Lessons for International Programmes from the Christchurch, New Zealand Earthquakes

by Dr. Laura Sessions

In February 2011, I was in Christchurch’s central business district on a lunch break when a 6.3-magnitude earthquake struck. An immense roar culminated in 10 seconds of violent shaking. Buildings swayed, sidewalks buckled, facades crumbled, and people screamed. When it stopped, we were surrounded by clouds of dust, piles of rubble and crowds of confused and scared people.

At the time, I ran a study abroad service provider, and luckily we did not have any students in the area, but most of our staff were in a fifth story office in the hardest hit area of the city. Somehow we all managed to escape uninjured and evacuate the central city, but we saw some harrowing scenes. Water and silt filled the gutters and streets until eventually we had to roll up our jeans and wade barefoot through the deeper pools, trying not to think about what was in the murky water. We passed cars swallowed up by sinkholes, and brick buildings that lost their entire front facades, ending up like dollhouses with every room visible from the street. People gathered in their yards to listen to radios, as a thick cloud of dust and smoke spread outwards from the CBD.

This earthquake was New Zealand’s third deadliest natural disaster, killing 185 people and causing widespread destruction. At least 6,600 people were treated for minor injuries and Christchurch Hospital alone treated 220 major trauma cases connected to the quake. A cordon prevented public access to the CBD for over two years. If this earthquake had happened in a low or middle-income country with less efficient emergency response and infrastructure, the toll would likely have been much worse.

New Zealand lies on an active fault zone and earthquakes are experienced regularly, but still none of us were prepared for the scale of this natural disaster. Here are some of the lessons we learned that may help you to prepare your students and staff in seismically active regions.

Preparing for earthquakes

1)     Create a plan for where to meet. I was on a lunch break when the Christchurch earthquake struck, and most of my staff were in the office. Luckily, we were able to find each other in the chaotic aftermath, but it would have been much easier if we had made a plan for where to meet, along with a back-up location if our first choice wasn’t possible. Consider what structures might become unstable and where is likely to be a safe, open space to shelter. If you have students spread throughout a wider area, it will be even more challenging yet more important to know where everyone should gather. Consider creating maps that indicate all student and staff residences and each student’s primary and secondary rally points. Your office(s) should be indicated on the map as well as the location of fire stations, hospitals, etc.

2)     Think about communication. Directly after the Christchurch earthquake, phone lines were down and cellphone networks were overloaded. Calling anyone was virtually impossible, but texts still managed to sneak through. Ensure that students understand that they should text the appropriate person in your organization immediately following an earthquake to check in and establish contact. You may also want to consider having key staff carry a satellite phone or satellite texting device.

3)     Prepare emergency supplies. We were without power for several days, water for over a week, and without an operating toilet for several weeks. It could have been much longer (and was in some parts of the city). Especially in low and middle-income countries, road damage often means that large-scale rescue efforts cannot easily reach communities that need emergency assistance. If local resources are overwhelmed, it may be a few days before significant help arrives. Supplies should include drinking water (at least three gallons per person), non-perishable food (three days per person), toilet paper, soap, flashlights/batteries, first aid supplies, blankets or sleeping bags, and a radio. You might also consider a generator and fuel. Be sure to schedule annual checks of your supplies to replace water and expired food.

4)     Assign roles and responsibilities and use staff who don’t live in the area if possible. Everyone in our office was affected personally by the earthquake. Some lost their homes, others had injured or traumatized family members to look after, and everyone was dealing with the emotional strain of what had happened and the ongoing aftershocks. None of us was in a great position to be able to help students with so much going on in our own lives. Consider whether you could bring in staff from elsewhere to help in an emergency (although local staff will almost definitely need to handle the immediate aftermath). Think carefully about who will be responsible for students, who will communicate with families and the media, and who can administer first aid – while also managing their own families and personal circumstances.

During an earthquake

1)     Stay inside until the shaking stops and it is safe to go outside. Several people were killed by falling concrete as they ran from buildings onto the street where I was standing. Drop, cover and hold on whenever you feel shaking.

2)     Beware of fire and fumes. I still remember the mixture of gas and crushed concrete that wafted over the city that day. Fire is the most common hazard after an earthquake. Never use a lighter or matches near damaged areas and leave the area if you smell gas or fumes from other chemicals. If you can do so safely, shut off gas and electrical lines.

3)     Don’t go back into unstable buildings. I’m ashamed to say that I learned this one from experience. My laptop and phone were both in the office, and when I realized I didn’t know anyone’s phone numbers by heart, I panicked and went back in to find them. I managed to get back out unharmed, but I was just lucky. With all of the broken glass, falling debris, potential for fires, and constant aftershocks, it could have ended very differently. Keep your phone with you, memorize at least one relative’s phone number and keep a backup in the cloud.

After an earthquake

1)     Expect aftershocks. In Christchurch, there were more than 361 aftershocks in the week following the quake, some as big as magnitude 5.9. There were literally tens of thousands more in the hours, days, months and even years to follow. You need to be sure staff and students will not only remain safe during aftershocks, but also that their mental health is not affected. This may be a factor in your decision of whether to keep the program in situ or arrange for it to be moved or cancelled.

2)     Ensure all important files are backed up and easy to access outside the office. It was over three months before we could get back into our office building. Even then, two people were given access for one hour and could take only what would fit into two garbage cans. Luckily, we had our complete file server backed up remotely, and we were able to get back up and running within a week or so. Think about what you would do if your office was destroyed or inaccessible for any length of time, and make a contingency plan. In particular, consider what files you would need immediately, such as emergency contact details. How would staff work with no premises and possibly no computers or equipment? What equipment would you need to replace? How would you handle communications?

3)     Be prepared for lots of international attention. The media love a good earthquake, and I had people ringing me from overseas before I had even spoken with my husband in Christchurch. Be prepared for a quick response to families especially, who will be concerned about their loved ones. Be sure you have an easy way to disseminate updates and be sure that all stakeholders know where to look for them beforehand. For example, you could have an emergency page created on your website that can be activated if needed or communicate via Twitter or Facebook.

NOTE: As a result of her experience following the Christchurch earthquakes, Laura authored the book Quake Dogs.

First Aid Kits for International Trips

Should I be carrying a first aid kit?

What should be in a first aid kit?

What about antibiotics and prescription pain medications?

Epinephrine?

Bhutan First Aid Kit.jpg
 

International trip leaders frequently ask us about what they should be carrying in their first aid kits. The answer is invariably, “It depends.”

The first step in putting together a first aid kit for international travel is to ask the Safety Matrix® questions: the Who/What/Where/When/How/How long of your program.

  • Who – What age group and how many? Pre-existing conditions of group members?
  • What – Are you taking classes in a Western European city or engaged in wilderness adventure type activities, water based activities or field research type activities? Will the group divide up sometimes making it sensible to have more than one kit?
  • Where – Climate considerations? Local medical resources? Remoteness? Altitude? Sun? Dry/Wet?
  • When – Rainy season when there may be more rashes, slippery roads and more mosquitoes? Tourist season which may entail more crime or at least more alcohol? Will it be warm or cold or both?
  • How – What is your budget? Are you staying in high-end hotels that have first aid supplies or in home stays? How much do you want to spend on first aid kits? Will the kit be exposed to weather or to being crushed, etc.? Do you need to carry it on your back? Can a large kit be carried in vehicle or boat and smaller kits be carried?
  • How Long – Can supplies be easily replaced or is what you bring what you have for the duration?

The answers to these questions dictate what you should have for a first aid kit.

For war correspondents, safety in conflict zones may mean being able to travel light and fast even as they schlep heavy camera equipment while wearing body armor. They are often at high risk for sustaining life-threatening trauma. It makes sense for them to carry minimal first aid supplies designed to help a victim of trauma survive in the short term. To that end they may carry military grade tourniquets, tape, trauma dressings, a chest seal and tension pneumothorax decompression needle (an advanced scope of practice technique that wouldn’t be appropriate for lay persons outside of a combat zone). They are also often more at risk for travelers’ diarrhea, infectious disease and dog bites, but can access necessary supplies away from the conflict zone.

Some off-shore sailing programs operate in very remote areas. They may be more than 5 days away from the nearest port and well out of reach of helicopter rescue. They are legally permitted to carry advanced equipment and medications.  That doesn’t necessarily mean that they should. Inexperienced and untrained persons should not be trying to put in intravenous lines or insert endotracheal tubes. Off-shore sailing vessels usually have excellent communications and can be in frequent contact with medical professionals so including prescription medications makes sense.  Weight is not a consideration per se, so carrying bottled oxygen makes good sense as well.

For educational travel, if your program is operating in a high income country capital city with excellent medical facilities, where emergency medicine is a distinct discipline and where an ambulance is likely to show up within 10 minutes of calling the equivalent of 911, it might make sense just to advise students to carry whatever over the counter medications that they might need and not bother with a group first aid kit. If you are in a low-income country and conducting research in a remote area, it might make sense to carry an extensive first aid kit.

RULES OF THUMB

  • Ready-made commercial first aid kits are not usually a good value. They appear as if they are well stocked, but the bulk of the kit is packaging for individual doses of over the counter (OTC) medications. They usually include items you don’t want and lack important items that you do want.
  • A good organizer is worth the expense. There are very good soft pouch style and belt-pack style organizers available from outfits like Conterra®
  • If you are operating in a marine environment, you’ll need a waterproof hard box style organizer, e.g., a Pelican Case. If you are on a limited budget, small stuff sacks or Tupperware containers will suffice.
  • Don’t bring anything that you don’t know how to use.
  • Don’t bring multiple items that do precisely the same thing. You might choose to bring more than one NSAID (non-steroidal anti-inflammatory drug) like aspirin and ibuprofen because, while they both are comparable for managing pain and fever, aspirin has higher anti-clotting properties for someone who might be having a heart attack and ibuprofen has superior anti-inflammatory properties for sports injuries, etc. On the other hand you don’t need to bring 3 separate products for fungal vaginitis, athlete’s foot or jock itch. One antifungal should suffice.
  • Utilize items that have multiple uses. A 60cc syringe (no needle) is excellent for cleaning wounds and for suctioning airways. In a pinch, it works great for administering an enema.
  • Don’t store non-medical items (sun block, bug dope, tampons, etc.) in the first aid kit.
  • Do not store personal prescription medications in first aid kit.
  • Don’t bring goofy stuff, i.e., snake bite kits or tick pliers.

BASIC FIRST AID KIT

The list below is put together with the idea of keeping it simple. You could easily double the number of items here by adding fancy tools, high tech bandages (Gore-Tex impregnated with antibiotics, etc.) and a broader range of over-the-counter medications. However, for most issues, the kit below should suffice. Quantities of bandages, OTC medications, etc. would be determined by length of program, nature of activities and destination country.

Tools

  • Multiple pairs of latex or vinyl gloves (blood borne pathogen protection)
  • Bandage scissors
  • CPR mask or NuMask
  • 30cc or 60cc syringe (wound irrigation)
  • Tweezers
  • Thermometer
  • SOAP notes (standardized format for recording and organizing medical information) and pencil
  • Safety pins

Bandages/Dressings

  • Major trauma dressings
  • 4 x 4 dressings
  • Roller gauze (3“)
  • Athletic tape (better than medical tape)
  • Band-aids
  • Elastic bandage (“Ace wrap”)
  • Triangular bandages (cravats)

Topical Medications

  • Povidone-Iodine or Betadine for wound care
  • Bacitracin/Triple Antibiotic Ointment
  • Hydrocortisone Cream – Anti itch cream
  • Antifungal cream

Over the Counter Medications

  • NSAIDS, (ibuprofen)
    • Aspirin – Do not give aspirin to children (Reyes Syndrome)
  • Acetaminophen (Tylenol)
  • Imodium
  • Pepto-Bismol
  • Antacid tablets
  • Diphenhydramine (Benadryl)

Other

  • Epinephrine – EpiPens or ampules/vials with syringes for use in the event of life threatening system allergic reactions (anaphylaxis). Requires training and a prescription in the U.S.

NOTE: A number of programs do not do this because their participants with a history of anaphylaxis bring their own epinephrine. Understand that while food allergy history is predictive to a significant degree, 50% of people who die of anaphylactic reactions to bee stings and other hymenoptera exposures, have no history of significant allergic reactions.

Optional Recommended Additions

  • Trauma shears
  • Stethoscope – For listening to lung sounds if spending significant time in water based activities or at high altitude
  • Kelly Forceps – May be useful for stopping bleeding or wound exploration and cleaning
  • Small Magnifying Glass – To assist in wound cleaning and for distinguishing small ticks
  • MoleFoam or 2nd skin - For blisters if hiking
  • Burn dressings
  • Small flashlight

ADVANCED FIRST AID KITS
If you are traveling in low/middle income countries and/or in remote locales, it might make sense to consider carrying a few prescription medications. These should be managed either by protocols written out by the prescribing physician or preferably by digital communication oversight (tele-medicine). Do not put program leaders into a position of practicing medicine. There is a reason why physicians undergo extensive schooling.

Antibiotics might include 1 – 3 broad-spectrum antibiotics, each intended to address a particular type of issue. One for butt/belly problems, one for wound infection and one for ears eyes nose and throat, etc. Your advisory physician might decide to include prednisone to stabilize an immune system if a student had an anaphylactic or asthma problem during the program.

Prescription pain medications are not generally recommended for most first aid kits. Carrying them can engender legal complications and there is potential for abuse.

Bill Frederick is the Founder and Director of Lodestone Safety International

What Do You Mean That Trail Was Safe? Cross-Cultural Risk Management in Developing Countries

What Do You Mean That Trail Was Safe? Cross-Cultural Risk Management in Developing Countries

Risk management in any context can be challenging, and crossing cultures can add some unexpected twists on risk management. This essay seeks to talk about some of the unexpected challenges and ways to deal with risk management in a cross cultural and developing country setting.

In a same-culture setting risk management is challenging enough. Clients have different backgrounds and don’t always fully disclose physical or mental health issues, the environment may have unexpected hazards, and rules and regulations can vary widely within a country or state.

Read More

Should Study Abroad Programs Carry Epinephrine?

Mari Dark of Naropa University recently posted a question to the SECUSS-L listserv asking if members included epinephrine in their medical supply kits for faculty led trips. She received 13 responses: 9 argued against it and 4 were for it.

She reported that the majority of respondents’ programs did not provide epinephrine. Presumably that also means that their programs do not authorize carrying epinephrine. This distinction is important as illustrated by the University of New Hampshire faculty leader whose trip to Nicaragua was cancelled in 2013 and whose appointment was not renewed by the University after it came to light via her submission of an invoice that she carrying unauthorized epinephrine on program.

Read More

Safety vs. Liability in International Risk Management

In most aspects of international risk management, safety and liability fly in formation. When you are working to improve safety, you are reducing your liability exposure and vice versa. However, there are some areas where safety and liability come into conflict.

Safety is generally spoken of as a good with the implication that more is better. And, while safety specifically refers to freedom from accidental harm, it is most generally used to refer to freedom from all harm (folding in both illness and intentional harm).

Read More

Vetting in International Programming: Pre-Program Evaluation of Staff, Vendors, High-Impact Activities and Providers

According to Wikipedia, vetting is a term that comes from horse racing. It referred to a requirement that horses be checked out for health and soundness by a veterinarian prior to being allowed to race.

As the hegemony of the OSHA certified world is carried into the furthest corners of the globe, an American vision of responsibility is sweeping away all notions of accident, bad luck and karma before it. Anything bad that happens is someone’s fault. Who is at fault and to what degree is most likely to be determined back in the U.S in a civil court as per a participant agreement.

A positive aspect of this is that liability from a cross-cultural point of view is a much less squishy concept than is safety.  When talking about safety with a Kenyan, a Bhutanese or a Costa Rican, it is difficult to be sure that you are all understanding the same things in the same way. However, everyone gets the concept that if anyone gets hurt, this program dries up and blows away or that the following year’s budget will be substantially reduced.

Read More

Travel Health, Safety and Security: Professionalizing Study Abroad

Travel Health, Safety and Security: Professionalizing Study Abroad

Traditionally, the majority of study abroad programs were conducted in High Income Countries (HIC – a World Bank designation) where students visited and viewed various cultural and artistic sites while perhaps trying to develop language skills. A faculty member would invite their students to participate and the trip would be conducted with minimal school oversight or involvement.

While some fraction of international education has always been somewhat more adventurous, there is an increasing trend to travel to “non-traditional” destinations in primarily Low and Middle Income countries (LMIC). Generally, lower income destinations mean greater hazards and fewer mitigating resources owing to lesser-developed infrastructure, torte law, regulations, enforcement and the fact that a high proportion of lower income countries also have greater natural disaster exposures, less political stability and higher incidents of crime.

Read More

Preventing Students from Becoming Prey

Many of the health, safety and security incidents that befall study abroad students involve their being victimized by predatory persons.

Most study abroad students are exposed to some cautionary information from their school or program in the form of handbooks, assumption of risk forms, orientations, and/or in-country briefings. However, as reported by Hartjes et al, 2009, 85% of students on study abroad programs report getting most of their risk management information from youth oriented guide books such as the Lonely Planet Guides and Rough Guides and only 9% cite their campus study abroad program materials as a resource for pre-departure information. Additionally, the study shows that students  tend to be under-informed about hazards abroad, under-concerned about them and overconfident in their abilities to manage them.

Read More

Psychotropic Medications: How to Manage in Remote Programming

Back in 1980 I became a somewhat disillusioned psychology major at the University of Colorado when upon taking a cooking job in the local psychiatric hospital, I discovered that mental healthcare was all about psychotropic medications.

Ten years later at Outward Bound, instructors were having anxiety attacks when reviewing their students’ medical forms and seeing the prevalence of psychotropic medication use.

Since then I have worked in and with a variety of programs which operate in remote or international locales, all of which have wrestled with how to manage potential issues for students/participants who were taking a variety of psychotropic medications.

Read More