Disaster management

Disaster management Community health

1. PRESENTED BY,
MR. KAILASH NAGAR
ASSIST. PROF.
DEPT. OF COMMUNITY HEALTH NSG.
DINSHA PATEL COLLEGE OF NURSING, NADIAD

2. WHO defines Disaster
•"anyoccurrence,thatcausesdamage,ecologicaldisruption,
lossofhumanlife,deteriorationofhealthandhealth
services,onascalesufficienttowarrantanextraordinary
responsefromoutsidetheaffectedcommunityorarea“
Disaster in hospital
“Arrivalwithlittleornowarningofalargenoofcausalitiesthan
thehospitalisusedtohandle

3. Other definitions
•¨Adisasterisanoverwhelmingecologicaldisruption
occurringonascalesufficienttorequireoutside
assistance
•Adisasterisaneventlocatedintimeandspace
whichproducesconditionswherebythecontinuity
ofstructureandprocessofsocialunitsbecomes
problematic
•¨Itisaneventorseriesofeventswhichseriously
disruptsnormalactivities

4. Some premises
•Deathsandillnessescausedbydisastersare
preventablehealthrisks
•Disastermanagementistheresponsibilityof
everyinstitution
•TheHealthSectorhasakeyroletoplay,
althoughitisnottheleadsector

5. Responsibilities of the Health Sector
•Reduce Deaths, Disability & Diseases
•Reducethevulnerabilityofitsown
infrastructure:HospitalMitigation
•Raiseawarenessonhealthimpactsof
disasters
–healthstaff,alliedpersonnel&community
•Increasepreparednessofthehealthstaff
andthecommunity

6. Role of hospital
•Hospitals have multiple missions:• patient
care,• clinical education,• clinical research,
and• community service.
•Two of these missions come together when a
community prepares for and faces an
emergency or disaster: patient care and
community service

7. Classification
Natural
•Cyclone,
•Fires
•Hurricanes Cyclone,(Sea)
•Floods / Sea Surges /
Tsunamis
•Snow storms,
•Earthquakes,
•Landslides,
•Lava
Man Made
•Toxicological accidents
(e.g. release of hazardous
substances),
•Nuclear accidents,
•Explosions
•Civil disturbances,
•Water contamination
•Existing or anticipated
food shortages.

8. CRISIS NODAL MINISTRY
Natural disaster (except drought) and
Civil Strife
Ministry of Home Affairs
Drought Min. of Agriculture
Biological Disaster Ministry of Health
Chemical Disaster Ministry of Environment
Nuclear accidents and leakages Dept. Of Atomic Energy
Railway accidents Ministry of Railways
Air accidents Ministry of Civil Aviation

9. EFFECTS OF MAJOR
DISASTERS
•Deaths
•Severeinjuries,requiringextensivetreatments
•Increasedriskofcommunicablediseases
•Damagetothehealthfacilities
•Damagetothewatersystems
•Foodshortage
•Populationmovements

10. Health problems common to all Disasters
•Social reactions
•Communicable diseases
•Population displacement
•Climatic exposure
•Food and nutrition
•Water supply and sanitation
•Mental health
•Damage to health infrastructure

11. Top Natural Disasters by Lives Lost, 1945-1990*
Year Location Type # of Deaths
1970 BangladeshTropical cyclone 300,00
1976 China Earthquake 242,000
1991 BangladeshTropical cyclone 132,000
1948 Soviet Union Earthquake 110,000
1970 Peru Earthquake 67,000
1949 China Flood 57,000
1990 Iran Earthquake 40,000
1965 BangladeshTropical cyclone 36,000
1954 China Flood 30,00
1965 BangladeshTropical cyclone 30,000
]1968 Iran Earthquake 30,000
1971 India Tropical cyclone 30,000
* Based on estimated number of fatalities.
•Source: Cutter, Susan. 1996. Societal vulnerability to environmental hazards. International Social Science Journal 48,4: 525.
Oxford, UK: Blackwell Publishers. © 1996 United Nations Educational, Scientific, and Cultural Organization (UNESCO).
Reprinted by permission of Blackwell Publishers.

12. Top Natural Disasters by Economic Losses,
1985-1995
Year Location Event Losses (US$bn)
1995 Kobe, JapanGreat Hanshin Earthquake 50.0
1992 Florida, USA Hurricane Andrew 30.0
1994 California, USA Northridge Earthquake30.0
1993 Midwest, USA Mississippi Floods 12.01989
Caribbean, USA Hurricane Hugo 9.0
1990 Europe Winter storm Daria 6.8
1989 California, USA Loma Prieta Earthquake6.0
1991 Japan Typhoon Mireille 6.0
1993 Northeast, USA Blizzard 5.0
1987 Western Europe Winter gale 3.7
1990 Europe Winter storm Vivian 3.25
1992 Hawaii Hurricane Iniki 3.0
1995 Florida, USAHurricane Opal 2.8
1990 Europe Winter storm Wiebke2.25
1991 USA Forest Fire 2.0
Europe Winter storm Herta1.91991

13. India’s Disaster Ridden History
•About60%ofIndia’slandmassispronetoEarthQuakes
•Over40millionHectaresarepronetoFloods
•Nearly3lakhsq.kmareatriskofCyclones
•TheEarthquakeinBhujkilled14,000people
•CycloneinOrissatookaway10,000lives.
•Between1990and2000anaverageofabout3400
peoplelosttheirlivesannually.
•About3crorepeoplewereaffectedbyDisastersevery
year.
•About17,000peopleperishedbytheTsunamion26
Dec.04

15. ThefundamentalaspectsofDisaster
ManagementProgram
•Disaster Prevention
•Disaster preparedness
•Disaster response
•Disaster mitigation
•Rehabilitation
•Reconstruction

16. First responder to health impacts:
THE COMMUNITY
•AwarenessandCapacityofthecommunityiscritical
forEffectiveResponse
•AWARENESSONHEALTHIMPACTSANDTHEIRHANDLING
•FIRSTAIDTRAINING
•WATERDISINFECTION
•HYGIENE&SANITATION
•ENSURINGADEQUATENUTRITION
–OfChildren,Pregnant&Lactatingwomen,ChronicallyIll,Elderly
•PSYCHO-SOCIALCOUNSELLING

17. Mass Casualty Management
Triage
Hospitalization
•Triage
•Definitive
Treatment
Disaster Area Transportation

18. BEYOND COMMUNITY RESPONSE:
Mass Casualty Management
•TRIAGE AT SITE
•TRANSPORT TO HOSPITAL
•TREATMENT AT HOSPITAL

19. Mass Casualty Management
Is a multi sectoral effort
POLICE
•Security -At disaster site & At hospital
•Traffic Control
•Crowd Control
•Incident Investigation
FIRE SERVICE
•Search and Rescue
•Fire Control
•Hazardous material Control
AMBULANCE SERVICE
•First responder
•Transportation of Victims to the Health Care
Facility
HOSPITAL & EMERGENCY DEPARTMENT

20. TRIAGE
“Goal is to do the greatest good for the
greatest number of people”

21. Triage
Principles of Triage
•“Dynamic Process”
•Establishing priorities for treatment /
evacuation
•Determines the future of the victim being
triaged and other victims
•Must be as unemotionalas possible

22. TRIAGE CATEGORIES
Patient StatusSTART
Military /
International
Color
Code
Priority
Immediate
Critical /
Immedi
ate
Immediate Red 1
Delayed Minor Delayed Yellow 2
Hold
Urgent /
Delayed
Minimal Green 3
Deceased
Dead /
Dying
Expectant Black 4
Contaminated
(NBC Hazard)

23. MCM: Transport / Evacuation
•Strict control of the evacuation rate
•Victim must be in the most stable condition possible
before moving
•Victim must be adequately equipped for the transfer
•Receiving facility must be informed and prepared for
transfer
•The best possible vehicle must be used
Principles:

24. Disaster Management in Health
Sector is bigger than MCM
Mitigation & Risk reduction of facilities,
Health Care in Relief & Recovery Phases
Disease Surveillance & Control,
Water & Sanitation,
Environment,
Vector control
Nutritional Security of special groups,
Mental Health,
Resources & Logistics
Training & Capacity building
Inter-sectoral coordination,
Damage and Needs Assessment
Mass
Casualty
Management

25. Water
Food
Personal Hygiene
Surveillance
Toxicology
Vector Control
Hazard protection
Temporary
Settlement
Garbage disposal
Environmental
Health
Includes…
Sanitation

26. RESPONSE TO DISASTERS [EVENTS]
RESCUE AND IMMEDIATE RELIEF (One to three Months)
•Rescue
•Food
•Water Shelter Predominantly
External Agents
•Clothing
•Emergency Medical Aid Welfare
•Communication
•Census

27. SHORT-TERM REHAB (One to two years)
•Health
–Continuing Medical Aid
–Environmental Sanitation/ Safe Drinking Water
•Economic
–Food / Money for Work
•Re-Establish Local Industry
•Social
–Find missing persons
–Start Comm. Organization
•Shelter / Bunds / Schools / Religious
•Institutions.
Community
INVOLVEMENT
External Agencies
+Community

28. LONG-TERM REHAB (Two years beyond)
•COMMUNITY ORGANISATION
For Social / Economic / Health
•Development
•Preparing to face next disaster
PLANNING SHOULD IDEALLY AIM AT SELF-SUFFICIENCY OF COMMUNITY IN TACKLING
DISASTERS FROM PHASE-I ITSELF
Predominantly
community
Community
participation

29. Risk of Communicable Disease
•Supplyofdrinkingwaterisseverelyaffected
•Foodcontaminationmaytakeplace
•Overcrowdingandpoorsanitationinshelters
Theemphasisofresponsemustbeoneffectivenessofroutine
measuresratherthanonadoptionofhighvisibilitynew
measures:
•chlorinatingwater,foodprotection,latrinesandhygienemay
havesavedmorelivesthanemergencysurgeryinthe
aftermathofearthquakes
•Improvisedmassimmunizationsarecounterproductive

30. DISASTER MITIGATION IN THE HEALTH
SECTOR
•Identify areas exposed to natural hazards
•Coordinate the work of multidisciplinary
teams
•Identify the priority hospitals and critical
health facilities
•Inform, sensitize, and train those personnel
•inclusion of disaster mitigation in the
curricula

31. Disaster Mitigation in Hospitals
•Vulnerability analysis
•Improved design of new facilities
•Retrofitting existing facilities
•Norms, guidelines, and training

32. COMPONENTS OF DISASTER MITIGATION IN
HOSPITALS
•Structural Elements-building load bearing
components, such as beams, supporting columns, walls
•Non Structural elements–
architectural elements
life line systems –water, power, communication
the building contents –medicine, supplies,
equipment, furnishings
•Functional elements–
physical design, maintenance, administration,
operational aspects, plans, performance,
simulation exercises

33. Disaster preparedness
The objective is to:
•Ensure that appropriate systems are in place to provide
prompt and effective assistance to disaster victims.
•Prepare the community to handle the disaster in the first 48
hours or so when outside help has not reached and the local
administration is itself affected by the disaster.

34. Health Sector Contingency Planning
•Preparedness, Response, Mitigation
•Emphasis on Planning, Coordination and Advocacy
•Training & Capacity building is key
•Covering all types of disasters –natural & manmade
•Addressing issues at various levels
–Village, Panchayat, Block, District, State, Country
•In collaboration with the entire gamut of health providers
–Government, PSU, Voluntary, Private, Professional Assoc.
•Involving agencies like Civil Defense, Red Cross, St. John
Ambulance
•In coordination with other line departments
–ICDS, RWSS/PHE
•Integrated with overall Disaster Management Plan

35. MYTHS AND REALITIES OF NATURAL DISASTERS
•Myth:Foreignmedicalvolunteerswithanykindof
medicalbackgroundareneeded.
•Reality:Thelocalpopulationalmostalwayscovers
immediatelifesavingneeds.
•Myth:Epidemicsandplaguesareinevitableafter
everydisaster.
•Reality:Epidemicsdonotspontaneouslyoccurafter
adisaster

36. •Myth: The affected population is too shocked and
helpless
•Reality: many find new strength during an
emergency,
•Myth: Locating disaster victims in temporary
settlements is the best alternative.
•Reality: It should be the last alternative.
•Myth: Things are back to normal within a few
weeks.
•Reality: The effects of a disaster last a long time.

37. References
•NaturalDisasters,ProtectingthePublic’sHealth-Pan
AmericanHealthOrganization
•EstablishingaMassCasualtyManagementSystem-
PanAmericanHealthOrganization
•ResourcematerialfromtheFirstInternationalTraining
courseon“DisastersandDevelopment”organisedby
theAsianDisasterPreparednessCenterBangkok,
Thailand
•Publichealthactioninemergenciescausedby
epidemics-WHO