovery.

To guarantee timely stabilization to the injured in order to evacuate them to medical facilities quickly.

To establish hygienic-epidemiological measures so as to protect the population in high risk zones, prevent tainting of the food supply and prevent outbreaks of contagious diseases.

To have the necessary resources and logistic support to guarantee the action plan.

To assure ongoing training and education of health professionals and the population. (This constitutes the cornerstone in preparedness).

To establish cooperation among different sectors, in order to achieve a rational use of existing resources.

To inform international organizations about the exact needs (damage evaluation) in order to obtain assistance in a timely and efficient manner. 

Organization of Treatment and Evacuation Phases of Preventive Medical Assurance in Case of Disaster

Note: Victims receive psychological support in all phases.

*According to the latest figures from the Annual Health Statistics Report of the Ministry of Public Health (2003), there are 32,291 Family Doctors covering 99.2% of the total population in the country. 

Organization of the Integrated Medical Emergency System

The Integrated Medical Emergency System is an integrated system involving first aid by paramedics, small emergency and basic ambulance services and attention by medical personnel (medical doctor or a medical technician). This doctor or technician functions as the first link in a chain that begins with proffering first aid, after which the patient is moved to the second phase or directly to an intensive or intermediate care ambulance, depending on the urgency of the case. This assures the patient receives continuous care up to the moment he/she is out of risk and leaves the intermediate or intensive care unit.

The system consists of:

• A national coordinating center
• 15 provincial coordinating centers
• 35 emergency coordinating sub-centers
• 2421 emergency services throughout the primary care assistance network (policlinics and emergency rooms).

The whole system is supported by short, accredited emergency courses specializing in the principles of the chain of survival.

Organization of Hygienic-Epidemiological Assurance

The health surveillance system (alert-action) in our country plays a fundamental role in case of disaster, as any change in the epidemiologic pattern is quickly identified, allowing for the implementation of measures to combat any change in the health of the at-risk population. It also plays a fundamental role in the control of contagious disease outbreaks sparked by the possible deterioration of basic services, that guarantee the population's survival.

Hygienic-Epidemiological Assurance

• Hygienic-epidemiological teams in Defense Zones.
• Hygiene and epidemiology centers - They move mobile sanitary and anti-epidemic laboratories to the provincial and municipal levels.
• Hygiene and Epidemiology Units (municipal level).
• Research institutes support the hygiene and epidemiological sub-system (reference: Tropical Medicine Institute “Pedro Kourí" - IPK; National Center for Toxicology - Cenatox)
• Units for Health Analysis and Tendency (Health Surveillance System).

During the phase before the disaster, specialists from the Ministry of Public Health need to approve the hygienic conditions of suitable locations for evacuating the at-risk population; designates collective food distribution centers that have the appropriate conditions for this purpose; audits food handlers; assesses the quantity and quality of the water supply; reviews the liquid and solid waste disposal system and its hygiene; and assesses other areas crucial to public hygiene.

Assurance Organization

• List medical staff by occupational category for those installations involved in the case of a disaster.
• Calculate the number of hospital beds for use in each hospital unit according to the expected disaster, allowing for more should the need arise.
• Assess needs and reserves of vital medicines that can affect services (for how many days).
• Assure stocks of disinfectants, pesticides, detergent and soap.
• Assure reserves of water (m 3), gas, combustible and electricity generating equipments.
• Assure stocks of medicinal oxygen (for how many days).
• Ensure special medicines and other materials for regions that could become isolated.
• Assure means of transport, including ambulances, in sufficient quantity, in good technical condition and with the support they need.
• Assure alternative means of communication, for example amateur radio.
• Identify resources that must be available to other levels.

Evacuation of Injured and Sick People in Case of Disaster

Principles of evacuation are based on the prioritization system (triage), as well as a color-coded system established for the massive reception of hurt, sick and poisoned people.

• Red code: requires immediate stabilization, with good survival prognosis
• Yellow code: requires direct medical surveillance, but care can wait
• Green code: can wait or medical treatment is not required

Plan for the Massive Reception of Bodies

Before the expected disaster, measures should be taken for inquests and identification and classification of the dead. Steps taken to achieve this include:

• Training of medical forensic personnel and preparation of their working conditions.
• Preparation and location of refrigerated transport and designation of places with appropriate sanitary conditions to receive the dead.

This article was reprinted from Gerencia de Desastres en Cuba, published in 2003 by the Caribbean Disaster Information Network (CARDIN), the European Commision Humanitarian Aid Office (ECHO), and the Latin American Center for Disaster Medicine (CLAMED), pp. 38-41.