The need for evidence-based public health response in disasters

Broad outline of this paper was presented at the Evidence Aid Symposium, on 20 Sep 2014, at Hyderabad, India, before the 22nd Cochrane Colloquium.

Survey of the field and review of literature.

Response to disasters is usually vulnerable to myths and misconceptions. Effective healthcare response requires evidence and information to meet various and often unpredictable eventualities. The knowledge base should facilitate rapid assessment of adverse health outcomes, availability healthcare infrastructure, appropriate organizational strategies, and selection of feasible medical interventions to deal with any given disaster. Most rapid surveys have to adopt some stratification and a cluster sampling design for representativeness. Qualitative research methods are useful to study organizational challenges. Adequate and accurate description of the context is important for interpretation of organization behavior studies. Testing efficacy of medical interventions by randomized trials is usually difficult, unless feasible study designs are planned in advance and ready for execution at short notice. A lot of disaster healthcare research literature is based on surveys and case studies, as these are more feasible. Hence, systematic reviews ought to rate the level of evidence from qualitative studies and adequately summarize the context of case studies.

Research on health response to disaster has picked up momentum only recently in the 21(st) century. There is also a need to develop disaster healthcare research capacities to address regional vulnerabilities. Generating evidence is not enough. Concerted societal action is needed to sensitize, train, and equip adequate human resources to fill in various key emergency medical and public health roles when disaster strikes.