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1、災難需求之快速評估,Purpose,Confirm the emergency Describe the type, impact and possible evolution of the emergency Measure its present and potential health impact Assess the adequate of existing response capacity and immediate additional needs Recommend priority action for immediate response,快速評估的範圍(1),確認災難對
2、社會的衝擊和社會的處理能力 確認弱勢族群，特別是婦女和兒童 確認緊急的需求與可提供給災民的有效方法 確認災區的反應程度與內部（包括災民）的處理能力 確認災民需求的優先性，與災民自己喜歡的策略 確認外援反應的程度,快速評估的範圍(2),向中央建議災難處理的優先順序 確認那種深度評估應該進行 提供基本資料以作為後來監測的參考 狀況無法確定或需求超過US25000 清楚自己的能力並告知當地政府,評估的種類,災難狀況評估 需求評估,災難狀況評估項目(1),災難的位置及範圍 災民數 死亡率 外傷及疾病種類 災民的特徵及狀況 緊急醫療、衛生、營養、飲水及健康狀態 持續或緊急威脅的程度（天然人為）,災難狀況
3、評估項目(2),基層組織及重要設施的損害。 房屋及商業建築物的損害。 農業及食物供應系統的損害。 經濟資源及社會組織的損害。 無助災民在未來數週（月）對災難嚴重程度的影響。 災區本身處理災難能力的程度及反應。 其他團體的動員形情。,Indicators,Death No of impact-related deaths in population of disaster area No of impact-related deaths by age and gender No of impacted-related deaths in population within specific lo
4、cation or habitat No of deaths per number of destroyed houses No of impact-related deaths per unit of time after disaster in population of disaster area,Indicators,Morbidity No of medical consultations in surviving population Time distribution of medical consultation Distribution of types of medical
5、 conditions Incidence of communicable diseases Occupancy of hospital beds and duration of hospitalization Geographical origin of hospitalized supplies,Indicators,Casualties No of deaths per number of casualties No of casualties per population of disaster area Distribution of types of casualties,評估的基
6、本要素,預備計劃 標準化：名詞、分類、調查、技術、程序、表格 調查和資料收集 快速且完整標明資料來源、潛在問題的形態及指標 分析 預測 報告 監測,Methodological Problems,Compromise between timeliness and accuracy Competing priority for information Logistical constrain Absence of baseline information Denominator data unavailable,Methodological Problems, cont.,Underreport
7、ing of health events Lack representativeness Resource costs of collecting and analyzing data Lack of standardized reporting mechanisms,資料收集方法,資料資訊 正確性 及時與適當頻率 取得資訊的有效性,常用收集資料的方法,地方政府的重要項目自我評估 目視和訪問 訪問重要消息人士 醫療衛生機構 災民特殊特徵的樣本調查 簡單隨機抽樣 系統隨機抽樣 分層隨機抽樣 族群抽樣,No conclusion can be made about persons who are
8、not in the sampling universe,Process of Selecting A Sample,Define the area under study Draw a rough map Geographical feature, people live, relative population concentration Use local information Ask different people their opinion,Process of Selecting A Sample,cont1,Simplest and quickest survey 50 ho
9、useholds at random 2 or 3 people/ one afternoon,Process of Selecting A Sample,cont2,Decide how to select the sample and its size Size of the area under study Number of investigators available Amount of time available for survey Availability of transport Distribution of the affected population Differ
10、ent circumstances facing people in various parts of the emergency-affected area,Process of Selecting A Sample,cont3,Cluster sampling Save survey cost No of households visited in each cluster What is to be assessed Vaccination survey 7 households are chosen in each cluster 3 to 5 teams of interviewer
11、s/ at least 3 days,評估的成功關鍵(1),使用者的特殊性 確認計劃所需的資訊 規格化 考量評估時間 確認取得正確資訊的最佳地點 區分緊急與長期需求,評估的成功關鍵(2),評估需求和弱點與能力的關係 Needs：immediate requirements for survival. Vulnerabilities：potential areas for harm and include factors that increase the risks to the affected population. Capacities：means and resources that
12、can be mobilized by the affected population to meet their own needs and reduce vulnerability. 使用統一的名詞、標準和程序,評估過程要點(1),一般(1) 誤差的產生 資訊會隨時間而改變 如果災難處理者能確認接續的災情、監測將比評估來的重要 你看不到的東西通常比你看得到的東西來得重要,評估過程要點(2),一般(2) 使用初次評估來建立接續的資料收集及分析系統 大部分的報告應該是重覆，而非詳細 初步評估要能直接對計劃形成提供資訊 報告的時機很重要，沒有參考點，大部分評估資料將缺乏價值,評估過程要點(3),
13、評估的建議對復原的影響 某些救濟計劃可能造成依賴性及嚴重降低存活者處理下次災難的能力 協助災民修復具活力的社會經濟體係 建議應該是簡單、協助使用地方物資系統,災後疾病監測醫療實務,天然災害 疫病爆發流行,?,疾病爆發流行的因素,感染,流行,居住環境改變,空氣污染,土地污染,水源污染,病媒孳生,通報不及,民眾抵抗力降低,供水系統破壞,媒體炒作(假疫情),通訊破壞,住處擁擠,食物儲存設備破壞,各種災害可能引起之防疫問題,防疫應變工作參考手冊,中央防疫處理組織圖,災後防疫體系各權責單位分工架構圖,重大災害發生時縣市支援分配表,災害發生後應考慮之防疫事項,疫苗儲存設備是否受損 通訊設備是否中斷 進行災
14、區防疫需求評估 環境致病危險因子監視與控制 傳染病監視與控制,災害發生,防疫需求評估 (災害防疫緊急應變小組),環境衛生監視系統,環境衛生,環境衛生調查,病媒監測,水質監測,疫病監視,自來水,食品,災民臨時 聚集場所,廢污處理,有害動物,屍體,資料分析,防疫措施,決定動員之人力及監視系統,監測,改善,災害發生後之防疫需求評估流程簡圖,防疫需求評估的實施步驟,災後由地方防疫緊急應變工作小組立即進行防疫需求調查 視災區範圍區域決定由地方或中央緊急應變工作小組快速進行問題之評估及分析，供主管機關決策或政策判斷 地方無法單獨進行防疫需求調查時，可由中央防疫緊急應變工作小組視情況成立先遣部隊，協助進行防
15、疫需求評估調查及問題分析,Need assessment,Random sampling 100 households Interview face-to-face by structure questionnaire,Assessment of post-earthquake needs,Items of Needs the most % - Adequate no. of shower and toilets in the shelter 63.8 - Drinking water 47.8 - The sanitation of shower and toilets 36.2 - The
16、 assurance of living in those home 33.3 - The structural safety of homes 30.0 - School of children 18.8 - Job 8.7 - Tents 7.3 - Food 2.9 - Medication supply 2.9 - Clothes for winter 2.9 - Blanket 2.9,The most needed from the government,Items % Household arranged 75.3 Reconstructure of home 13.0 Livi
17、ng expense 10.1 Job 7.2 Schooling of children 5.8,疾病監視及疫情處理,決定疫情監視通報點 工作分派 決定疫情監視通報內容及項目 決定監視通報之頻率 決定監視通報之通訊及傳輸方式 彙整監視通報資料 對於法定傳染病及暴發流行疾病之處理 對於假疫情之處理,Establish active surveillance,25 monitor stations Staff from central and local Health Department Monitored diarrhea, respiratory illness, injuries, de
18、rmal conditions, 38 notifiable disease, chronic disease, drinking water, garbage Reporting every day,No. of Teams and Workers Assigned for Disease Surveillance,Supporting Agency No. of Teams No. of workers* Duration (person-times) CDC,DOH 3 77 29/9-16/10 Health Bureau (less bureaus 7 141 13/10-30/11
19、 in central part) *one team a week ; teams worked together for one day for shift- relief,Morbidity, percentage for selected diseases (from Oct. 4 to Nov. 14),Data:Wei-Jen Chen, M.D., Ph.D.,Crude incidence for selected disease in earthquake ARI,No. of cases (per sentinel physician per week),Post-eart
20、hquake time,Crude incidence for selected disease in earthquake Acute gastroenteritis,Post-earthquake time,No. of cases (per sentinel physician per week),Cases* of Shigellosis identified in Nantou County during the quake,Comparison of Shigella Dysentery Cases between 1997-1998 in Taichung and Nantou
21、County,Taichung County,Nantou County,Reported Cases,Confirmed Cases,災後飲用水處理注意事項,自來水用戶 以蓄水池貯水時應檢查是否淹水，如有淹水應予適當消毒，才可繼續使用 若災後水質濁度增高，應煮沸後再飲用或暫時飲用包裝水 災後因加氯量增加，燒開水煮沸後應再開煮三分鐘，以保障飲水安全,災後飲用水處理注意事項,簡易自來水用戶 災後管理單位應清除水井或水源地之污泥，並刷洗乾淨，必要時施以消毒 飲用水煮沸後才可飲用,災後飲用水處理注意事項,非自來水地區 個人飲用水來源為井水，山泉水或河川池塘等者，在災後水質濁度增高時， ，宜加強過濾或
22、投以適量明礬充份攪拌後，靜置一段時間，取其澄清液煮沸後再飲用 必要時可暫時飲用包裝水，以保障飲水安全,災後廢污處理注意事項,廢棄物 廢水應設法排入下水道，垃圾應裝在不透水的垃圾袋並妥善存放定點，以利消毒及清除 廢棄物消毒應取一公斤裝30%濃度之漂白粉，直接灑於表面，灑漂白粉時應配帶護目鏡，手套與口罩 一般環境消毒應使用二十五加崙或100公升大型塑膠桶裝滿清水後，倒入4-5平複方媒餾油酚，攪拌，靜止後以噴灑方式使用,災後廢污處理注意事項,疫苗供需與管理,冷運冷藏系統、疫苗損施及請求支援通報 確認災區尚可支應之冷藏動力與設備及重建 疫苗供應 臨時接種站之建立 預防接種應變措施之即時宣導與通知管道之
23、建立,行政院衛生署,行政院衛生署疾病管制局,大 區 域 性 災 害,區域性災害,縣（市）衛生局,鄉（鎮、市、區）衛生所,衛生室、合約院所,其他鄉（鎮、市、區）衛生所,其 他 縣 (市) 衛 生 局,地方性災害,天然災害後疫苗供應及冷儲管理緊急作業流程,陳報,支援,統籌調撥支援,*,災害報告應於二小時內完成；局彙整報告於*二十四小時(*四小時*二小時)內通報,支援,支援,*,支援,支援,*,Immunization,Vaccination Established temporary vaccination station Influenza vaccination for 65 years ol
24、d persons Hepatitis A vaccination for cook Keep routine immunization program influenza for the elderly additional 70,000 doses procured 50,292 persons immunized hepatitis A vaccines for food handlers 3,750 doses used,Health Education for Public,Provide the Information of Communicable Diseases Report
25、 of disease information Correct of Rumors Health education of the public,Publishing a “ Manual on Disease Control at Earthquake”,To educate the public how to handle food and drinking water, and how to dispose of refuses and human wastes to prevent communicable diseases,Publishing a “ Manual on the Prevention and Control of Communicable Diseases in Disaster Area”,To educate the public on the routes of transmission of various communicable diseases and ways to prevent and control them,News Released,