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Assessing the Health Consequences of Major Chemical Incidents: Epidemiological Approaches
WHO Regional Publications, European Series, No. 79
1997, xiv + 90 pages [E]
ISBN 92 890 1343 5
Sw.fr. 22.-/US $19.80; in developing countries: Sw.fr. 15.40
Order no. 1310079
Explains how epidemiological tools can be used to guide the emergency management of chemical accidents and support actions to minimize adverse effects on health. Addressed to public health officials as well as epidemiologists, the book offers extensive practical advice on the choice of epidemiological methods, the design of studies, and the use of findings to support decisions during the acute phase, long-term follow-up, and the preparation of services to manage future incidents. Throughout, recommended uses of epidemiology draw on experiences gained during the investigation of several major chemical accidents in Europe.
The book opens with an introduction to the nature of chemical accidents, routes of exposure, types of effects on health, and factors that can modify these effects. Against this background, guidelines are presented in three parts. The first explains the contributions of epidemiology to the immediate and longer-term management of a major chemical incident. Information includes the types of data needed according to the nature and phase of the emergency, sources of relevant data, and the ethical issues raised by studies. The second and most extensive part gives epidemiologists a comprehensive guide to the range of tools and approaches that may be needed when investigating an accident. Details range from advice on when rapid appraisals are appropriate, through a description of the advantages and disadvantages of using biomarkers of exposure, to a table listing diagnostic tests appropriate for measuring effects on specific organs and systems. The final part discusses the contribution of epidemiology as part of a multidisciplinary response to chemical emergencies.
Further practical information is provided in an annex, which summarizes methods used and lessons learned during the investigation of the chemical fire in Schweizerhalle, Switzerland, the escape of toxic chemicals in Seveso, Italy, the Shetland oil spill in the United Kingdom, and the toxic oil syndrome in Spain.
1999, iv + 141 pages [E, F*]
ISBN 92 4 154519 4
Sw.fr. 42./US $37.80; in developing countries: Sw.fr. 29.40
Order no. 1150464
A guide to policies, procedures, and planning techniques that can help mitigate the consequences of natural and man-made disasters. Addressed to managers in health administrations, hospitals, public works, and volunteer organizations, the manual draws on abundant evidence that emergency preparedness can help stricken communities limit the consequences of emergencies and overcome them at an early stage. With this goal in mind, the manual covers the full range of considerations needed to identify vulnerable populations, predict the likelihood and consequences of emergencies, and plan for an appropriate response.
The manual has six chapters. The first introduces the concepts of emergency preparedness and vulnerability reduction, and explains their importance in the context of several recent trends. Chapter two, on policy development, identifies eleven policy issues and lists various options that can help guide decisions.
Against this background, chapter three describes a series of steps, supported by different analytical and assessment techniques, for an analysis of hazards aimed at identifying vulnerable populations, determining the likelihood of an emergency, and gauging its effects. Chapter four provides an outline of the principles of emergency planning, followed by a detailed guide to each step in the process. The remaining chapters address the need for training and education of vulnerable communities, and outline procedures for monitoring and evaluation. The book concludes with tables for gauging the scale of damage caused by wind storms, hurricane disasters, earthquakes, landslides, and volcanic eruptions.
Coping with Natural Disasters: The Role of Local Health Personnel and the Community
1989, x + 97 pages [Ar, E, F, R, S]
ISBN 92 4 154238 1
Sw.fr. 18.-/US $16.20; in developing countries: Sw.fr. 12.60
Order no. 1150310
Provides a well-structured collection of facts, advice, and recommended actions that can enable community leaders and health personnel to take control when disaster strikes. While noting that reliance on outside assistance is an inevitable part of disaster management, the book emphasizes the many things communities can do to save lives while awaiting help and guard against the tragedy of inappropriate aid. Information is specific to emergencies caused by earthquakes, volcanic eruptions, floods, hurricanes, gales, tidal waves, and droughts.
The first half sets out plans of action for coping with a progression of likely events, moving from immediate rescue operations and treatment of the injured, through the sheltering of survivors and burial of the dead, to the coordination of relief operations and the planning of long-term recovery. Using checklists, action plans, and abundant illustrations, chapters help readers to anticipate problems, visualize procedures, and be prepared to move into action. Details range from advice on how to locate survivors to a list of dangers to avoid during food distribution.
The second half concentrates on special problems requiring detailed explanation or instructions. Readers are given information on the diseases that should be monitored in temporary shelters, measures for assessing nutritional status and determining the need for supplementary feeding, and instructions for preparing record cards, self-evaluation reports, and maps of risks and resources. Readers are also given information on what to do during an earthquake, how to interpret damage to different types of buildings in terms of the risk of continued residence, and what types of medical equipment will be needed.
Earthquakes and People's Health
Vulnerability Reduction, Preparedness, and Rehabilitation
Proceedings of a WHO Symposium, Kobe, Japan 1997
Document issued by the WHO Centre for Health Development, Kobe, Japan
1997, x + 285 pages [E]
Sw.fr. 34.-/US $30.60; in developing countries: Sw.fr. 23.80
Order no. 1930115
Reports the proceedings of an international symposium where experts in medicine, public health, engineering, and economics convened to exchange experiences about the management of severe earthquakes in urban areas. Experiences during all major recent earthquakes - from Kobe, Japan to Northridge, California - are presented and discussed in terms of lessons that can help reduce the immediate and long-term impact on health and prepare services to cope with future events.
Papers are presented in five parts. The first identifies key issues in the management of earthquakes, including factors that increase the risk of casualties and injuries, the value of seismological forecasting, and the impact of earthquakes on physical and mental health. Papers in part two present data documenting the immediate and long-term health effects of recent earthquakes, including information on the most common injuries and causes of death. The third and most extensive part, on vulnerability reduction and preparedness, discusses the forecasting of seismic hazards, the use of urban earthquake masterplans, regulations for earthquake-resistant construction, methods of protecting hospitals, and the organization and logistics of emergency preparedness. Topics discussed range from the reasons why earthquakes continue to be so destructive despite advances in construction engineering, through the need for disaster management manuals in hospitals, to the importance of providing vulnerable communities with training in first-aid. The remaining parts describe experiences in the rehabilitation of cities and summarize national approaches to disaster management.
Field Guide on Rapid Nutritional Assessment in Emergencies
WHO Regional Office for the Eastern Mediterranean
1995, iii + 63 pages [E]
ISBN 92 9021 198 9
Sw.fr. 12.-/US $10.80; in developing countries: Sw.fr. 8.40
Order no. 1460013
A spiral-bound guide describing a simple step-by-step procedure for carrying out a rapid survey of nutritional status in emergency situations in Eastern Mediterranean countries, where natural and man-made disasters have been common. Emphasis is placed on the steps required to make quick but reliable estimates as a basis for subsequent action. Throughout, checklists, model forms, reference charts, and tables are used to facilitate rapid data collection in emergency situations.
Decisions concerning the recommended minimum sample size, survey participants, and the level of analysis needed were made with the goal of striking a balance between the methodologically appropriate and the logistically feasible. The recommended method is based on simple anthropometric data and limited to children of preschool age. The result is a series of steps, appropriate to field conditions, that can be followed by individuals with little statistical or epidemiological training, and can produce the essential data needed for immediate decisions and interventions.
The guide has eight chapters, moving stepwise from selection of the survey subjects and sample, through collection of data on weight-for-height, to the recording, analysis, and interpretation of results. Further practical guidance in provided in a series of eight annexes, which include examples of systematic and cluster sampling, the CDC/WHO normalized reference table of weight-for-height, mean Z-scores and corresponding prevalences below -2 Z scores, a list of equipment, and advice on using Epi-Info software for data analysis.
Health Laboratory Facilities in Emergency and Disaster Situations
edited by M. El-Nageh and C. Heuck
WHO Regional Publications, Eastern Mediterranean Series, No. 6
1994, 169 pages [E]
ISBN 92 9021 182 2
Sw.fr. 16.-/US $14.40; in developing countries: 11.20
Order no. 1440006
A comprehensive, illustrated guide to the provision of prompt and appropriate laboratory services during an emergency or disaster. Addressed to national health authorities, aid agencies, and relief workers, the manual draws on over 20 years of experience to define the essential laboratory services needed to limit morbidity and mortality, prevent epidemics, manage trauma, and collect vital epidemiological data. Throughout the manual, flow charts, tables, and checklists are used to illustrate key actions and procedures, while line drawings and photographs depict essential equipment, types of laboratories, and model plans and layouts.
Guidelines are specific to the harsh conditions usually seen in disasters, where equipment and supplies are limited, power supplies erratic, and the number of trained staff inadequate. To facilitate planning and purchasing decisions, the manual includes abundant information on the advantages and disadvantages of equipment in terms of costs, durability, ease of maintenance, and appropriateness to the anticipated workload. Additional details range from instructions for making a waste incinerator out of a metal drum, to advice on calculating energy requirements.
The book has twelve chapters. The opening chapters identify 29 diseases commonly encountered in different types of disasters and offer advice on how to anticipate disease outbreaks and the corresponding laboratory needs. Other chapters describe and illustrate different mobile and portable laboratories, identify the most suitable tests, including commercial kits for rapid diagnosis, outline procedures for testing water supplies, and explain the principles of laboratory safety, disinfection, and waste disposal during emergencies.
In a key achievement, a chapter on laboratory kits and modules sets out the exact supplies that should be included in each of 22 modules designed to support different components of emergency laboratory work. Modules, which can be combined according to need, range in focus from kits for water testing, through a recommended microscope and accessories, to the supplies needed to perform 200 tuberculosis or bacteriology tests. The remaining chapters provide more detailed guidelines for energy supply, essential laboratory equipment, blood supply for transfusions, the safe handling and transport of specimens, and record keeping and reporting during emergencies.
"... an excellent resource for those responsible
for drawing up national contingency plans for an emergency or disaster ... highly
New Zealand Journal of Medical Laboratory Science
"A hurried response that is not based on an impartial assessment only contributes to chaos. It is better to wait until real needs have been assessed. It is more economical, appropriate and hygienic to buy new articles locally than to send used items... Donors should not compete among themselves to satisfy the more visible needs of the affected country... Emergency assistance should complement - rather than duplicate - the measures used by the affected country. "
These are some examples of the practical advice and recommendations offered in this guide. It provides strong evidence that humanitarian assistance can considerably benefit a country ravaged by disaster if it responds to real needs. Likewise, when responding with unsolicited donations, or when donors have a misguided view of those needs, it can also become a burden. This new guide combines and updates several publications that PAHO has published in the last 15 years.
Pan American Health Organization
2000, 24 pages [E, S]
ISBN 92 75 12301 2
Swiss francs 16.--/US $8.00
In developing countries: Sw.fr. 11.20
The management of supplies, whether from an external
source, in most cases is a complex logistical problem that should not be left to
improvised decision-making. The acquisition, storage, mobilization and distribution of
supplies to the victims of a disaster require a minimum framework of organization that
permits efficient handling and better use of resources. This new book provides guidelines
to manage this process. It points out that countries and organizations should incorporate
the topic of logistics into their planning and preparedness for disasters. It also
underlines the fact that each step in the supply chain should be seen as a critical and
Published jointly by PAHO and WHO, this book is the
result of many years of practical experience (especially thanks to the use of the SUMA
methodology). Despite the fact that it places emphasis on drugs and pharmaceutical
supplies, the techniques and procedures that it proposes are multisectoral in nature and
can be used in any type of emergency operation.
Pan American Health Organization
Humanitarian Supply Management and Logistics in the Health Sector
A practical guide to measures needed to ensure that the food and nutrition needs of disaster-stricken populations, refugees, or internally displaced persons are adequately met. Noting that nutrition is always a key concern in emergency management, the book offers expert advice based on both the latest knowledge in the nutritional sciences and advances in concepts of emergency management that stress preparedness and long-term recovery. The engagement of local health services and authorities is emphasized as the best strategy for building national capacity and ensuring rapid recovery.
The book covers the concepts, principles, and precise measures needed to ensure adequate nutrition in both the relief phase and the subsequent rehabilitation and development phases. Details range from a list of the equipment needed for a weight-for-height survey, through a diagram illustrating arrangements for ration distribution in camp situations, to instructions for preparing feeding mixtures for the treatment of specific deficiency diseases. Throughout, particular attention is given to conditions in developing countries, where inadequate nutrition and infectious diseases can make populations especially vulnerable to malnutrition in emergencies.
The book has seven chapters. The first, on meeting nutritional requirements, explains the importance of nutritional assessment as a fundamental management tool for calculating food needs, monitoring the adequacy of food access and intake, and ensuring adequate food procurements. The chapter also sets out recommendations for mean daily per capita intakes of energy and protein and for micronutrients and other specific nutrients.
The major nutritional deficiency diseases are covered in chapter two, which includes detailed information on the signs, symptoms, prevention, and treatment of protein-energy malnutrition, iron-deficiency anaemia, vitamin A deficiency, iodine deficiency disorders, beriberi, pellagra, and scurvy. Chapter three describes the methodology for measuring malnutrition. Information includes target audiences for assessment, advice on body measurements and clinical indicators of malnutrition, and precise instructions for conducting rapid nutritional surveys, individual screening, and nutritional surveillance.
Chapter four provides a detailed guide to the planning, organization, and delivery of general feeding programmes aimed at the affected population as a whole. Topics covered include basic requirements for suitable food commodities, principles of good organization and coordination, and the composition of a general ration calculated to meet the populations' minimum requirements for energy, protein, fat, and micronutrients. Guidelines for selective feeding programmes are presented in chapter five, which covers both the supplementary feeding of vulnerable groups and the therapeutic feeding of individuals suffering from deficiency diseases.
In view of the close link between infectious diseases and malnutrition, chapter six offers advice on the organization of services to ensure priority immunizations and to monitor and treat each of twelve infectious diseases commonly seen in developing countries. The book concludes with advice on the planning, administration, and logistics of emergency preparedness and response programmes, emphasizing the need to detect vulnerability to nutritional deficiencies and monitor early warning indicators.
Management of Severe Malnutrition
A Manual for Physicians and Other Senior Health Workers
1999, vi + 60 pages
ISBN 92 4 154511 9
Sw.fr. 23.-/US $20.70; in developing countries: Sw.fr. 16.10
Order no. 1150465
Table of Contents
This manual provides expert practical guidelines for the management of severely malnourished children. Addressed to doctors and other senior health workers, the manual explains exactly what must be done to save lives, achieve successful management and rehabilitation, prevent relapse, and thus give these children the greatest chance of full recovery. Throughout, the importance of treating severe malnutrition as both a medical and a social disorder is repeatedly emphasized. As successful management does not require sophisticated facilities and equipment or highly qualified personnel, the manual also performs a persuasive function, encouraging health professionals to do all they can to save these children and meet their great need for care and affection.
Recommended procedures draw on extensive practical experience as well as several recent therapeutic advances. These include improved solutions of oral rehydration salts for the treatment of dehydration, better understanding of the role of micronutrients in dietary management, and growing evidence that physical and psychological stimulation can help prevent long-term consequences of impaired growth and psychological development. Noting that the physiology of malnourished children is seriously abnormal, the manual gives particular attention to aspects of management whether involving the interpretation of symptoms or the use of specific interventions that differ considerably from standard procedures for well-nourished children. Details range from the reasons why IV infusion easily causes overhydration and heart failure, through a list of treatments that have no value and should never be used, to the simple reminder that underarm temperature is not a reliable guide to body temperature in a malnourished child during rewarming.
The manual opens with a concise introduction to the principles of management during three phases: initial treatment, rehabilitation, and follow-up. Chapter two briefly discusses treatment facilities, explaining why hospital or other residential care is essential for initial treatment and when a child can be moved to a rehabilitation centre. Chapter three, on evaluation, provides advice on how to assess nutritional status, take a medical history, and conduct a physical examination. Some useful laboratory tests are listed, though the book stresses that such tests are not needed to guide or monitor treatment.
Against this background, the most extensive chapter gives detailed guidelines for initial treatment. Separate sections are devoted to hypoglycaemia, hypothermia, dehydration and septic shock, dietary treatment, infections, vitamin deficiencies, very severe anaemia, congestive heart failure, and dermatosis of kwashiorkor. Information includes instructions for the preparation of formula diets from a few basic ingredients, and numerous tables and charts for determining the amount of feed to give, at which interval, to achieve an acceptable daily intake of calories. Subsequent chapters provide equally detailed guidelines for rehabilitation, including emotional and physical stimulation as well as feeding, for follow-up, and for managing cases that fail to respond to treatment. The manual concludes with brief advice on the management of severely malnourished children in disaster situations and refugee camps, and of severely malnourished adolescents and adults.
Further practical guidance is provided in eight appendices, which use numerous tables, charts, sample recording forms, instructions for preparing feeds, and examples of easily constructed toys to help ensure that management is thorough, safe, and in line with the latest knowledge.
Evaluation of the malnourished child
- Assessment of nutritional status and criteria for admission
- History and physical examination
- Laboratory tests
- Principles of management
- Dehydration and septic shock
- Dietary treatment
- Vitamin deficiencies
- Very severe anaemia
- Congestive heart failure
- Dermatosis of kwashiorkor
- Principles of management
- Nutritional rehabilitation
- Emotional and physical stimulation
parents how to prevent malnutrition from recurring
- Preparation for discharge
Failure to respond to treatment
- General principles
- Problems with the treatment facility
- Problems with individual children
- Learning from failure
Management of malnutrition in disaster situations and refugee camps
- General considerations
- Establishing a therapeutic feeding centre
- Criteria for enrolment and discharge
- Principles of management
- Evaluation of the therapeutic feeding centre
Malnutrition in adolescents and adults
- Principles of management
- Classification of malnutrition
- History and physical examination
- Initial treatment
- Criteria for discharge
- Failure to respond to treatment
Mental Health Services in Disasters
Mental Health Services in Disasters: Manual for Humanitarian Workers is composed of a noteworthy summary of the most updated knowledge in this field, in a world in which the effects from natural disasters are increasingly more dramatic - be they hurricanes, earthquakes, volcanoes, floods, etc. Crucial aspects in the management of different disaster victims are emphasized, with special attention to those most vulnerable: the children, the aged, HIV patients, individuals with substance abuse problems and their interaction with other victims.
The author, Dr. Raquel E. Cohen, is a world-renowned authority in the field of psychological and social consequences from disasters and intervention methods. She has extensive experience in managing these situations and has been consulted by several victim relief governmental and non-governmental organizations. She recently worked on assistance projects for the victims of Hurricane Mitch in Central America.
Pan American Health Organization
by R.E. Cohen
2000, 96 pages [E, S]
ISBN 92 75 12273 3
Swiss francs 36.--/US $18.00
In developing countries: Sw.fr. 25.20
Mental Health Services in Disasters
This Instructor's Guide complements Mental Health Services in Disasters: Manual for Humanitarian Workers. It serves as an instrument for the creation and execution of training courses and programmes on the subject. The Instructor's Guide is designed to be flexible and easily translated. It can be adapted to the customs of different countries or regions. The goal is to have a well-prepared and trained relief work force to respond efficiently and thereby contribute to reducing the social and psychological consequences from any disaster.
Pan American Health Organization
by R.E. Cohen
2000, 176 pages [E, S]
ISBN 92 75 12274 1
Swiss francs 36.--/US $18.00
In developing countries: Sw.fr. 25.20
Order no. 1630131
Protecting the Public's Health
PAHO Scientific Publication, No. 575
2000, xi + 119 pages [E, S from PAHO]
ISBN 92 75 11575 3
Sw.fr. 44./US $39.60; ion developing countries: Sw.fr. 30.80
Order no. 1610575
A didactic guide to all health-related measures needed to prepare for natural disasters, reduce their immediate impact, and facilitate recovery. Noting that all natural disasters share several features, the book aims to provide a framework that administrators can rely on when planning and managing the health sector's response. Details range from a list of eight misconceptions that may cause authorities to take inappropriate action, through a discussion of the sensitive issues surrounding inappropriate drug and food donations, to a distinction between responsibilities best handled by the affected country and those requiring international aid. Throughout the book, recent experiences from the Americas are used to illustrate both the impact of specific types of disaster and opportunities for mitigating their effects.
The book has fourteen concise chapters. The first describes the main health effects seen following earthquakes, destructive winds, floods and sea surges, volcanoes, and landslides. Chapter two outlines the components and key responsibilities of a national programme for managing disasters. A chapter offering advice on the preparation of disaster plans is following by a discussion of the main activities to be undertaken by a mitigation programme, giving particular attention to health facilities, drinking-water supplies, and sewerage systems.
Coordination of disease response activities is considered in the next chapter, which includes advice on the best methods for collecting information after a disaster strikes. Subsequent chapters explain the principles of mass casualty management and provide guidelines for epidemiological surveillance, disease control, laboratory services, and vaccination programmes. Other chapters cover environmental health problems, food and nutrition, temporary settlements and camps, communications and transport, and the management of relief supplies. The book concludes with a review of the types of international assistance available, followed by guidelines for reestablishing normal health programmes. Of particular practical value is a chapter on the management of relief supplies, which offers abundant advice on the sorting, classification, inventory, distribution and storage of both local and donated supplies.
The New Emergency Health Kit 1998
Lists of Drugs and Medical Supplies for 10,000 People for Approximately Three Months
1998, vi + 73 pages [E, F]
Sw.fr. 8./US $7.20; in developing countries: Sw.fr. 5.60
Order no. 1931018
Explains how to use standardized packages of essential drugs, supplies, and equipment to provide effective medical care under the primitive, demanding conditions that follow emergencies or disasters. Both the concept and the contents of the kit, which was developed by WHO in collaboration with a large number of international and non-governmental agencies, are designed to expedite the provision of supplies in line with priority health needs. Although primarily addressed to relief agencies, the book also provides useful information for national authorities and hospital managers interested in stockpiling drugs and supplies in advance.
Now in its second edition, the book has been significantly revised to reflect changes in the selection of drugs included in the WHO Model List of Essential Drugs and to bring recommendations in line with a new United Nations list of priority drugs for use in acute emergencies. New in this edition are WHO guidelines for drug donations and model guidelines for the international provision of controlled medicines for emergency care.
A complete emergency kit contains two separate sets of drugs and supplies. The first set consists of 10 identical packages of basic drugs and supplies intended for use by community health workers located in remote areas. Each package weighs approximately 45 kg and is calculated to serve 1,000 persons for approximately three months. The second, or supplementary kit, which weighs around 410 kg, contains drugs, renewable supplies, and equipment needed by doctors working in first- or second-referral health facilities.
The book includes background information on the development of the kit, a detailed description of its contents, comments on the selection of items, treatment guidelines for prescribers, and some useful checklists for suppliers and prescribers.Principles of Disaster Mitigation in Health Facilities
This book focuses on problems encountered in areas of high risk for seismic events. It introduces the essential aspects of carrying out vulnerability assessments and applying practical measures to mitigate damage in hospitals, addressing structural and nonstructural aspects, as well as administrative and internal organization. In a period of only 15 years, between 1981 and 1996, 93 hospitals and 538 health care centers in Latin America and the Caribbean were damaged as a consequence of natural disasters. The direct cost of these disasters has been enormous; just as devastating has been the social impact of the loss of these critical facilities at a time when they were most needed.
For these reasons, special consideration must be given to disaster planning for these facilities. Assessing and reducing their vulnerability to natural hazards is indispensable. Principles of Disaster Mitigation in Health Facilities is an updated compilation of various documents on the topic already published by PAHO/WHO. Sections of previous publications have been revised to address the needs of professionals from a variety of disciplines, particularly those involved in health facility planning, operation and maintenance. Figures and photographs illustrate situations that can increase disaster vulnerability in health facilities. Examples are given of how countries in Latin America have conducted vulnerability assessments and applied specific disaster mitigation measures in their hospitals and health centers.
Pan American Health Organization
2000, 132 pages [E, S]
ISBN 92 75 12304 7
Swiss francs 44.--/US $22.00
In developing countries: Sw.fr. 30.80
Rapid Health Assessment Protocols for Emergencies
1999, vi + 97 pages (available in English; French and
Spanish in preparation)
ISBN 92 4 154515 1
Sw.fr. 31./US $27.90; in developing countries: Sw.fr. 21.70
Order no. 1150463
This book provides a collection of ten protocols for conducting rapid health assessments in the immediate aftermath of different types of emergencies. Noting the vital importance of rapid and accurate information in the earliest stage of an emergency, the protocols respond to the urgent need for common standardized technical tools for assessing damage, gauging health risks, and gathering the information immediately needed by decision-makers at the national and international level.
The protocols were prepared by WHO in collaboration with a large number of international agencies and experts with broad experience in the field of emergency management. Although all protocols follow a common format, each is specific to the circumstances, potential hazards, and immediate information needs that characterize a distinct type of emergency. Emphasis is placed on the exact information needed, the best sources of data and methods for rapid collection, and the specific questions that need to be answered in order to draw initial conclusions and direct immediate actions. Although the advantages of using experienced assessments teams are stressed, the book also explains how the protocols can be used to train general health workers as part of emergency preparedness.
The book opens with an introductory protocol covering the aims and methods, responsibilities, complexities, and inherent difficulties of rapid health assessments. Addressed to health authorities as well as assessment teams, the chapter also includes abundant advice on preparedness for emergencies. Details range from the comparative need for speed in different types of emergencies, through a suggested format for presenting the results of assessments, to a list of common logistic, organizational, and technical errors. Advice on the best working practices, including ways to avoid being an "emergency tourist", is also provided.
Against this background, the additional nine protocols are presented according to a common format which covers the purpose of the assessment, preparedness, the steps to follow during the assessment, assessing the impact on health, assessing local response capacity and immediate needs, and presenting results. A general protocol on epidemics of infectious origin is followed by protocols specific to meningitis outbreaks, outbreaks of viral haemorrhagic fever, including yellow fever, and outbreaks of acute diarrhoeal disease, with information specific to dysentery and cholera.
Sudden-impact natural disasters are covered in the next protocol, which includes a day-by-day list of information priorities for different stages of the disaster. A protocol dealing with sudden population displacements offers guidelines for conducting rapid health assessments in all emergencies caused by sudden displacement of refugees or population groups within a country. Included are a sample checklist for rapid assessments and a sample form for weekly reports on morbidity and mortality. Subsequent protocols deal with the special situations of nutritional emergencies and chemical emergencies, including those caused by food contaminated with chemicals or toxins. The final protocol addresses the difficult task of conducting assessments in complex emergencies in which the cause of the emergency, as well as the assistance to the afflicted, is complicated by intense levels of political considerations. The protocol includes a form which has recently been used for rapid health assessment at local level in Bosnia and Herzegovnia.
The book concludes with a brief summary of survey techniques, followed by a tabular presentation of reference values for assessing needs, hazards, and logistic requirements in developing countries.