Disaster management

Disaster Management

1. Disaster management
By
Dr Utpal Sharma
Assistant Professor
Department of Community Medicine
SMIMS, Gangtok, Sikkim

2. Introduction
What is a disaster?
The dictionary meaning is calamity or
sudden or great misfortune.
It is a catastrophe causing injury or
illness simultaneously to atleast 30
people who will require
hospitalization and emergency
treatment.
Colin Grant-1973

3. Cont…
Defined as “Any occurrence that causes damage, ecological
disruption, loss of human life or deterioration of health and
health services…..
….. on a scale sufficient to warrant an
extraordinary response from outside the affected community
or area.”
WHO
“Disaster needs to be declared when immediate patient load
in the emergency medical services system is greater than
normal operators can care for.”
A N Jenkins (1975)

4. Cont……
Disaster not confined to a particular part of the world
Many types of disasters, each event having its own special
features. E.g cyclones & floods could be predicted
beforehand but calamities like earthquakes occurs without
warning.
Relative number of injuries and deaths differs and depends
on factors such as:
Type of disaster
Density and distribution of the population
Condition of the environment
Degree of preparedness and opportunity of the warning

5. Cont…
Type of emergency varies with the kind of disaster and
how and when it strikes. Eg earthquakes more fatal at
the nightime, sudden floods tolls for more damages.
Morbidities in a disaster situation classified as:
Injuries
Emotional stress
Epidemic of diseases
Increase in indigenous diseases

6. Associated terms
Risk:
Risk is a measure of the expected losses due to a hazardous event .
The level of risk depends on:
Nature of the Hazard
Vulnerability of the elements which are affected
Economic value of those elements
Vulnerability:
Predisposition of a community, structure, service, and/or geographic
area to damage on account of their nature, construction and proximity
to hazardous terrain or a disaster prone area”
Hazards:
“Phenomena that pose a threat to people, structures, or economic
assets and which may cause a disaster.

7. Emergency and Disaster….
Emergency
A situation in which the
community is capableof
coping.
Generated by the real or
imminent occurrence of
an event that requires
immediate attention.
Requires immediate
attention of emergency
resources.
Disaster
A situation in which the
community is incapable
of coping.
Natural or man-made
events causing intense
negative impacts on
goods, services and/or
the environment,
Assistance of government
and international
agencies is mandate.

8. Classification of Disasters
1. Natural Disasters
(a) Phenomena beneath earth’s surface
(i) Earthquake
(ii) Volcanic eruptions
(iii) Tsunamis
(b) Phenomena at earth’s surface
(i) Landslides
(ii) Avalanches

9. Cont…
( c ) Meteorological / Hydrological Phenomena
(i) Windstorms ( Cyclones, Hurricanes )
(ii) Tornadoes
(iii) Hailstorms, snowstorms
(iv) Sea surges
(v) Floods, dam bursts
(vi) Droughts
( d ) Biological Phenomena
(i) Locust swarms
(ii) Epidemics of diseases

10. Cont…
2. Man Made Disasters
(a) Caused by Warfare
( i) Conventional Warfare
( ii ) Nuclear, Biological & Chemical Warfare
(iii) Terrorism (includes Bioterrorism)
( b ) Accidents
( i) Vehicular ( All types of transportation)
( ii ) Conflagrations, explosions, fires, building collapses.
( iii ) Deliberate explosive attacks
( iv ) Toxic gas leaks, chemical/poisoning
(v) Insidious disasters
(c) Others
Green house effect

11. Disaster management
Disaster managementis the managerial function charged
with creating the framework within which communities reduce
vulnerability to hazards and cope with disasters.
Does not avert or eliminate the threats, instead focuses on
creating plans to decrease the impact of disasters
There are three fundamental aspect of Disaster Management
Response
Preparedness
Mitigation

12. Disaster cycle

13. Management sequence of a sudden-onset
disaster
Response
Reconstruction
Mitigation
Preparedness Disaster
impact
Recovery phase after a disaster
Risk reduction phase before a disaster

14. Cont….

15. Disaster Response
Response measures are usually those which are taken
immediately prior to and following disaster impact.
Most injuries during impact; so greatest need of emergency
care during first few hours
Typical measures include :
Search, Rescue and First aid
Immediately after a disaster organized relief services
unable to cater to the need of victim owing to the great
numbers.
Mostly help comes from the existing survivors

16. Search and Rescue
•Most immediate help comes from uninjured
survivors
•To reduce the demand of organized relief
services
•Identification of local & specific agencies
(govt. or non govt. organizations)
Uninjured survivors helping the injured people

17. Cont….
Evacuation measures
Field care
All health care resources to be directed towards the new priority
Bed availability and surgical services to be maximized
Provision for food and shelter
Separate centre for dealing with enquiries by relatives
(grievance cell)
Priority to victim’s identification
and enough space in mortuary

18. Cont…..
Triage
Rapid classification of injured on the basis of severity of
injuries and chances of survival.
High priority given to those having better prognosis by
simple intensive care
Moribund victims requiring great deal of attention and
questionable prognosis given lowest priority
Red-High priority t/t or transfer
Yellow-Medium priority
Green-Ambulatory patients
Black-Dead/ moribund patients

19. Cont…
Tagging
Victims to tagged with particulars like name, age, place
of origin, triage category, diagnosis and initial t/t
Taking care of the dead
Redressal mechanism to receive bereaved relatives
Removal of the dead bodies
Shifting to the mortuary
Mass cremation

20. Relief phase
The disaster-stricken areas are assisted from outside in
returning to their proper level of functioning following
the event.
Type and quantity of relief supplies is determined by:
Type of disaster
Resources available
In initial phase most important of these
supplies are:
Health supplies to treat causalities
Resources to prevent
communicable diseases

21. Cont…
Following these, other commodities viz. food , blankets ,
shelter, sanitary engineering etc comes second.
Damage assessment to be carried out figure out the
needs and resources available
For managing the relief supplies principle components
are:
Acquisition of the supplies
Transportation of these supplies
Storage of supplied materials
Distribution

22. A relief camp

23. Planning of Relief
Management of medical Supply
Assessment of immediate health needs
Care and Shelter(Relief camps)
Environmental management
Food safety
Clothings& Utensils
Disposal of dead
Water supply
Basic Sanitation
Personal Hygiene
Vector control

24. Planning of relief

25. Epidemiologic surveillance and disease control
Increase of communicable diseases during disaster by:
Overcrowding and poor sanitation in temporary
settlements.
Migration during emergency may introduce diseases to
new areas either by man or by animals.
Disruption and damage to the water supply, sewerage
and power systems
Diversion to relief work-disruption of routine control
programmes

26. Cont….
Favorable ecology for breeding of vectors during
disasters
Source of provision of food, water and shelter may
itself be a source of infection
To combat communicable disease in emergency:
Implementation of all public health measures
Reliable disease reporting system to identify
outbreaks and prompt control measures
Investigate all reports of disease outbreak

27. Surveillance and control..

28. Vaccination
WHO doesn’t recommend typhoid and cholera
vaccines use in routine care during disasters
Compliance poor owing to multi-dosing
Large number of workers engaged who
otherwise could be utilized elsewhere.
Supervision of sterilization & injection
technique impossible.
Mass vaccination may induce a false sense of
security .

29. Cont….
Vaccination against tetanus considered prudent if RI
conducted in the camps.
Disasters causes disruption of ongoing eradication
programmes like polio and measles
Cold-chain facilities to be procured
Vaccination however is necessary for the health
workers
Best protection is maintenance of high level
immunity in general population by RI before the
disaster.

30. Vaccination during disaster

31. Nutrition
Disasters affects nutrition depending on type,
duration, extend of disaster and preexisting
nutritional condition.
Infants, pregnant, lactating mothers, & sick more
vulnerable.

32. Cont….
Effective food relief programmes includes:
Assessing of food supplies after disaster
Estimating the nutritional need of affected
population
Calculating daily food rations and need for large
population group.
Monitoring the nutritional status of the affected
population

33. Food supplies in a disaster

34. Energy Requirements for
Disaster Situation*
Broad Groups Age Male (kcal) Female (kcal) Combined (kcal)
Under 5s 0–4 1320 1250 1290
Children 5–9 1980 1730 1860
Adolescents 10–14 2370 2040 2210
Adolescents 15–19 2700 2120 2420
Adults 20–59 2460 1990 2230
Elderly > 60 2010 1780 1890
Preg/Lact 285/500
(extra)
285/500(extra)
Whole pop 2250 1910 2080 (2100)
*The Managementof nutrition in major emergencies. Geneva, World Health Organization, 2000

35. Rehabilitation
Services to be restructured & reorganized as health
needs changes from causality M/M to routine primary
health care with time.
Priorities shifts from health care to environmental
measures
Water supply
First priority of ensuring water quality in emergency is
chlorination (residual chlorine about 0.2-0.5 mg/lit).
Water quality and potential contaminants have to be
identified and analyzed.

36. Water supply cont…..
Existing & new sources require protection like:
Restricted access to people and animals
Adequate excreta disposal at a safe distance
Prohibit washing, bathing & animal husbandry
upstream
Upgrade wells so as protected from contamination
Estimate maximum yield of wells and ration water
if necessary

37. Water Supply in disaster
During evacuation
–3 liters/person/day in cold & temperate climates
–6 liters/person/day in hot climates
During relief operations
–40-60 liters/person in field hospitals
–20-30 liters/person in mass feeding centers
–15-20 liters/person in temporary shelters & camps

38. Disinfection of water
Chlorine tablets (Halazone)
One tablet (4mg) for 1 litre of water
Granular calcium hypochlorite
One teaspoon (7gm) for 8 liters of water to make stock
solution
One part of solution to be added to 100 parts of water
Allow to stand for 30 minutes
Sodium hypochlorite bleach
10 drops for 1 litre of water

39. Disinfection cont….
Iodine tablets
One tablet for I litre of water
Iodine Solutions
Five drops of tincture iodine for 1 liter of water
Potassium permanganate
Dissolve 40 mg of KMnO
4in 1 liter of warm water
It will disinfect 1 cubic meter of water after 24 hrs of
contact time

40. Disinfection of water
Chlorine tablets
Iodine SolutionsIodine tablets
Sodium hypochlorite
bleach
Granular calcium
hypochlorite
Potassium permanganate

41. Cont…….
Food safety
Every precaution taken to prevent food borne
diseases.
Personal hygiene to be monitored and maintained in
people involved in food preparation
Basic sanitation and personal hygiene
Ensure safe disposal of excreta.
Emergency latrines facilities to set in the camps
Washing, cleaning & bathing facilities to be provided

42. Food safety and hygiene in relief camps

43. Cont…
Vector control
Intensification of vector-borne disease control
programmes during crisis situation
Special concerns for diseases like malaria,
dengue leptospirosis , plague etc.

44. Disaster mitigation
This involves measures designed for lessening the likely
effects of emergencies.
Includes appropriate land-use planning, flood mitigation
works, improved building codes…..
……. improving structural qualities
of schools, houses and such other buildings so that medical
causalities can be minimized.
Ensuringthesafetyofhealthfacilitiesandpublichealth
servicesincluding…..
……….watersupplyandseweragesystemtoreduce
thecostofrehabilitationandreconstruction.
Mitigationcomplimentsthedisasterpreparednessand
disasterresponseactivities.

45. Disaster preparedness
Long term development activities with goals to
strengthen…….
…… capacity and capability of a country to
manage all types of emergencies
Should bring about an orderly transition from relief
through recovery and back to sustained development.
Objective is to ensure that systems, procedures and
resources are in place to provide prompt assistance.
It is an ongoing multi-sectoral activity
Evaluate the risk of the country/region to disaster
Adopt standards and regulations

46. Activities cont….
Organize communication , information and warning
systems
Ensure coordination and response mechanisms
Ensure that resources are available and can be easily
mobilized in disaster for improved preparedness
Develop public education programmes
Coordinate information sessions with news media
Organize disaster stimulation exercises that test
response mechanisms.

47. Cont…
Reasons for preparedness at local level
Effective and appropriate preparedness programmes
can avert considerable losses
First response is from within the community, as
disruption of transport system may defer external help
Resources easily pooled at the local level
Sustained development best achieved when
communities design the assistance programme
themselves

48. Photographs of GEMEx 2012

49. Policy development
The formal statement for course of action
Policy follows the strategies:
a)Establish long term goals
b)Assign responsibilities for achieving goals
c)Establish recommended work practices
d)Determine criteria for decision making
Policies tends to be “top-down” ……
…….implementation of strategies arising from
policy tend to be “ bottom-up”.

50. Cont…
Six sectors required for response and
recovery strategies
–Communication
–Health
–Social welfare
–Police & security
–Search & rescue
–Transport

51. India’s Vulnerability to Disasters
57% land is vulnerable to earthquakes. Of these,
12% is vulnerable to severe earthquakes.
68% land is vulnerable to drought.
12% land is vulnerable to floods.
8% land is vulnerable to cyclones.
Apart from natural disasters, some cities in India are
also vulnerable to chemical and industrial disasters
and man-made disasters.

52. Triangle of life

53. Thank you