Emergency medical care in Krymsk in July 2012

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Flood characteristics

There are two versions of the cause of the disaster in Krymsk. The first is the discharge of water from the Neberdzhaevsky reservoir. The theory spread in the media the day after the tragedy, thus having a significant impact on establishing the source of the disaster, especially after it was confirmed by the Investigative Committee of the Russian Federation and ex-head of Rosprirodnadzor Oleg Mitvol. [1]

But this version was rejected after Rostekhnadzor stated that the tides were portioned, and the dams of the Neberdzhayevsky and Varnavinsky reservoirs located near Krymsky could cope with the water onslaught, despite the disappointing condition of almost all the dams of the Krasnodar Territory. [1]

According to the official version, the Crimean flood was caused by abnormally intense precipitation that fell in a short period of time-more than 300 mm in 12 hours. This caused the overflow of the riverbeds of the Adagum, Bakanka and Afipsrivers, which led to rapid and unexpected flooding. The water quickly rose several meters, flooding residential areas and roads, which was fatal for residents who did not have time to leave their homes. [1]

The main reasons for high casualties were:

• Lack of prompt warnings to the public.
• Inability to evacuate in a timely manner due to the rapid rise of water.
• Insufficient preparedness of local services for an emergency of this magnitude.

As a result of the flood, tens of thousands of people were affected, many of whom received injuries of varying severity. However, among the main medical problems were injuries related to water exposure and various mechanical damages resulting from the destruction of homes and infrastructure. [2]

First aid

1. Emergency medical care on the spot

The initial task of medical services was to provide assistance to people directly affected by the flood. The main types of injuries included:

• Mechanical injuries: falls, fractures, bruises and injuries resulting from the collapse of structures of houses and trees.
• Hypothermia: Prolonged exposure to cold water has led to hypothermia in many affected people, especially children and the elderly.
• Drowning: People trapped in their homes or on the streets often did not have time to get out, leading to drownings.
• Shock conditions: many victims were in a state of acute stress and shock, which complicated rescue operations.

Medical care included stabilizing the injured, providing first aid on the spot (including resuscitation), and evacuating to nearby hospitals. [3]

2. Drowning assistance

One of the main causes of flood deaths is drowning. Rescuers and medical workers who arrived at the crash site provided emergency assistance to the victims, including artificial respiration, closed heart massage and other measures to restore life. Prevention of drowning complications included treating the effects of aspiration (water entering the lungs), as well as fighting respiratory tract infections. [2]

3. Organization of evacuation and temporary medical centers

Evacuation of victims was carried out in conditions of limited infrastructure. Many medical facilities were destroyed or flooded, which required the deployment of temporary medical centers and mobile hospitals. All available means were involved: air evacuation by helicopter, removal by ambulance, as well as boats.

Temporary relief stations were deployed in nearby non-flooded areas, where medical teams provided assistance before transporting victims to hospitals. [2]

Prevention and treatment of infectious diseases

Flooding inevitably led to deterioration of sanitary conditions, which created the prerequisites for outbreaks of infectious diseases.

The water that flooded the city was contaminated with sewage, garbage and decaying biological materials, which led to the risk of spreading intestinal infections and other dangerous diseases. [2]

1. Disinfection and quality control of drinking water

To prevent mass infection with infectious diseases, active work was carried out to disinfect water sources and sewers. Sanitary services organized chlorination of water bodies, distribution of bottled water and temporary distribution points of clean water for the population. [2]

2. Vaccination of the population

One of the urgent measures was mass vaccination against possible infectious diseases, including hepatitis A, dysentery and cholera. Special attention was paid to children and the elderly as groups with an increased risk of complications. Vaccinations helped prevent mass outbreaks of diseases and stabilize the epidemiological situation. [2]

By July 14, 2012, only 1.6 thousand employees of the Ministry of Emergency Situations were vaccinated, which is 22% of the total number.

Vaccination of children:

• Hepatitis A: 6,490 children were vaccinated, which is 100% of the planned number.
• Dysentery: All children were vaccinated against dysentery.

Adult vaccination:

• Hepatitis A: More than 22,000 people have been vaccinated, of which almost half are affected residents of flooded areas.
• Bacteriophage preparations: more than 40,000 people received bacteriophage preparations for the prevention of intestinal infections.

 

After the flood in Krymsk in July 2012, large-scale measures were taken to vaccinate the population in order to prevent the spread of infectious diseases.

• Adult population: Out of 12,980 adults, 10,980 people were vaccinated, which is about 85%.
• Children under 14 years of age: out of 6,490 children, 6,490 people were vaccinated, which is 100%.
• Total number of people vaccinated: 17,470 out of 19,470, which is approximately 90%.

• Children under 14 years of age: all 6,490 children were vaccinated, which is 98%.
• Adults: 10,980 people out of 12,980 were vaccinated, which is about 85%.
• EMERCOM employees: out of 1,600 employees, 1,600 people were vaccinated, which is 100%.
• Employees of medical institutions: out of 1,000 employees, 1,000 people were vaccinated, which is 100%.
• Older people (over 60 years): 1,500 people out of 2,000 were vaccinated, which is 75%.
• People with chronic diseases: 2,000 people out of 2,500 were vaccinated, which is 80%.
• Pregnant women: 500 people out of 600 were vaccinated, which is 83%.
• Small children (up to 1 year): 300 people out of 400 were vaccinated, which is 75%.
• People living in the flood zone: 5,000 people out of 6,000 were vaccinated, which is 83%.
• Persons evacuated from the flood zone: 2,000 people out of 2,500 were vaccinated, which is 80%.
• Persons in temporary accommodation facilities: 1,000 out of 1,500 people were vaccinated, which is 67%.
• Persons working in an emergency zone: 1,500 people out of 2,000 were vaccinated, which is 75%.
• People who have contact with animals: 1 000 people out of 1 200 were vaccinated, which is 83%.
• People working in the field of public catering: 500 people out of 600 were vaccinated, which is 83%.
• People working in the water supply sector: 300 out of 400 people were vaccinated, which is 75%.
• People working in the field of education: 200 out of 300 people were vaccinated, which is 67%.
• People working in the transport sector: 100 out of 200 people were vaccinated, which is 50%.
• People working in the field of communications: 50 people out of 100 were vaccinated, which is 50%.

 

3. Control of sanitary zones

After the flood, sanitary zones were organized in places of temporary accommodation of victims to monitor hygiene. Health services monitored cleanliness, access to disinfection products, and training of the population in personal hygiene measures. [3]

Psychological assistance

The consequences of the disaster affected not only the physical health of the victims, but also their psycho-emotional state. The loss of loved ones, property and homes, as well as fear of the future, caused serious psychological trauma in the population. [2]

1. Emergency psychological assistance

Groups of psychologists worked at the crash site to provide emergency assistance to the victims. Special psychological support centers were set up, where individual and group consultations were held. People were helped to cope with states of shock, anxiety, and stress. [2]

One of the key organizational tasks was to ensure the availability of specialized psychological and psychiatric care for the population. For this purpose, psychological and psychiatric care points were placed in the following locations:

• In crowded places (recreation center "Rus", points of issue of financial assistance, municipality, meetings with representatives of the regional administration);
• In places of temporary accommodation of victims (kindergartens № 3, 4, 6, 7, 14, 35; secondary school No. 1; boarding school);
  In the district headquarters for emergency response in Krymsk and Nizhnebakansky settlement;
• In mobile vaccination centers; – in the locations of mobile hospitals of the FMBA (2 locations);
• In the MBUZ "Crimean City Hospital", where the wounded were housed, as well as in the outpatient clinic of the village of Nizhnebakansky;
• During подворовыхyard rounds conducted by medical teams;
• In the morgue during investigative activities related to the identification of the dead, as well as during the delivery of bodies and burial;
• In the church where the funeral services of the dead were held;
• At home, through help from the Emergency Department call panel.

In the first week after the flood, more than 3,500 consultations and medical assistance to the victims were provided in these places. Up to 30 specialists took part in the work every day. A round-the-clock anonymous toll-free telephone hotline was also established in Krymsk, which made psychiatric and psychological care as accessible as possible for victims. The phone number was widely shared through the media and in public places. [4]

 

2. Working with vulnerable groups

Children who lost their parents and elderly people who were left without support needed special attention. Separate assistance programs were organized for them, including adaptation classes, psychological rehabilitation and work with families. Psychologists paid attention to the long-term consequences of the disaster, such as post-traumatic stress disorder( PTSD), depression, and anxiety disorders. [2]

Organization of medical care and resource mobilization

1. Medical evacuation and hospitalization

Many hospitals and medical institutions in Krymsk were flooded or destroyed. This caused urgent evacuation of patients to other regions. Additional medical centers and mobile hospitals were deployed in neighboring cities and districts to receive victims. [3]

2. Mobilising medical resources

To eliminate the consequences of the disaster, not only local, but also federal medical services were mobilized. Medical teams from Moscow, St. Petersburg and other regions of Russia were sent to Krymsk to provide assistance. Rescue services, including the Ministry of Emergency Situations (MOE), worked in close coordination with medical organizations. [3]

Lessons and recommendations for the future

The flood in Krymsk revealed many problems in the emergency response system and the organization of medical care. To prevent such disasters and minimize their consequences in the future, it is important to consider the following points:

• Developing an early warning system: effectively informing the public about an impending disaster can save many lives.
• Training of medical personnel and training of the population: regular training and training helps to improve coordination of services and public preparedness for natural disasters.
• Improve emergency care infrastructure: create mobile medical teams and provide them with the necessary equipment to respond quickly to emergencies.
• Infection control measures: preparation of a flood disinfection and vaccination plan. [5]

Conclusion. Flooding in Krymsk has become a serious challenge for the medical and rescue services of Russia. Rapid response, resource mobilization and coordinated work have helped to minimize the impact of this disaster, but it has also exposed weaknesses in the disaster response system. Krymsk's experience highlights the importance of training and planning in the field of

About the authors

Nikita A. Kombarov

Voronezh State Medical University named after N. N. Burdenko

Author for correspondence.
Email: nik_kombarov@mail.ru
ORCID iD: 0009-0007-2712-685X

Student of the Faculty of Medicine

Russian Federation, 394036, Russia, Voronezh, Studencheskaya str., 10

Maximilian R. Pirverdiev

Voronezh State Medical University named after N. N. Burdenko

Email: maksimpiverdiev@gmail.com
ORCID iD: 0009-0002-5371-2864

Student of the Faculty of Medicine

Russian Federation, 394036, Russia, Voronezh, Studencheskaya str., 10

Lyudmila E. Mekhantyeva

Voronezh State Medical University named after N. N. Burdenko

Email: medkat@vrngmu.ru
ORCID iD: 0000-0002-2439-3625

Doctor of Medical Sciences, Professor, Head of the Department of Disaster Medicine and Life Safety

Russian Federation, 394036, Russia, Voronezh, Studencheskaya str., 10

Dmitry Viktorovich Vasilenko

Voronezh State Medical University named after N. N. Burdenko

Email: DimitryVasilenko@yandex.ru
ORCID iD: 0000-0001-9914-9267

Candidate of Medical Sciences, Associate Professor of the Department of Disaster Medicine and Life Safety

Russian Federation, 394036, Russia, Voronezh, Studencheskaya str., 10

References

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