Review

Common Myths and Fallacies in Disaster Medicine:

An Evidence-Based Review

Tzong-Luen Wang1,2,*

Risk stratification during a disaster drives the priorities and adequacies of disaster
management, policies, and government funding. Since disasters always produce a severe imbalance
between supply and demand in human communities, it is essential for disaster risk assessment to
understand the major factors involved in future hazards and vulnerabilities. However, evidence-
based disaster medicine studies reveal a large gap between perceptions of what occurs and what
actually occurs in disasters. There are thus some common myths and fallacies regarding disaster
medicine. First, I distinguish among hazards, events, health damage, and health disasters, when a
disaster actually occurs somewhere in the world. Ninety percent of disasters are hydro-
metrological. The best measure of the magnitude of a health disaster should be the number of
survivors requiring health services instead of the number of deceased. Most survivors do not panic,
and they usually rescue themselves or are rescued by bystanders. Most victims, if not
incapacitated, bypass emergency medical services (EMSs) to reach hospitals, as is also true for
contamination victims. Victims are usually non-uniformly distributed, i.e., some hospitals receive
a disproportionate share of victims. Victims may begin arriving at hospitals within minutes after a
sudden-onset event, and those with minor injuries tend to reach hospitals first. Relatively few
victims die in emergency departments (EDs) and some are successfully resuscitated. Most victims
are treated and released from EDs. Outside medical assistance such as disaster management
assistance teams (DMATs) normally provides little emergency medical care, and search teams
rescue few survivors. Most victims entrapped in a sudden-onset emergency event do not have the
often-quoted golden period of 72 h for rescue. Only pathogens which are already endemic in a
community pose a risk of infectious diseases after a disaster, so dead bodies pose a negligible risk
of plague infection, for example, after a disaster. Critical incident stress debriefing does not prevent
post-traumatic stress disorder. ( FJJM 2009; 7 (3) :149-160 )

Key words: disaster medicine, misconceptions, evidence-based medicine

INTRODUCTION to explain some phenomenon, often sacred, whereas

a fallacy is defined as a statement based on invalid
A myth is a traditional story which attempts inferences. There are some common myths and

From the Department of Emergency Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan1 Medical College, Fu-Jen Catholic
University, Taipei, Taiwan2
Submitted September, 10, 2009; final version accepted September, 30, 2009.
*Correspondence author: M002183@ms.skh.org.tw

輔仁醫學期刊 第7卷 第3期 2009 149

Tzong-Luen Wang
fallacies in the field of disaster medicine because
most people do not understand the essential truth
of disasters or of related problems. Such people,
even including policy makers, therefore might
believe certain incorrect concepts and make decisions
based on these inaccurate ideas.
Disasters arise from a devastating imbalance
betweenhazardsin theenvironment andvulnerabilities
of human communities. They also reflect severe
imbalances between the supply and demand of
human resources. Risk stratification of disasters
thus drives the priorities and adequacies of disaster
management, policies, and government funding.
Understanding the major factors that tend to
produce hazards and vulnerabilities plays a key
role in disaster risk assessment. However, it is not
clear if such good bases of evidence truly exist to
establish good models to predict and respond well
to future challenges from disasters.
Taiwan is located between the Philippines
and the Euro-Asian tectonic plates, which is one
of the most active seismic belts of the Pacific Rim
in Asia, and is frequently impacted by earthquakes.
[1]
According to past epidemiological data, more
than 2000 earthquake events occur on average
every year.[2] More than 200 among these are
perceptible. Taiwan has suffered severe losses in
the past from such disasters. The general public
has long been very concerned about natural disasters,
and the government has taken this matter seriously.
Since a very powerful earthquake hit Taiwan on
September 21, 1999, the National Center for Research
on Earthquake Engineering in Taiwan has expended
great efforts in developing methodologies for hazards
potential analysis and building disaster risk and
damage assessment models. The same efforts have
also been made in response of other types of
disasters such as floods. However, continuing efforts
in disaster prevention and mitigation have had
seemingly limited effects. One of the major reasons
150
may be the common myths and fallacies which
exist in disaster medicine, as described above.
Evidence-based medicine (EBM) integrates
the best research evidence concerning clinical
expertise and patient values.[3-7] Recent developments
in EBM include strategies for efficiently tracking
down and appraising evidence, publication of
evidence-based journals, systemic reviews and
concise summaries of the effects of health care, and
the identification and application of effective
strategiesfor lifelonglearningandqualityimprovement;
these developments have rapidly spread across the
globe.[3-7] However, it is difficult to develop evidence-
based disaster medicine because many of the
methods of scientific research such as double-
blinded, randomized trials cannot be applied to
the study of disaster medicine. Such a dilemma
might also explain why there are so many myths
and fallacies in disaster medicine that are commonly
held by the general public. This article reviews all
possible evidence to elucidate the true situation
with disaster medicine.
Myths and Fallacies about the Frequency of
Disasters
Frequencies of disasters are growing at an
amazing speed globally. It is estimated that there
is 1 disaster-producing event every day somewhere
in the world.[9] With an increasing number and
scope of hazards and vulnerabilities, this number
will likely continue to increase. There are multiple
and complicated interactions among numerous
factors involved in the increasing hazards and
vulnerabilities which result in greater than curviliner
increases in disasters in the world.
It is possible that any given disaster can be
modified by managing its various components of
hazards and vulnerabilities.[10] There are 10 currently
recognized factors that are most likely to produce
hazards: population growth, environmental
Fu-Jen Journal of Medicine Vol.7 No.3 2009

degradation, global warming, deforestation, emerging
infectious diseases, hazardous materials, chemical
warfare, nuclear materials, economic crises, and
culture tribalism.[8] In addition, factors that will
likely contribute to increasing global vulnerability
include population growth, aging, poverty, unequal
population distribution, urbanization, and structural
and functional failures.[8]
By definition, a so-called hazard includes any
condition that contains energy with the potential
to cause harm, and events which occur when the
energy is released with the potential to cause harm.
When there are actually adverse consequences of
energy release, "damage" or "harm" occurs. And
finally, a disaster is defined as any circumstance
for which needs produced by the damage greatly
exceed the resources available in the community
or affected area.[11] With deterioration of natural
and human environments, the frequency and damage
of major events have resulted in increasing numbers
of disasters, even mega-disasters.
Myths and Fallacies about Common Types
of Disasters
Common candidates include transportation
(or traffic-related), geological (e.g., earthquakes
and volcanic eruptions), hydrological-meteorological
(e.g., floods and hurricanes), industrial (e.g., chemical
release, fires, and structural collapse), and complex
humanitarian emergencies. While many people
believe that transportation may be the most common
type of disaster, the real situation is that hydrological
and meteorological disasters account for the majority
of overall disasters.[12,13] Global warming as well
as many other human-related factors may contribute
to these serious issues. According to the Centre
for Research on the Epidemiology of Disasters in
Belgium, over the period 1993~2002, hydro-
meteorological hazards were responsible for 86%
of the 531,000 deaths related to natural disasters
輔仁醫學期刊 第7卷 第3期 2009
Disaster Medicine Overview
and about 63% of the damage worth over 550
billion Euro dollars. The mitigation of such hazards
cannot be achieved without the ability to accurately
monitor, detect, and predict these phenomena and
issue warnings with sufficient lead times.
To achieve optimal forecasting and responses
to natural hazards requires effective coordination
and cooperation among responsible agencies,
institutions, governments, the media, and other
agencies at the local, national, and international
levels. As to hydro-meteorological hazards, timely
and effective forecasts and warnings of natural
hazards coupled with local capabilities to take
mitigating actions are essential requirements for
disaster mitigation.
Myths and Fallacies about the Definition of
Disasters
As mentioned above, a disaster is defined as
any circumstance in which needs produced by the
damage vastly exceed the resources available in
the community or affected area.[11] In other words,
a supply-demand mismatch is the key point in
considering disasters and the response to them.
While most people consider the Tokyo subway
sarin attack in 1996, the Chi-Chi earthquake in
1999 in Taiwan, the World Trade Center attack
in 2001 in New York, and the London bombing in
2005 to all be disasters, the only true health disaster
was the earthquake.
Before defining disaster, 2 questions must first
be answered: whether needs exceed resources in
the affected area and what types of needs are
involved. The types of needs can include health,
property, environment, and economics. A health
disaster is defined as a sudden or gradual decline
in the overall health status of a community for
which the community is unable to cope with
without outside assistance.[11] The disaster response,
eithercrisismanagementorconsequentialmanagement,
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Tzong-Luen Wang
includes search and rescue, triage and medical care,
and ongoing healthcare needs of the affected
population. It thus becomes clear that not every
natural disaster is a so-called "health disaster". If
the government focuses upon health problems in
any disaster, it should take healthcare resources
into consideration.
Myths and Fallacies of Measuring the
Magnitude of Health Disasters
The next issue regards the best way to measure
the magnitude of a health disaster. Most people
consider the number of the dead as the best measure
of the magnitude of a health disaster. The truth is
that a more-useful measure of the magnitude of a
health disaster is the number of injured or ill
survivors when regarding a health disaster as a
large-scale mass-casualty incident (MCI). In other
words, the number of injured or ill survivors is
much more relevant than the number of dead to
the health emergency response, and the best measure
should be the extent of health needs relative to
the extent of available health resources in the
affected area.[14]
The National Disaster Medical System (NDMS)
of every country is aimed at medical care needs
resulting from catastrophic events, which may
cause thousands of deaths and injuries. Earthquakes
and other geophysical events may cause great
mortality, and leave few injured survivors. Weather
incidents, technological disasters, and common
MCIs cause much lower mortality and morbidity.
Catastrophic disasters overwhelm local medical
care systems. Supplemental care is provided by
disaster relief forces; this care should be adapted
to the prevalent types of injuries. Most care should
beprovided at the disasterscene through supplemental
medical facilities, while some can be provided by
evacuating patients to remote hospitals. Medical
response teams capable of stabilizing, sorting, and
152
holding victims should staff supplemental medical
facilities. The NDMS program includes hospital
facilities, evacuation assets, and medical response
teams. The structure and capabilities of these
elements are determined by the medical care needs
of the catastrophic disaster situation.[14] A well-
established definition of "health disasters" is logically
tightly linked to the criteria and mechanisms of
adequate NDMS activation.
Myths and Fallacies about the
Psychological Reactions of Victims
Most people believe that the majority of victims
in real disasters often panic, but that is not the
truth. Research concerning communication with
the public revealed that warnings can be one of
the most important types of disaster communication,
allowing recipients to avoid a threat altogether or
to significantly lessen its effects.[15] A number of
disaster countermeasures can be taken as a result
of effective forewarning. Probably the most effective
is to leave the threatened area before the disaster
hits. Other adaptive responses include sandbagging
to prevent flooding, boarding up windows to
prevent wind damage,mobilizingteams inanticipation
of search and rescue activities, and stocking up on
food, fuel, water, flashlight batteries, and medical
supplies. In a number of disasters, many lives were
saved, even in the face of tremendous property
losses, because the affected population received
advanced warning.[16-18] Effective procedures for
warning must be based on accurate assumptions
about how the public will react to warning messages.
Unfortunately in the past, officials have put out
warning bulletins with great caution, or withheld
warnings until the last minute, because they felt
that the inevitable panic would be almost as
dangerous as the disaster itself.[19-23] In fact, most
victims gathered their friends calmly and then
evacuated the area, either during a fire in the
Fu-Jen Journal of Medicine Vol.7 No.3 2009

Coconut Grove Nightclub, in Massachusetts, USA
in 1942, the atomic bomb explosion in Hiroshima,
Japan in 1945, a tornado in Waco, Texas, USA in
1964, or a fire in the Beverly Hills Supper Club,
Kentucky, USA in 1977.[19-23] Most of the victim's
behaviors were a normal adaptation which totally
differs from maladaptive behavior presenting as
lack of a flight response from a dangerous event.
When considering emerging infectious diseases
such as severe acute respiratory syndrome (SARS),
the outbreak was associated with substantial use
of hospital and emergency department (ED) resources
aimed at infection control, comparatively less
utilization of resources related to the medical care
of patients with suspected or probable SARS, and
decreased use of routine medical services. However,
most residents in the affected area remained calm
and followed the directions of the government.[24]
Myths and Fallacies about the Main Force
Performing Search and Rescue Operations
in Large-Scale, Sudden-Impact Disasters
Most people believe that the staff of fire
departments, emergency medical services, or military
services are always the major part of search and
rescue operations in a disaster. This is absolutely
a myth. Most search and rescue is performed by
the victims and other survivors in large-scale,
sudden-impact disasters. Research on previous
disasters demonstrated that more than 80% of
survivors were found and rescued by survivors
themselves, e.g., in the Tangshan earthquake, China
[25]
the Campani-Irpinia earthquake, Mexico,26 and
the Loma Prieta earthquake, California, USA.[27] In
fact, victim perceptions that can lead to panic
include an immediate threat of entrapment in a
confined space, escape routes rapidly closing, no
possibility of survival except via flight, and no one
being available to help. Because these conditions
are uncommon in disasters, panic is also rare.[28]
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Myths and Fallacies about Injured
Survivors Reaching EDs
The general public usually erroneously believes
that most injured survivors are brought to hospitals
by emergency medical services (EMSs) in disasters.
However, most of the victims actually bypass EMSs
to get to hospitals themselves if not incapacitated.
In the Tokyo subway sarin attack in 1995, for
example, among 640 victims who came to St. Luke's
International Hospital, 576 (90%) of them bypassed
EMSs and went directly to the hospital by themselves.
This surprising phenomenon created a great risk
to first-line medical staff because none of these
victims had been decontaminated.[29] In the Istanbul
bombing on November 20, 2003, there were 450
injured and 33 dead in Taksim Education and
Research Hospital, but only 184 victims (48%) had
been transported by ambulance.[30] The same story
can be found in almost all other disasters, such as
the Loma Prieta earthquake in 1989,[27] the Oklahoma
City, USA bombing,[31] and New York September
11 attack.
These observations provide some implications.
First, public communication is a key step in
managing disasters, during usual times and the
acute phase of a disaster. Second, subsequent
secondary disasters due to a lack of decontamination
can occur with a chemical emergency because EMSs
are bypassed.
Myths and Fallacies about the Distribution
of Victims
Is it true that victims are usually evenly
distributed to nearby hospitals in sudden-onset
emergencies? The answer is an emphatic "No".
Victims are often unequally distributed in hospitals.
In the 1964 Alaska, USA earthquake, almost all
victims were taken to 1 of 5 available hospitals. In
1976, 85% of 381 injured were taken to 3 of 11
available hospitals in a train crash in Chicago,
153
Tzong-Luen Wang
Illinois, USA. In 1981, 42% of 200 victims were
taken to 4 of 26 available hospitals after the Hyatt
Hotel Skywalk collapsed in Kansas City, Missouri,
USA. In 1982, 86% of 22 victims were taken to
only 1 hospital after an Air Florida crash in
Washington DC, USA. The same situation occurred
in the Oklahoma (USA) bombing in 1995.[31]
The associated factors include the distance of
the hospitals from the epicenter, and the preference
of patients.[30,31] The nearest hospitals are rapidly
crowded with too many patients although most of
the patients might only have minor injuries. In
addition, a great proportion of those with minor
injuries may also choose a hospital according to
their preference.
Myths and Fallacies about the Timing of the
Arrival of the First Victim
It is generally thought that the first victim
arrives at the hospital about 1 h after a sudden-
onset emergency. However, related research reveals
that the first victim can arrive at the hospital within
minutes.[32-39]
There is the dual-wave phenomenon in health
disasters. Casualties generally arrive for care at
emergency department after a disaster in 2 waves.
[40,41]
The first wave of patients usually begins
appearing within 15~30 min of the impact of the
disaster. It is comprised primarily of the walking
wounded or priority 3 casualties due to the fact
that they were able to self-extricate and walk or
drive to an ED. Within a variable time (on average,
30~60 min), a second wave of casualties begins to
arrive. These casualties are typically unable to get
to the ED by themselves because of the need for
extrication or transport and the severity of their
injuries. This second wave mostly consists of priority
1 and 2 casualties. There is a danger of overloading
the ED with priority 3 and 2 casualties from the
first wave before the arrival of the more-critical
154
cases in the second wave. Some experts also suggest
that there is a third wave defined as a secondary
distribution of injured survivors to hospitals for
definitive care within 24 h.[30,42] Some large-scale
events such as SARS might have a fourth wave
phenomenon.[24]
Myths and Fallacies about the
Characteristics of Patients Arriving at EDs
It is also incorrectly believed that most victims
die in EDs during a disaster. The truth is that only
a few victims pass away in EDs. In the Tokyo
subway sarin attack, as an example, 500 of 640
victims arrived at the ED of St. Luke's International
Hospital in 48~108 min.[29] However, only 3 victims
(0.6%) arrived in cardiac arrest, and 1 of them
survived after successful resuscitation.[29]
On the other hand, there is always a biphasic
distribution of mortality in mass-casualty terrorist
bombings.[43] The so-called biphasic distribution
of mortality includes immediate mortality and late
mortality (mortality which occurs beyond 4 h).
The 3 types of mass-casualty terrorist bombings-
structural collapse, confined space, and open air-
produce unique patterns of mortality, immediately
surviving injured, hospitalization, and injury rates
among the injured survivors. Although unique
patterns of injury rates are found in all bombing
types, biphasic distributions of mortality were
identified in all bombing types. The early mortality
(mortality within 4 h) at EDs is almost negligible
for each type. Understanding the epidemiologic
patterns associated with these major types of mass-
casualty terrorist bombings may assist ED and
hospital disaster responses.
The above research demonstrated that most
mortalities occurred immediately. The implication
is that at the scene of search and rescue, the "
expectant" victims should be delayed or deferred
after adequate triage using the START (simple
Fu-Jen Journal of Medicine Vol.7 No.3 2009

triage and rapid treatment) system, for example.
However, it is not known if urban search and
rescue (USAR) team and DMAT members can
adhere to these principles and avoid unnecessary
wasting of limited resources, including personnel
and equipment.
Myths and Fallacies about the Disposition
of Victims Arriving at EDs
Most victims are treated and released from
EDs instead of being hospitalized, receiving critical
care, undergoing an operation, or being transferred
to other hospitals. Among the reported epidemiology
of previous sudden-onset emergencies or disasters,
the majority of the patients visiting the first hospital
after the event were released from the EDs.[26,27,31,32]
Even in mass-casualty terrorist bombings, only
14%~36% of patients required hospitalization, after
being injured from a structure collapse, in a confined
space, or in open air.[43] The situation with
earthquakes is also similar, in which the majority
of victims brought to EDs have minor injuries such
as lacerations, contusions, fractures, sprains, and
dislocations.[44]
Myths and Fallacies about the 72-h golden
period
Most people, at least in Taiwan, believed that
there was a 72-h golden period for the search and
rescue of injured survivors for all types of disasters.
This is definitely wrong. To elucidate this myth,
we can begin with the concept of USAR. USAR
involves the location, rescue (extrication), and
initial medical stabilization of victims trapped in
confined spaces. Structural collapse most often
results in victims being trapped, but victims may
also be trapped in transportation accidents, mines,
and collapsed trenches. Urban search-and-rescue
is considered a "multi-hazard" discipline, as it may
be needed for a variety of emergencies and disasters,
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Disaster Medicine Overview
including earthquakes, hurricanes, typhoons, storms,
tornadoes, floods, dam failures, technological
accidents, terrorist activities, and hazardous material
release. The events may be slow in developing, as
in the case of hurricanes, or sudden, as in the case
of earthquakes.
However, it is interesting to investigate why
there is no rural search and rescue. First, there is
always a dual wave phenomenon of mortality during
disasters as mentioned above. Most people die
immediately when a sudden-onset emergency occurs.
Most survivors extricate and transport themselves
to EDs. Search and rescue teams can save only a
limited number of lives. The lives saved by search
and rescue teams are of people with minor injuries
in the first minutes of an event. Second, only those
with minor injuries who are trapped in a confined
space can maintain stable vital signs and tolerate
dehydration or starving before being extricated. In
a devastating earthquake, as an example, only the
people living in relatively strong buildings will
have the chance to be rescued and saved. That is
why there is only USAR instead rural search and
rescue. It also explains why the so-called 72-h
golden period exists for only a very limited number
of victims, depending upon the type of disaster
and the environment at the epicenter.
Myths and Fallacies about the Function of
DMATs
People say that DMATs usually provide
substantial emergency medical care during disasters.
In fact, national DMATs can only be deployed
within at least 6 h, so DMATs outside the disaster
points usually provide little emergency medical
care in sudden-onset disasters. We should not
overemphasize the role that DMATs can play in
an emergency medical care setting. In the Chi-Chi
earthquake in Taiwan in 1999, 86% of the entrapped
victims were rescued within 3 h.[1] Similar findings
155
Tzong-Luen Wang
were reported for other disasters in which very
few entrapped victims were rescued after more
than 3 days.[43,46] During 1989~1998 in the US,
DMATs were mostly activated for gradual-onset
emergencies such as floods and hurricanes.
DMATs generally arrive too late to provide
substantial emergency medical care. These team
are rarely on-scene within 24 h unless pre-deployed.
In the US, the CA-2 DMAT arrived in Los Angeles
more than 24 h after the Northridge earthquake
in 1995. The MA-1 team arrived in St. Thomas, US
Virgin Islands more than 24 h after Hurricane
Marilyn hit in 1995. Except for events that render
local EDs non-functional such as Hurricane Katrina
in New Orleans in 2005, DMATs usually only
supplement local emergency care.[47]
Myths and Fallacies about the Risks of
Plague and Other Communicable Diseases
Due to Dead Bodies
When Hurricane Katrina hit the Gulf states
of the US in 2005, the Secretary of the Department
of Health and Human Services (DHHS) described
how they were gravely concerned about the potential
for cholera, typhoid, and dehydrating diseases
resulting from the stagnant water and other
conditions. A similar myth was also found in
Taiwan. Most people incorrectly believed that
copious dead bodies pose a significant risk of
infectious diseases such as plague. However, such
thinking is totally illogical and without evidence.
Only pathogens endemic in a community before a
disaster pose a risk after a disaster. In other words,
if there are no pathogens such as Yersinia pestis
and pathogen-carrying fleas, it is impossible to
have a plague outbreak even with an accumulation
of dead victims. Major infectious disease problems
after a disaster include wound infections and
possible outbreaks of communicable diseases that
originally exist in the area.[48] Disasters may actually
156
lessen the risk of certain communicable disease
when infectious disease vectors are eliminated from
the population.[49] During the first month after an
earthquake, volcanic eruption, hydro-metrological
events, and complex humanitarian emergencies,
enteric diseases are the first priority for resolution
due to water supply or sanitation failures.
Overcrowding in shelters can result in respiratory
and enteric diseases. Beyond the first month after
hydro-metrological events, increased vector
populations can pose significant risks of vector-
borne diseases such as Dengue fever.[50-52] Results
of epidemiological studies indicate that the focus
should be on possible infectious diseases instead
of highly unlikely plague outbreaks.
Myths and Fallacies about
Overemphasizing Early Critical Incident
Stress Debriefing (CISD)
Even many disaster experts believe that early
CISD helps prevent post-traumatic stress disorder
(PTSD) after a disaster. Unfortunately, evidence-
based studies or meta-analyses have disproved such
considerations.[53,54] Most such studies demonstrated
that CISD might help normalize events, but it is
not a priority for emergency preparedness. There
is evidence that it decreases the incidence of neither
PTSD nor depression and anxiety.
CONCLUSIONS
Studies of evidence-based disaster medicine
reveal a large gap between perceptions of what
occurs and what actually occurs in disasters. We
must distinguish hazards, events, health damage,
and health disasters, as a disaster occurs somewhere
in the world every day. Ninety percent of disasters
are hydro-metrological. The best measure of the
magnitude of a health disaster should be the number
of survivors requiring health services.
Fu-Jen Journal of Medicine Vol.7 No.3 2009

In addition, most survivors do not panic, and
victims usually rescue themselves or are rescued
by bystanders. Most victims bypass emergency
medical services to reach hospitals if not incapacitated,
as is true for contamination victims.
An unequal distribution of victims is common,
with some hospitals receiving a disproportionate
share of victims. Victims may begin arriving at
hospitals within minutes after a sudden-onset event
and almost all may arrive within the first hour.
Victims with minor injuries tend to reach hospitals
first. Relatively few victims die in EDs and some
may be successfully resuscitated. Most victims are
treated and released from EDs.
External medical assistance such as that
provided by DMATs provides little emergency
medical care, and search and rescue teams find few
survivors. Most of the victims entrapped due to a
sudden-onset emergency event do not have the
golden period of 72 h to be rescued.
Only pathogens already endemic in a community
pose an infectious disease risk after a disaster. Dead
bodies pose negligible risks of a plague infection,
for example, after a disaster. Critical incident stress
debriefing does not prevent post-traumatic stress.
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Tzong-Luen Wang

災難醫學常見的迷思與謬誤：實證醫學觀點

王宗倫 1,2 ,*

對於災難的風險分析，有助於促進災難管理的優先考量、政策制定與預算支持。
由於災難通常係指人類資源的嚴重供需失調，瞭解與未來環境危害程度及耐受能力主
要相關因素，極為重要。然而，實證災難醫學研究顯示，人們對於災難醫學常有認知
上的差距。因此，在災難醫學中，一直存在著許多迷思與謬誤。首先，我們應該區分
有關危害、事件、健康傷害及健康災難的精確定義；亦應瞭解當今世上災難每天發生。
百分之九十的災難是與水災有關。評估健康災難的最好指標，是需要健康照護的存活
者數目，而非死亡總數。災難發生時，大多數的災民並不會驚慌失措，而且大多數的
存活者是因自救或鄰近旁人的救助。大多數的災民只要自己能行動，不會藉助緊急救
護系統，而會逕行至醫院就診；甚至遭受污染的災民亦然。災民在各醫院分佈情形極
不平均，有些醫院過度擁擠，且常為輕症病患所擠滿。災民通常在災後幾分鐘就抵達
醫院。極少數的災民死亡，發生在急診；大多數的災民在急診治療後即可出院。外來
的災難醫療援助，能提供災民的緊急醫療有限。大多數的受難者，並沒有黃金 72 小時
的救援時間。災區原有的流行病才有蔓延可能，但絕不會無中生有；因此受難者屍體
並不會帶來瘟疫。 危急事件壓力會報並不會減輕創傷後壓力症候群的發生。
(輔仁醫學期刊 2009；7 (3)：149-160)

關鍵詞：災難醫學，錯誤觀念，實證醫學

財團法人新光吳火獅紀念醫院急診科主任 1 輔仁大學醫學院醫學系教授 2
投搞日期：2009 年 09 月 10 日；接受日期：2009 年 09 月 30 日
*通訊作者：電子信箱：M002183@ms.skh.org.tw

160 Fu-Jen Journal of Medicine Vol.7 No.3 2009