Disaster epidemiology: prudent public health practice in the Pacific Islands.

Natural or technological disasters may strike a community at any time, causing death, disability, illness and material destruction. Loss of human life, healthcare costs associated with disaster-related injuries and illnesses, pain and suffering, economic loss from destruction of homes, commercial enterprises and public structures are some of the myriad ways in which the impact of the disaster may be felt by the community. Disaster managers seek to prevent, mitigate and prepare for disasters during the pre-impact phase. If and when a disaster occurs, they seek to provide timely, appropriate and effective response, relief and rehabilitation services. Disaster epidemiology arose out of a need to apply objective descriptive and analytic tools to the field of disaster management in order to improve its reievance, effectiveness, and efficiency. The table illustrates the types of studies that can be undertaken during each phase of disaster management. During the pre-impact phase vulnerability and community hazards analyses can provide useful information to public health officials responsible for prevention and mitigation of potential disasters. Epidemiologic surveys of the disaster-affected area to assess the nature and the impact of the disaster are crucial during the impact phase since the information is valuable to public health, paramedical, and medical staff in tailoring their response and relief efforts. Post-impact retrospective and prospective epidemiologic studies can assistwith the establishment of appropriate rehabilitation services. They can also serve as pre-disaster exercises since results and conclusions from these studies can help disaster managers in planning the resources needed for future disasters. Finally, there is a need for surveillance of disaster-related or emergency-related illnesses, injuries and deaths during all three phases so that baseline data is readily available for comparison during or after the disaster occurs. See Table 1.