COMMUNITY HEALTH 183
and the U.S. Federal Emergency Management Administration
(FEMA), based at Emmitsburg, Maryland, who provide
control and coordination of disaster relief efforts. Analysis
of responses to previous disasters is also a major effort of
governments in all of the Americas where an international
networking exists to share information and prepare or a wide
range of mutual support efforts by communities in emergen-
cies. Easily accessible first aid stations provide initial care for
injured and ailing persons and transfer critically ill persons
to hospitals via designated medical transport. When catas-
trophes occur in limited areas, well-defined routes into and
out of the disaster area must be defined for ambulances that
are to be used to evacuate patients. Dispatchers should main-
tain accurate lists of patients and their destinations to provide
timely information to communities of relatives and friends.
Supplies of special protective clothing and personal equip-
ment that support workers in the rescue operations must also
be in the planning calculus. Schultz, Koenig, and Noji have
described a modified simple triage and rapid treatment system
aimed at reducing immediate mortality after earthquake.^23
Hospitals may not be able to use telephone lines in some
areas, for example, and should become part of the radio net for
disasters. If hospitals are liable to be damaged by earthquakes,
floods, or major neighborhood fires, all staff persons should be
trained in rapid and safe patient evacuation techniques. When
even modest numbers of casualties are expected, hospitals must
prepare to receive worried relatives and curious friends as well
as patients. Hospitals should be assured of effective highway
traffic control for ambulances in addition to their own internal
management of patient flow and necessary restriction of visi-
tors. Administrators plan to meet needs of hospital personnel
who may have difficulty in reaching the hospital, and may have
to be housed and fed until the emergency has subsided.
Continued supplies of medications and surgical mate-
rial, food, and laundry are additional concerns of municipal
departments that support the hospital community. During
early recovery and mop up periods, community health plan-
ners should anticipate that a disturbed environment may be a
seed-bed for enteric diseases due to several bacteria, such as
salmonella or staphylococci, and other pathogens that con-
taminate damaged water supplies and foodstuffs that lack
refrigeration or safe storage. Increased numbers of respira-
tory diseases can be expected among the very young and old
survivors, as well as exacerbated severity of many existing
chronic diseases that require a continuous supply of remedies,
like diabetes, heart or kidney disease, and seizure disorders.
A natural disaster or major industrial calamity often calls
out the best in a community and may reveal unsuspected
leadership strengths. Nonetheless, each jurisdiction should
be prepared by careful community planning to meet the
abrupt challenges of a flood, tornado, earthquake, building
collapse, explosion, or fire.CONCLUSIONSCommunity health care is more than what is provided by
an official public health department. It includes manifoldbasic structures and services that give a community an iden-
tity and allow it to serve the needs of its citizens. A cata-
log of core services would include both governmental and
non-governmental agencies and range from police, fire, health
and public works to housing, food supply and safety, sickness
care, education, and entertainment—and more. A healthy
community is a vital organization, continually growing by
systematic or irregular alterations and adjustments to meet
continuing challenges. Not all of its activities are planned by
a central agency but each contributes to some degree to the
general good. Whether hamlet or major city, a community
must form friendly liaisons with its neighbors and eschew
bitter relations if they are to prosper as a region. Councils
of governments can bring together the elected officials of
adjoining subdivisions conjointly to solve selected adminis-
trative problems such as fire and police protection along bor-
ders, trash disposal, recreation and entertainment, and public
health. To keep a community in good health, the chief execu-
tive officer directs that each of its elements be alert to changes
and any resultant needs to adjust, as well as continuing to be
secure financially. A healthy community, like a healthy body,
needs constant care even when it appears to be functioning
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