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Disaster medicine and response: Optimizing life-saving potential

Mehmet Sukru Sever, MD, Giuseppe Remuzzi, MD, Raymond Vanholder, MD


Background: Natural and technological mass disasters strike densely populated areas on a regular basis, causing ever growing numbers of deaths and injured, economical losses, social problems, and damage to the environment.

Objective of the review: This review aims to provide a comprehensive idea about the spectrum of main problems, essentially presenting a number of basic principles to save as many lives as possible after natural and man-made mega disasters.

Discussion: Medical problems following disasters may be acute, acute-on-chronic, or chronic; they appear from the disaster period up till long thereafter. All these problems may be nonspecific, or specific for particular disaster types. Decreasing death toll after mass disasters can be accomplished by preparations before, and effective medical response after disasters. These interventions should be considered at both national/governmental and regional/hospital levels. Disaster medicine, the art and science of providing healthcare to the victims, differs significantly from routine medical practice because of disparities between demand and supply of rescue and healthcare, the need for unusual medical interventions, and the occurrence of ethical and legal dilemmas.

Conclusions: Adherence to the principles of disaster medicine, is vital to minimize the extent of medical, logistic, ethical, and legal problems, and saving as many lives as possible.


disaster medicine, disaster response, disaster victims, disaster ethics, rescue activities

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ReliefWeb: Glossary of humanitarian terms. Available at Accessed February 1, 2018.

Sever MS, Vanholder R, Lameire N: Management of crush-related injuries after disasters. N Engl J Med. 2006; 354(10): 1052-1063.

Guha-Sapir D, Below R, Hoyois PH: EMDAT: The International Disaster database. Center for Research on the Epidemiology of Disasters—CRED. General classification of disasters. Available at Accessed February 1, 2018.

Katz SK, Parrillo SJ, Christensen D, et al.: Public health aspects of nuclear and radiological incidents. Am J Disaster Med. 2014; 9(3): 183-193.

Perlman SE, Friedman S, Galea S, et al.: Short-term and medium-term health effects of 9/11. Lancet. 2011; 378(9794): 925-934.

Hagopian A, Flaxman AD, Takaro TK, et al.: Mortality in Iraq associated with the 2003-2011 war and occupation: Findings from a national cluster sample survey by the university collaborative Iraq Mortality Study. PLoS Med. 2013; 10(10): e1001533.

Guha-Sapir D, Below R, Hoyois PH. EM-DAT: The CRED/OFDA International Disaster Database. Available at Brussels, Belgium: Université Catholique de Louvain. Accessed February 1, 2018.

Suzuki S, Sakamoto S, Miki T, et al.: Hanshin-Awaji earthquake and acute myocardial infarction. Lancet. 1995; 345(8955): 981.

Miller AC, Arquilla B: Chronic diseases and natural hazards: Impact of disasters on diabetic, renal, and cardiac patients. Prehosp Disaster Med. 2008; 23(2): 185-194.

Bartels SA, VanRooyen MJ: Medical complications associated with earthquakes. Lancet. 2012; 379(9817): 748-757.

Steinberg SM, Nichols RL: Infections and sepsis in disasters. Crit Care Clin. 1991; 7(2): 437-450.

Takakura R, Himeno S, Kanayama Y, et al.: Follow-up after the Hanshin-Awaji earthquake: Diverse influences on pneumonia, bronchial asthma, peptic ulcer and diabetes mellitus. Intern Med. 1997; 36(2): 87-91.

Baba S, Taniguchi H, Nambu S, et al.: The Great Hanshin earthquake. Lancet. 1996; 347(8997): 307-309.

Glynn LM, Wadhwa PD, Dunkel-Schetter C, et al.: When stress happens matters: Effects of earthquake timing on stress responsivity in pregnancy. Am J Obstet Gynecol. 2001; 184(4): 637-642.

Harville E, Xiong X, Buekens P: Disasters and perinatal health: A systematic review. Obstet Gynecol Surv. 2010; 65(11): 713-728.

Itabashi R, Furui E, Sato S, et al.: Incidence of cardioembolic stroke including paradoxical brain embolism in patients with acute ischemic stroke before and after the Great East Japan Earthquake. Cerebrovasc Dis. 2014; 37(6): 431-437.

Shibahara I, Osawa S, Kon H, et al.: Increase in the number of patients with seizures following the Great East-Japan Earthquake. Epilepsia. 2013; 54(4): e49-e52.

Keven K, Ates K, Sever MS, et al.: Infectious complications after mass disasters: The Marmara earthquake experience. Scand J Infect Dis. 2003; 35(2): 110-113.

Kazancioglu R, Cagatay A, Calangu S, et al.: The characteristics of infections in crush syndrome. Clin Mictobiol Infect. 2002; 8(4): 202-206.

Alpak G, Unal A, Bulbul F, et al.: Post-traumatic stress disorder among Syrian refugees in Turkey: A cross-sectional study. Int J Psychiatry Clin Pract. 2015; 19(1): 45-50.

North CS, Pfefferbaum B: Mental health response to community disasters: A systematic review. JAMA. 2013; 310(5): 507-518.

Kristensen P, Weisaeth L, Hussain A, et al.: Prevalence of psychiatric disorders and functional impairment after loss of a family member: A longitudinal study after the 2004 Tsunami. Depress Anxiety. 2015; 32(1): 49-56.

Sever MS, Erek E, Vanholder R, et al.: Clinical findings in the renal victims of a catastrophic disaster: The Marmara earthquake. Nephrol Dial Transplant. 2002; 17(11): 1942-1949.

The University of Rhode Island, Hurricaines: Science and Society: Katrina impacts. Available at Accessed February 1, 2018.

Vanholder R, van der TA, De SM, et al.: Earthquakes and crush syndrome casualties: Lessons learned from the Kashmir disaster. Kidney Int. 2007; 71(1): 17-23.

Schwartz D, Goldberg A, Ashkenasi I, et al.: Prehospital care of tsunami victims in Thailand: Description and analysis. Prehosp Disaster Med. 2006; 21(3): 204-210.

Bhandarwar AH, Bakhshi GD, Tayade MB, et al.: Mortality pattern of the 26/11 Mumbai terror attacks. J Trauma Acute Care Surg. 2012; 72(5): 1329-1334.

DiCarlo AL, Ramakrishnan N, Hatchett RJ: Radiation combined injury: Overview of NIAID research. Health Phys. 2010; 98(6): 863-867.

Mian MA, Mullins RF, Alam B, et al.: Workplace-related burns. Ann Burns Fire Disasters. 2011; 24(2): 89-93.

Herbert K, Lawrence JC: Chemical burns. Burns. 1989; 15(6): 381-384.

Konno S, Hozawa A, Munakata M: Blood pressure among public employees after the Great East Japan Earthquake: The Watari study. Am J Hypertens. 2013; 26(9): 1059-1063.

Nakamura A, Satake H, Abe A, et al.: Characteristics of heart failure associated with the Great East Japan Earthquake. J Cardiol. 2013; 62(1): 25-30.

Spiegel P, Khalifa A, Mateen FJ: Cancer in refugees in Jordan and Syria between 2009 and 2012: Challenges and the way forward in humanitarian emergencies. Lancet Oncol. 2014; 15(7): e290-e297.

Sever MS, Erek E, Vanholder R, et al.: Features of chronic hemodialysis practice after the Marmara earthquake. J Am Soc Nephrol. 2004; 15(4): 1071-1076.

Kadowaki M, Saito M, Amada N, et al.: Medication compliance in renal transplant patients during the Great East Japan Earthquake. Transplant Proc. 2014; 46(2): 610-612.

Brown LM, Dosa DM, Thomas K, et al.: The effects of evacuation on nursing home residents with dementia. Am J Alzheimers Dis Other Demen. 2012; 27(6): 406-412.

Aoki A, Aoki Y, Harima H: The impact of the Great East Japan earthquake on mandatory psychiatric emergency hospitalizations in Tokyo: A retrospective observational study. Transl Psychiatry. 2012; 2: e168.

Franz VA, Glass CR, Arnkoff DB, et al.: The impact of the September 11th terrorist attacks on psychiatric patients: A review. Clin Psychol Rev. 2009; 29(4): 339-347.

Hayman KG, Sharma D, Wardlow RD, et al.: Burden of cardiovascular morbidity and mortality following humanitarian emergencies: A systematic literature review. Prehosp Disaster Med. 2015; 30(1): 80-88.

Sakata R, Grant EJ, Ozasa K: Long-term follow-up of atomic bomb survivors. Maturitas. 2012; 72(2): 99-103.

Armenian HK, Melkonian AK, Hovanesian AP: Long term mortality and morbidity related to degree of damage following the 1998 earthquake in Armenia. Am J Epidemiol. 1998; 148(11): 1077-1084.

Kaufman FR, Devgan S: An increase in newly onset IDDM admissions following the Los Angeles earthquake. Diabetes Care. 1995; 18(3): 422.

Vlahov D, Galea S, Ahern J, et al.: Sustained increased consumption of cigarettes, alcohol, and marijuana among Manhattan residents after September 11, 2001. Am J Public Health. 2004; 94(2): 253-254.

Little MP: Cancer and non-cancer effects in Japanese atomic bomb survivors. J Radiol Prot. 2009; 29(2A): A43-A59.

Christodouleas JP, Forrest RD, Ainsley CG, et al.: Short-term and long-term health risks of nuclear-power-plant accidents. N Engl J Med. 2011; 364(24): 2334-2341.

Redlener I, Reilly MJ: Lessons from Sandy—preparing health systems for future disasters. N Engl J Med. 2012; 367(24): 2269-2271.

Better OS, Stein JH: Early management of shock and prophylaxis of acute renal failure in traumatic rhabdomyolysis. N Engl J Med. 1990; 322(12): 825-829.

Kario K: Measuring the effects of stress on the cardiovascular system during a disaster: The effective use of self-measured blood pressure monitoring. J Hypertens. 2010; 28(4): 657-659.

Oda J, Tanaka H, Yoshioka T, et al.: Analysis of 372 patients with Crush syndrome caused by the Hanshin-Awaji earthquake. J Trauma. 1997; 42(3): 470-475.

Sever MS, Erek E, Vanholder R, et al.: Treatment modalities and outcome of the renal victims of the Marmara earthquake. Nephron. 2002; 92(1): 64-71.

Sever MS, Vanholder R: Recommendations for the management of crush victims in mass disasters. Nephrol Dial Transplant. 2012; 27(suppl 1): i1-i67.

Waeckerle JF: Disaster planning and response. N Engl J Med. 1991; 324(12): 815-821.

Haynes BE, Freeman C, Rubin JL, et al.: Medical response to catastrophic events: California's planning and the Loma Prieta earthquake. Ann Emerg Med. 1992; 21(4): 368-374.

Crisis Center of the Turkish Prime Ministry: Earthquakes 1999. Ankara, Turkey: Press of Prime Ministry, 2000: 3-15.

Schultz CH, Koenig KL, Lewis RJ: Implications of hospital evacuation after the Northridge, California, earthquake. N Engl J Med. 2003; 348(14): 1349-1355.

Sever MS, Erek E, Vanholder R, et al.: Lessons learned from the catastrophic Marmara earthquake: Factors influencing the final outcome of renal victims. Clin Nephrol. 2004; 61(6): 413-421.

Sever MS, Vanholder R: Management of crush victims in mass disasters: Highlights from recently published recommendations. Clin J Am Soc Nephrol. 2013; 8(2): 328-335.

Peters MN, Moscona JC, Katz MJ, et al.: Natural disasters and myocardial infarction: The six years after Hurricane Katrina. Mayo Clin Proc. 2014; 89(4): 472-477.

Shimizu Y, Kato H, Schull WJ: Risk of cancer among atomic bomb survivors. J Radiat Res. 1991; 32(suppl 2): 54-63.

Morren M, Dirkzwager AJ, Kessels FJ, et al.: The influence of a disaster on the health of rescue workers: A longitudinal study. CMAJ. 2007; 176(9): 1279-1283.

United Nations International Strategy for Disaster Reduction: Natural disasters and sustainable development: Understanding the links between development, environment and natural disasters. Background Paper No. 5. Geneva, Switzerland: United Nations Department of Economic and Social Affairs, 2002. Available at Accessed February 1, 2018.

Vanholder R, Borniche D, Claus S, et al.: When the earth trembles in the Americas: The experience of Haiti and Chile 2010. Nephron Clin Pract. 2011; 117(3): c184-c197.

EMDAT The International Disaster Database, Center for Research on the Epidemiology of Disasters—CRED: Disaster Profiles. Available at Accessed February 1, 2018.

Ashkenazi I, Isakovich B, Kluger Y, et al.: Prehospital management of earthquake casualties buried under rubble. Prehosp Disaster Med. 2005; 20(2): 122-133.

Noji EK: Acute renal failure in natural disasters. Ren Fail. 1992; 14(3): 245-249.

Khan S, Rai MA, Khan A, et al.: Prevalence of HCV and HIV infections in 2005-earthquake-affected areas of Pakistan. BMC Infect Dis. 2008; 8: 147.

Richards NT, Tattersall J, McCann M, et al.: Dialysis for acute renal failure due to crush injuries after the Armenian earthquake. BMJ. 1989; 298(6671): 443-445.

Schultz CH, Annas GJ: Altering the standard of care in disasters—Unnecessary and dangerous. Ann Emerg Med. 2012; 59(3): 191-195.

Hodge JG Jr, Bhattacharya D, Garcia AM: Assessing criminal liability of volunteer healthcare workers in emergencies. Am J Disaster Med. 2006; 1(1): 12-17.

Rothstein MA: Currents in contemporary ethics. Malpractice immunity for volunteer physicians in public health emergencies: Adding insult to injury. J Law Med Ethics. 2010; 38(1): 149-153.

Frykberg ER: Medical management of disasters and mass casualties from terrorist bombings: How can we cope? J Trauma. 2002; 53(2): 201-212.

Born CT, Briggs SM, Ciraulo DL, et al.: Disasters and mass casualties: I. General principles of response and management. J Am Acad Orthop Surg. 2007; 15(7): 388-396.

Pepe PE, Kvetan V: Field management and critical care in mass disasters. Crit Care Clin. 1991; 7(2): 401-420.

Schultz CH, Koenig KL, Noji EK: A medical disaster response to reduce immediate mortality after an earthquake. N Engl J Med. 1996; 334(7): 438-444.

Perera C, Briggs C: Guidelines for the effective conduct of mass burials following mass disasters: Post-Asian tsunami disaster experience in retrospect. Forensic Sci Med Pathol. 2008; 4(1): 1-8.

PAHO, WHO, ICRC, International Federation of Red Cross and Red Crescent Societies: Management of dead bodies after disasters: A field manual for first responders. Available at Accessed February 1, 2018.

Sztajnkrycer MD, Madsen BE, Alejandro Baez A: Unstable ethical plateaus and disaster triage. Emerg Med Clin North Am. 2006; 24(3): 749-768.

Parsons T, Toda S, Stein RS, et al.: Heightened odds of large earthquakes near Istanbul: An interaction-based probability calculation. Science. 2000; 288(5466): 661-665.

Federal Emergency Management Agency: FEMA Training. Available at Accessed February 1, 2018.

Federal Emergency Management Agency: National disaster recovery framework. Strengthening disaster recovery for the nation. Available at Accessed February 1, 2018.

Boatright CJ, Brewster PW: Public health and emergency management systems. In Koenig KL, Schultz CH (eds.): Koenig and Schultz's Disaster Medicine: Comprehensive Principles and Practices. Cambridge: Cambridge University Press, 2010: 133-150.

Phillips BD: Special needs populations. In Koenig KL, Schultz CH (eds.): Koenig and Schultz's Disaster Medicine: Comprehensive Principles and Practices. Cambridge: Cambridge University Press, 2010: 113-130.

Zoraster RM, Amara R, Fruhwirth K: Transportation resource requirements for hospital evacuation. Am J Disaster Med. 2011; 6(3): 173-186.

Pan-American Health Organization, World Health Organization: Protecting new health facilities from natural hazards: Guidelines for the promotion of disaster mitigation. Prehosp Disaster Med. 2004; 19(4): 326-351.

Sever MS, Lameire N, Vanholder R: Renal disaster relief: From theory to practice. Nephrol Dial Transplant. 2009; 24(6): 1730-1735.

Sever MS, Erek E, Vanholder R, et al.: The Marmara earthquake: Admission laboratory features of patients with nephrological problems. Nephrol Dial Transplant. 2002; 17(6): 1025-1031.

Darkins DA: Telemedicine and telehealth role in public health emergencies. In Koenig KL, Schultz CH (eds.): Koenig and Schultz's Disaster Medicine: Comprehensive Principles and Practices. Cambridge: Cambridge University Press, 2010: 345-360.

Piza F, Steinman M, Baldisserotto S, et al.: Is there a role for telemedicine in disaster medicine? Crit Care. 2014; 18(6): 646.

Center For Disease Control (CDC) Emergency Preparedness and Response: During an earthquake: Indoor safety. Available at Accessed February 1, 2018.

Knowlton LM, Gosney JE, Chackungal S, et al.: Consensus statements regarding the multidisciplinary care of limb amputation patients in disasters or humanitarian emergencies: Report of the 2011 Humanitarian Action Summit Surgical Working Group on amputations following disasters or conflict. Prehosp Disaster Med. 2011; 26(6): 438-448.

Rathore FA, Gosney JE, Reinhardt JD, et al.: Medical rehabilitation after natural disasters: Why, when, and how? Arch Phys Med Rehabil. 2012; 93(10): 1875-1881.

Biddison LD, Berkowitz KA, Courtney B, et al.: Ethical considerations: Care of the critically ill and injured during pandemics and disasters: CHEST consensus statement. Chest. 2014; 146(4 suppl): e145S-e155S.

Centers for Disease Control and Prevention, MMWR:. Guidelines for field triage of injured patients. Recommendations and Reports. Vol. 61, No. 1. 2012. Available at Accessed February 1, 2018.

WHO: WHO-PAHO guidelines for the use of foreign field hospitals in the aftermath of sudden-impact disasters. Available at Accessed February 1, 2018.

Autier P, Ferir MC, Hairapetien A, et al.: Drug supply in the aftermath of the 1988 Armenian earthquake. Lancet. 1990; 335(8702): 1388-1390.

United Nations: The guiding principles on internal displacement. Available at Accessed February 1, 2018.

UNHCR: UNHCR Note on refugee integration in Central Europe. Available at Accessed February 1, 2018.

Barnett DJ, Taylor HA, Hodge JG Jr, et al.: Resource allocation on the frontlines of public health preparedness and response: Report of a summit on legal and ethical issues. Public Health Rep. 2009; 124(2): 295-303.

Sever MS, Erek E, Vanholder R, et al.: The Marmara earthquake: Epidemiological analysis of the victims with nephrological problems. Kidney Int. 2001; 60(3): 1114-1123.

Bushberg JT, Kroger LA, Hartman MB, et al.: Nuclear/radiological terrorism: Emergency department management of radiation casualties. J Emerg Med. 2007; 32(1): 71-85.

Vanholder R, Sever MS, De SM, et al.: Intervention of the renal disaster relief task force in the 1999 Marmara, Turkey earthquake. Kidney Int. 2001; 59(2): 783-791.

O'Neill PA: The ABC's of disaster response. Scand J Surg. 2005; 94(4): 259-266.

Noji EK: Natural disasters. Crit Care Clin. 1991; 7(2): 271-292.

Norton I, vo Schreeb J, Aitken P, et al.: Classification and minimum standards for foreign medical teams in sudden onset disasters. Available at Accessed February 1, 2018.

Azuma T, Seki N, Tanabe N, et al.: Prolonged effects of participation in disaster relief operations after the Mid-Niigata earthquake on increased cardiovascular risk among local governmental staff. J Hypertens. 2010; 28(4): 695-702.



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