DISASTER MANAGEMENT

DISASTER MANAGEMENT

1. DISASTER MANAGEMENT DR. MAHESWARI JAIKUMAR [email protected]

2. DISASTER DISASTER is “Any occurrence that causes damage, ecological disruption, loss of human life or deterioration of health & health related services on a scale sufficient to warrant an extraordinary response from outside the affected community area”

3. HAZARD “Any phenomenon that has the potential to cause disruption or damage to people & their environment”

4. CLASSIFICATION OF DISASTERS 1. WATER & CLIMATE RELATED DISASTERS 2. GEOLOGICAL RELATED DISASTERS.

5. 3. CHEMICAL, INDUSTRIAL & NUCLEAR RELATED DISASTERS. 4. ACCIDENT RELATED DISASTERS. 5. BIOLOGICAL RELATED DISASTERS.

6. WATER & CLIMATE RELATED DISASTERS Flood, Cyclone, Tornadoes, Hurricanes, Hailstorm, Cloud burst, Heat waves, Snow avalanches, Droughts, Sea erosion, Thunder & lightening.

7. GEOLOGICAL RELATED DISASTERS Land slides & mudflows, Earthquakes, dam failures/Dam burst, Minor fires, Tsunami.

8. CHEMICAL, INDUSTRIAL & NUCLEAR RELATED DISASTERS Chemical and industrial disasters, Nuclear disasters.

9. ACCIDENT RELATED DISASTERS. Forest fires, Urban fires, Mine flooding, Oil spills, Major building collapse, Serial bomb blast, Festival related disasters, Electrical disasters & fires, Air, road & rail accidents, Boat capsizing, village fire, Stampede.

10. BIOLOGICAL RELATED DISASTERS. Biological disasters & epidemics, Pest attacks, Cattle epidemics, Food poisoning.

11. RESULTS &CONSEQUENCES OF DISASTER Affect health & well being of people. 2. Large number of people are affected & displaced. 3. People are killed or injured.

12. DISASTER MANAGEMENT 1.Disaster response. 2.Disasrer preparedness. 3.Disaster mitigation.

13. DISASTER CYCLE DISASTER IMPACT RESPONSE REHABILITATION RECONSTRUCTION MITIGATION PREPARDNESS RISK REDUCTION PHASE RECOVERY PHASE

14. I. DISASTER IMPACT & RESPONSE Greatest need for emergency care occurs in the first few hours.

15. The management of mass causalities can be further divided into search & rescue, first aid, triage & stabilization of victims, hospital treatment & re distribution of patients to other hospitals if necessary.

16. SEARCH, RESCUE & FIRST AID FIELD CARE. TRIAGE. TAGGING. IDENTIFICATION OF THE DEAD.

17. FIELD CARE

18. FIELD CARE

19. FIELD CARE Most injured persons converge to the health care facility spontaneously, using what ever transport is available, regardless of the facilities, operating status.

20. This requires health care resources be properly re directed to this new priority. Moribund patients who require a great deal of attention, with questionable benefit, have the lowest priority.

21. Bed availability & surgical services should be maximized. Provisions should be made for food & shelter.

22. A centre should be established to respond to enquiries from patient’s relatives & friends. Priority should be given to victim’s identification & adequate mortuary space should be provided.

23. TRIAGE

24. TRIAGE The principle of “first come, first treated” is not followed in mass emergencies. A system of TRIAGE is followed.

25. Triage should be carried out at the site of disaster in order to determine transportation priority & admission to the hospital or treatment center.

26. A system of triage is followed when the quantity & severity of injuries overwhelm the operative capacity of health facilities.

27. Triage consists of rapidly classifying the injured on the basis of the severity of their injuries & the likely hood of their survival with prompt medical treatment.

28. High priority is granted to victims whose immediate or long term prognosis can be dramatically affected by simple intensive care.

29. Triage is the only approach that can provide maximum benefit to the greatest number of injured in a major disaster situation. The most often used triage system is the four colour code system.

30. NEED OF THE DISASTER TRIAGE 1. Inadequate resource to meet immediate needs 2. Infrastructure limitations 3. Inadequate hazard preparation

31. 4. Limited transport capabilities 5. Multiple agencies responding 6. Hospital Resources Overwhelmed

32. ADVANTAGES OF TRIAGE 1.Helps to bring order and organization to a chaotic scene. 2.It identifies and provides care to those who are in greatest need

33. 3. Helps make the difficult decisions easier. 4. Assure that resources are used in the most effective manner. 5. May take some of the emotional burden away from those doing triage.

34. TYPES OF TRIAGE There are two types of triage: 1. SIMPLE TRIAGE 2. ADVANCED TRIAGE

35. SIMPLE TRIAGE Simple triage is used in a scene of mass casualty, in order to sort patients into those who need critical attention and immediate transport to the hospital and those with less serious injuries.

36. This step can be started before transportation becomes available. The categorization of patients based on the severity of their injuries can be aided with the use of printed triage tags or colored flagging.

37. COLOURS USED IN TRIAGE The colours used are : RED YELLOW GREEN BLACK

38. TRIAGE

39. Red indicates high priority & treatment or transfer. Yellow signals medium priority,

40. Green indicated ambulatory patients & Black for dead or moribund patients.

41. START S.T.A.R.T. (Simple Triage and Rapid Treatment) is a simple triage system that can be performed by lightly trained lay and emergency personnel in emergencies.

42. TRIAGE CLASSSIFIES INJURED PERSONS INTO FOUR GROUPS 0 – The deceased who are beyond help. 1 – The injured who can be helped by immediate transportation.

43. 2 – The injured whose transport can be delayed.  3 – Those with minor injuries, who need help less urgently.

44. ADVANCED TRIAGE In advanced triage, doctors may decide that some seriously injured people should not receive advanced care because they are unlikely to survive.

45. Advanced care will be used on patients with less severe injuries. Because treatment is intentionally withheld from patients with certain injuries, advanced triage has an ethical implication.

46. PRINCIPLES OF ADVANCED TRIAGE Do the greatest good for the greatest number. Preservation of life takes precedence over preservation of limbs.

47. ADVANCED TRIAGE CATEGORIES CLASS I (EMERGENT)   RED    IMMEDIATE Victims with serious injuries that are life threatening but has a high probability of survival if they received immediate care.

48. They require immediate surgery or other life-saving intervention, and have first priority for surgical teams or transport to advanced facilities; they “cannot wait” but are likely to survive with immediate treatment. Critical; life threatening—compromised airway, shock, hemorrhage.

49. CLASS II (URGENT)  YELLOW  DELAYED Victims who are seriously injured and whose life is not immediately threatened; and can delay transport and treatment for 2 hours.

50. Their condition is stable for the moment but requires watching by trained persons and frequent re-triage, will need hospital care (and would receive immediate priority care under “normal” circumstances). Major illness or injury;—open fracture, chest wound

51. CLASS III (NONURGENT)  GREEN MINIMAL “Walking wounded,” the casualty requires medical attention when all higher priority patients have been evacuated, and may not require monitoring.

52. Patients/victims whose care and transport may be delayed 2 hours or more. “minor injuries; walking wounded—closed fracture, sprain, strain”

53. CLASS IV (EXPECTANT)   BLACK    EXPECTANT They are so severely injured that they will die of their injuries, possibly in hours or days (large-body burns, severe trauma, lethal radiation dose),

54. ……..or in life-threatening medical crisis that they are unlikely to survive given the care available (cardiac arrest, septic shock, severe head or chest wounds)

55. They should be taken to a holding area and given painkillers as required to reduce suffering. Dead or expected to die—massive head injury, extensive full-thickness burns.”

56. Persons with minor or moderate injuries should be treated at their own homes to avoid social dislocation & the added drain on resources of transporting them to central facilities.

57. The seriously injured should be transported to hospitals with specialized treatment facilities.

58. RPM CLASSIFICATION CATEGORY (COLOR) : RPM INDICATORS Critical (RED) R = Respiratory rate  >  30; P = Capillary refill  >  2 seconds; M = Doesn’t obey commands

59. Urgent (YELLOW) R  <  30 P  <  2 seconds M = Obeys commands

60. Expectant: dead or dying (BLACK) R = not breathing

61. TAGGING

62. TAGGING All victims should be identified with tags stating their name, age, place of origin, triage category, diagnosis & initial treatment.

63. IDENTIFICATION OF THE DEAD

64. Taking care of the dead is an essential part of the disaster management. A large number of dead can impede the efficiency of the rescue operation.

65. CARE OF THE DEAD

66. Care of dead includes : 1. Removal of the dead from the disaster scene. 2. Shifting to the mortuary. 3. Identification

67. 4.Reception of bereaved relatives & proper respect of the dead. ( If human bodies contaminate wells or other water sources as in floods, they may transmit gastroenteritis or food poisoning to survivors. 5.The dead bodies represent a delicate social problem.

68. II RELIEF PHASE This phase starts when assistance from outside starts to reach the disaster area.

69. The type & quantity of humanitarian relief supplies are determined by two factors. 1.The type of disaster. 2.Type & quantity of supplies available locally.

70. Disaster managers must be prepared to receive large quantities of donations. There four components in managing humanitarian supplies. 1.Acquisition of supplies. 2.Transportation. 3.Storage. 4.Distribution.

71. INTERVENTIONS – RELIEF PHASE 1. Epidemiological surveillance & disease control. 2.Nutrition. 3.Vaccination. 4.Rehabilitation

72. Displacement of domestic & wild animals, who carry with them zoonoses that can be transmitted to humans as well as to other animals. ( Leptospirosis ).

73. Provision of emergency food, water & shelter in disaster situation from different or new source may itself be a source of infectious disease.

74. VACCINATION Mass vaccination programme is to be organized, usually against cholera, typhoid & tetanus.

75. The pressure may be increased by the press media & offer of vaccines from abroad. Routine vaccination programme may be organized with camps with a large number of children population.

76. NUTRITION A natural disaster may affect the nutritional status of the population by affecting one or more components of food chain depending on the type, duration & the extent of the disaster .

77. Specially if vulnerable population is more. (Pregnant mothers, children) Measures for an effective food relief programme are : 1. Assessing the food supplies after a disaster.

78. 2.Gauging the nutritional needs of the affected population. 3.Calculated food rations & need for large population groups. 4.Monitoring the nutritional status of the affected population.

79. REHABILITATION The final phase in a disaster should lead to restoration of the pre disaster conditions. Rehabilitation starts from the very first day of disaster.

80. Services should be reorganized & re structured. Priorities will shift from health care towards environmental health measures, as follows.

81. WATER SUPPLY A survey of all water supply should be made. This includes water source & distribution system.

82. It is important to determine physical integrity of system components, the remaining capacities & bacteriological & chemical quality of water supplied.

83. The main public safety aspect of water quality is microbial contamination. The first priority of ensuring water quality in emergency situations is chlorination.

84. TESTING

85. It is the best way of disinfecting the water. It is advisable to increase residual chlorine level to about 0.2 – 0.5 mg / litre .

86. Low water pressure increases the risk of infiltration of pollutants into water mains. Repaired mains, reservoirs & other units require cleaning & disinfection.

87. Chemical contamination & toxicity are a second concern in water quality & potential chemical contaminations have to be identified & analyzed. The existing & new water sources require the following protection measures :

88. WATER CONTAMINATION

89. 1.Restrict access to people & animals, if possible, erect a fence & appoint a guard. 2.Ensure adequate excreta disposal at a safe distance from water source.

90. SAFE EXCRETA DISPOSAL

91. 3.Prohibit bathing, washing & animal husbandry, upstream if intake points in rivers & streams. 4.Upgrade wells to ensure that they are protected from contamination.

92. 5.Estimate the maximum yield of wells & if necessary, ration the water supply. In many emergency situations, water has to be trucked to disaster site of camps . 6.All water tankers should be inspected for fitness & be cleaned & disinfected before transporting water.

93. TESTING

94. FOOD SAFETY Poor hygiene is a major cause of food – borne disease in disaster situations. Kitchen sanitation is important in the feeding camps.

95. Personal hygiene of individuals handling food should be monitored.

96. BASIC SANITATION & FOOD HYGIENE Many diseases spread through fecal contamination of water & food. Hence every effort should be made to ensure the sanitary disposal of excreta.

97. Emergency latrines should be made available to the displaced where toilet facilities have been destroyed. Washing, cleaning & bathing facilities should be made available for the displaced persons.

98. VECTOR CONTROL Control programme for vector borne diseases should be intensified in the emergency & rehabilitation period. Of special concern are malaria, dengue fever, leptospirosis , plague.

99. RODENTS IN FLOOD WATERS

100. Flood water provides ample breeding opportunities for mosquitoes.

101. III RESPONSE PHASE 1. Implementing plans. 2. Implementing disaster legislation or declarations. 3. Issuing warnings

102. 4. Mobilizing resources. 5. Notifying public authorities. 6. Providing medical assistance. 7. Providing immediate relief. 8. Search and rescue.

103. IV RECOVERY PHASE 1. Myth that “things go back to normal in a couple of weeks.” - Psychological effects may last a lifetime

104. 2. Cost of recovery means loss of opportunity for development. 3. Most need for financial and material assistance is the months after a disaster…but forgotten by then ….

105. RECOVERY - Examples 1. Restore essential services. 2. Community rehabilitation. 3. Counselling .

106. 4. Temporary housing. 5. Financial support or assistance. 6. Health and safety information. 7. Long-term medical care.

107. 8. Physical restoration/re- construction. 9. Public information. 10.Conducting economic impact studies.

108. V. PREPAREDNESS

109. PREPAREDNESS: Planning Failure to plan is planning to fail”. Planning provides the opportunity to network and engage participants prior to the event.

110. Planning provides the opportunity to resolve issues outside of the “heat of battle”.

111. PREPAREDNESS: Surveillance Mechanisms to identify disease trends. Mechanisms to monitor risks including monitoring vector disease e.g. Avian diseases.

112. Influenza in birds. Diagnostic capabilities Laboratories -Reporting of infectious diseases

113. PREPAREDNESS 1. Community awareness and education. 2. Disaster Plans. 3. Training and test exercises

114. 4. Disaster communications. Mutual aid agreements. 6. Warning systems. 7. Resource inventories.

115. 8. Provision of special resources. 9. Evacuation plans.

116. TRAINING There is a need to do this better. Key area is decision making. Trained staff will make better decisions.

117. PRINCIPLES OF DISASTER MANAGEMENT

118. A PARADIGM SHIFT ALL FOR ONE ONE FOR ALL

119. 1. Disaster management is the responsibility of all spheres of government. 2. Disaster management should use resources that exist for a day-to-day purpose.

120. 3. Organizations should function as an extension of their core business. 4. Individuals are responsible for their own safety.

121. 5. Disaster management planning should focus on large-scale events. 6. Disaster management planning should recognize the difference between incidents and disasters.

122. 7. Disaster management operational arrangements are additional to and do not replace incident management operational arrangements.

123. 8. Disaster management planning must take account of the type of physical environment and the structure of the population. 9. Disaster management arrangements must recognize the involvement and potential role of non - government agencies.

124. DISASTER NURSING DEFINITION

125. Disaster nursing can be defined as “the adaptation of professional nursing knowledge, skills and attitude in recognizing and meeting the nursing, health and emotional needs of disaster victims.”

126. PRINCIPLES OF DISASTER NURSING The basic principles of nursing during special (events) circumstances and disaster conditions include:

127. 1. Rapid assessment of the situation and of nursing care needs. 2.Triage and initiation of life- saving measures first.

128. 3. The selected use of essential nursing interventions and the elimination of nonessential nursing activities. 4. Evaluation of the environment and the mitigation or removal of any health hazards.

129. 5. Adaptation of necessary nursing skills to disaster and other emergency situations. The nurse must use imagination and resourcefulness in dealing with a lack of supplies, equipment, and personnel.

130. 6. Prevention of further injury or illness. 7. Leadership in coordinating patient triage, care, and transport during times of crisis.

131. 8 . The teaching, supervision, and utilization of auxiliary medical personnel and volunteers. 9. Provision of understanding, compassion, and emotional support to all victims and their families.

132. CHARATERISTICS OF A GOOD DISASTER INTERVENTION…. IT MUST FOCUS ON KEY ISSUES Taking care of the most vulnerable first

133. Foster a culture of prevention. 2. Integration into development Equity. 3 . It must ensure community involvement

134. 4. It must be driven in all spheres of government. 5. It must be transparent and inclusive. 6 . It must accommodate local conditions

135. 7. It must have legitimacy 8. It must be flexible and adaptable. 9. It must be efficient and effective.

136. 10.It must be affordable and sustainable. 11.It must be needs-oriented and prioritized. 12. It must be based on a multi- disciplinary and integrated approach

137. GOALS OF THE DISASTER NURSING The overall goal of disaster nursing is to achieve the best possible level of health for the people and the community involved in the disaster. Other goals of disaster nursing are the following:

138. 1.To meet the immediate basic survival needs of populations affected by disasters (water, food, shelter, and security). 2 To identify the potential for a secondary disaster.

139. 3. To appraise both risks and resources in the environment. 4.To correct inequalities in access to health care or appropriate resources.

140. 5. To empower survivors to participate in and advocate for their own health and well- being.

141. 6. To respect cultural, lingual, and religious diversity in individuals and families and to apply this principle in all health promotion activities.

142. ROLE OF A NURSE N- ursing Plans should be integrated and coordinated. U- pdate physical and Psychological preaparedness

143. R- esponsible for Organizing,Teaching and Supervision. S- timulate Community Participation. E- xercise Competence.

144. D- isseminate information on the prevention and control of environmental Hazards. I- nterpret health laws and regulations. S- erve yourself of self-survival.

145. S- election of Essential Care. A- ccepts directions and take orders from an organized authority. A- daptation of Skills to Situation

146. S- erve the best of the MOST. T- each AUXILLARY personnel. T- each the meaning of warning signals

147. E- xercise leadership. R- efer to appropriate agencies.

148. DISASTER TIMELINE AND NURSING ACTION/ RSPONSIBILITIES

149. DISASTER MITIGATION TOOLS

150. DISASTER MITIGATION TOOL 1. Health kit. 2. First Aid Medicine Kit. 3. School Kit. 4. Kit for Kids. 5. Domestic Kit. 6. Sewing Kit. 7. Cleaning & Utensils. 8. Individual Items for Disaster mitigation.

151. HEALTH KIT 1 Hand towel. 2.1 Wash cloth. 3.1.Hair comb. 4.1 Nail clipper. 5.1 Bathing Soap. 6.Tooth brush, tooth paste. 7.Band aids. 8.Cloth line/Tie.

152. FIRST AID MEDICINE KIT Sterile Gauze Pads (4x4) 50 pads. 2. Adhesive tape 6 rolls, ½” or 1x10 yds . 3. Triple antibiotic topical ointment 4 tubes. 4. Ferrous sulphate tab 500 tab -325mg.

153. 5. Children’s MVT with iron chewable tab 500. 6. Adult MVT with iron-500 tabs. 7. Children’s acetaminophen chewable tabs 300. 8. Asprin 325mg tabs.

154. 9. Antacids. 10. Mebebdazole / Thiabendazole . 11. Sulfamethoxazole / Trimethoprim tabs. 12. Tetmosol soap.

155. 13. ORS packs. 14. Promethazine tabs. 15. Metronidazole – intestinal amebiasis . 16.Antifungal cream.

156. 17. Rolled bandages & sterile gauze pads (4x4) 50 pads, adhesive tape rolls-6, ½” or 1”x10 yds or more.

157. SCHOOL KIT 1. Blunt scissors. 2. 2 pads of 8”x11” ruled paper. 3. Ruler 4. Pencil sharpener. 5. 6 unsharpened pencils with eraser. 6. Ereser . 7. Crayons. 8. Cloth bags.

158. KIT FOR KIDS All items should be new. 1. 6 cloth diapers. 2. 2 shirts. 3. 2 baby wash cloths. 4. 2 gowns. 5. 1 sweater. 6. 2 receiving blankets. 7. Bundle the items with receiving blankets & secure it with diaper pins.

159. DOMESTIC KIT BEDDING PACK : 2 flat double bed sheets,2 pillow cases,2 pillows, other necessities (linen-sheets, pillows, towels,blankets )

160. OTHERS Sewing kits, cleaning utensils, cleaning supplies, paper products, personal items.

161. FIELD WORK ELECTRICAL TOOL

162. AFTER THE DISASTER “We need to ensure that we learn from our experiences as well as ensuring the well being and recovery of our community .”

163. Equipment Review Debriefing Review of Plans Documentation Education and Training Research

164. Rehabilitation Restoration Function Safety Assessment Emotional Impact Recovery Process

165. Rally. Group participation for rebuilding efforts . Sensitization process. Community training programmes

166. DISASTER & INDIA

167. TSUNAMI ZONES

168. LAND SLIDE ZONES

169. EARTHQUAKE ZONES

170. FLOOD ZONES

171. WIND & CYCLONE ZONES

172. HIERARCHY 0F DISASTER MANAGEMENT IN INDIA

173. NATIONAL DISASTER MANAGEMENT AUTHORITY HEADED BY PM STATE DISASTER MANAGEMENT AUTHORITY HEADED BY CM DISTRICT DISASTER MANAGEMENT AUTHORITY HEADED BY COLLECTOR BLOCK DISASTER MANAGEMENT COMMITTEE HEADED BY BDO & NGO VILLAGE COMMITTEE FOR DISASTER MANAGEMENT-PANCHAYAT RAJ & COMMITTEE

174. AGENCIES/MINISTRIES & DISASTER MANAGEMENT DISASTER AGENCY MINISTRY Heat wave/Cold wave/Cyclone /Earthquake Indian Meteorological Dept (IMD) Earth Sciences Tsunami Indian National centre for Oceanic Information System (INCOIS) Earth Sciences

175. AGENCIES/MINISTRIES & DISASTER MANAGEMENT DISASTER AGENCY MINISTRY Land Slides Geological Survey of India (GSI) Mines Flood Central Water Commission (CWC) Water Resources

176. AGENCIES/MINISTRIES & DISASTER MANAGEMENT DISASTER AGENCY MINISTRY Avalanches Defence Research & Development Organization (DRDO) Defence

177. LEGISLATION IN INDIA National cyclone mitigation project. National Disaster Response Force. (2005). National Earthquake Risk Mitigation Project.

178. National Executive Committee Act (2005). State Disaster Management Authority. National Policy on Disaster Management (2009).

179. ROLE OF NMDA IN DISASTER PREPAREDNESS Specialist Response Teams. Setting up of Search and Rescue Teams in States.

180. Regional Response Centres . Health Preparedness. Hospital Preparedness and Emergency Health Management in Medical Education.

181. Incident Command System. Emergency Support Function Plans. India Disaster Resource Network. Emergency Operation Centres .

182. National Emergency Operation Centre (Multi mode & Multi channel system, GPRS Etc). National Emergency Communication Network ( polnet , ISRO).

183. Strengthening of Fire Services. Strengthening of Civil Defence . Handling of Hazardous Materials. Special Focus to Northeastern States.

184. OTHER INSTITTIONAL ARRANGEMENT Armed Forces. Central Parliamentary Forces. State Police Force & Fire Services.

185. Civil Defense & Home Guards. State Disaster Response Force. NCC, NSS, NYKS. International Cooperation

186. INTERVENTIONS-NMDA Human Resources Development – organising /sponsoring programmes to enhance the awareness/skill of Government functionaries at Central, State and district level as well as NGOs, CBOs, Panchayat leaders for successful implementation of disaster reduction programmes .

187. Research and Consultancy Services. Documentation of major events of Natural Calamities. Vulnerability assessment projects.

188. Establishment of National Centre of Disaster Management. Creation of natural disaster management faculties in the State Level Training Institutes.

189. Public Education and community awareness programmes . Regional cooperation.

190. DISASTER WARNING SYSTEM IN INDIA Early Warning System : Cyclone Forecasting Indian Meteorological Department (IMD) is mandated to monitor and give warning.

191. Warnings regarding Tropical Cyclone (TC). Monitoring process has been. Revolutionized by the advent of remote sensing techniques

192. FLOOD FORCASTING The Flood Forecasting involves the following four main activities :- ( i ) Observation and collection of hydrological and hydro-meteorological data;

193. ( ii) Transmission of Data to Forecasting Centres . (iii) Analysis of data and formulation of forecast; and. (iv) Dissemination of forecast.

194. BEFORE FLOOD Avoid building in a flood prone area unless you elevate and reinforce your home. Elevate the furnace, water heater, and electric panel if susceptible to flooding.

195. Install "check valves" in sewer traps to prevent floodwater from backing up into the drains of your home. Contact community officials to find out if they are planning to construct barriers. (levees, beams, floodwalls) to stop floodwater from entering the homes in your area.

196. Seal the walls in your basement with waterproofing compounds to avoid seepage

197. DURING A FLOOD Listen to the radio or television for information. Be aware that flash flooding can occur. If there is any possibility of a flash flood, move immediately to higher ground. Do not wait for instructions to move.

198. Be aware of streams, drainage channels, canyons, and other areas known to flood suddenly. Flash floods can occur in these areas with or without such typical warnings as rain, cloud or heavy rain.

199. OTHER INTERVENTIONS Pl refer do’s & don’ts in Disaster.

200. DISASTER’ alphabetically means: D - Destructions I - Incidents S - Sufferings A - Administrative, Financial Failures. S - Sentiments T - Tragedies E - Eruption of Communicable diseases. R - Research programme and its implementation

201. THANK YOU Tsunami warning