Preventive Medicine Checklist
For Planning a Public Health and/or Clinical Personnel
Deployment to a Disaster Area
Draft 1, 10 January 2005
Jim Popplow, MD, MSc, FACPM

Purpose of this paper:
This paper provides a short checklist and report form for your use if you are thinking about volunteering or actually in charge of moving and sustaining a small or large team of public health care members somewhere in the world that is in crisis already. The people you are preparing to help do not have the capability of housing, feeding and protecting you and your team. You must do your homework and take the materials you need to maintain and protect yourself while you get the aim accomplished. The use of a pre-deployment reconnaissance team is highly recommended. It will provide the most reliable up-to-date information about conditions on the ground.

This material is adapted by the author from unclassified Canadian Forces Health Services unpublished sources. Any misrepresentations are the author’s. The additional sources listed are not formally cited in this checklist approach, but do provide in depth information about the complex logistics, intelligence and planning required before moving personnel into a disaster zone. They are recommended for planners with more time to read and prepare. Source E, from the Pan American Health Organization, is recommended for a first glance since it contains some very practical advice on a variety of topics such as housing and dead body handling and other items.
 

1. Aim (Mission) Planning
This is the first element of any deployment mission because one is setting out to help others, not to become a burden. You must plan for your own support, protection and security.

  “Now the general who wins a battle makes many calculations in his temple ere
  the battle is fought. The general who loses a battle makes but few calculations
  beforehand. Thus do many calculations lead to victory and few calculations to
  defeat: how much more no calculation at all!  It is by attention to this point that I
  can foresee who is likely to win or lose”.   -- SUN TZU ON THE ART OF WAR: http://www.instantknowledgenews.com/artofwar.htm

Define the Mission
• Who,
• What,
• Where,
• When (and how long)
• Why

2. Briefly describe the pre-event Situation   (Background or History)

3. Briefly describe the current Situation

4. Pre-deployment Decision Discussion and Cautions
• Who will go, skills needed, age and general physical capability if the deployment will involve strenuous trekking or loading/unloading, especially in mountains, specify any medical conditions that preclude going, be aware of the possibility of unavailability of renewing medications
• Time to prepare equipment, logistics and vaccinations
• Time needed for pre-deployment briefing, preferably by the pre-deployment reconnaissance team leader (see checklist, below) to include cultural awareness, inter-family relationships, languages, religions
• Estimate of risk in different areas from exposure to hostilities, land-mines and other environmental disease hazards
• Climate, time needed for acclimatization to time zone, temperature, humidity, drinking water, food, air conditioning or lack of, traffic accident potential, indigenous animal threat and last but not least – travelers diarrhea
• Land and air evacuation policy to medical facilities if emergency occurs upon or near arrival and later, (see recce checklist)

5. Other Issues (see pre-deployment reconnaissance team checklist for more details)
• Languages spoken
• Economic and political influences
• Population density and regional distribution
• Population statistics, birth rate, death rate, net migration rate, infant mortality rate, life expectancy rate at birth, total fertility rate
• Indigenous public health services
• Endemic disease rates, enteric, respiratory, skin, STD, vector-borne
• Illicit drug use, types, availability
• Prostitution and STD health risk estimate
• Food, refrigeration availability, drinking water treatment or source of bottled water, dairy pasteurization, bakery conditions, meat facilities, fruit and vegetable condition, use of human fertilizer on crops
• Flora and Fauna awareness
• Type of housing available
• List tasks that need to be carried out immediately upon arrival to set up living area, space available, separate rooms or common rooms, is there room to hang up mosquito netting, is there evidence of insects or rodents, are immediate pest control measures needed
• Hygiene and sanitation, showers, baths, sinks, soap, paper towels, toilets, urinals, laundry, sewage effluent, garbage handling
• Blood discipline (standard precautions)
• Noise hazards in work or living areas especially near industrial areas
• Sun exposure, especially combined with medications such as doxycycline
• Reliable electric power for communication is critical (batteries will not be there!)
• Emphasize the importance of documentation of environmental and industrial health hazard or public health concern of both recce team and deployed team members. Private medical health information must be treated in accordance with current privacy legislation

Additional Sources
A. Australian Federal Emergency Management Agency, Emergency Support Function #8 Health and Medical Services Annex
http://www.au.af.mil/au/awc/awcgate/frp/frpesf8.htm
B. U.S. Army, Combat Health Logistics in Theater of Operations, Tactics, Techniques and Procedures
http://atiam.train.army.mil/portal/atia/adlsc/view/public/296885-1/fm/8-10-9/8-10-9_toc.htm
C. WHO, Emergency Preparedness and Response http://www.who.int/mip/2003/other_documents/emergency/en/
D. U.S. CDC Public Health Emergency Response Guide for State, Local, and Tribal Public Health Directors
http://www.bt.cdc.gov/planning/responseguide.asp
E. Pan American Health Organization, has prepared many technical guidelines and information sheets on public health issues in disaster situations.
http://www.paho.org/english/dd/ped/tguidelines_menu.htm

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Pre-Deployment Reconnaissance Team
Checklist and Reporting Format
Draft 1

1. Dates that the Reconnaissance trip will begin and end
2. Recce team members names, passports, visas and list of home contacts
3. Country and location of proposed deployment
4. Immunizations required for team members (Infectious Disease Specialist to be consulted before deployment and, if possible, in country)
5. In country liaison contacts, phone, fax, e-mail
6. Embassy/Consulate/High Commission, phone, fax, e-mail
7. Topography in area of operation
8. Climate, four seasons or dry/wet, temperature ranges
9. Drinking water availability, source, treatment quality, generally only commercial bottled water from Canada, USA, Western Europe, Australia or New Zealand is recommended. Otherwise use water purification tablets in the bottle.
10. Food quality, if in doubt, boil it, cook it, peel it, or forget it
11. Indigenous diseases, prevalence, mode of transmission, etc.
12. Treatment possibilities for team members and local residents if they come under care
13. Special factors, especially hostilities and land-mines
14. Flora, especially dangerous plants, recommendations for avoidance and treatment
15. Fauna, especially dangerous snakes, scorpions, insects and sea life, recommendations for avoidance and treatment. Available sources of local medical expertise and antivenins.  Rabies levels in animal population, assume to be endemic unless otherwise shown. Do not handle or keep small animals.
16. Local hospitals quality and cost, ICU, ER, CCU, Surgery, X-Ray, Blood supply, level of nursing care, medical holding facilities, medical laboratories, pharmacies, fees, method of payment
17. Local physicians, training, availability, specialties especially tropical medicine
18. Road ambulance service, air-ambulance service, costs, road access, air access, nearest airport location and services, heliport
19. Evacuation destination and cooperation with other countries medical evacuation and hospital facilities
20. Indigenous public health services Malaria, types and prophylaxis recommended by Canadian medical specialists
21. Other forms of protection against biting arthropods including bed nets and permethrin pouch treated clothing before deployment with dry cleaning after return to Canada
22. Immunizations and Immunoglobulin (see below)
23. Dental facilities
24. HIV population prevalence
25. Deployment team members medical care area availability, suitability, lighting, power supply, heat, ventilation, air-conditioning, clean running hot/cold water, toilets, size, telephones, fax, computer hook-up
26. Accommodations, tents, hotels, private or public building with sleeping areas, are there separate accommodations for males and females
27. Miscellaneous, restaurants, hotels, bars, traffic, police, crime, safety, swimming pools, salt water beaches, and a caution against entry into fresh water rivers and lakes, if necessary. Caution against irresponsible alcohol consumption often associated with unsafe sex behaviour
28. Special requirements, insect repellant skin and clothing, insect screening or secure air-conditioned building, hats, clothing, boots, sunscreen, drinking water bottles

Infectious disease specialist consultation for the particular region is mandatory, but a typical immunization list may include:
• Measles/Mumps/Rubella vaccine
• Tetanus and diphtheria toxoids
• Poliomyelitis vaccine
• Hepatitis A and B vaccine
• Typhoid vaccine
• Quadrivalent meningococcal vaccine
• Current influenza vaccine
• Consideration of malaria prophylaxis
• Insect discipline, deet, bed-nets, permethrin clothing treatment with dry cleaning on return to Canada
• Others as recommended