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The medical contingent of the field hospital has different roles to play as the deployment continues, due to the changing case load and breakdown of patients and disease. If deployment occurs more than a few days from the event, the need for medical (as opposed to surgical) personnel will increase. This is due to the need to treat chronic medical conditions- due to the collapse of local medical services- and to treat infectious disease (wound infections) and to prevent and treat disease outbreaks.
Preparation for the mission will ultimately determine its success, due to the very short interval between the decision to deploy and deployment. Team preparation should ideally form a vaccinated group who will form the basis of those deployed.
The team must be self-sufficient in most aspects, taking only the minimum from the community: this will require requisition of many items and training in their use.
Infectious diseases personnel will not only guide treatment of patients but also be responsible for the health of the team and disease prevention.
The laboratory is an essential part of the team: microbiology capacity will enable guiding of treatment decisions by identifying antibiotic resistance.
Rabies is a major public health problem in Bangladesh, where most of the population live in rural areas. However, there is little epidemiological information on rabies in rural Bangladesh. This study was conducted in 30 upazilas (subdistricts) covering all six divisions of the country, to determine the levels of rabies and animal bites in Bangladesh. The total population of these upazilas was 6 992 302. A pretested questionnaire was used and data were collected by interviewing the adult members of families. We estimated that in Bangladesh, 166 590 [95% confidence interval (CI) 163 350–170 550] people per year are bitten by an animal. The annual incidence of rabies deaths in Bangladesh was estimated to be 1·40 (95% CI 1·05–1·78)/100 000 population. By extrapolating this, we estimated that 2100 (95% CI 1575–2670) people die annually from rabies in Bangladesh. More than three-quarters of rabies patients died at home. This community-based study provides new information on rabies epidemiology in Bangladesh.
During deployment following Hurricane Ike in September 2008, bites from domestic animals were among the top three trauma complaints seen at the National Disaster Medical System (NDMS) Disaster Medical Assistance Team (DMAT) base of operations.
Problem::
Unlike previous reports of frightened, misplaced dogs and cats biting strangers and rescue workers, there was an increase in bites associated with presumed non-rabid pets who were known to the bite victim.
Methods:
This was an observational sampling of all patients presenting for medical care during deployment to the AL-3 DMAT base of operations in Webster, Texas, following Hurricane Ike. Findings were compared with unofficial local norms and observations from the literature.
Results:
Of the people with animal bites presenting to the field hospital, dog bites accounted for 55%, cat bites, 40%, and snake bites, 5%. Most of the wounds required suturing and were not simple punctures. Most bites (70%) involved the hand(s). Some patients presented > 24 hours after the bite, and already had developed cellulitis. One patient required transfer and inpatient admission for intravenous antibiotics and debridement of a hand injury with spread into the metacarpophalangeal space.
Conclusions:
Most of the bites were severe and occurred within the first 72 hours after the hurricane, and waned steadily over the following weeks to baseline levels. No animal bites caused by misplaced dogs and cats biting strangers were seen. There was an increase in bites associated with domesticated pets known to the bite victim. The current NDMS cache is stocked adequately to care for most wounds caused by animal bites. However post-exposure rabies treatment is not part of the routine medications offered. For future disaster preparedness training, pet owners should be aware of the increased potential for dog and cat bites.
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