S-1994-01-1994_OVE

L’ASSOCIATION MEDICALE MONDIALE. INC ASOCIAQON MEDICA MUNDIAL, INC
… :.
Telephone: 50 40 75 7S
Fax: 50 40 59 37
THE WORLD MEDICAL ASSOCIATION, INC.
B. P. 63 • 01212 FERNEY·VOLTAIRE Cedex, France
28. avenue des Alpes· 01210 FERNEY.VOLTAIRE. France
C.ble Address:
WOMEDAS, Ferney.Voltaire
September 1994
WORLD MEDICAL ASSOCIATION STATEMENT
on
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Original: French
MEDICAL-ETHICS IN THE EVENT OF DISASTERS
Adopted by the 46th WMAGeneraJ Assembly
Stockholm, Sweden, September 1994
1. The definition of a disasterfor the purpose of this document focuses particularly
on the medical aspects.
A disaster is the sudden occurrence of a calamitous event, usually sudden and
violent, resulting in substantial material damage. considerable displacement of
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violent, resulting in substantial material damage. considerable displacement of
people and/or a large number of victims and/or significant disruption of society,
or a combination of these. The definition in this context excludes situations
arising from conflicts and wars, whether international or internal, which give rise
to other problems in addition to those considered in this paper. From the
medical standpoint, disaster situations are characterized by an acute and
unforeseen imbalance between the capacity and resources of the medical
profession and the needs of the victims or the people whose heatth is
threatened, over a given period of time.
2. Disasters, whether they are natural (e.g. earthquakes). technological (e.g.
nuclear or chemical accidents) or accidental (e.g. train derailments) are
characterized by several features which give rise to particular problems:
a)
b)
c)
d)
their sudden occurrence, demanding prompt action;
the inadequacy-of medicat resources, which are geared to normat
circumstances: the large number of victims means that available
resources have to be used most efficiently in order to save as many
lives as possible;
material or natural damage making access to the victims difficult and/or
dangerous;
adverse effects on the health situation due to pollution and the risks of
epidemic;
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e) a context of insecurity calling for police or military measures to maintain
order;
f) media coverage.
Accordingly, disasters call for a multifaceted response involving many different types
of relief ranging from transportation and food supplies to medical services, against a
background of tight security (police, fire service, army….). These operations require
an effective and centralized authority to coordinate public and private efforts. Rescue
workers and physicians are confronted with an exceptional situation in which their
individual ethics must somehow blend with the ethical requirements demanded by
the community in such an emotionally exacerbated situation.
Ethical rules defined and taught beforehand should complement the individual ethics
of physicians.
Inadequate and/or disrupted medical resources on site and the large number of
people injured in a short time present a specific ethical problem.
Providing medical services under such conditions involves technical and
organizational issues that add to the ethical issues. The World Medical Association
therefore recommends the following ethical attitudes in the physician’s role in ..
disaster situations. •
3. TRIAGE
3.1 Triage poses the first ethical problem owing to the limited treatment
resources immediately available in relation to the large number of victims
in varying states of health. Triage is a medical action of prioritizing
treatment and management based on making a diagnosis and
formulating a pragnosis. Patient survival will depend on triage. It must be
carried out quickly. taking into account the medical needs, medical
intervention capabilities and available resources. Vital acts of
carried Out quickly. taking into account the medical needs, medical
intervention capabilities and available resources. Vital acts of
reanimation may have to be carried out at the same time as triage.
3.2 Triage should be entrusted to an authorized, experienced physician,
assisted by a competent staff.
3.3 The physician should separate victims as follows:
a) victims that can be saved but whose lives are in immediate e
danger, requiring treatment straight away or as a matter of
priority within’the next few hours;
b)
c)
d)
e)
victims whose lives are not in immediate danger and who are in
need of urgent but not immediate medical care;
injured persons requiring only minor treatment, who can be
treated later or by relief workers;
psychologically traumatized victims needing to be reassured,
who cannot be taken care of individually but who might need
reassurance or sedation if acutely disturbed;
victims whose condition exceeds the available therapeutic
resources, who suffer from extremely severe injuries such as
irradiation or burns to such an extent and degree that they
cannot be saved in the specific circumstances of time and place,
or complex surgical cases requiring a particularly delicate
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