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Floods in the Czech Republic and eastern Germany in 2002 – KAMEDO-report 88

The Kamedo-reports are published by the Swedish Disaster Medicine Study Organisation (Kamedo), at the National Board of Health and Welfare. Observers study the medical, psychological, organisational and social aspects of disasters. The results, with a focus on experiences gained, are presented in the reports.

This report is entirely in Swedish. Only summary in English.

Summary

In autumn 2002 the Czech Republic and southeast Germany suffered heavy flooding along the rivers Moldau and Elbe. The cause was heavy rain, espe-cially on 7-8 and 11-13 August. It had also rained heavily in the Alps earlier in the summer. The peak water levels were 7.5 m above average for the Moldau and 9.4 m above average for the Elbe.
The flood had devastating consequences. Villages and towns, large areas of arable land, roads, streets and industrial areas were flooded. Thousands of people were forced to leave their homes and several hospitals were evacu-ated. The flood put a strain on the entire community, both at the emergency stage and in the long term, but neither panic nor chaos ever arose.
A total of 48,000 inhabitants of the Czech capital Prague were evacuated, about 25,000 of them elderly. Two urban districts in Prague were completely evacuated, mostly by bus. Evacuation centres were set up in schools, student hostels and military camps. Ten percent (10%) of those who had to leave their homes, i.e. about 5,000 people, took advantage of this opportunity.
The evacuation was so extensive that it was impossible to check that every house had actually been evacuated. It was up to individuals to leave their homes.
In the German city of Dresden five large hospitals with a total of over 5,000 beds were evacuated when the hospital buildings became surrounded by water. Electricity, heating, water and sanitary facilities were put out of action. This hampered or prevented data-based dissemination of information and case-note management. Disaster plans, which largely required a func-tioning telephone system, also proved to be vulnerable.
In Germany the defence forces' resources can be mobilised when the country suffers a disaster. This facility proved to be an important prerequi-site for the subsequent large-scale air evacuation of patients from Dresden to other hospitals all over Germany. Coordination of the evacuation proved to be a key issue.
The small German town of Coswig on the Elbe was also affected by the flood. Village life was highly structured, and the inhabitants themselves assumed a large part of the responsibility for successfully coping with the consequences of the flood.

Observers' experiences

Czech Republic
Fewer alarms
• There were fewer emergency alarms (calls to the police/hospital services) than usual during the evacuation period. It is a remarkable fact that fewer emergency calls are made when a disaster is in progress – though this is not a new observation. Since disasters are characterised by severe stress amongst the populace, the opposite might be expected, e.g. more emergency calls regarding stress related illnesses such as heart attack.

Robustness of hospitals
• The Czech Republic has access to mobile field hospitals that can provide backup for existing hospitals in the event of major accidents and disas-ters. This is of interest to Sweden, which could very well encounter similar difficulties in the event of a major accident or disaster. Thus the current practice of shutting down field hospitals does not seem logical. Instead, field hospitals could be kept under civilian command and used regularly for practice emergencies.
• The floods caused power cuts, making it difficult or impossible to in-form and communicate with staff and patients in the hospitals. Commu-nication equipment that works without electricity and reaches both staff and patients in all the wards in the hospitals must be installed. Such equipment is often lacking in Swedish hospitals, and this can lead to ma-jor difficulties in the event of power cuts and telecommunication break-downs.
• The evacuation showed that staffing of all types is needed in the event of a serious event. It is not enough just to provide backup doctors and nurses. All categories of staff must be available, e.g. including caretak-ers and kitchen staff.
• Computerised case-record systems totally or partially broke down as a result of the floods. A prerequisite for secure patient reports is that they be backed up on computer servers outside the hospitals. Quick provision of hard copies must be possible from this source.

Evacuation and its consequences
• The Social Services were responsible for the evacuation of the long-term care wards at the Na Františku Hospital in Prague. In Sweden evacua-tion of hospitals is the responsibility not of social services but of the medical authority. Probably no emergency hospital in the country would be capable of adequately dealing with 40 extra patients at long-term care ward. Swedish emergency hospitals have no surplus capacity in terms of beds. Neither is municipal housing for the elderly capable of temporarily dealing with more people – residents have their own rental contracts and make their own decisions about accommodation.
• Following patients' return to hospital a deterioration in their state of health was noticeable. This was probably because of lack of physiother-apy, thus demonstrating the importance of not interrupting treatment. This deterioration meant that patients needed more care than before the evacuation, thus necessitating more staff.
• The evacuation of the sick and disabled in the Czech Republic seems to have worked well. No problems were identified during interviews with social services representatives. The fact that such a large proportion of sick and disabled people in the Czech Republic are looked after in insti-tutions of various kinds could explain this. In Sweden, where many sick and disabled people have their own housing, an evacuation would re-quire greater resources, in terms of both vehicles and staff. It would also be hard to ascertain whether everyone in need of help had been reached.
• At the acute stage of the disaster, the social services concentrated on the immediate need for practical assistance of those affected. Not until the later stages, when many people felt anxiety and worry, did any need for psychological support arise. The psychologists who had registered their voluntary support were needed after the emergency..
• Many questions about the risk of infection and the need for vaccinations arose during the flood, since cleaning and refuse collection no longer functioned. Measures to combat the spread of infection must be priori-tised, e.g. making plans so that refuse can be removed and does not pile up. This is most important after a flood. When planning for a disaster of this nature it is particularly important to predict the possible lack of vac-cines and disinfectant. A well functioning organisation that can meet these needs should form part of our Swedish contingency plans.

Dissemination of information
• The public-information measures at the time of the flood were compre-hensive. This was probably a major reason for the absence of any panic. People in crisis are largely dependent on information from crisis organi-sations in order to be able to make their own decisions.
• It is necessary to plan for alternative information systems that do not require electricity, including systems for notifying the general public. Positioning loudspeakers in central locations and on vehicles was a good way of issuing the information. Use of loudspeakers can work especially well at night, when it is harder to issue visual information.
• During evacuation of the Karlin area of Prague major informational me-thods were implemented. But the dissemination of information was made easier by the fact that everyone speaks Czech in Prague. As a mul-ticultural country, Sweden should, in its crisis plans, prepare for both written and oral dissemination of information in various languages. At a time of crisis people prefer to be given information in their mother ton-gue.


Germany
Robustness of hospitals
• At the flooded hospitals many of the electrical, building services and computer server facilities were installed in underground ducts. It is questionable whether it is functional and cost-effective to install sensi-tive technical equipment underground when there is a risk of flooding. Emergency equipment should be placed relatively high in the building, but it is hard to convince architects of this and also difficult to convince hospital administrators to spend the money converting systems that al-ready exist. The experiences of this flood indicate that there is a risk of the equipment again being put out of action in a similar situation.
• In Sweden occurrences such as floods, power cuts and fires can also necessitate evacuation of an entire hospital at short notice. The disaster plans should therefore clarify the procedure in the event of hospital evacuations (National Board of Welfare's Code of Statutes 2005:13, Chap. 4, Section 2). It can be hard to practise such measures. Medical staff should thus be prepared for such a situation.

Evacuation
• There is much to be learnt from the German defence forces' air support capability for large-scale evacuation of severely ill patients over long distances. A Swedish National Air Ambulance Service (SNAM) is cur-rently being developed in Sweden. In future the procedure for long distance transportation of a large number of severely ill or injured people should be clarified in national plans. Implementation of the plans must be possible at short notice. Coordination and management of a large-scale evacuation are the key issues that must be clarified and prac-tised.
• Helicopters for short-distance transportation and planes for long-distance transportation are the best ways to evacuate patients from hos-pitals. Hospitals should have helipads above possible flood levels.
• Reloading sites in airport premises work well – they have plenty of space. Access to communication routes, toilets and restaurants are another strength.
• Direct, safe communication routes to the emergency staff are necessary. The defence forces have good and usually well-functioning communica-tion aids.
• Having your own care teams in helicopters and planes is a strength; they are well versed and know the air environment, and it is thus unnecessary to take staff from other hospitals with you.
• You must gain prior knowledge of the medical problems, medications, equipment and measures which will become necessary during transpor-tation. It is important that transport documents accompany patients.
• Alternative landing sites for helicopters should be chosen in advance.


The social services and emergency standby
• In both the Czech Republic and Germany the social services retained their normal organisational structure during the flood disaster. Repre-sentatives emphasised that crisis management was made easier by the staff's excellent knowledge of the consumers and access to the normal contact network. These experiences support the principles of responsi-bility, equality and proximity on which the Swedish crisis management system is based.
• Dresden Social Services found it hard to gain insight into the actions of small private nursing homes at the time of the flood, since the social services were not responsible for them. But in Sweden the authorities are also responsible if consumers are living in housing run by private contractors. It is thus important for there to be an agreement between the authorities and the private contractors that regulates undertakings in the event of a crisis about who is in charge during a crisis.

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Contact

Susannah Sigurdsson
+46 (0)75 247 30 00