Letter to the Editor| Volume 12, ISSUE 2, P154-155, June 2001

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Disasters and therapeutic or prophylactic interventions

      War, political uprising, famine, civil war, and natural disasters such as earthquakes, floods, or cyclones involve considerable disability, mortality, and economic loss for the masses. Apart from emergency operations involving search and rescue for survivors, health care personnel are obliged to tackle infections, psychological disorders, and other emergency situations besides those afflicted by disasters. Survivors need an uninterrupted supply of medications for different medical disorders. Prophylactic substance usage is an integral component of the strategies directed to prevent disease outbreaks among large
      Tabled 1Therapeutic agents requiring constant storage between 2 and 8°C
      Table thumbnail fx1
      congregations of survivors. Rescue team members responsible for immediate and routine interventions have to be well immunized and receive adequate prophylactic or therapeutic agents as well.
      • Gdalevich M.
      • Ashkenazi I.
      Infection control in earthquake rescue team.
      Predisaster plans and preparedness by international and allied organizations to combat future calamities would not be comprehensive unless they address issues relating to adequacy of therapeutics, prophylactics, and diagnostics for usage in the adverse environment created by disasters. Survivors can face great temperature extremes, from subzero to 45–50°C, during the aftermath of disasters.
      Disasters disrupt the infrastructure of routine health care. Apart from negligible residual services available in different establishments, earthquakes or aerial bombings disrupt local power generation plants.
      • Horton R.
      Croatia and Bosnia: the imprints of war—II. Restoration.
      Disruption of electricity supplies to pharmacy and nonpharmacy locations affects the supply and quality of therapeutics and prophylactics. The storage requirements of therapeutic agents against common disorders encountered among disaster-afflicted individuals stipulate constant storage at temperatures ranging from 2–8°C
      Physicians’ Desk Reference.
      : they are not to be frozen. The quality of labile therapeutics like insulin, thrombolytic agents, antibiotics, interferon, and uterine stimulants (Table 1) would not be expected to be optimal when these agents are stored outside the recommended temperatures. An inadvertent exposure in a disaster-devastated site to higher or lower temperatures might be associated with a poor therapeutic response to such agents. This could adversely affect patients with injuries, communicable diseases, cardiovascular disease, and psychological sequelae of the disaster. Furthermore, the storage requirements for vaccines and immunoglobulins used for prevention of certain diseases are stringent: storage is either at subzero temperature or between 2 and 8°C. The liquid or lyophilized vaccines protecting against varicella and polio must be kept frozen. Mass immunizations with roughly handled vaccines, which are found at refugee camps for those afflicted by disasters, might be less effective in preventing outbreaks of vaccine-preventable diseases.
      Future plans to combat disasters should incorporate research efforts to produce therapeutic and prophylactic formulations that could withstand adverse environments, including changes in temperature, humidity and atmospheric pressure during wars, earthquakes, and similar catastrophes. Stabilization of labile vaccines with trehalose, pirodavir, or deuterium oxide has been encouraging.
      Such stabilized formulations would interest armed forces globally.
      One would expect appropriate research input to tackle the issues of inadvertent therapeutic or prophylactic failures among those subjected to a strenuous life after a disaster.


        • Gdalevich M.
        • Ashkenazi I.
        Infection control in earthquake rescue team.
        Lancet. 1999; 354: 1564
        • Horton R.
        Croatia and Bosnia: the imprints of war—II. Restoration.
        Lancet. 1999; 353: 2223-2228
      1. Physicians’ Desk Reference.
        53rd ed. Medical Economics Company, Montvale1999
      2. Brown F. New Approaches to Stabilization of Vaccine Potency. Karger, Basel1996

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      • Errata
        Wilderness & Environmental MedicineVol. 12Issue 3
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          In a collective review by E. Ben Welch and Barry J. Gales, “Use of stun guns for venomous bites and stings: a review,” published in Issue 2, Volume 12, page 111, reference 29, the reference to Dr David L. Hardy, Sr, MD, was misprinted as “Harding.” The reference citation, however, is correct. The authors and editors regret the error.
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