Venezuela
Emergency And Disaster Preparedness: An Experience In Training Undergraduate Medical Students
Dr. Luis O. Báez, UCV, Venezuela

Disaster preparedness has long been a global concern. It reached the Latin American health sector in the 1970s thanks to the Emergency Preparedness and Disaster Relief Coordination Program (PED) of the Pan American Health Organization (PAHO) and the World Health Organization (WHO).

The many emergencies and disasters that have hit our countries over the years have tragically underscored our deficiencies in preparedness, prevention, response, rehabilitation, and reconstruction. To respond effectively to natural or manmade disasters, we need proper planning, an efficient disaster management agency or system, and the right training, particularly in the field of health care.

Emergency Medical Care Systems need their own infrastructure and organization, with clear delimitation of responsibilities in the outpatient, inpatient, and rehabilitation areas, and qualified technicians and professionals who know how to respond successfully to life-threatening contingencies. The better organized an Emergency Medical Care System at the national or local level, the greater the odds of a patient surviving an emergency situation.

Health staff needs the skills to rescue and stabilize the injured, and to use the life-support systems that can guarantee their survival until they arrive at a hospital with the necessary infrastructure, equipment and specialists to take care of the injuries. In a disaster situation, the health officials best qualified to care for the injured are professionals who have specialized in emergency response. However, they are not always available on the spot, or their physical and mental resources may be stretched to the limit by the large number of patients that need care, or the need to deal with logistical issues such as separating and categorizing the victims in order to ensure the best possible use of the health facilities, equipment, and staff.

Civil society often responds spontaneously in a disaster situation, engaging in search and rescue operations and providing non-professional health care or at least psychological support until the paramedics or doctors can intervene. Similarly, it is not uncommon for medical undergraduate students to join response teams without having the training required to perform correctly in an emergency.

Aware of these facts, the José Vargas School of medicine of the Faculty of Medicine of the Central University of Venezuela (UCV) has since 1989 included in the curriculum of undergraduate studies a series of subjects related to emergency and disaster preparedness and response.

In the very first year of medicine, the subject called Primary Techniques in Medicine I trains students in first aid, taking advantage of the anatomical and physiological knowledge they are acquiring in other classes.

Second year students study Primary Techniques II, where they learn procedures such as the use of probes, the interpretation and execution of medical orders, and mobilization and evacuation of hospital patients. By this stage, undergraduates can help rescue teams by providing first aid, or they can give support as paramedics in the observation or handling of the injured.

In the third year of medicine, students must take Disaster Medicine, based on instruction modules designed and developed by PED/PAHO-WHO, adapted to local customs and organizational structures. They learn about epidemiological management, environmental management, mass health care, categorization techniques, shelter management, technical disasters, and hospital contingency plans. Undergraduates are also required to produce a practical research paper on risk management, preparedness, disaster response, or contingency plans for health or educational facilities.

In the fifth year of medicine, during their surgery internship, students are trained in advanced techniques for managing multiple-trauma victims, using the Advanced Trauma Life Support (ATLS) techniques of the American College of Surgeons. By the time they complete their first year, students begin their Rotating Internship, in which they act under direct medical supervision in such fields as surgery, pediatrics, and rural medicine, handling emergencies, diagnostics, hospitalization, and preventive medicine.

Since 1995, 392 graduates have taken these courses, and are now practicing throughout the country. The earthquake that took place in Cariaco, in the state of Sucre, in 1997, and the floods that hit the country in December 1999, have enabled us to assess the role of students and doctors trained in disaster response. Results have been very satisfactory. However, all health professionals should receive this training, and we are working hard to make sure that they can receive it.

For more information, please contact:
Dr. Luís Oswaldo Báez,
General Surgeon, Associate Professor, UCV
Head of the Surgical Department of Vargas Hospital, Caracas, Venezuela
Member of the UNDAC Latin America Team (OCHA-UN)
Email: cons506@cantv.net.