Chemical hazards
Building related damage and risks
Health implications associated with fires
Cold weather risks
Health Protection advice on water and food during extreme weather event or natural hazard
Other health guidance
Mental Health
Fatalities
Value of having a registry of victims and responders

Chemical hazards

HPA – Incident Checklists

• Checklist for acute incident management (PDF, 41 KB) Includes: questions to ask the notifying organisation; recommendations for acute phase response; recommendations for incident investigation (post-acute phase response); and post incident questions for public health.
• Checklist for non-domestic fires i.e. industrial fires (PDF, 50 KB) i.e. industrial fires. The following checklist covers many of the issues these fires have presented and recommendations are based on observed best practice and lessons learned from past incidents.
• Checklists for decisions on sheltering or evacuation during chemical incidents (PDF, 42 KB) This checklist includes questions to help make the decision about sheltering or evacuating, and criteria for those returning home.

Advice on chemical hazards for health protection

• Compendium of Chemical Hazards. The Compendium of Chemical Hazards  is the HPA online information resource for those involved in advising and responding to chemical incidents, providing chemical-specific general information, incident management information, and toxicological information.
•  Internation Programme on Chemical Safety International Chemical Safety Cards – (ICSCs) [external link]
• US National Library of Medicine – TOXNET. Databases on toxicology, hazardous chemicals, environmental health, and toxic releases. [external link]
• Chemical Agents – Centers for Disease Control and Prevention Emergency preparedness and response: Chemical Agents. [external link]
• Wireless Information System for Emergency Responders (WISER) – WISER is a system designed to assist first responders in hazardous material incidents. WISER provides a wide range of information on hazardous substances, including substance identification support, physical characteristics, human health information, and containment and suppression advice. [external link]

Generator related risks

• Carbon monoxide – Exposure to carbon monoxide resulting from the use of emergency electricity or heat providers, can be a key health risk in the aftermath of a disaster. In indoor environments, oil, gas or kerosene heaters and faulty gas appliances produce significant amounts of carbon monoxide. 
  Information on carbon monoxide in the Compendium of chemical hazards
  Carbon monoxide - Full Document (PDF, 150 KB)
• Diesel – The diesel used in emergency generators can further cause health problems.
  Information on diesel in the Compendium of chemical hazards

Building related damage and risks

• Respiratory – Exposure to small particle matter resulting from the collapse of buildings can lead to respiratory problems
  WHO: Hazard prevention and control in the work environment: Airborne dust  [external link]
• Building collapse – Chemical Hazards and Poisons Report - Issue 4 - May 2005 (PDF, 691 KB) Acute and massive building collapse. A case study of the World Trade Centre towers' collapse, examining health and environmental consequences and highlighting some of the unique aspects of an acute building collapse, particularly the chronic aspects of the event including decontamination and clean up, environmental monitoring, and epidemiological follow up. Chemical hazards, populations at risk, and health effects are presented.
• Clean up – after the damage to buildings from mud and other debris, exposure during both the impact as well as the clean-up are of concern. 
  Health advice - How to clean up safely following floods (PDF, 104 KB)

Health implications associated with fires

• A Toxicological Review of the Products of Combustion (PDF, 159 KB) (HPA – HPA CHaPD 004). This detailed review document considers the toxicity of combustion products and aims to identify generalisations which may be made regarding the toxicity of common products present in fire smoke, with respect to the combustion conditions (temperature, oxygen availability, etc.), focusing largely on the adverse health effects to humans following acute exposure to these chemicals in smoke.
• Shelter and evacuation – US Environmental Protection Agency.Evidence base supporting shelter-in-place advice and discussing expedient shelter-in-place and evacuation.  
  Questions and Answers: EPA Shelter-in-Place Research. [external link]     
• Burns – Burns can result from fires caused by the disaster or subsequent use of stoves inside buildings. 
  National major incident plan for burn injury  [external link]       
  British Burn Association [external link]

Cold weather risks

• Hypothermia – Exposure to the cold following loss of an adequate shelter and/or immersion in water can result in hypothermia. 
  NHS Choices information on hypothermia [external link]
• Existing Chronic Diseases – worsening of existing diseases which go untreated because medication are unavailable. 
  The use of epidemiological tools in conflict-affected populations: open-access educational resources for policy makers.  [external link]

Health Protection advice on water and food during extreme weather event or natural hazard

• Water – Emergency drinking water supplies are essential to protect against dehydration, psychological distress and risk of infectious disease. Advice is provided on coping without mains water (including advice about baby formula) 
  Health advice: Coping without mains water (PDF, 89 KB)
  Sphere Project: information on accessa and water supply [external link]
• Food – General advice on food safety in natural disasters 
  WHO: Ensuring food safety in the aftermath of natural disasters [external link]
  CDC: Emergency Preparedness and Response – Food and Water Concerns [external link]
• Breastfeeding during emergencies
  WHO: Breastfeeding: a vital emergency response. Are you ready? [external link]

Other health guidance

• Trauma – WHO: General trauma care guidance [external link: pdf file]
  GP Notebook: ATLS (Advanced Trauma and Life Support) [external link]            
• Paediatric trauma –  Maternal & Childcare Advocacy International/Advanced Life Support Group  
  Pocket book of obstetric, neonatal and paediatric emergencies including major trauma. [external link: pdf file]  
• Head injury and cervical spine injury guidance – NICE clinical guideline: Triage, assessment, investigation and early management of head injury in infants, children and adults [external link]
• Pelvic, hip, spinal and open fracture guidance – British Orthopaedic Association: BOA standards for Trauma (BOAST) [external link]
• Compartment Syndrome – Clinical practice guidelines for the management of acute limb compartment syndrome following trauma [external link: pdf file]  
• Analgesia Adults and children – College of Emergency Medicine: clinical guidelines [external link]  
• Deep Vein Thrombosis (DVT) / Pulmonary Embolism (PE) – trauma secondary to immobility.
  DVT – NHS Choices: information on deep vein thrombosis [external link]  
  PE – British Thoracic Society: pulmonary embolism guidelines [external link]  

Mental Health

A devastating event such as an earthquake will expose individuals to traumatic and stressful scenes and experiences. This is likely to have implications for emotional and psychological wellbeing and is perfectly normal.  In a minority of individuals, psychological and emotional reactions may remain during the weeks and months after the incident and after individuals from responding agencies have returned home. There are a number of well-established, evidence-based sources of advice and guidance relating to helping to manage the psychosocial consequences of a traumatic event:

• Inter-Agency Standing Committee (2007). IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings.[external link: pdf file]  
• The UK Department of Health has also produced guidance on the psychosocial and mental health care of people affected by major incidents and disasters.
  Emergency Preparedness Division (2009) NHS Emergency Planning Guidance – planning for the psychosocial and mental health care of people affected by major incidents and disasters: Interim national strategic guidance. [external link]

Fatalities

Deaths from tsunami injuries occur in three phases:

1. injuries within the first few minutes that are incompatible with life (severe head, chest, and spine injuries)
2. immediate complications set in over the next few minutes to hours (such as bleeding, lung collapse, and blood clots in the lung).
3. Death from delayed complications over the coming days that are mostly associated with infectious disease (such as wound infections and aspiration pneumonia)

Keim ME.  Cyclones, tsunamis, and human health. The key role of preparedness. Oceanpgraphy 2006; 19 (2):40-9.  [external link: pdf file]

In the section on general practical advice provided for the Haiti earthquake risk assessment 2010, HPA states that dead bodies are unlikely to pose a significant health risk. 

• This belief that dead bodies pose a health risk is wrongly promoted by the media, as well as some medical and disaster professionals.
• Dead bodies do not cause epidemics after natural disasters.
• The political pressure brought about by these rumours of health risks associated with dead bodies causes authorities to use unnecessary measures such as rapid mass burials and spraying so-called 'disinfectants'.
• The consequences of mismanagement of the dead include mental distress and legal problems for relatives of the victims.
• The surviving population is much more likely to spread disease.
• Although dead bodies in themselves are unlikely to pose a risk, be aware of possible chemical contamination from the use of 'disinfectants' such as caustic soda.

Value of having a registry of victims and responders

The importance of systematically following up the health outcomes of individuals involved in major incidents has been well documented in the scientific literature. The steps required to develop such a register could be:

1. Consider how to identify the population affected.
2. Consider how to recruit the population affected onto the health register.
3. Consider how the information gathered would be used, including:
   a. To offer appropriate advice on relevant interventions
   b. To facilitate access to appropriate services

The following articles point to the value of registries of victims and responders:

• Brackbill RM, Thorpe LE, DiGrande L, Perrin M, Sapp JH 2nd, Wu D, et al. Surveillance for World Trade Center disaster health effects among survivors of collapsed and damaged buildings. MMWR Surveill Summ 2006 Apr 7;55(2):1-18. [external link]  
• Zock JP, Rodriguez-Trigo G, Pozo-Rodriguez F, Barbera JA, Bouso L, Torralba Y, et al. Prolonged respiratory symptoms in clean-up workers of the Prestige oil spill. Am J Respir Crit Care Med 2007: 176(6): 610-616. [external link]  
• Yanagisawa N, Morita H, Nakajima T. Sarin experiences in Japan: acute toxicity and long-term effects. J Neurol Sci 2006 Nov 1; 249(1):76-85. [external link]  
• Buncefield Fire Occupational Health Working Group. Buncefield Occupational Health Final Report (PDF, 957 KB) Cambridge: erpho; 2007.

The following articles and websites concern the practicalities of the process of setting up a health register

• Rapid response Registry (USA) [external link]
• Catchpole M, Morgan OW. Physical Health of Members of the Public who Experienced Terrorist Bombings in London on 7th July, 2005. Prehospital and Disaster Medicine 2010;25(2):139-44. [external link: pdf file]