Risk Analysis of Health Impact of Disasters and Preventive Strategies Implication in Taiwan

Disaster, a sudden ecological disruption by natural or manmade force that requires external assistance, may results in huge impact to social welfare and health loss. Disaster could be managed through mitigation, preparedness, response and recovery. Taiwan is vulnerable to earthquakes, typhoons, and technical disasters though history data were inadequate. Focusing on the mitigation and preparedness, this study proposed strategies for alleviating the impact through describing the epidemiology of disaster health impact and emergency medical preparedness.
Firstly, a framework definition of disaster by World Health Organization was applied in analyzing the history document. Then response mechanism and strategies of disasters in different stages were analyzed qualitatively. Thirdly, the casualty data in governmental reporting system was analyzed for injury pattern, triage categories, medical resources utilization. Fourthly, the typhoons were grouped into three levels according to the Potential Injury Creating Event Nomenclature based on health loss. Polytomonous logistic regression was used to identified the risk meteorological factors. Finally, the demographical data relating to disaster preparedness was collected. Variable reduction was performed by using factor analysis and cluster analysis was further used to define prototypes of medical preparedness.
For typhoon casualty, minor injuries was the majority and only a small portion was sent by fire services ambulance. Admission was indicated in small part. Drowning (45.5％) and mudslide burial (40.0％) was the most common pre-hospital death, injury prevention would be the only strategies. Finding was similar in other hazards. The meteorological risk factors were: landing of typhoon, central pressure depression, wind velocity, and rainfalls.
The disaster case studies demonstrated the response system from local to central and from volunteer to official. Functions responded independently with little tactical coordination, and hospitals were vulnerable to disasters. Results of factor analysis revealed two main factors: medical resources and area size. They were related to mortality of heart, stroke and injury. The districts could be grouped into three patterns: urban, luxurious medical resources with moderate area; city/suburb, adequate resources with small area; wildness, huge area with scarce resources.
Besides direct injury and death, indirect health impact from disruption of health care system and community infrastructure was also important. Advanced warning technique, sophisticated medical care and increase coverage of mass media, can not alleviate the impact without injury prevention intervention, risk perception of the civilian, behavior modification and maximize the utilization of current resources. In community level, the implementation of disaster mitigation program including warning system towards behavior change and risk perception, efficient command structure should be emphasized. The health delivery system should focus on resilience of the facility, increasing surge capability and capability through system improvement. In civilian level, fundamental education/training to protect themselves during disasters, and support the mitigation program balancing the economic development and hazards management.