COPING WITH NATURAL DISASTERS: THE ROLE OF LOCAL HEALTH PERSONNEL AND THE COMMUNITY
( By A Working Guide (WHO - OMS, 1989) )

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Chapter 1.Rescue operations

A disaster may result in people being:


trapped under the ruins of buildings that have collapsed,
buried under mud or landslides,
cut off by floods or the blockage of communication routes.

These people must be reached and rescued. The rescue work will mostly be carried out spontaneously by relatives, friends and local volunteers. Often it is essential to have available:


ladders,
ropes,
heavy gloves,
spades,
picks,
planks,
pocket torches.

Groups of volunteers must be organized to reach families that live in isolated places.

Certain elementary rules must be observed:


Do not trample over ruins.

Do not move rubble before being sure of not causing further collapses of buildings or falls of material.

Use manual methods for preference and handle spades and picks very gently and cautiously.


When it is difficult to reach a victim or when there is a risk of further caving-in, it is advisable to leave the work of extrication to experts (firemen, trained volunteers, building workers, the army, etc.). As soon as the rescuers reach an injured person, they should be careful to:


Maintain and ease respiration.

Clear the victimís airways by using fingers to clean the mouth and throat, taking out dentures and loosening collars, belts and clothing.

Use blankets to prevent the victim catching cold.


In order to locate those trapped under the rubble, an attempt must be made - with the help of those nearby or in the same building - to determine the number of people trapped and the places where they are probably to be found (stairwells, cellars, ramps, etc.). To find them, it is necessary first of all to obtain absolute silence and then to shout to them from different points in the ruins. If no response can be obtained, signals must be made, for instance, by knocking on pieces of metal pushed down into the rubble or by using loudspeakers. In the event of a response, contact must be maintained. The link with the person discovered is important: it is essential to talk to him and give him confidence. While the rescue workers are freeing the trapped person, those responsible for transporting him or her to the health centre or hospital will be preparing the stretcher.

The stretcher must be put down near the injured person. If no stretcher is available, one can be improvised with blankets, pieces of cloth or plastic, camp beds, ladders, doors, shutters, etc.

When lifting the injured person, certain rules must be followed:


Movements must be calm and coordinated and carried out in accordance with the instructions of a rescue worker.

The injured person must be moved as little as possible.

The victimís head, neck and trunk must be kept in the same axis (see figure).



Figure


CAUTION: Do not carry like this!

Conveyance by stretcher to the local health establishment must follow certain simple, common-sense rules:


The stretcher must go forward with the patientís head foremost.

Jerkiness must be avoided (no sudden stops, bumps or tilting).

No stretcher-bearer should walk backwards.

The injured person, together with any ventilation equipment, must be fastened to the stretcher.

If the victim is given artificial respiration (mouth-to-mouth, mask) the rescue worker responsible for it will get between the two shafts level with the victimís head; it is only in such a case, to avoid the rescue worker having to walk backwards, that the injured person will be transported feet first.

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