Lecture №1

“Extreme situations and disasters their influence on the population”

THE PLAN OF LECTURE

1. Introduction. ES and their influence on a ability to live of the people.

2. Classification and the notions of the Extreme Situations (ES) and catastrophes.

3. The tasks and organization of state service of Medicine of Catastrophes (MC).

4. Basic features of a service MC in ES.

5. Basic divisions of a service MC.

1. Introduction. Es and their influence on a ability to live of the people

The present-day century has aggravated the contradiction of interrelations of a human society and nature to the extreme. Shift of ecological equilibrium to the crisis edge observed everywhere has reduced buffer possibilities of nature and has weakened its natural protective mechanisms. Since the prolongation of negative economic cause and effect ties has a stable character, the possibility of human involvement has increased. The new objective factor of increase of potential damage in extreme situations is deepening of transforming activity of the man himself. And now we can realize the thoughts of V.I.Vernadsky about the planetary character of human activity to full extent: ”Created during the whole geological time and established in its equilibrium, biosphere starts to change more and deeper under the influence of the scientific thought of humanity. The scientific thought changes the life phenomena, geological processes, planet power engineering. It is obvious that this way of the human scientific thought is the natural phenomenon".

The main medical consequences of catastrophes are a large number of casualties, mental disorders in people in the disaster area, disorganisation of management of local public health services, material and human losses. As a result there is a discrepancy between urgent need of medical aid and possibilities of medical service in rendering it.

Natural disasters have the most severe consequences. 3 million people have died due to catastrophes for the last 20 years, the number of injures makes about 800 million, the total cost of damage is estimated in 100 billion dollars.

The catastrophes where international forces participate in its eradication are registered on an average weekly. The analysis shows, that 90 % of them constitute: floods 40 %, typhoons 20 %, earthquakes and droughts on 15%. The rate and the range of technological disasters are comparable with natural ones. The events at Chernobyl Nuclear Electric Power Station (NEPS) caused the death of 30 men, hospitalization even more than 200 men with the diagnosis of radiation disease, material damage is estimated to be 8 billion rubles, but medico-social, ecological and other consequences are still serious problems. Sinking of passenger vessel "Admiral Nakhimov" carried away more than 400 human lives. As a result of railway accidents of 1988 more than 120 men were lost and more than 500 were hospitalized. On the 3^rd of June, 1989 at 23 hours there was gas escape from the pipeline of the liquefied gas due to the accident near the railway of Chelyabinsk – Ufa. A powerful explosion and fire occurred in collision of two counter trains resulting in death of over 300 people (there were a lot of children among them) and more than 700 people were hospitalized.

In contrast to disasters, the sources of which are uncontrollable by a man, technological accidents can be regulated. Therefore it is of great importance to work out scientifically grounded complex of measures not only for liquidation of consequences of technological accidents, but also concerning the analysis of the reasons of their origin.

The extreme situation can be a consequence not only of catastrophe. It may be a conclusion of long-term evolutionary development of negative processes and phenomena resulting in crisis. So crisis medico-ecological situation in area of the Aral sea have been developing for 20 years. To our mind, significant signs of an extreme situation are also considerable spatial - territorial characteristics, involvement of large mass of the people in destructive processes and as a result the sharp increase of need in medical aid for a long period of time.

Thus, there are bases to consider the notions "medicine of catastrophes" and "medicine of extreme situations" to be close in their contents, though they are not identical.

WHO suggests four main groups of catastrophe classification (meteorological; topological; tellurian and tectonic accidents).Several decades ago we might speak with certainty about prevalence of the natural phenomena as a cause factor resulting in death and injury of people. Lately, the significance of antropogenic catastrophes (technological accidents, crashes, etc.) has increased considerably. Due to risk increase of emergency situations it was necessary to organize and prepare special structures capable of functioning and giving medical aid to the population in the disaster area.

The last two decades are characterized by active development of synthesis of new chemical compounds and by now over 7 million names have been registered in the world. They are actively introduced into industry, agriculture. According to the World Health Organization a man utilizes about one million of chemical substances and their number is growing by 200-1000 new substances annually. Over 53 thousands of them are considered to be toxic and potentially dangerous to a man.

The most dangerous are chemical compounds used in national economy, having high toxicity and capable to pollute an environment for a long time. They are called highly active toxic agents (HATA). Their number exceeds several hundred and their production per head in the world exceeds on thousand tons per year (WHO, 1988). Only in the countries of Western Europe the number of annually produced common toxic chemical products – phosgene, ammonia and hydrocyanic acid is 100 billions of lethal doses, and the number of chlorine production is 100 times more.

The world experience of the analysis of chemical accidents gives evidence that damage of chemical plants, stores and other objects and the emission of different toxins into the environment may lead to serious consequences. The similar situations can develop both in disasters (earthquakes, fires, floods), and at industrial failures. The tragedy of Indian city Bhopala, located 600 km to the south of India’s capital of Delhi illustrates this. On December 2, 1984 from 23 o'clock till 1 o'clock one of the greatest as to the number of the dead and injured industrial accidents happened at the chemical plant on production of pesticides of the American corporation “Union Carbide”. As a result of escape of 30 tons of poisonous gas methylizocyanate(MIC), toxicity of which is 10 times higher than that of phosgene, more than 2500 people died and over 170000 people were in need of medical aid.

The same year has become tragically for Mexico, where the explosion of storehouse of liquefied hydrocarbon in Sun-Juan-Iksyatake has resulted in death of 500 and injury of over 5000 men. The largest chemical catastrophe in the former USSR for last years was the accident at industrial association "NITROGEN" in Ionava (Lithuania) in March, 1989. The destruction of isothermal storehouse has resulted in emission in an atmosphere more than 7000 tons of ammonia and fire in a warehouse of nitrophosk, where there were about 15000 tons of this substance. During the accident 7 men were lost, 64 men have received lesions of bodies of breath and chemical burns.

The real analysis and correct evaluation of processes occurring in nature and society speaks about the growing role of medicine of catastrophes in general system of knowledge and practical activity of the people and public health services. Therefore, the medicine of accidents may be defined as scientific discipline interrelated with practically all medical specialties (organization of public health services, surgery, therapy, radiology, toxicology, pediatrics, psychiatry etc.). It studies problems of organization of rendering urgent medical aid to casualties directly in the disaster area.