Chapter 26 - Primary and Ambulatory Care in a Field Hospital in Disaster Areas

Summary

Acute injuries contribute to significant morbidity in the immediate time following high magnitude earthquake. Illnesses resulting from poor shelter and lack of access to electricity, clean water, and sanitation will appear later.

The most common complaints are respiratory, gastrointestinal, genitourinary,malnutrition, and acute stress disorder.

Ambulatory service can be delivered as a department within the field hospital or by outreach. The triage is a crucial part of the clinic and the medical team should identify patients who could most benefit. Other parts of the ambulatory service should contain consultation area, treatment area, pharmacy and laboratory.

In the initial period the primary physicians will participate in triage of trauma patients, treating minor trauma and preparing patients for surgery. Therefore, they should be skilled in emergency medicine, ATLS and minor trauma.

Later on, the primary physician may lead the postoperative management and the last efforts will be treatment of acute problems emerging due to poor sanitation and crowding and also management of chronic medical problems. For this purpose, they should be familiar with common infections in the disaster area and antibiotic resistance. And finally, communication with local health-care services as well as public and religious facilities is mandatory.