The Asian Tsunami: PAHO disaster guidelines in action in India.
BACKGROUND
On 26 December 2004, an earthquake (9.0 Richter, 10 kilometers below the sea) near Sumatra, Indonesia, triggered a tsunami, which traveled at approximately 800 km per hour to strike the Indian coastline. The disaster response at a 100-bed hospital situated on the beach front (2,028 km from the epicenter) is described. This paper underlines the benefit of the Pan-American Health Organization (PAHO)/World Health Organization (WHO) Guidelines for Natural Disasters in the Indian setting.


METHODS
The demand on the healthcare system in the affected study area (50 km2, 40,000 population) was assessed in terms of preparedness, response time, casualties, personnel, and resources. Other disaster issues studied included: (1) the disposal of the dead; (2) sanitation; (3) water supply; (4) food; (5) the role of the media; and (6) rehabilitation. Two hospital paramedics administered a disaster-related questionnaire in the local language to the victims (or an accompanying person) upon arrival at the hospital. Personal interviews with administrative officials involved in incident management, aid, volunteers, and response, also were conducted. The outreach programs consisted of medical camps, health education, re-chlorination of contaminated drinking water, and spraying bleaching powder on wet floor areas.


RESULTS
The total death toll in the area was 62 (with 56, four, and two bodies being recovered on Day 1, 2, and 3 respectively). There were 17 deceased males and 45 females. The bodies immediately were handed over to the relatives upon identification or sent to the mortuary. The attendance in the makeshift accident-and-emergency department on the day of the Tsunami was 219, surged to 339 patients on Day 2, and returned to baseline census on Day 7. Essentially, injuries were minor, and two children with pulmonary edema secondary to salt-water drowning recovered fully. The hospital was cleaned of debris and seaweed on Day 3 and the equipment was restored, but it remained only partially functional. This is because many staff members did not come to work because of rumors that another tsunami was imminent. There were no outbreaks of water-borne illnesses. Post-traumatic stress disorder (PTSD) symptoms such as panic attacks, nightmares, insomnia, fear of water, being startled by loud sounds, and palpitations were detected in 17% of the patients.


CONCLUSIONS
After an event, medical rescue personnel often are instructed by well-meaning authorities to conduct interventions and response, which have high visibility in the media. However, strictly adhering to the PAHO/WHO guidelines proved to be cost-effective in terms of resource allocations and disaster responses in the Tsunami-affected areas. Unnecessary mass vaccinations, mass disposal of dead bodies without identification, and an influx of untrained volunteers were avoided. Inappropriate aid by developed nations often is unmindful of the victims' needs and self-esteem. The survivors demonstrated natural coping mechanisms and resilience, which only required time and psychosocial support.
Roy
Nobhojit
N
World Association of Disaster and Emergency Medicine. nobsroy@yahoo.com
D004190:Disasters; D004636:Emergency Service, Hospital / Q000458:organization & administration / Q000706:statistics & numerical data*; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D007194:India; D007407:Interviews as Topic; D008297:Male; D009026:Mortality; D019982:Organizational Case Studies; D011795:Surveys and Questionnaires