STAYlavalava

CHAPTER10PreventiveHealthMeasuresinVolcanicEruptionsPETERJ.
BAXTER,MD,ROBERTS.
BERNSTEIN,MD,PHD,ANDA.
SONIABUIST,MDIntroductionMajorvolcaniceruptionsareoftenprecededsufficientlyfarinadvancebypremonitoryeventstoenablegeologistsandemergencyworkerstoplanforapossibledisaster.
However,someoftheseveresteruptionshaveoccurredwithoutappar-entwarning;suchanexplosiveeruptioninpopulatedareaswillinevitablyleadtoaheavylossoflifeinthevicinityofthevolcano.
Itisfortunatethattheseeruptionsarerarebecauseitisimpossibleforalldormantaswellasactivevolcanoestobecontinuallymonitoredbygeologists.
Hazardevaluationandemergencyplanningforaneruptionshouldthereforebedoneforallvolcanoesinpopulatedareasirrespectiveoftheirapparentstateofactivity.
ThefollowinggeneralrecommendationsarebasedonexperiencewithMountSt.
Helensandareintendedforhealthworkerswhobecomeinvolvedineithertheplanningforormanagementofvolcanicdisasters.
Theyareintendedtobeapplicableinbothaffluentanddevelopingcountries.
Specificadviceonreliefandrescueoperations,includingmedicaltreatment,isnotincluded.
Theemphasisisonprevention:medicaltreatmenthasonlyalimitedplaceinalleviatingtheworstconsequencesofvolcanicdisaster.
Thereaderisadvisedtoconsultthegeneralreferences'"3andotherpartsofthisSupplement,usingthischapterasacheck-listwhenpreparingaplan.
AssessmentoftheVolcano(Table1)Volcanologistswillpredictthewayaparticularvolcanowillbehavefrominformationonitspreviousbehavior(ifknown)anditsgeologicalcharacteristics.
ThekeygeologicalinformationrequiredbyhealthworkersissummarizedinTable1.
Ingeneral,volcanoeswhicharemainlyeffusiveposetheleastrisk:lavaflowstendtobeslowmovingandlittleashisproduced,mostofwhichiscoarse-grained(non-respirable)andcontainslittle,ifany,crystallinesilicawithpotentialtocausesilicosis.
Volcanoeswithexplosivecharacteristicsare,ontheotherhand,themostdangerous.
Furthermore,afteracatastrophicexplosiveeruption,furthereruptions(usuallyofdecreasingviolence)mustbeanticipated.
EmergencyMeasuresintheVicinityoftheVolcano(Table2)Explosiveeruptionsusuallycausemostdamagewithinafewkilometersofthevolcano,themainagentsbeingexplo-siveblast,mudflows,andglowingavalanches.
Becausegravityplaysthegreatestpartinthemovementofmudflowsandglowingavalanches,low-lyingareasandrivervalleysdrainingthemountainsmaybeatriskfordistancesofmanykilometers.
GeologistsshouldbeabletopredicttherelativeimportanceoftheseandtheotherhazardslistedinTable2.
Theonlyeffectiveprotectionagainstthesedevastatingforcesistodemarcaterestrictedareasandevacuatecommu-nitiesandworkersatmostimmediaterisk.
Long-termevac-uationmayobviouslyresultinseveresocioeconomicdisrup-tionandshouldneverberecommendedwithoutsoundNOTE:Authoraffiliationsandaddressesarelistedonpvi.
reasons.
Decisionsontheboundariesofrestrictedzones,includingtheneedforevacuation,areessentiallypoliticaljudgmentstobetakenbygovernmentofficialsonthebasisofadvicereceivedfromvolcanologists.
Theviewsofemergen-cyservicesandhealthofficialsamongothersalsoneedtobeconsidered.
However,despitethepaucityofavailabledatafrompreviouseruptions,itisevidentthattheexpectednumberofinjuredsurvivorswhocouldbenefitfromemer-gencymedicaltreatmentislikelytobequitesmallcomparedwiththenumberofpeoplekilledwithinminutesofacata-strophiceruption.
Asimilarratioofdeadtoihjuredalsoappliestothefloodingwhiqhmayresultfrommudflowsormeltingsnowandice.
Nevertheless,afewsurvivorssufferingfromsevereburnsandtraumamustbeanticipated.
Urgentplanningmeasuresmayinclude:*Welfareofevacueeswhomayhavetoberelocatedformanymonths;*Precautions,includingemergencywarningandevac-uationplansforcommunitiesatriskoffloodsalongriversdrainingthevolcano;*Searchandrescueplansforthedeadandanyma-roonedsurvivors;*SitesofemergencyfieldMorguesandtheirstaff;*Rehearsaloflocalhospitalemergencyplansforsuddeninfluxofvictimswithbodysurfaceburnsandlungdamagefromtheinhalationofhotash,andallkindsoftrauma;*Informinglocalcommunitiesofactiontobetakenwhenaneruptionbecomesimminentandafterithasoccurred;*Adviceandequipmentforpeoplewhoaretemporarilypermittedtoworkinrestrictedareas,includingdevisinganalertsystemforemergencyevacuationifaneruptionisimminent,andsurvivalmeasuresintheeventofanerup-tioninwhichworkerscouldbecomemaroonedfordays.
Thisinformationshouldbeencapsulatedinahand-out(Figure1).
Intherareeventofaground-levelreleaseoftoxicgas(e.
g.
,fromaventinthevolcano'sflanks)equipmentforemergencyairmonitoringforSO2,H28andCO2andothergases(Table2)shouldalsobeavailable.
EmergencyMeasuresataDistancefromtheVolcanoAshfallcanhavehealthimplicationsforpopulationsasfarashundredsofkilometersawayfromamassiveeruption(Table3).
Theperiodwhenexposuretorespirableashparticleswillbeatitsgreatestisduringtheashfallandinthefewdays,orevenweeks,afteraneruption,aperiodwhenmanyoutdooractivitieswill,inanycase,beinevitablycurtailed.
Rainfallisakeyfactorinclearingtheairofashandminimizingresuspensionbywindsandtraffic.
Inaddition,rainwillwashoutsolubletoxicelementsfromsettledashinamatterofweeks.
Itis,therefore,indryareasthatashfallsmayposethegreatestproblems.
AshCollecionandAnalysisLaboratorytestsfortoxicityareessentialtoprotecthumanandanimallife.
SpecimensofashmustbecarefullyAJPHMarch1986,Vol.
76,Supplement84PREVENTIVEHEALTHTABLE1-HealthandSafetyHazardsAccordingtoCharacteristicsofVolcano,Magma,EruptionCharacteristicsMainHazardsVolcanoEffusive(littleormoderateLavaflow;gasesdanger)Explosive(verydangerous)Blast,heat:Destructionaroundvolcano,perhapsformanymiles,especiallylowlyingareasandvalleysFineash:RespiratoryillnessesEyeirritationToxicityDestructionofhabitatGasesTidalwaves(Tsunami)-rareEffusiveandexplosiveAlloftheaboveMagmaTotalcontentofsiliconcon-tainingminerals:55%(explosive)Riskofsilicosisifashparticlesofrespira-blesize(<10rm)andcontainingcrystallinesilicaEruptionEffusive:HawaiianGases,lavaflowExplosive:StrombolianExplosionsVulcanianExplosions,ashandgasesPeleeanGlowingavalanches(burns,asphyxiation)PlinianExplosions,ashPhreaticExplosions,ashcollectedfromeacheruptionatdifferentdistancesfromthevolcanoandinrelationtothelikelihoodofhumanexposure,preferablybyapre-arrangednetworkofcollaborators.
Acleanplasticsheetlaidonaflatroof,e.
g.
,ahospital,isbest,withtheashbeingtransferredtoacleanglassjarfordispatchtothelaboratorytogetherwithdetailsofthelocation,time,weather,andmodeofcollection(Table4).
Aspecializedlaboratoryisrequiredforanalysisoftheashforparticlesizeandshapeandcrystallinesilicacontent,butstudiesofleachabletoxicelementsadherenttothesurfaceoftheashcanbedonebygeneralchemicallaboratories.
Itisessentialtoexcludethepresenceofhighconcentrationsofleachablefluoridewhichmaycontaminatefoodandwaterandpoisonlivestock.
Thereshouldbealocallaboratorycapableofperformingthistestastransportofspecimenstoacentrallaboratorymaybeimpossibleforseveraldaysafteraheavyashfall.
Inexpensiveportableequipmentforfluorideestima-tionsinwaterisavailablecommercially.
RespiratoryandEyeProtectionInexpensive,disposable,highefficiencymasks(i.
e.
,capableoffilteringparticlesofsub-micrometresize)arenowavailablewhichcanbestockedlocallybeforeaneruptionforimmediatedistribution*ocommunitiesafteranashfall.
Half-maskrespiratorsorairstreamhelmets(poweredvisorrespi-rators)andgogglesshouldbeavailableforemergencyandotheroutdoorworkersandclean-upcrews.
Residentsshouldbeadvisedthatweatherproofingtheirhomeswillreduceinfiltrationoffineash.
NorthAmericanhousinggenerallyprovidesaneffectivebarrier.
Airborneashwillmostlyaffectpersonswithasthmaandotherrespiratorydiseases,buteveryoneshouldbeadvisedtostayindoorswhentheashisfallingorbeingresuspendedbystrongwinds.
Indevelopingcountrieswherepoornutritionandinfectiousdiseasesareimportantcausesofprematuremortality,childrenmayalsobeatspecialrisk;littleisknownabouttherespiratoryeffectsofashinsuchcommunities.
Silicosisisapotentialproblemtooutdoorworkersiftheyareexposedforlongperiodstohighconcentrationsofashwithanelevatedcrystallinesilicacontent.
Silicosisisnotamajorconsiderationforthegeneralcommunityoremergcncyworkers,butforotherswhoseregularoccupationisoutdoors(e.
g.
,farmers,loggers)specialrecommendationsmaybenecessary.
Theseshouldideallybebasedonlaboratoryanalysesofash,andfieldstudiesincor-poratingmeasurementsoftotalandrespirablelevelsofashinthebreathingzoneofworkers.
Inouropinion,recommendationsonoccupationalex-posurelevelsforrespirablevolcanicashshouldbebasedonregardingthissubstanceasanyothersiliceousdust,forwhichthereareagreedmethodsofcalculatingexposurelimitsinindustrialsettings,usuallyover8-hourperiods.
Thereiscurrentlynoscientificbasisforguidanceonambientairlevelsor24-hourexposurestolowerconcentrationsoffineashinthegeneralcommunitywhich,ofcourse,includesthesick,theelderlyandchildren;airqualitystandardsinindustrial-izedcountriesforfossilfuelpollutants(i.
e.
,totalsuspendedparticulatesandSO2)arenotapplicable.
AirMonitoringMeasurementoflevelsofairborneashincitiesisneverthelessusefulformonitoringlocalconditionsandre-TABLE2-PrincipalHealthEffectsofEruptionsinVicinityoftheVolcanoandMainPreventiveMeasuresEruptiveEventConsequenceHealthImpactPreventiveMeasuresExplosionsLateralblast,rockfragmentsTrauma,skinburnsEvacuationAirshockwavesLacerationsfrombrokenwindowsMinimizeexposuretoflyingglassHotashreleaseGlowingavalanchesSkinandlungburnsEvacuationAshflowsandfallsAsphyxiationLightningElectrocutionForestfiresBurnsMeltingice,snowandrainMudflows,floodsEngulfing,drowningEvacuation,DiversionbarriersaccompaningeruptionLavaLavaflowEngulfingandbums(rare)Evacuation,DiversionbarriersForestfiresBurnsEvacuationGasemissions:S02,CO,CO2H2S,HFPoolinginlowlyingareasandAsphyxiationEvacuationinhalationAirwaysconstrictionRespiratoryprotectiveequipmentforgeologistsRadonRadiationexposureLungcancerEvacuationEarthquakesBuildingdamageTraumaEvacuationAJPHMarch1986,Vol.
76,Supplement85BAXTER,ETAL.
ScientistscannotpredictwhenorifMt.
St.
Helenswillhaveamajoreruption.
Al-thoughmanyfederal,state,andlocalofficialsaremonitoringthemountain'sactivities,itisuncertainwhethertherewillbeadequatetimetowarnpeopleintheareaifamajoreruptionshouldoccur.
Thefollowinginformationisprovidedsothatyouwillbeawareofemergencyproceduresandinformationshouldtheybecomeneces-sary.
Remember,Mt.
St.
Helensisnowconsid-eredtobeamajorhazard.
YouareassumingariskbyenteringtheMt.
St.
Helensarea.
WARNINGInstrumentshavebeenplacedonthemountainthatcouldprovideadvancednoticeofamajoreruption.
Iftheseinstrumentsindicateaneruptionisimmi-nent,emergencyservicespersonnelwillimmediatelynotifylocalradioandtelevi-sionstationsservingtheMt.
St.
Helensarea.
Whileinthishighhazardareayoushould:STAYTUNEDTOYOURLOCALRADIOORTELEVISIONSTATIONThefollowingradiostationstransmittotheimmediateMt.
St.
Helensarea:KGWKWJJKGAR62-AM1080-AM1550-AM24hours24hours24hours226-5096228-4398256-9043PortlandPortland285-5575VancouverThefollowingtelevisionstationsarere-ceivedintheMt.
St.
Helensarea:Channel2,(inCougararea).
Channel2,6,&8(inthePinecreekarea).
Duringperiodsofhighdensityaherup-tions,theashparticlesbecomehighlychargedwithstaticelectricity.
Cloudsofhighlychargedashmaytemporarilydisrupttelephone,televison,andradiocommunica-tions.
Ifyourtelevision,radio,andtele-phonedoesn'tworkduringaneruption,youmaybenotifiedofemergencyproceduresby-GroundvehicleswithPAwarningan-nouncements.
orAircraftwithPAwarningannounce-ments.
WHATTODOIFNOTIFEDTHATANERUPTIONISOCCURRINGDON'TPANIC.
.
.
REMAINCALMIfyouliveorworkinthearea,youshouldbepreparedtoleaveyourhouseorworkplaceandrelocateimmediatelyviaevacua-tionroutesasdirected.
Whenevacuating,pleasebringthefollowingwithyou:-Specialmedicinesorfoodsrequiredbymembersofyourfamily.
-Blanketsandadequateclothingforeachfamilymember.
-Abatterypoweredradio,aflashlightandextrabatteries.
Relocationcenterswillbeprovidedbylocalgovernmentsandvolunteeragencies.
Youmayexperienceheavyashfalwhileinthishighhazardarea.
Ifyoudo,STAYINDOORS.
Ifyoureoutside,seeksheltersuchasinacarorbuilding.
Ifyoucannotfindshelter,breathethroughaclothtofilterouttheashandkeepyoureyesclosedasmuchaspossible.
Heavyashmaycausedarknessduringdaylighthoursandtempo-rarilyinterferewithradio,television,andtelephonecommunications.
STANDBY.
Theinterruptionwillprobablybetempo-rary.
Heavyashfallmayimpairvisibility.
DONOTTRYTODRIVEunlessin-structedtodosobyemergencypersonnel.
ThawingtemperaturescombinedwiththeactivityonMt.
St.
Helenshasincreasedthepotentialformudflows,avalances,andfloods.
WHATTODOIFAMUDFLOWOCCURSMudflowsgenerallyoriginateonsteepslopeswhenshallowsoillayersaretrans-formedtoaliquidstate.
Theliquefiedsoilflowslikestreamsofwaterdowngulleys,canyons,andvalleybottoms.
Largemudflowsmayspilloutofstreamchannelsandspreadoutacrossadjacentlowgrounds.
Mudflowscanmovefasterthanyoucanwalkorrun,butyoucandriveacardownavalleyfasterthanamudflowwilltravel.
Yourcarshouldbeequippedwithanautomobileemergencypreparednesskit(seelastsection).
Whiledrivingalongavalleythatheadsonavolcano,watchtheriverchannelandpartsofthevalleyfloorforoncomingmudflows.
Beforecrossingahighwaybridge,lookupstream.
DONOTCROSSABRIDGEWHENAMUDFLOWISMOVINGBE-NEATHIT.
REMEMBER:Thedangerofmudflowsincreasesasyouapproachariverchannelanddecreasesasyoumovetohigherground.
Ifyoubecomeisolated.
.
.
DONOTSTAYNEARTHERIVERCHANNEL-MOVEUPSLOPE.
Theriskofmudflowsdecreasesthefartheryoumoveawayfromthevolcano.
WHATTODOIFCAUGHTINANAVALANCHEIfyouarecaughtinanavalanche,youshouldimmediatelytrytogetoutoftheslidepathorgrabaholdoftrees,shrubs,orotheranchorages.
Ifescapeisimpossible,trytodiscardskis,packorotherimpedi-mentsandmakeaswimmingmotionwithyourarmsandlegs.
Youronlyhopeatthistimeistotrytostaynearthesurfaceandworktowardtheedgesoftheslide.
Itmaybepossibletoescapebyreachingthesidesoftheslidepath,ratherthanattemptingtooutrunit.
WHATTODOIFFLOODINGOCCURSLeavethearea.
Donotattempttocrossaflowingstreamwherethewaterisabovetheknees.
Donotdriveoverafloodedrood,youmaygetstrandedortrapped.
Iftrapped,KEEPCALM.
Gotothehighest,safestlocationandremainthere.
NEVERTRYTOSWIMTOSAFETYINFLOODWATERS.
Trytoprovideadistresssignal.
BEPREPAREDBEFOREYOUGOINTOTHEMT.
ST.
HELENSHIGHHAZARDAREA,shouldanemergencyoccur,youmayhavetobeself-sufficientuntilhelparrives.
Forpersonalcomfort,ssfetyandlifesupport,yourautomobileshouldcontainanemergencypreparednesskitcontaining:-blanketsforeachpassenger-extraclothingforeachpasenger-firstaidkit-basictoolkit-water-fireextinguisher-emergencyfoodrations-flsahlight(extrabatteries)-portableradio(extrabatteries)-shovel,ae-roadmap-matches,candle-emergencyflares-waterprooftarp-heavyropeortowcable-survivalmanualAsinanywildernesemergencysituation,whenyouenterthishighhazardares,itwillbeyouagainstnature.
WARNING__--MT.
ST.
HELENSISANACTIVEVOLCANOYouareenterIngaHighHazardAreaYOUDOSOATYOUROWNRISKPLEASEREADTHEFOLLOWINGINFORMATIONBEFOREPROCEEDINGBEPREPAREDFORPOSSIBLE:ASHFALLMUDFLOWSFLOODSLAVAFLOWSAVALANCHEPrearditheherestofpublcsfetyandrbrWAS4UGTONSTATEDEPARTMETOFEMRGNCYSERVICESDixyLeeRayGovernorEdwardChow.
Jr.
DirectorFIGURE1-ExampleofbrochureforworkersenteringrestrktedareasSOURCE:WashingtonStateDepartmentofEmergencyServicesAJPHMarch1986,Vol.
76,Supplement86PREVENTIVEHEALTHTABLE3-PrincipalHeafthEffectsofEruptionsataDistancefromtheVelcano,andMainPreventiveMeasuresEruptiveEventConsequenceHealthImpactPreventiveMeasuresAshfallRespiratoryInhalationoffineash(<10,umdi-Asthma,exacerbationofpre-existingLaboratorytestforparticlesize;Wearhigh-ameter)lungdiseaseefficiencymasks;Protecthomes/officesfromashinfiltrationInhalationofsiliceousdust(pres-Silicosis,ifexposureheavyandcon-Laboratorytestsforcrystallinesilica,respira-enceofcrystallinesilica,e.
g.
,tinuous(years):outdooroccupa-toryprotectiveequipmentquartz)tionalhazardToxicIngestionofwatercontaminatedwithGastrointestinalupset,evendeathinLaboratorytestsforleachabletoxicelements;fluoride,possiblyalsoheavymet-vulnerable(chronicsick)Avoidsurfacewatersfordrinkingsuppliesals(e.
g.
,cobalt,arsenic)(i.
e.
,usewellwater)Ingestionofcontaminatedfood(asAsaboveLaboratorytestsforbloavailabilityoftoxicele-above),includingmilkments;Observehealthofforaginganimals,laboratoryanalysesofmilkOcularForeignbodiesineyesConjunctivitis,cornealabrasionsGogglesforheavilyexposed(e.
g.
,outdoorworkers)MechanicalRoofcollapseandfallsfromroofsTraumaPreventbuild-upofash;exercisecareifdan-geroffallingfromaroofAutomobileaccidents(slipperyroadsTraumaTrafficcontrolandpoorvisibility)AircraftenginedamageTraumaRadarwamingoferuptionRadioandTVinterferenceUnabletoreceivewamingsPre-eruption:advisoryleafletstoallhomesElectricityoutages(moistashonBreakdownofpublicutilities,homeCoverinsulatorsororganizeemergencyre-horizontalinsulators)heating,etc.
paircrewsPoorvisibilityCessationofemergencytransport;DesignateemergencysheltersStrandedhomesandtravelersGaseousEmissionsAcidrainEyeandskinirritation;PossibletoxicProtectionduringrainfall;Avoidcollectionofcontaminationrainwaterfordrinking,especiallyfrommetalroofs,etc.
Explosion/EarthquakeTsunami(Tidalwave)DrowningRareandunpredictablelatingthesetomorbidityandmortality.
Somecitiesinindustrializedcountrieswhichmonitorairpollutionmayalreadyhavefacilitiesformeasuringsuspendedparticulates.
Staticsamplersshouldotherwisebeprovidedinkeylocationsand,ifpossible,sitedataheightcorrespondingtothebreathingzoneratherthanonrooftops.
WaterandFeedCentaminatienFluoride,andpossiblyothertoxicelements,mightcontaminatedrinkingwaterfromashfallinginriversandreservoirs.
Alternativesourcesofpotabledrinkingwatershouldbeplannedandhomesshouldstockpilewaterinadvance.
Outdoorcropsmaybesafetoconsumeafterashiswashedoff,butlaboratoryteststoexcludecontaminationoffoodandmilk,includingthebioavailabilityoftoxicelements,shouldbedone.
Thehealthofoutdoorforaginganimalsshouldbemonitoredforevidenceoftoxiceffectsandemer-gencyfoodsuppliesstockpiledatfarms.
ThepHoftheashisanimportantfactorasheavyashfallsmayresultinsurfacewaterqualitybecomingimpaired.
GeneralMeasuresPre-planningshouldalsoallowforthefollowingeffectsofwidespreaddisruptionofcommunitiesandpublicutilities:TransportandCommunicationRoadandrailwayscanbedestroyedbymudflows,lavaflowsandfloods;drivingisalmostimpossiblethroughsus-pendedash.
Darknessisafeatureofashfallsandcanlastforseveraldaysinagiganticeruption.
Aircraftandhelicoptersmaybeunabletoflyfordaysafterheavyashfallduetopoorvisibilityandtheriskofenginedamagefromtheash.
Elaborateprecautionsmaybeneededtoprotectautomobileengines.
AshfallscanalsointerferewithradioandTVTABLE4-AshCollectionInformatlonForm1.
(a)TimeCollectionbegan:--AMPM(b)TimeCollectionended:--AMPM2.
DateofCollection:3.
Physicallocationofpointofcollection(ground,rooftop,etc.
):4.
Addresspointofcollection(building,cityandoounty;zipoodeifknown):5.
Weatherconditionsduringoollections:dryanyrainoccurringweLapproximatespeedanddirectionofwind6.
Weightofash(tothenearestgram):Areaofthesamplecollectionsurface(inm2)7.
Othercomments(e.
g.
,potentialsourcesofcontamination):8.
Nameofpersoncollecting:Address(includA7inrnde\-Telephonenumber~-communications,anddamagetelephoneswitchgear.
Localtelephonesshouldnotberelieduponforemergencycommu-nications-thesysitembecomesrapidlyoverloadedwithcallers.
Electricaloutagesmayalsooccur.
WaterSupplies,SewageandInfectiousDiseasesWaterintakesatriversandreservoirscanbedestroyed.
Poweroutagesmayclosedownpumpingstations.
Watersuppliescanbeseverelydepletedbycleaning-upactivities,e.
g.
,washingashoffsidewalks,streets,androoftops.
Sew-ageandwatertreatmentplantscanbreakdowninheavyashfallsandcontaminationofwatersupplieswithsewageandanimalcarcassesmayoccur.
AdequatechlorinationofwaterAJPHMarch1986,Vol.
76,Supplement87BAXTER,ETAL.
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WhatisvolcanicashVlcanicashisnot"ash"atall.
Itispulverizedrock.
Aone-inchlayerofdryashweighstenpoundspersquarelootasitlands.
Itoftencon-tainssmallpiecesoflight,expandedlavacalledpumiceorcinders.
Freshvolcanicashmaybeharsh,acid.
gntty,glassy.
smelly,andthoroughlyunpleasanl.
Al-thoughgasesareusuallytoodilutedtoconstitutedangertoanormalperson,thecombinationofacidicgasandashwhichmaybepresentwithinafewmilesoftheeruptioncouldcauselungdamagetosmallinfants,veryoldandinfirm,orthoseal-readysufferingfromsevererespiratoryillnesses*AheavyashfaiIblooutfghf.
Suddenheavydemandforelectriclightmaycausepowersuppliestobrownout"orfail.
*Ashclogswatecours,reeervoi,swers,sewageplantandmachnwyofallkinds.
*Ashdriftsontoroadways,railways,andrunwayslikesnow,butresemblessoftwetsand.
*Fineashmaybeslippewy.
TheweightofashmaycasrootstoWhattodoifVolcanicAshisFalling*Don'tpanic,staycalm.
*Stayindoors.
*Ifoutside:seekshelter(e.
g.
.
car,building).
usemask-orahandkerchief/cfloth(dampenedclothmosteffective).
*Ifatwork,gohomeifpossible.
beforeashbeginstofall.
Ifashisalreadyfalling,stayindoorsatworkifpossible.
untiltheheavyashissettled.
*Godirectlyhome.
donotrunerrands.
*Unlessanemergency.
donotusethetelephone.
*Useyourradioforinformationontheashfall.
I,-lI-030r,.
i0I"mgaII93;o~ifjIIIC,D*WhatVolcankAshis*WhattodowhenAshisFalling*HowToBePreparedforanAshlaiipsforProtectonofyourChildren,yourHome,yourPetsandAnimals,yourAutomobile.
FIGURE2-ExampleofbrochuredistributedtoresidentsInvolcanicareasinanticipationofashfallSOURCE:FederalEmergencyManagementAgencyAJPHMarch1986,Vol.
76,Supplement88HOWTOPREPAREFORANDWHATTODODURINGAVOLCANICASHFALLPREVENTIVEHEALTHsuppliesshouldthereforebeensured.
Stillwaterareascreatedbythedevastationandfloodingmaypromoteen-demicdiseasessuchasmalariaandleptospirosis.
Asinothernaturaldisasters,vaccinationprogramsshouldneverbeundertakenexceptonfirmepidemiologicalindications,e.
g.
,thefindingsofadiseasesurveillancesystem(seebelow).
EmergencyShelterandFoodReliefInremoteanddevastatedareas,particularlyindevel-opingcountries,deathsfromextremeenvironmentalexpo-suremayoccur.
Theriskishighestinthefirstfewdaysafterthedisasterhasstruck,particularlyifthetransportationsystembreaksdown.
Itisdoubtfulwhethersuchdeathscanbereadilyprevented.
Evacuationcentersshouldhaveroofsstrongenoughtowithstandlargecollectionsofash.
Indevelopingcountries,thedeathoflivestockanddisruptionofhabitatsmaycausefoodshortagesandrelieffooddistributionmayberequired,atleastforashortperiod;historically,evenfamineshaveoccurredaftervolcaniceruptions.
PsychologicalReactionsThereissomeevidenceforpsychologicalproblemsarisingfromtheMountSt.
Helenseruptions(chapter9).
Howseverepsychologicalreactionsassociatedwiththethreatortheaftermathofsevereeruptionscanbebestpreventedbyinterventionmeasuresbyhealthprofessionalsiscurrentlynotclearonavailableevidenceandwearereluctanttospeculatehere,especiallyastheguidanceavailablefromothertypesofdisasterisconflicting(see,forexample,Ref3,Chapter5).
AdvicetoResidentsPersonalprotectionmeasurestobeadoptedduringavolcanicemergencyshouldbegiventoallpeopleinat-riskareaswellinadvance.
AbrochurecontaininginformationwasmailedtoallhomesbeforetheMountSt.
Helensdisaster(Figure2).
PreventiveMeasuresOnceADisasterHasOccurredManylocalandgovernmentalagencieswillbeinvolvedintheemergencysoitisessentialthatacoordinatingcenterbeestablishedbythenationalgovernmentwithoutdelay.
Here,representativesfromnumerouskeyagenciescanbeco-locatedwiththegeologicalteamresponsibleforpredictingfutureactivityofthevolcano.
Animportantfunctionofthecenteristoissueauthoritativeinformationonhealthandsurvivalmatters.
Initially,assessmentsofthesizeofthedisaster(areaandpopulationaffected)andtheneedsforrescueandevacuationinanticipationofafurthereruptionmustbeundertaken.
Thepreventivehealthteamhasfourmainfunctionsinavolcanicdisaster:1.
Collaboratewithotheragenciesinthecoordinatingcentertoprovide:*Adviceonhealthmatters,e.
g.
,togovernmentofficialscommunityandoccupationalgroups(includingvolcanolo-gists)andmedia;*Adviceonappropriatehealthresourcesfordisasterrelief;*Informationforreliefplanningandimmediatereliefaction;*Informationonthesurveillanceandcontrolofdiseaseafterthedisaster(e.
g.
,inaffectedcommunitiesandevac-uationcamps).
2.
Provideafieldsurveyteamtocollectdataonthedeadandsurvivorsinthevicinityofthevolcanoincollaborationwithrescuersandthestaffofemergencycentersandfieldmorgues.
3.
Provideafieldsurveyteamtotravelassoonasconditionspermitintoareasofheaviestashfalltomakerapidassessmentsofthehealthneedsofaffectedcommunities,includingfoodandshelter,andtheconditionofmedicalservices.
Rapidlyexecutedhouseholdsurveysmaybere-quiredtoprovideimmediateassessmentofthehealthimpactoftheash.
4.
Establishahealthsurveillancesystem.
Keymedicalfacilities(hospitals,emergencyrooms)inareasaffectedbythedevastationandashfallsshouldbecoordinatedintoinformationnetworkssupplyinginformationtothepreventivehealthteamonthedailynumberofpatientsattendingwithdisordersofinterest,andincludingdeaths.
Bycomparingtheresultswithdatafortheperiodbeforetheeruption,orthepreviousyear,orfromanunaffectedarea,anyunusualtrendwouldbehighlightedandappropriateinvestigationsinstituted,e.
g.
,todetermineifatrueincreaseindiseaseincidenceisoccurring.
Preventivemeasurescanthenberapidlyputinhand.
Asanexample,alistofdiagnosticlabelsandnumberofpatientvisitstoahospitalemergencyroominMosesLake,WAisshowninchapter3.
Baselinepopulationandhealthstatisticsshouldbecollectedbeforeaneruptionifpossible.
Anall-purposerecordingformtofacilitatedatacollec-tionfrompatientswhiletheyareactuallyattendingemer-gencydepartmentsissuggestedinTable5;itcouldalsobeusedfordatacollectiononsurvivorsandvictimsrecoveredfromdevastatedareas.
Theadvantagesofsuchinstantaneousdatacollectionareobvious,butitdoesneedtobeplannedbeforeaneruptionifitisgoingtobeworkable.
AdditionalStudiesTherapidlyexecutedsurveysmentionedabovecanbeconductedusingquestionnairesandmedicalrecordsandwiththeminimumofapparatus.
Moredetailedstudiesinvolvinglungfunctiontestsandcomputeranalysisofresultsmaysuggestthemselves,e.
g.
,studiesoflungfunctionandmor-bidityamonggroupsofworkersorpatientswithchroniclungdisordersexposedtovolcanicash.
However,suchstudiesneedtoinvolveexpertsintheirplanningandexecutionandmorerightlybelongtotherecoveryphaseafterthedisaster.
Informationgatheringwilladdtoknowledgeforthemitigationofdisastersinthefutureasthereisaremarkabledearthofstudiesonthehealthimpactofvolcaniceruptions.
Deficienciesincurrentknowledgeinclude:1.
Specialproblemsoferuptionsindevelopingcoun-tries,e.
g.
,morbidityandmortalityafterheavyashfalls,especiallyinareaswithinadequatehousingandshelter,andahighprevalenceofinfectiousdiseases;effectsofextremeenvironmentalexposuresandfoodshortages;andhealthofevacuees.
2.
Characterizationofashfromdifferentvolcanoes:particlesizeandshape,crystallinesilicacontentandleach-abletoxicelements.
3.
Cost-effectivenessofdisposableindustrialfacemasksforthepreventionofrespiratorydisordersinash-exposedcommunities.
4.
Profilesofvolcanicgases,includingradon,andtheirconcentrationinairatthecraterandgroundlevel,includingpersonalmonitoringandmedicalsurveillanceofgeologistsinactivecraters.
AJPHMarch1986,Vol.
76,Supplement89BAXTER,ETAL.
TABLE5-EmergencyRoomandFieldMorgueVolcanoQuestlonnaireMEDICAL-CONFIDENTIALNo.
Date:Time:AM/PMA.
IDENTIFICATION:NameofIDNumber:Sex:MFAge:LastFirstM.
InitialAddressorLocationwhenFound:CityStateZipPhone:UsualOccupation:B.
EXPOSURETOVOLCANICHAZARDS(Checkallthatapply):1.
VictimorSurvivorof:Blast_,Pyroclasticflow,Mudflow/FloodingAshfall_Other_2.
(a)Livedinashfallarea:YesNo__(b)Workedoutdoorsinashfallarea:YesNo__(c)Averagetimeexposedtoashperday(e.
g.
,inclean-upactivities):Hours(d)RegularuseofindustrialmaskYes__No__C.
PASTMEDICALHISTORY,HOSPITALADMISSIONS,ANDMAJORCHESTILLNESSES:1.
PastMedicalHistory:AsthmaNoYesDuration:YearsChronicBronchitisNoYesDuration:YearsHeartDiseaseNoYes_Duration:YearsOtherNoYesDuration:Years2.
PastHospitalAdmissionsYearIllnessSurgery3.
IllnessinPreviousFourWeeks:4.
CigaretteSmoker:Never__ExWhenstoppedCurrentPks/daysD.
PRESENTDIAGNOSIS:1.
Onset:(a)Time:am/pm;Date:(b)Activity:2.
Relationshipwithash/blast:Yes__NoIfyes,specify:3.
Outcome:Admitted/Discharged/Referredto_E.
CLINICAL,AUTOPSYANDOTHERNOTES-USEBACKSIDESignature:5.
Specialproblemsofvolcanismintechnologicallyadvancedsocieties,e.
g.
,poweroutagesandcomputercircuitdamagefollowingvolcanicashfall.
6.
Causesofdeathandinjuryinrelationtoeruptivephenomenainthevicinityofvolcanoes.
7.
Psychosocialeffectsarisingfrom:*thelossoflifeandpropertyfollowinganeruption;and*disruptionscausedbythelong-termthreatofvol-canicactivity.
8.
Epidemiologicevaluationoftheoverallmanagementofvolcanichazards,e.
g.
,thestudyofaseriesofthreatenedandactualeruptionstoassesstheeffectivenessofpublichealthmeasures(includingtheadvicegiveninthischapter)incountrieswithdifferenthealthandeconomicinfrastruc-tures.
ConclusionComparedtoothernaturaldisasters,volcaniceruptionsoffergoodprospectsforprevention.
Volcanoesare,byhumanstandards,permanentandoftenmajesticfeaturesofthelandscapewhichchallengeinvestigatorsandthosewhodwellbythemtolearnoftheirbehaviorandplanaccordingly.
Futureadvancesintechnology,e.
g.
,volcanosurveillanceusingsatellites,willundoubtedlyimprovethepredictivepowerofvolcanologistsindeterminingwhen,how,andforhowlongaparticularvolcanowillerupt;thesegainsneedtobematchedbyscientificstudiesoftheimpactoferuptionsonpopulationssothatinnovativeandrationalapproachestodisastermanagementcanbedevised.
Untilthen,carefulplanningandcoordinationofalltheinvolvedagenciesandofficialswellinadvanceofaneruptionistheessentialkeytoprevention.
SummaryMedicaltreatmenthasonlyasmallroleinseverevolcaniceruptionsandsopreventivemeasuresarepara-mountifinjuriesandlossoflifearetobereduced.
Thehealthteammustbeincorporatedinemergencyplanningandresponseattheearlieststage.
Guidanceontheinterpretationofgeologicalinformationaboutavolcanoandtheappropriatehealthmeasuresthatshouldbeadoptedbeforeandafteraneruptionaresummarizedforthebenefitofhealthworkers.
REFERENCES1.
BaxterPJ,BernsteinRS,FalkH,FrenchJ,IngR:Medicalaspectsofvolcanicdisasters:anoutlineofthehazardsandemergencyresponsemeasures.
Disasters1982;6:268-276.
2.
BlongRJ:VolcanicHazards:ASourcebookontheEffectsofEruptions.
Sydney,Australia;AcademicPress,1984.
3.
SeamanJ:EpidemiologyofNaturalDisasters.
Basel:Karger,1984.
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76,Supplement