地震指南概要
前 言
中国是一个地震多发，饱受地震灾害之苦特别多的国家之一。1976年的唐山大地震和2008年汶川大地震，都是新中国成立以来，破坏性极强、波及范围极大、救灾难度极大、影响极其深远的地震灾害。地震灾害不仅造成人员伤亡和财产损失，而且也给疾病预防与控制工作带来了巨大的挑战。为进一步明确地震灾害的公共卫生影响，有针对、有计划、有目标地开展地震灾害疾病预防控制工作，确保大灾之后无大疫，中国疾病预防控制中心在世界卫生组织的支持和帮助下，联合华西医科大学、安徽医科大学，以及有关省市疾病预防控制中心，在总结唐山大地震和汶川大地震疾病预防与控制工作实践，以及其他国家的地震灾害疾病预防与控制工作经验后，提出了本工作指南。本指南根据地震灾害公共卫生特征，按照灾前准备、灾后应急和恢复重建等核心业务工作分别进行了描述，以期指导各级疾控机构进一步理清思路、积极主动、科学规范地开展地震灾害的疾病预防与控制工作。
第一章 总论
一、地震灾害及危害
（一）地震灾害特征
地震灾害具有突发性、灾难性、次生灾害多发性、影响巨大性和重建艰巨性等五大特征。
（二）地震灾害的主要危害
1、直接危害。包括：建筑物倒塌，人员伤亡，水、电、气、道路等基础设施破坏，能源供应受损，交通通讯中断，社会服务设施受损，生态环境破坏等；
2、间接危害。包括：政治、经济、社会和人群健康影响；
3、次生灾害。包括：火灾、化学品爆炸、化学品和放射性物质泄漏、洪涝灾害、海啸、交通事故、社会骚乱等。
二、地震灾害不同时期引起的主要公共卫生问题
（一）应急期，主要是地震灾害在短时期造成的直接后果
1、对人群健康的直接影响
（1）大量的人员伤亡。主要是指建筑物倒塌，山体滑坡等造成身体的机械性损伤和死亡。
（2）传染病的发生。主要是由不清洁的饮用水和食物，大规模人群迁移和聚集，卫生设施不完善，媒介生物迁移和人群暴露等引起。
（3）意外伤害。主要是由中暑，犬伤，烧灼伤，冻伤， CO中毒，食物中毒，化学品中毒，放射性物质污染等偶发事件引起。
（3）慢性非传染病病。主要是由于生活和生存环境的改变，导致心脑血管疾病，高血压，糖尿病等疾病发作。
（4）精神及心理创伤。主要是地震灾害的突发性、灾难性引起的早期心理应急反应，以及生活和生存环境的改变引起的短期心理沟通障碍等。
2、对公共卫生服务系统的破坏
（1）公共卫生服务能力受到冲击。一方面是公共卫生服务机构受损。包括建筑物毁坏，设备仪器损坏，实验室遭到破坏，数据和技术资料丢失。另一方面是卫生服务人员受损。包括个人和家庭成员失踪，家庭财产受损、长期劳累造成的人员减员等。
（2）卫生服务需求增加。由于大量的伤病人员需要紧急救治，大量的心理疾患者需要疏导，因此，短时间内需要大量的医务人员和医用物资，如医疗器械、血液等。
（二）恢复重建期，主要是地震灾害的间接后果和长期影响
1、对人群健康的间接影响
（1）破坏了公共卫生服务体系。包括免疫规划，妇幼卫生，精神卫生，药物和疫苗供给等正常工作秩序受到破坏；
（2）增加了潜在的伤残寿命。机械性损伤导致的伤残；气性坏疽引起的截肢；建筑物倒塌产生的粉尘吸入而引起尘肺；精神性创伤等。
（3）打乱了正常生活，身体抵抗力下降，精神和情绪紊乱，极易诱发多种疾患；
（4）生态环境破坏，有可能导致某些传染病升高。
2、对公共卫生服务系统的间接影响
（1）破坏了公共基础设施。饮水，电力、燃料，通讯和排水系统破坏，导致公共卫生服务能力和工作秩序受到影响；
（2）道路交通和通讯中断，导致医疗卫生服务的及时性受到影响；
（3）媒体、国际国内社会等的过分关注和期望，造成公共卫生服务的工作压力、工作强度和工作难度增加。
三、地震灾后疾控工作周期
分为灾前准备、灾后响应和恢复重建三个阶段。其中灾前准备包括组织准备、公共卫生风险评估、避灾和减灾、应急计划、政策和能力建设等。应急响应应急救援和疾病控制。恢复重建包括公共卫生服务能力恢复、传染病和慢性非传染病疾病预防与控制等。
四、疾控工作面临的挑战
（一）准备不充分
主要是应对体制和机制不完善，物资与技术储备不足够，风险与危害认识不到位，导致灾后短期内工作混乱，不系统全面。
（二）组织机构不健全
主要是指预案启动不经常性，机构的临时性，导致应急指挥不统一，信息不通畅，反应不灵敏，不能有效动员内部和外部资源。
（三）短时期人员和物资缺乏
主要是指公共卫生服务需求与公共卫生服务能力之间存在的短时间差距，导致在人员、应急装备、运输工作和专业设备不足。
（四）工作条件简陋
主要是灾后公共设施破坏，疾控工作现场缺电、少水，食物、药品不足，生活条件十分艰苦。
（五）工作压力巨大
主要是指灾害造成的公共卫生影响大，灾后面临的形势复杂，任务繁重，政府和群众的需求与要求都比较高。特别是“大灾之后无大疫”的艰巨任务，容不得疾控部门有丝毫的懈怠和马虎。
五、地震灾害疾控工作关键要素
（一）做好日常应急准备工作
包括完成组织准备、公共卫生风险评估、避灾和减灾、应急计划、政策和能力等建设。
（二）建立卫生部门统一协调机制
包括指挥决策，组织协调，监测预警，信息收集和报告，社会动员，应急保障（含物资分发机制）等机制。
（三）当地的疾控力量是战胜灾害的关键
主要是指当地的疾控队伍，比其他力量更熟悉当地的人文和地理环境，能更好的组织开展疾病预防控制工作。
（四）外援疾控力量要以灾区需求为导向
外部援助可以帮助受灾地区迅速从灾难的打击中恢复过来。但如果这种援助并不是当地真正需要的，或救援物资和人员过剩，极易给灾区带来新的负担，并影响当地疾病预防与控制工作的顺利进行。
（五）建立适宜的保障措施
首先是通信保障。采用各种有线、无线以及卫星通讯以及人员传递等方式，保证指挥系统、疾控机构、医院、消防队、机场、车站、港口、各救援力量等重要部门和组织之间的通讯联络畅通，以确保指挥和协调各疾病预防与控制力量的行动，及时了解灾区受灾的消息以及他们的需求。其次是物资装备保障。包括个人生活携行装备、个人防护装备、办公通讯装备和现场快检装备等，确保现场工作顺利开展。再其次是后勤保障。包括车辆的调配，生活安排，各类救灾物品的接收和分发管理等。
第二章 灾前准备
地震灾前准备是为了降低地震灾害对疾病预防与控制工作秩序的冲击和破坏，提高疾控部门应对灾害的能力，预防和减缓各种与地震相关的突发公共卫生事件发生。
疾病预防与控制工作的地震灾前准备主要包括了组织准备、公共卫生风险评估、预防和减轻公共卫生影响、人力资源准备、应急物资准备、现场处置工具准备等六个关键因素。
一、组织准备
（一）建立组织框架
包括指挥部门、协调部门和执行部门的逻辑框架。重点构建日常应急处置中心（EOC），提供相关人员进行规划、组织、获取和分配资源的场所，完成评估灾情和需求、决策应对方式、调动各种资源、启动行动指令、跟踪资源利用和上报工作进展等六项工作任务，来提供政策指导和支持、确定工作重点和协调机构之间行动。
（二）制定政策，即运行机制和制度
1、机制。包括指挥决策机制，组织协调机制，监测预警机制，信息收集和报告机制，社会动员机制，应急保障机制（含物资分发机制）。
2、制度。包括岗位职责，监督评价，奖惩等制度。
（三）制定计划和预案
1、编制应急预案准备。包括全面分析本系统、本单位危险因素，可能发生的突发事件类型及事件的危害程度；排查突发事件隐患的种类、数量和分布情况，并在隐患治理的基础上，预测可能发生的突发事件类型及其危害程度；确定突发事件危险源，进行风险评估；针对突发事件危险源和存在的问题，确定相应的防范措施；客观评价本单位应急能力；充分借鉴国内外同行业突发事件教训及应急工作经验。
2、预案的主要内容。主要包括组织指挥体系，各部门的职责和分工，信息收集、分析和报告，灾后的疾病预防与控制措施和行动（包括饮水卫生、食品卫生、环境管理与消毒、传染病监测与控制、媒介生物控制、伤害预防、健康教育等），沟通协调方式，后勤支持，安全与保障等相关内容。
3、预案的基本结构。包括背景、目的、职责分工、操作思路、协作配合和附录等六部分。其中背景可简单介绍当地地震灾害及其影响、预案的必要性等；操作思路可简要说明总体政策、结构和预案目标；协作配合可对报告程序、通讯渠道和建立有效、适宜的协作机制做出安排。附录主要显示协作程序的框架图，以及不同部门支持履行职责分别制定的配套预案等。
二、地震灾害的公共卫生风险评估
收集当地灾害信息，进行危害识别，社区人群、供水系统、环境卫生等脆弱性分析，应对能力分析以及社区风险分析。在此基础上，完成风险管理地图。标识出本地区危害、脆弱性提示图和风险、信息资源、物资资源、人力资源分布图。
三、预防和减轻灾害对公共卫生影响
（一）倡导社区环境改善
依靠社区健康教育活动，组织和动员社区群众清洁生活环境，改变不良的生活习惯，提高防病意识。
（二）参与制定环境安全规则
包括建立供水设施，厕所等公共卫生设施，垃圾和污水处理设施等环境卫生地方标准。
（三）评价和督导社区环境卫生基础设施的改善
在法律框架范围内，积极主动参与当地建设规划和防震减灾设施的卫生学评价工作中，指导进行合理设置和建设。
（四）加强公共卫生服务设施的安全
确实保障卫生部门自身基础设施设备在地震灾害中免于或减轻破坏。
四、人力资源准备
（一）建立相关专业专家库
建立由公共卫生、医院、交通、通讯等部门以及各大专院校相关专业组成的专家团队，完善专家信息，加强专家从业素质、专业能力、工作态度、敬业精神、廉洁自律等方面培训和考核。
（二）成立由专业人员组成的应急队伍
建立由传染病、食品和化学中毒、核和辐射安全等专业的流行病学专业人员和实验室专业人员，以及后勤保障人员组成的专业团队，并配备专业的现场工作装备，进行经常性的培训和演练。
（三）公共卫生专业人员灾害卫生应急培训
培训分为专业知识培训和现场技能培训两部分；其中专业培训包括各种相关法律、法规，灾害现场信息收集、评估和报告，突发公共卫生事件的应急调查和处置等，现场技能包括各种急救医学知识，急危重病人的急救技能，群体伤病员处理流程，传染病和常见中毒的急救知识，自然灾害、意外事故状态下自救互救技能，心理素质培训以及怎样联络报警，怎样接近伤员等。培训要求制订培训计划和编写培训教材，制定考核标准和奖惩措施，对参与培训人员进行考核，确保培训实效。
（四）组织灾难卫生应急模拟演习
演练主要是为了检验预案、完善准备、锻炼队伍、磨合机制和宣传教育。演练的形式有研讨式型演练、桌面推演、操作演示、特定功能演练和全面系统演练五种。
五、卫生应急物资资源的准备
包括建筑设施和场所，通讯设施和设备、应急能源设备和物资，交通工具和设备，个人防护用品，队伍标识，健康教育材料，试验室快检设备。准备原则要因地制宜，确保安全、经济和适用。
六、现场处置工具准备
（一）快速评估工具开发
包括灾情、灾后需求、灾后公共卫生风险等评估工作。根据评估现场条件，采用不同的评估工具。
（二）地震灾害疾控工作手册
经常进行地震灾害疾控工作技术资料的跟踪和整理汇编，内容包括各种政策、指南、预案、技术方案和规范等。
（三）现场个人防护和安全手册
包括前期准备、现场工作备忘、现场生活注意事项、常见疾病防治和防护、常见病媒生物的活动规律、各地基本情况及重点传染病提示、工作通讯录等内容。
第三章 灾后应急阶段疾病预防控制
一、灾后快速反应行动
包括快速核实和评估灾情，并迅速报告有关部门；启动预案措施，初步确定应急目标；紧急动员专业人员和社会力量参与行动；紧急调配物资调用，实现既定目标；建立公共卫生信息交流平台；收集和反馈群众需求信息；确保监测系统和应急实验室正常运转，核实功能是否健全；编写人事计划、更新联络相关信息和花名册，以供后来者使用，告知后来者目前的工作任务和以待解决的问题；做好国家和政府领导到达现场援助的准备工作；评估已经获得和还未满足的卫生资源需求；做好救援力量的后勤保障和心理援助等十一项内容。
二、现场的协调和组织
重点是疾控队伍内部资源及相关外部资源。包括本地，外援，督导队伍和自愿者等人员管理，物资管理，信息管理，后勤保障管理。
三、灾区公共卫生现状与需求的快速评估
（一）快速评估的原则
根据响应确定优先内容，边响应边评估，建立在可得到的信息。力求快速简洁，不苛求完整全面详尽，
（二）评估的内容
灾情和医疗能力，风险源，服务对象状况，卫生服务能力。
（三）评估的方式和渠道
建立信息收集的机制，临时收集信息的平台。利用评估工具，包括评估表。
（四）评估结果分析和表达，及表达渠道。
四、灾后疾病监测
利用幸存的监测能力和开展应急监测；必要时开展特殊人群的症状监测。
五、传染病风险控制与流行病预防
（一）饮用水卫生
指导和帮助寻找、监测、宣传、督导和评估可用的水源；采取简易、快熟、可用的观察和检测手段及评估指标，初步分析饮用水风险，应急饮用水标准，提出可饮用水指导意见；指导采取必要可行的卫生措施，进行饮用水的处理；开展清洁卫生饮用水的宣传教育。
（二）食品安全
识别食物风险，提出可食用的食物类型；及时诊断和处理各种食物中毒事件；尽可能调查食物中毒原因，防止食物中毒的扩大和再发；食物运输、仓储和加工管理；开展预防食物中毒的宣传教育。
（三）环境卫生与消毒
参与与指导人畜粪便、垃圾、尸体的处理，保护水源；采用当地易于接受的方式，指导灾民正确的卫生习惯。
（四）病媒生物控制
采用个人感觉或者利用技术手段等监测老鼠、蚊子、苍蝇等媒介生物活动；指导社会力量正确开展环境消杀灭，控制媒介生物孳生；开展健康教育，指导群众做好个人防护。
（五）丧葬服务与死亡处理
消除尸体在传染病传播中的作用的谣言和误解；根据现场实际情况，协助有关部门快速制定尸体处理的流程和注意事项；快速评估尸体处理所需资源；指导尸体处理过程中体现的人文关怀和尊重；对尸体处理者提供心理援助。
六、传染病预防与控制
（一）疫情处置
评估紧急情况下特定传染病流行阈值；监视异常信息，并迅速核实；暴发证实，如有可能实验室确认；传染源和传播方式的现场调查；现场控制过程中防止暴露、预防感染、预防疾病和防止死亡；
（二）应急疫苗接种
制定详细的应急接种计划；确定疫苗群体接种策略；接种的危险性评估和后勤需求评估；接种人员培训；接种地点的选择；注射安全；疫苗的冷链；疫苗的紧急供应。
七、意外伤害事故的风险源管理
确定化学物质、放射性物质和致癌、致畸物质，如房屋中的石棉等危险源；指导做好泄漏的巡查和暴露的防范；协助做好泄漏的控制和受威胁人员转移；指导暴露人员的救治和心理咨询。
八、健康宣传与风险沟通
进行灾区的健康教育社会学、流行病学和行为学诊断；以饮水卫生、食品卫生、个人卫生、蚊蝇等媒介防护、疾病常识、就医指南等为宣传重点，利用宣传专栏、宣传画、传单等平面媒体、广播和电视等现代传播手段、以及讲座和口头传帮等传统方式进行宣传。确定媒体和公众沟通核心信息，主动开辟媒体宣传专栏，建立群众健康热线。
灾后风险沟通的目标是预防和防范风险、控制公众愤怒和危机沟通。沟通的原则是平等、真诚、坦率和透明。沟通策略有四点：一是告诉人们会发生什么，不要追求零恐惧；二是承认不确定性；三是愿意负责任作出推测；四是让公众参与。
九、心理关怀与危机疏导
明确干预对象；遵循干预原则；制定详细的工作方案；开展心理健康状况评估；根据不同的心理健康状况采取不同的心理危机现场干预措施；干预结束后要及时随访和评估。
处理情感时注意不要追求零恐惧，不要嘲笑公众的情绪，认同人们的恐惧，表现您自己的仁慈。
十、集中安置场所卫生管理
参与和指导安置场所的卫生设施设置和建设；指导做好安置场所的人畜粪便、生产生活污水和固体垃圾的评估、储存、收集和运输，以及媒介控制和环境消杀灭；设立临时医疗卫生防疫点，开展常见病救治、传染病登记、报告工作，开展饮水、食品、环境卫生监测与指导、卫生防病知识宣传等工作，必要时开展症状监测的登记报告工作。
十一、专业人员安全及防护
为参与应急处置工作人员进行培训并携带安全手册；事先告知可能的安全风险和必要的注意事项；装备个人防护服、防护眼镜、口罩、手套、消毒液等必要的个人防护用品；如有可能，进行疫苗注射和预防性服药。
第四章 恢复和重建疾病预防与控制工作
一、恢复重建时期的准确含义和工作重点
恢复重建时期是指服务体系和能力没有完全恢复的时期。重点是恢复疾病预防控制工作秩序；逐步提高疾病预防与控制工作能力；减轻和减缓地震灾害可能带来的公共卫生风险。
二、公共卫生需求和恢复状况评估与评价
持续对灾区医疗卫生机构能力现状与需求，安置点医疗卫生服务、饮用水与环境卫生、食品卫生和营养、媒介生物监测和控制、健康教育等方面的现状与需求，以及特殊人群（残疾人、儿童、老年人、孕产妇和哺乳期妇女等）卫生服务需求进行评估，并实时调整恢复重建策略；开展恢复重建项目效果评价，提高项目效率。
三、传染病预防与控制
（一）传染病监测与报告
根据灾区实际情况，科学规划、设计灾区传染病监测网络，确保疫情监测报告系统覆盖灾区所有临时和固定的医疗卫生单位以及城乡社区。通过监测报告网络的恢复重建，传染病疫情报告的指导、培训和督导，疫情分析会商机制的建立，实验室重点传染病诊断能力的加强，不断提高传染病监测和预警能力，及时发现和识别聚集性病例或暴发苗头。
（二）传染病暴发调查与控制
努力提升传染病暴发疫情识别的技术手段和发现能力；完善传染病暴发调查和控制程序和规范；吸收和增加专业人员，并及时进行流行病学等知识培训；提高实验室重点传染病诊断技术装备水平和检测能力；提高综合运用控制传染源、切断传播途径、疫苗接种和公众教育等手段的技术储备和能力；不断开展传染病风险评估和危险源控制，减少和减缓传染病暴发的发生频次。
（三）媒介昆虫与啮齿动物监测与控制
制定常规的媒介生物监测控制计划和方案；选择适合本地、简便易行的方法进行蚊、蝇、鼠的密度监测，根据监测结果，适时调整消杀灭策略；参与建筑物的规划和卫生学评价，考虑厕所、垃圾的合理配置和管理，减少孳生地和蚊蝇的孳生；倡导爱国卫生运动，积极提供技术支持；指导公众做好媒介生物的个人防护。
（四）医院感染控制
医院感染控制工作进入常态管理，恢复医院感染控制组织运转，开展常规医院感染监控工作；加强医院内传染病预防控制，严格消毒、隔离和防护制度，按相关规定处理医疗废物和医院污水；选择综合性医疗机构建立传染病病区，统一收治传染病病人；综合性医疗机构建立、恢复消毒供应室，并可对其它医疗机构提供服务；强化医务人员的消毒、隔离和防护知识的培训，并开展对传染病患者及陪护人员的健康教育工作。
四、公共卫生与环境卫生
（一）饮用水卫生
指导和参与永久性供水水源选择、设施建设的卫生学评价；持续开展重点供水设施常规监测评估；推动居民安全饮水知识的普及。
（二）环境卫生
开展环境卫生状况评估；指导做好水源保护，生活垃圾粪便的处理，环境清理、消毒、杀虫和灭鼠工作；开展公众宣传教育，动员和指导社会力量参与环境卫生保护。
（三）食品卫生
开展灾后餐饮业、熟食加工业、安置点以及外援工作队集体食堂等重点对象的食品监测和安全风险评估；参与处置食物中毒事件处置；指导群众正确的就餐和饮食习惯。
五、基本公共卫生服务（项目）恢复
（一）公共卫生实验室
逐步重建和恢复公共卫生实验室，开展重要传染病、饮用水和食品卫生检测检验项目，为灾后疾病预防控制工作提供实验室支持。
（二）结核病防治
恢复灾区结核病防治工作，确保灾前在治肺结核患者能够完成后续的治疗管理；及时发现新发的肺结核患者并予以及时报告、规范治疗与管理。
（三）儿童免疫服务
定期进行免疫规划工作综合评估；恢复免疫规划资料管理；恢复和重新设定预防接种场所，配备接种人员，恢复冷链运转，促进儿童免疫接种服务尽快恢复运转；开展疫苗可预防疾病的监测，根据疫情预防控制需要，及时组织开展群体性接种或强化免疫。
（四）艾滋病防治
优先保障已经接受抗病毒治疗的艾滋病病人、美沙酮门诊病人的治疗工作；适时开展对现有艾滋病病毒感染者/艾滋病病人的随访、干预工作；恢复和重建艾滋病检测实验室的建设和网络直报。
（五）妇幼卫生
对妇幼卫生资源和服务对象需求进行快速评估；尽快完成妇幼卫生基本服务网络体系的重建，优先恢复亟需的基本妇幼保健服务；充实人员，开展知识、技能培训；制作妇幼保健健康教育材料，开展妇幼卫生大众健康教育；恢复和重建妇幼卫生信息网络。
（五）营养改善与健康
开展儿童、孕产妇等重点人群的营养状况监测和评价，提出合适的保障、干预措施。
六、其他健康管理秩序的恢复
（一）慢性非传染性疾病预防与管理
整理和登记社区高血压、糖尿病等慢性病患者资料；指导患者合理用药，帮助养成健康的生活方式；为重点对象提供血压测量、血糖测量等服务；开展合理膳食、心理健康、戒烟限酒等知识的宣传教育，营造有利于健康生活方式的支持环境。
（二）心理卫生关怀
在安置场所和学校，以讲课、座谈、宣传资料、娱乐等形式开展人群心理健康教育；对教师、安置点医务人员和管理人员等进行培训，提高他们对心理障碍的识别能力，将需要进一步干预者及时转介给精神科医师或经过认证的心理治疗师。
（三）伤害预防与控制
开展公众宣传和教育，提高交通意外、中暑、犬伤、冻伤、一氧化碳中毒、防火用电等意外伤害的防范意识；倡导犬只管理、消杀灭药物管理、高温作业管理、老人和儿童照料、水域安全护栏和建筑物危险区域警示设置等安全措施。
七、健康促进和社区参与
建立并完善县、乡、村及灾区群众集中安置点开展健康教育工作的机制；评估确定优先解决的健康问题；确定目标人群；确定传播核心信息。
八、重建项目的卫生学评价
参与重大公共设施和建设项目的卫生学评价。
九、开展地震灾害健康影响及灾后卫生应急评估研究
长期监测与追踪灾后公共卫生风险；科学分析地震灾害对灾区群众健康造成的直接和间接影响，识别相关危险因子；全面的评估和总结灾后卫生应急救援工作的经验与教训；开展深入的专项评估和专题研究。
Forward
China is a one of the earthquake-prone countries that suffer a lot from earthquakes. Tangshan Earthquake in 1976 and Wenchuan Earthquake in 2008 were both disasters of great destructiveness and vast affected area, resulting in a great deal of difficulties in disaster relief and leaving very deep and far impact. The earthquakes not only caused casualties and property losses, but also brought big challenges to disease prevention and control after disasters happened. In order to further guide the work of disease control institutions at all levels, and to carry out plans pertinent to the disease prevention after earthquakes to ensure no outbreak of epidemics, with the help and support from the World Health Organization, the Chinese Center for Disease Control and Prevention has cooperated with West China University of Medical Sciences, Anhui Medical University and some provincial centers for disease control and prevention to develop this technical guide based on summarization of experience obtained from disease prevention and control in Tangshan Earthquake and Wenchuan Earthquake and lessons learned from other countries’ disease prevention and control work. According to the characteristics of public hygiene in earthquakes, this guide describes separately such core work at different stages as pre-disaster preparation, post-disaster emergency measures and restoration and reconstruction, so that disease control institutions at all levels can carry out their earthquake-related disease prevention and control work in a clear, active, scientific, orderly and efficient manner.
Chapter I Overview
I. Seismic Disaster and Its Hazards
(i) Seismic disaster and its characteristics
It contains the definition of seismic disaster and the five characteristics of seismic disaster, that is, emergent, cataclysmic, secondary-disaster prone, tremendously-impacted, and arduous restoration.
(ii) Main hazards of seismic disaster
1. Direct hazards. Include: collapse of buildings, casualties, destruction of infrastructure like water, electricity, gas, road, etc., damages to energy supply, break of communication, impairment of social service facilities and destruction of ecological environment
2. Indirect hazards. Include: impacts on politics, economy, society and people.
3. Secondary disaster. Include: fires, explosion of chemicals, leak of chemicals and radioactive substance, floods, tsunami, traffic accidents, social disturbances, and so on.
II. Public Health Problems Occurred at Different Stages of Seismic Disaster
(i)The emergency stage: most are direct outcomes caused by the seismic disasters in a short time
1. Direct impacts on public health
(1) Large numbers of casualties. It mainly means mechanical injuries to bodies and deaths caused by collapse of buildings, landslide, etc;
(2) Outbreak of infectious disease. It is mainly caused by unclean water and food, massive human migration and gathering, imperfect sanitary facilities and changes in distribution of biological vector and human exposure;
(3) Accident injury. It is mainly caused by contingencies such as fires, heat stroke, CO intoxication, food poisoning, chemical poisoning, radioactive substance contamination, etc;
(4) Chronic non-communicable diseases. These are mainly attacks of cardia-cerebrovascular disease, hypertension, and diabetes and so on resulted from changes in living environment.
(5) Mental and psychic trauma. These are mainly contingent reaction in psychology caused by the emergent disaster and short-term psychological communication difficulty when living and surviving environment changed.
2 Damages to public medical facilities
(1)The capability of public medical facilities is under impact. On one hand, the hardware of public medical services has been impaired, including destruction of buildings, impairment of apparatus, damages of laboratories, and loss of data and technological documents; on the other hand, the medical services personnel have been affected, including individual and family members injuries and death, loss of family properties and depletion of personnel because of long-term overwork.
(2)Increase of need for medical services. A lot of wounded and sick people needing urgent medical care and a lot of mind-hurt people need consolation and communication, therefore, a great amount of medical personnel and materials like medical instrument and blood will be required in a short time.
(II) The stage of restoration and reconstruction: mainly indirect outcomes and long-term impacts caused by seismic disasters
1. Indirect impacts on public health
(1) Destruction of the public medical care system: including damages to normal public health services such as immunization, maternal and children health, mental health, and medicine and vaccine supply;
(2)The public normal life order has been changed, bodies’ resistance to diseases is lowered down, and people incurred mental and emotional disorder. All of these are prone to result in diseases;
(3)Destruction of the biological environment can lead to higher occurrence possibility of some infectious diseases.
2. Indirect impacts on public medical care system
(1) Infrastructure such as water, electricity, fuel, communication and drainage are destroyed, resulting in adverse effect on public medical care capability and work order;
(2) Traffics and communication are blocked, which have impact on timely supply of medical care services;
(3) Over attention and expectation from media and domestic and international communities increase pressure, intensiveness and difficulty of public medical care services.
III. Work Cycle of Disease Control in Seismic Disaster
The work cycle of disease control in seismic disaster is divided into three stages, that is, pre-disaster preparation, post-disaster response and restoration and reconstruction. Pre-disaster contains organization and preparation, risk assessment on public health, disaster avoidance and reduction, emergency plans, policy and capability establishment, etc. Post-disaster response contains emergency rescue and disease control. Restoration and reconstruction contains restoration of the capability of public medical care services and prevention and control of infectious diseases and chronic non-communicable diseases, etc.
IV. Challenges Confronted by Disease Control
(i) Insufficient preparation
This mainly means that imperfect dealing system and mechanism, insufficient reserve of materials and technology, unclear recognition of disaster-related public health risks and hazards. These can lead to disordered work in the short time after disaster.
(ii) Imperfect organization and institution
This mainly pertains to lack of unified and efficient emergency command and management, impeded information channel, and slow response. Internal and external resources cannot be mobilized and allocated effectively.
(iii) Lack of personnel and materials in the early post-disaster period
This mainly indicates that in the short time after disaster, there exists a gap between demand and supply of public medical care services. Personnel, emergency equipment, transportation and professional facilities are also comparatively lacked.
(iv)Work conditions are poor
This indicates that public facilities are destroyed so much in disasters that living condition is very hard at disease control work site due to lack of electricity, water, food, medicine and so on.
(v) High pressure on work
This implies that disasters have made huge impacts on public health and complicated situations are confronted after disasters with massive tasks and social pressure. Especially, the arduous task of ensuring no outbreak of epidemics after big disasters can bear little carelessness.
V. Key Factors of Disease Control in Seismic Disaster
(i) Preparation for emergency measures in daily work shall be completed well.This includes organization and preparation, assessment on the risks of public hygiene, disaster avoidance and reduction, contingent plan, policy and capability, etc.
(ii)Establishment of unifying and coordinating mechanism and disaster emergency management system within health authorities shall be completed, including mechanism such as commanding and decision-making, organization and coordination, monitoring and warning, information collection and report, social mobilization and emergency guarantee (material distribution included), etc.
(iii) The key to winning the battle against disasters is the local strength in disease control, which means the local workforce of disease control are more familiar with local culture, customs, and geology, so that they can do a better job.
(iv)The aid to disease control workforce outside disaster area should be oriented at the needs of disaster area.The external aids can help disaster-affected areas return to normal quickly from disaster. However, if the aids do not match the local needs, or excessive aiding materials and staff are allocated, the disaster-affected area is prone to be put on new burdens, thus the work of disease prevention and control will be influenced.
(v) Appropriate guarantee measures shall be taken. The first is communication guarantee.Efforts shall be made to ensure successful communication among the main departments and organizations, such as commanding system, disease control institutions, hospitals, fire brigade, airport, stations, ports, all aid forces, by applying wired, wireless, satellite and labor communication, so that all forces of disease prevention and control can be commanded and coordinated with timely information from the disaster-affected area and understanding of their needs. The second is materials and equipment guarantee, including individual portable living equipment, individual safeguard equipment, office and communication equipment and on-site fast detection equipment. They can help smooth work on site. The third is logistic guarantee, including allocation of vehicles, life arrangement and receiving and distribution management of all kinds of disaster relief materials.
Chapter II Pre-disaster Preparation
The fundamental purpose of pre-disaster preparation is to raise the capability to deal with disasters and carry out the work of post-disaster disease prevention and control.
Pre-disaster preparation for disease prevention and control primarily includes six key factors, that is, organization and preparation, risks assessment on public health, prevention and reduction of impacts on pubic health, preparation of human resources, emergency materials and on-the-spot treatment equipment.
I. Organization and Preparation
(i)Establishment of organization structure
The organization structure is logical structure that includes command department, coordination department and execution department. Great importance should be paid to EOC and provide sites for related personnel to develop planning, to conduct organizing, to obtain and distribute materials as well as to complete the six tasks including assessing on the condition of disasters and the needs, deciding handling measures, mobilizing all kinds of resources, starting action instructions, following the usage of resources and reporting the work development to superiors, aimed at providing policy guide and support and ensuring the key works and coordinating actions among institutions.
(ii)Formulation of policies – running mechanism and system
(1) Mechanism. It includes commanding and decision-making mechanism, organizing and coordinating mechanism, monitoring and warning mechanism, information collecting and reporting mechanism, social mobilizing mechanism, contingent guarantee mechanism (material distribution mechanism).
(2) System. It includes position responsibilities, supervision and assessment, encouragement and punishment, etc.
(iii) Formulation of plan
(1) Formulation of emergency plan and preparation. This includes overall analyses on risk factors of the system and the unit, types of possible emergency events and their hazardous degree; identification and elimination of hidden dangers’ type, number and distribution, forecasting of the types of possible emergencies and their hazardous degree; determination of risk sources for emergency events and risk assessment; determination of corresponding preventing measures based on the identified risk sources and existing problems; subjective evaluation on the unit’s emergency response capability; full reference to domestic and overseas emergencies’ lessons in the same industry and their experience.
(2) The contents of the plan. The contents of the plan are mainly organization and commanding system, responsibilities and division of work, information collection, analysis and report, measures and actions disease prevention and control after disasters (including drinking water health, food safety, environmental management and disinfection, infectious disease surveillance and control, control of vector organisms, injury prevention, health education, etc.), ways of communication and coordination, logistical support, safety and security, etc.
(3) Basic structure of the plan. The basic structure includes six parts: background, purpose, division of responsibilities, operation ways, coordination and cooperation and appendix. In the background part, the seismic disaster and its impacts, the necessity of the plan, etc are introduced; the overall policy, structure and purpose of the plan are explained in the operation ways parts; the coordination and cooperation part can make arrangement for the reporting procedure, communication channel and establishment of effective and appropriate coordinating mechanism. The appendix shows the flow chart of the procedure and separate completing plans made by different departments when supporting and practicing responsibilities.
II. Risk Assessment on Public Health in Seismic Disaster
Efforts shall be made to collect disaster information, identify the hazards and make analysis on vulnerability of community and population, water supply system and environmental hygiene, as well as on response capabilities and community risks. And risk management map shall be developed based on the analyses, at the same time, marking of the hazards and vulnerability on the maps and marking of risk distribution, information, materials and human resources shall be completed.
III. Prevention and Mitigation of Disaster Impacts on Public Health
(i)Advocating improvement of community environment
Upon community health education, organize and mobilize the community masses to clean living environment, change unhealthy habits and raise awareness of disease prevention.
(ii)Participating in setting environmental security rules
The rules include setting up local standards for environmental health of some public facilities like water supply, toilet, disposal of refuse and sewage.
(iii)Evaluating and supervising the improvement of community environmental health infrastructure
Within the frame of laws, participate actively in hygienic evaluation of local construction planning and facilities for seismic disaster prevention and mitigation. Guide the local setting up and construction to be conducted in a reasonable way.
(iv)Improving the security of the public hygiene facilities
Efforts shall be made to ensure no or less damages to the health departments’ facilities.
IV. Reserve on Human Resources
(i) Establishment of expert reservoir of related majors
Expert team composed of some departments like public health, hospitals, transportation, communication and related majors in universities shall be established. Experts’ information shall be complete and training and assessment on experts’ professional quality, capability, work attitude, devotion and honesty and self-discipline shall be strengthened.
(ii)Establishment of an emergency team composed of professionals
A professional team composed of epidemic professionals majored in infectious disease and food and chemical poisoning and nuclear radiation, laboratory professionals and logistics professionals shall be built. The professional team should be furnished with on-site work equipment and on-going training and rehearsal.
(iii)Emergency training on disaster health for public health professionals shall be provided
The training contains professional knowledge and on-site skills. The professional knowledge training includes related laws and regulations, information collection, assessment and report at the site of disaster and contingent investigation and treatment of emergently-prompted public hygienic event. The on-site skill training includes all first-aid medical knowledge, first-aid skill for saving fatal and critical patients, treating procedure for the group of the wounded and the sick, first-aid knowledge of infectious disease and common poisoning, self and mutual aid when natural disasters and accidents happen, mental quality training, how to contact and call police, how to get close to the wounded, etc. To ensure effectiveness of the training, there should be training plans and teaching books, trainees will be evaluated according to the stipulated evaluation standards and encouraging and punishing measures.
(iv)Emergency rehearsal on health in disaster shall be organized and carried out
The purpose of the rehearsal is to test the plans, perfect preparation, exercise the team, gear the mechanism and communicate and educate the public. The forms of rehearsal can be the following five: seminars, desktop deduction, demonstration and presentation, specific function rehearsal and overall rehearsal.
V. Reserve of Emergency Materials and Resources
The reserve includes buildings and locales, communication facilities and equipments, emergency energy equipment and materials, means of transportation, individual protection apparatus, team symbols, health education materials and lab quick-testing equipment. The principle for reserve should be in line with local conditions, ensuring safety, cost-effectiveness and application.
VI. Preparation for On-site Disposal Tools
(i) Development of quick assessing tools
This includes assessments on disaster, needs after disaster and risks of public hygiene after disaster. Different tools are applied in alignment with different conditions.
(ii)Work handbook for disease control in seismic disaster
Keep following and compiling technical documents of disease control in seismic disaster.
(iii)Handbook for on-site personal protection and safety.
Chapter III Disease Prevention & Control at Post-disaster Emergency Stage
I. Post-disaster Rapid Response Action
Disaster conditions shall be rapidly verified and evaluated, as well as immediately reported to relevant authorities; measures given in the plan shall be initiated to primarily define the emergency objectives; professional personnel and private entities shall be urgently mobilized for participating in the action; material allocation shall be arranged in an urgent manner for helping the fulfillment of determined objectives; a public health information communication platform shall be established for collecting public demands and giving relevant feedback; efforts shall be made to ensure the normal operation of the monitoring system and emergency laboratories and to verify their sound functions; works such as preparation of personal plan, upgrading of relevant contact data and roster shall be completed timely to facilitate subsequent utilization and inform of current tasks and problems to be solved; preparation for the state-and government- leadership’ on-the-spot relief assistant shall be done well; evaluation on health resource demands that have been satisfied and are required to be met shall be carried out; and energetic effort on logistics and psychological aids shall be made for rescue forces.
II. On-site Coordination and Organization
Emphasis shall be placed on internal resources and relevant external resources for disease control & prevention, including management on personnel such as local human resource, external assistance, supervisors and volunteers, material management, information management and logistics management.
III. Rapid Assessment on Current Situation and Demands on Public Health in Disaster Areas
(i) Principle of rapid assessment
According to the response, priority of contents to be assessed shall be determined, thus the assessment will be conducted based on available data as the response is giving. The principle is to ensure rapidness and conciseness rather than completeness and comprehensiveness.
(ii)Contents to be assessed
The contents to be assessed shall include disaster situation, medical treatment capacity, risk sources, conditions of service objects and health service capacity.
(iii)Methods and approaches for assessment
The information collection system and a temporary information collection platform shall be established; while the tools for assessment include assessment forms.
(iv)Analysis and expression on assessment results and result expression channels
IV. Post-disaster Disease Surveillance
Emergency disease surveillance shall be implemented by making use of those surviving surveillance resources and based on demands; and if necessary, syndromic surveillance for special groups shall be carried out.
V. Infectious Disease Risk Control and Epidemic Disease Prevention
(i)Drinking water health
Guidance and assistance shall be provided for searching, monitoring, publicizing, supervising and assessing the usable water supply. Simple, rapid and available means for observation and inspection as well as assessment parameters shall be adopted to preliminarily analyze risks of drinking water, determine criteria of emergency drinking water and give instruction opinions on potable water. In addition, guidance shall be given for taking necessary and feasible health measures to treat drinking water; and propaganda and education for clean and health drinking water shall be carried out.
(ii)Food safety
Food risks shall be identified and eatable food types shall be determined; various food poisoning events shall be diagnosed and disposed in a timely manner; effort shall be made as much as possible to investigate the cause of food-poisoning for the purpose of preventing expansion and reoccurrence of food poisoning; management on food transportation, storage and processing shall be strengthen and propaganda and education for food-poisoning prevention shall be carried out.
(iii)Environment health and disinfection
Endeavors shall be made to participate and instruct the disposal of human and animal excreta, garbage and cadaver as well as the protection of water sources; methods that local natives are ready to accept shall be adopted for the purpose of guiding the people in the disaster areas to form a proper health habit.
(iv)Vector organism control
methods such as making use of personal sense organs or technical measures shall be applied to monitor the activities of various vector organisms such as mice, mosquitoes and flies; guidance shall be given for private entities’ correct disinfection activities so as to control the breeding of vector organisms; health education shall be carried out for the purpose of instructing the public’ personal protection.
(v)Funeral service and handling of death cases
Rumors and misunderstanding of cadaver’s effect on transmission of infectious diseases shall be eliminated; according to the actual situation on the spot, assistance shall be provided to the relevant authorities for rapidly stipulating the process flow and precautions of cadaver disposal; resources required for cadaver disposal shall be estimated quickly; guidance shall be given for demonstrating humanistic care and respect during cadaver disposal; psychological assistance shall be offered for personnel engaging in cadaver disposal.
VI. Prevention and Control of Infectious Diseases
(i)Outbreak treatment
Thresholds for outbreaks of specific infectious diseases shall be assessed in case of emergency; abnormal signals shall be monitored and confirmed quickly; outbreaks of infectious diseases shall be verified and confirmed via laboratory if necessary; field investigation shall be conducted for identifying infectious sources and modes of transmission; during on-the-spot control, exposure and infection shall be prevented, and measures shall be taken for disease prevention and death prevention.
(ii)Emergency vaccination
A detailed emergency vaccination plan shall be prepared; and strategy of community vaccination shall be determined; assessment on vaccination risks and logistic demands shall be conducted; training shall be offered for personnel to be engaged in vaccination work; emphasis shall be placed on selection of vaccination spots, injection safety, vaccine cold chain and emergency vaccine supply.
VII. Risk Source Management for Accidents
Risk sources such medical substances, radioactive substances, cancerogenous substance and teratogen (for example: asbestos in buildings) shall be identified; instruction on leakage inspection and exposure prevention shall be given; assistance shall be provided for leakage control and evacuation of affected persons; instruction on rescue and treatment as well as psychological consultation for persons exposed to risk sources shall be given.
VIII. Health Propaganda and Risk Communication
Diagnosis in terms of health education sociology, epidemiology and behavioral science shall be carried out; propaganda shall be carried on via various modern communication means such as plane media (including propaganda column, picture poster and leaflet), radio and TV together with conventional forms such as giving lectures and oral communication, with propaganda emphasis placed on drinking water health, food safety, personal hygiene, prevention and protection from insect vector, disease knowledge and treatment guideline. Moreover, core information for media and public communication shall be determined, media propaganda columns shall be established positively and public health hotline shall be set.
IX. Mental State Concern and Mental Crisis Rectification
Intervention objects shall be defined; intervention principles shall be followed; detailed work schemes shall be developed; mental health assessment shall be conducted; different field intervention measures for mental crisis shall be taken based on different mental health status; follow-up visits and assessment shall be carried out after intervention.
X. Hygienic Management at Concentrated Settlement Places
Efforts shall be made to participate in and guide the establishment and construction of hygienic facilities at concentrated settlement places; instructions on assessment, collection and transportation of human and animal excreta, domestic and industrial waste water and solid waste at the settlement places shall be given, and vector control and environment disinfection shall be implemented; temporary health and anti-epidemic stations shall be established for implementing common diseases, registration and report of infectious diseases, surveillance and guidance on drinking water, food and environment hygiene, and propaganda of health and disease prevention, even registration and report of syndromic surveillance if necessary.
XI. Safety and Protection for Professional Personnel
Training shall be provided for working personnel who will participate in emergency treatment with carry-on safety manuals; safety risks that might be encountered and necessary precautions shall be informed in advance; required personal protective equipment including personal protective clothing, protective goggles, respirator, gloves and disinfectant shall be provided; if necessary, vaccine injection and preventive medication can be implemented.
Chapter IV Restoration and Reconstruction of Disease Prevention and Control
I. Definition and Work Focus of Restoration and Reconstruction Stage
The restoration and reconstruction stage means the stage when service system and capacity have not recovered yet. The work focus during this stage is to restore the working order of disease prevention and control, gradually enhance working capacity of disease prevention and control, and alleviate and lighten the public health risks that might be brought by earthquake disasters.
II. Assessment and Evaluation on Public Health Demands and Restoration Situation
Medical capacity and demands of health organizations in the disaster areas, current situation and demands at settlement spots in other aspects such as medical and health services, drinking water and environment hygiene, food safety and nutrition, surveillance and control of vector organism and health education, and health service demands of special groups (including the disabled, children, the old aged, pregnant women and breast feeding women) shall be assessed continuously; and strategies for restoration and reconstruction shall also be adjusted from time to time. In addition, evaluation on restoration project effect shall be carried out for enhancing project efficiency.
III. Prevention and Control of Infectious Disease
(i) Surveillance and report of infectious disease
According to the actual situation in the disaster areas, a network of infectious disease surveillance shall be planed and designed in a scientific way, for the purpose of ensuring epidemic surveillance and report system covering all temporary and permanent medical units and communities. Through the restoration and reconstruction of the surveillance and report network, the capacity of infectious disease surveillance and early-warning can be enhanced continuously and case clusters or outbreak symptoms can be found and identified base on establishment of a system for instruction, training and supervision of infectious disease epidemic reports and for analysis and discussion of epidemic situation.
(ii)Investigation and control of infectious disease outbreak
Endeavor shall be made to elevate technical means for identification of infectious disease outbreak and identification capacity; procedures and norms for investigation and control of infectious disease outbreak shall be improved; recruitment of professional personnel shall be carried out and timely training on epidemiology shall be provided in a timely manner; technical equipment for diagnosis and examination capacity of key infectious disease in laboratories shall be enhanced; technical reserve and capacity for integrated utilization of various means such as controlling infection sources, cutting routes of transmission, vaccination and public education shall be intensified; risk assessment on infectious disease and risk source control shall be carried out continuously for decreasing the frequency of infectious disease outbreak.
(iii)Monitoring and control of insect vector and rodent
Routine plans and schemes for surveillance and control of vector organisms shall be developed; simple methods available in local areas for density surveillance on mosquitoes, flies and mice shall be selected and according to surveillance results, disinfection strategies can be adjusted from time to time; efforts shall be made to participate in planning and hygienic evaluation of buildings, allowance shall be made for proper configuration and management of toilets and garbage, so as to reduce the breeding places and breeding of mosquitoes and flies; the patriotic heath activity shall be advocated and carried out and technical support shall be provided; instruction on personal protection from vector organisms shall be given to the public.
(iv)Nosocomial infection control
The nosocomial infection control shall be included in normal management and operation of organizations for nosocomial infection control shall be restored so as to carry out the routine nosocomial infection control; prevention and control of infectious disease in hospitals shall be strengthened, meanwhile the system of disinfection, separation and protection shall be strictly followed and medical waste and nosocomial sewage shall be treated according to relevant regulation; the comprehensive medical organizations shall be selected to establish infectious disease zones for giving medical treatment to infected patients in a concentrated way; the disinfectant rooms which could offer services to other medical organizations shall be provided or reconstructed in those comprehensive medical organizations; training on disinfection, separation and protection of medical staff shall be strengthened and health education for infected patients and caretakers shall be offered.
IV. Public Health and Environmental Health
(i)Drinking water health
Efforts shall be made to instruct and participate in selection of permanent water sources and hygienic evaluation on facility construction; routine monitoring and assessment on key water supply facilities shall be carried out in a sustainable way; and popularization of knowledge about safe drinking water shall be promoted.
(ii)Environmental health
Assessment on environmental health situation shall be conducted; instructions on water source protection, disposal of domestic garbage and excreta, environmental cleaning, disinfection, insect elimination and deratization shall be given for doing this work well; propaganda shall be carried out in the public for mobilizing and guiding the private entities to participate in protection of environmental health.
(iii)Food safety
Post-disaster food inspection and safety risk assessment for key objects such as catering industry, cooked food processing industry, settlement spots and canteens of external aid teams shall be carried out; participation in disposal of food-poisoning events shall be realized; and instructions on proper dining habits shall be given to the public.
V. Restoration of Basic Medical Care & Health Services (Project)
(i)Public health laboratory
Public health laboratories shall be reconstructed and restored gradually, for the purposes of conducting inspection of serious infectious diseases and inspection of drinking water and food and providing laboratory supports for post-disaster disease prevention and control.
(ii)TB prevention and control
TB prevention and control shall be recovered in disaster areas, for the purpose of ensuring the subsequent treatment and management of TB patients who were under treatment before disaster; newly infected TB patients shall be identified and reported in time so as to standardize medical treatment and management.
(iii)Immunization service of children
Comprehensive assessment on immunization planning shall be conducted regularly; management on immunization planning materials shall be restored; efforts shall be made to restore and reconstruct immunoprophylaxis and vaccination stations equipped with vaccination personnel, restore cold chain operation and promote quick restoration of children’s immunization services; surveillance on vaccine-preventable diseases shall be implemented and mass vaccination or strengthened immunization shall be organized and carried out in time.
(iv)Prevention and control of AIDS
Medical treatment of AIDS patients who have accepted antivirus treatment and methadone out-patients shall be given a priority; follow-up survey and intervention on existing persons infected with HIV and AIDS patients shall be carried out from time to time; construction and network direct report shall be restored.
(v)Maternal and child health
A rapid assessment on material and child health resources and service object demands shall be conducted; reconstruction of a network system of basic maternal and child health service shall be completed as soon as possible and especially the restoration of basic maternal and child health care services shall be given a priority; personnel recruitment and training on medical knowledge and skills shall be carried out; materials for education on maternal and child health care shall be prepared for the purpose of carrying out public health education on maternal and child health; the information network of maternal and child health shall be recovered or reestablished.
(ⅵ). Nutrition Improvement and Health
Surveillance and assessment on nutrition status of key groups such as children, pregnant women shall be carried out so as to put forward appropriate measures for guarantee and intervention.
VI. Restoration of Other Health Management Orders
(i)Prevention and management of chronic non-communicable disease
data of patients of chronic diseases such as hypertension and diabetes shall be sorted and registered; instructions on rational use of medicine shall be given to patients for cultivating a healthy lifestyle; services such as measuring of blood pressure and blood sugar shall be offered to key objects; Propaganda education on proper diet, mental health and abstention from smoking and alcohol shall be carried out for forming a supporting environment conducive to the healthy lifestyle.
（ii）Mental health care
In settlement places and schools, mass mental health education shall be carried out in forms of giving lessons, lectures, propaganda materials and entertainment; training shall be provided for teachers, medical staff and management personnel at settlement spots to enhance their capacity of identifying mental barriers; and those persons who need further mental intervention shall be treated by psychiatrists or accredited psychotherapists.
(iii) Prevention and control of injury
Public propaganda and education shall be carried out, for the purposes of strengthening the awareness of preventing various accident injury resulted from traffic accidents, heat stroke, dog bite, carbon monoxide poisoning and fire-fighting power utilization; safety measures such as advocating dog management, disinfectant management, high-temperature working management, care of the old aged and kids, safety railing along water body and warning setting on dangerous zones in buildings shall be taken.
VII. Health Promotion and Community Participation
A mechanism of health education at counties, towns, villages and concentrated settlement spots in disaster areas shall be established and improved; assessment shall be conducted to determine health problems to be solved in priority, targeted groups and core information for spreading.
VIII. Hygienic Evaluation on Restoration Projects
Efforts shall be made to participate in hygienic evaluation on key public facilities and construction projects.
IX. Carrying out Study on Health Impact Caused by Earthquake and Post-disaster Health Emergency Assessment
Post-disaster public health risks shall be monitored and tracked for a long term; a scientific analysis of direct and indirect effects on public health in disaster areas caused by earthquake shall be carried out and relevant risk factors shall be identified; a comprehensive assessment and summary of experience and lessons about post-disaster emergency health rescue shall be conducted; and a further specific assessment and study shall also be carried out.
