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WFNS Mass Casualty Committee



The role of neurosurgeons in natural disaster sites
in response to natural disasters in Indonesia.
Eiichi Suehiro, Secretary General of MCC

First of all, regarding the several disasters in Indonesia, I would like to offer my sincere condolences for victims and their families and I hope injured persons will get well very soon.

Our committee received a call for help from an Indonesia neurosurgeon in late December, 2018. They needed a big tent to function as a small hospital and any portable craniotomy equipment.

We report here briefly the basic concepts of disaster medicine for your help.

  1. Action of Neurosurgeons in disaster medicine

    Neurosurgeons should be general medical doctors in the initial phase, might be commanders to manage multidisciplinary teams in accordance with the following basic principles.

    MIMMS (Major Incident Medical Management System) shows the CSCATTT approach to disaster response:

    C: Command and Control
    Raise up the chain of command and join; in charge of Health Service resources; delegation of key tasks to other officers
    S: Safety
    Ensure the safety of yourself and the site; overall responsibility for safety of health service personnel delegated to the Safety & Security Officer
    C: Communication
    Transmission of information within and between organizations; liaison with other commanders
    A: Assessment
    Evaluation of the situation and review of activities; health service scene assessment; need for additional ambulances, medical support, voluntary agency report, equipment, etc
    T: Triage
    Oversee scene triage
    T: Treatment
    Primary survey with ABCDE approach and stabilization of vital signs
    T: Transport
    Organize the provision of suitable transport

    The flow of patients affected

    Patients affected at the disaster sites


    Patients affected will be collected for triage.
    According to circumstances, neurosurgeons will participate in the triage.


    Patients affected will be collected by the color of tag card.
    Neurosurgeons should try to stabilize the respiratory status and the circulation state as general medical doctors in the field hospital.


    Patients affected will be conveyed to the tertiary hospital after stabilization of ABC. Patients will receive definitive treatment in the hospital.

    When traumatic brain injury patients who require surgical treatment are transported to the tertiary hospital, that is where neurosurgeons come in as neurosurgeons. Make certain your hospital is ready for surgery.


  2. The basic principles of emergency humanitarian action

    Humanitarian action is regulated by binding and non-binding international humanitarian and human rights laws, as well as the humanitarian principles of humanity, neutrality, impartiality and independence.

    Humanity: Human suffering must be addressed wherever it is found. The purpose of humanitarian action is to protect life and health and ensure respect for human beings.
    Neutrality: Humanitarian actors must not take sides in hostilities or engage in controversies of a political, racial, religious or ideological nature.
    Impartiality: Humanitarian action must be carried out on the basis of need alone, making no distinctions on the basis of nationality, race, gender, religious belief, class or political opinions.
    Independence: Humanitarian action must be autonomous from the political, economic, military or other objectives that any actor may hold in relation to areas where humanitarian action is being implemented.

    United Nations General Assembly resolution 46/182 defines the role of the UN in coordinating international humanitarian assistance when a Government requests external support. The resolution establishes a number of UN mechanisms to strengthen effectiveness of international humanitarian action, namely the Central Emergency Response Fund (CERF), the Consolidated Appeal Process (CAP), the Emergency Relief Coordinator (ERC) and the Inter-Agency Standing Committee (IASC). Resolution 46/182 was unanimously adopted by UN Member States in 1991. Sovereignty, territorial integrity and national unity of States shall be fully respected in accordance with the Charter of the United Nations. In this context, humanitarian assistance should be provided with the consent of the affected country and in principle on the basis of a request by the affected country.


  3. Available tools and services by scale of disaster as requested by affected Government

    Emergency scales Small Medium Large
    TECHNICAL TEAM MOBILIZATION USAR "Light" USAR "Medium" USAR "Heavy"
    RDRT ERAT ERAT
      UNDAC UNDAC
      RDRT FACT
      ERU RDRT
        ERU
    TECHNICAL SERVICES MOBILIZATION   MCDA MCDA
      APHP IHP
      UNHRD Network UNHRD Network
      INGO seed money INGO seed money
    FINANCIAL RESOURCE MOBILIZATION UN OCHA
    Emergency Cash
    Grants
    UN Flash Appeal UN Flash Appeal
    IFFRC DREF as grant CERF CERF
    INGO seed money UN OCHA
    Emergency Cash
    Grants
    UN OCHA
    Emergency Cash
    Grants
      IFRC DREF as start-up loans IFRC DREF as start-up loans
    INFORMATION MANAGEMENT & ASSESSMENTS   Humanitariann Coordinator Humanitarian Coordinator
      Clusters Clusters
      MIRA HIC
        MIRA
        PDNA-RF
        UN OCHA SitRep
        CDAC

  4. Access to technical team mobilization

    A range of international technical teams can be mobilized within hours of a disaster to support a Government’s relief efforts. Described here are the purpose, composition and activation modalities of (a) bilateral, (b) intergovernmental, and (c) RCRC Movement.

    Bilateral:
    Urban Search and Rescue teams are composed of trained experts who provide rescue and medical assistance in an emergency. USAR teams that deploy internationally generally comprise expert personnel, specialized equipment, and search dogs. They can be operational within 24 to 48 hours of a disaster. USAR teams are offered and received bilaterally and/or with the coordination support of the OCHA-managed International Search and Rescue Advisory Group (INSARAG).
    Access method: Government seeking assistance in activating international USAR teams through INSARAG can do so through a pre-identified INSARAG National Focal Point or directly through the INSARAG secretariat at insarag@un.org.

    Bilateral technical response teams are emergency teams deployed by assisting Governments to make an initial assessment of needs for contributions to the affected Government and/or to UN agencies, the RCRC Movement, and NGOs.
    Access method: More information on these bilateral technical response teams can be attained from the embassies of the respective countries.

    Intergovernmental:
    UN Disaster Assessment and Coordination (UNDAC) teams are standby teams of specially-trained international disaster management professionals from UN Member States, UN agencies, and other disaster response organizations that can be deployed within 12 to 48 hours of a disaster. The primary elements of the UNDAC mandate are assessment, coordination, and information management. UNDAC teams are self- sufficient in telecommunications, office, and personal equipment. A UNDAC team normally stays in the affected area for the initial response phase, which can be up to three weeks.
    Access method: A UNDAC team is deployed at the request of an affected Government, the UN RC or the HC. A UNDAC team can be requested through OCHA at +41 22 917 1600, undac_alert@un.org, or through OCHA-ROAP at +66 2288 2611 or at ocha-roap@un.org.

    ASEAN Emergency Rapid Assessment Teams (ERAT) are a pool of trained and rapidly deployable (within 24 hours) experts on emergency assessment for disasters in ASEAN countries. The purpose of the ASEAN ERAT is to assist NDMOs in the earliest phase of an emergency in a variety of areas. ASEAN ERAT members consist of trained NDMOs and related ministries staff from within the 10 ASEAN Member States enabling stronger collaboration with affected ASEAN Member States’ government and communities.
    Access method: The ASEAN-ERAT deployment is free of charge. ERATs are deployed through a request to the ASEAN AHA Centre at info@ahacentre.org, or at +62 21 2305006 or through the ASEAN National Focal Point.

    RCRC Movement:
    Regional Disaster Response Teams (RDRTs) are trained regional response teams composed of National Society staff and volunteers who can be deployed within 24 to 48 hours of a disaster to bring assistance to National Societies in neighboring countries. RDRTs aim to promote the building of regional capacities in disaster management. The primary functions of RDRT members are as follows:

    1. To undertake primary assessments
    2. To develop operational planning
    3. To conduct relief management

    Field Assessment Coordination Teams (FACT) are rapidly deployable teams comprising RCRC movement disaster assessment managers who support National Societies and IFRC field offices. FACT members have technical expertise in relief, logistics, health, nutrition, public health and epidemiology, psychological support, water and sanitation, and finance and administration. FACTs are on standby and can be deployed anywhere in the world in 12 to 24 hours for two to four weeks.

    Emergency Response Units (ERUs) are teams of trained technical specialists mandated to give immediate support to National Societies in disaster-affected countries. They provide specific support or direct services when local facilities are destroyed, overwhelmed by need, or do not exist. ERUs work closely with FACT. The teams use pre-packed sets of standardized equipment and are designed to be self-sufficient for one month. ERUs can be deployed within 24 to 72 hours and can operate for up to four months.
    Access method: Information about ERUs can be accessed through National Societies and IFRC.

     


  5. The member of WFNS Mass Casualty Commitee

    Chair: Michiyasu Suzuki (Department of Neurosurgery, Yamaguchi University School of Medicine, Japan) michi@yamaguchi-u.ac.jp
    Russell J Andrews(Nanotechnology & Smart Systems Groups, NASA Ames Research Center, USA) rja@russelljandrews.org
    Leonidas Quintana (Department of Neurosurgery, Faculty of Medicine Valparaíso University, Chile)  leonquin@gmail.com
    Kee Park (World Health Organization, Harvard Medical School, USA)  keebpark@gmail.com
    Peter Reilly (Neurosurgery Department, Royal Adelaide Hospital, Australia)  p.reilly@adelaide.edu.au
    Teiji Tominaga (Department of Neurosurgery, Tohoku University Graduate School of Medicine, Japan)  tomi@nsg.med.tohoku.ac.jp
    Jeffrey V Rosenfeld (Senior Neurosurgeon, The Alfred Hospital, Australia)  j.rosenfeld@alfred.org.au
    Anthony Figaji (Division of Neurosurgery, University of Cape Town, South Africa) anthony.figaji@uct.ac.za
    Muhammad Ehsan Bari (Neurotrauma Services and Functional Surgery, Aga Khan University Hospital, Pakistan) Ehsan.bari@aku.edu
    Secretary general: Eiichi Suehiro (Department of Neurosurgery, Yamaguchi University School of Medicine, Japan) suehiro-nsu@umin.ac.jp


  6. Appendix

    List of abbreviations:
    APHP: Asia-Pacific Humanitarian Partnership
    CDAC: Communicating with Disaster-Affected Communities
    CERF: Central Emergency Response Fund
    DREF: Disaster Relief Emergency Fund (IFRC)
    ERAT: Emergency Rapid Assessment Team (ASEAN)
    ERU: Emergency Response Unit (IFRC)
    FACT: Field Assessment Coordination Team (IFRC)
    HIC: Humanitarian Information Centre
    IFRC: International Federation of Red Cross and Red Crescent Societies
    INSARAG: International Search and Rescue Advisory Group
    JICA: Japan International Cooperation Agency
    MCDA: Military and civil-defence assets
    MIRA: Multi-Cluster Initial Rapid Assessment
    NDMO: National disaster management organization
    RCRC: International Red Cross and Red Crescent Movement
    RDRT: Regional Disaster Response Team (IFRC)
    UN: United Nations
    UNDAC: UN Disaster Assessment and Coordination
    UNHRD: UN Humanitarian Response Depot
    USAR: Urban search and rescue

Source: A Guide to International Tools and Services of OCHA

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