Due to the chaotic and disorganizing effects of disasters, initial triage is often inefficient and groups that look similar will be mixed. Intoxication and withdrawal phenomena, such as delirium tremens, commonly alter mental status. Differentiating between the etiologic chemical agents involved is essential to direct the patients to appropriate treatment. Infections such as CNS malaria, hepatitis, and tuberculosis, though much more prevalent in the third world, remain a consideration of which the clinician needs to be vigilant. It must also be remembered that disasters such as earthquakes may cause increased spread of pathogens such as cryptococcus.
Common things happen commonly.
Dehydration and fatigue, in both victims and rescue workers, can significantly degrade adaptation and performance. The mental health interventions of water and rest are simple and curative. The military literature is replete with vignettes of how adequate water intake, rest, and respite are necessary for continued effective functioning in high stress environments. In the initial stages after a disaster, efficient triage of casualties is the major priority. As noted earlier, the disaster-trained psychiatrist is the mental health expert ideally suited to triage because of his ability to distinguish medical and surgical conditions presenting as alterations in behavior or cognition.