Disaster management in hospital ppt

by- Dr.Diksha Tewari (MHA)

1. DISASTER MANAGEMENT IN HOSPITAL By- Dr.Diksha Tewari (MHA Trainee) “Are we never to educate ourselves to foresee such dangers and to prevent them before they happen? Hospita l- MGM Hospital, Kamothe, Navi Mumbai

2. SESSION 1 Introduction Definition of disaster Definition of management Definition of disaster management Phases of disaster management Disaster action plan Disaster management plan Disaster management act, 2005 Hospital disaster plan & committee Care at the site Internal disaster plan External disaster plan Different disaster zone Types of disaster Disaster management planning

3. INTRODUCTION Disaster Management refers to how we can protect or preserve maximum number of lives and property during a natural disaster . About 59% of the landmass is prone to earthquakes of various intensities; over 40 million hectares is prone to floods; about 8% of the total area is prone to cyclones and 69% of the area is susceptible to drought. In the decade 1990-2000, an average of about 4344 people lost their lives and about 30 million people were affected by disasters every year.

4. What is disaster? A disaster is a sudden, calamitous event that seriously disrupts the functioning of a community or society and causes human, material, and economic or environmental losses that exceed the community’s or society’s ability to cope using its own resources. Though often caused by nature, disasters can have human origins . (VULNERABILITY +  HAZARD  ) /   CAPACITY     =  DISASTER     

5. What is management? Management is a set of principles relating to the functions of planning, organizing, directing and controlling, A nd the application of these principles in harnessing physical, financial, human and informational resources efficiently and effectively to achieve organizational goals.

6. What is disaster management? Disaster Management  can be defined as the organization and management of resources and responsibilities for dealing with all humanitarian aspects of emergencies, in particular preparedness, response and  recovey  in order to lessen the impact of disasters.

7. PLANNING A. PREDICT Measures for efficient forecasting and warning systems Developing GIS for early detection and warning Information Technology for effective communication network. Pro-active measures for disaster preparedness and mitigation – administrative, financial, Legislative &techno- legal Developing public awareness to build up society’s strength to face disasters . National networking for immediate medical response Emphasis on risk reduction, mitigation & awareness, while strengthening response.

8. CONT.. B. PREVENT- Evoke existing system of response mechanism in the wake of natural and man-made disasters at all levels of government and steps to minimize the response time through effective communication & measures to ensure adequacy of relief operations. Develop strategies for inclusion of disaster reduction components in the on-going plan/ non – plan schemes . Prepare the community to face the challenge and respond in case of impending disaster. Lay stress on preparedness including prevention/ mitigation of Chemical Industrial Disasters while strengthening their emergency response. Stay up to date with the latest international best practices and recent developments within the country. Highlight the salient gaps evaluated based upon the critical review of the present status for future action.

9. PREPARE

10. DISASTER ACTION PLAN It is planned and systematic approach towards understanding and solving the disaster to minimize the effect. The approach should be multi sectoral . Plan should be realistic and easily adoptable Plan should be clearly laid down defining the role and responsibility of different agencies . Should be exercised in between to evaluate it . It should be prepared at the country, state, district and institutional level. National disaster management authority(NDMA) facilitate state with support and advice while plan and implementation by SDMA

11. Disaster Management Plan On 1 June 2016, Pranab Mukherjee, the Ex President of India, launched the Disaster Management Plan of India, which seeks to provide help and direction to government agencies for prevention, mitigation and management of disasters. This is the first plan nationally since the enactment of the Disaster Management Act of 2005 .

12. The Disaster Management Act, 2005 The Disaster Management Act was passed by the Lok Sabha on 28 November 2005, B y the Rajya Sabha on 12 December 2005. It received the assent of the President of India on 9 January 2006. The Act calls for the establishment of a National Disaster Management Authority (NDMA), with the Prime Minister of India as chairperson. The NDMA is responsible for "laying down the policies, plans and guidelines for disaster management" and to ensure very timely and effective response to disaster". Under section 6 of the Act it is responsible for laying "down guidelines to be followed by the State Authorities in drawing up the country Plans".

13. HOSPITAL DISASTER PLAN Hospital Disaster plan is prepared to reduce the pressure on the hospital management when a large number of casualties arriving suddenly in the hospital at a time , requiring different level of care. The plan should be activated immediately to provide efficient care to the patients within a short span of time. Mock drill to be conducted periodically to acquaint the staff to meet any eventuality. The action plan begins with formation of Disaster committee Keeping adequate storage of supplies in the emergency department. Keeping disaster SOP in the casualty.

14. Hospital Disaster A ction Plan

15. Hospital Disaster Committee

16. CARE AT THE SITE Do not allow Golden hour to expire,1st hour It is best if services can be provided in first 10 minutes (Platinum minute) BLS ABC= Air way. Breathing. Circulation ALS DEF= Defibrillator. ET intubation, ECG . Fluid & electrolyte Constitute the field team: 1.Ambulance 2.Anesthetist (To be identified and roaster made on daily) 3.OT Tech (Weekly and monthly basis). 4.Bearers 5.Drivers Dispatch the team to site Assess the situation in the site. Render first aid at the site and during transport Stabilize the serious cases. Transport serious cases to the hospital under direct supervision.

17. INTERNAL DISASTER PLAN It is activated when the hospital buildings are effected in disaster . Action plan should clearly mention: Alternate site (dharmashala , Temple, Schools, Playground nearby) Folding tents, cots, trolleys for temporary shelters Identify a nearby tent house to provide beds, blankets TPT for transportation of cases to alternate sites or hospital First aid and drug kits, potable lights. Portable communication system . Identify local voluntary organization, who can provide services of care , food and water.

18. Steps to follow during internal disaster: Step 1: - Press the disaster alarm from the source (anybody present in the source can press the alarm). Step 2: - Information should be passed through phone to the disaster management commanding centre by any staff from the concerned department. - Announce the particular emergency code by any staff from the concerned department (E.g.. Code RED in case of fire, Code ORANGE in case of disaster etc.) Step 3: - Turn off the lift (done by lift operator) The nursing personals should; - Evacuate the patients or personnel form the source. - Open the fire exit and direct the patients to use it. - Shift the bed ridden patients to nearby safe zone. - Sequence of evacuation should be- a) Patients in immediate danger b) Ambulatory patients c) Semi-ambulatory patients d) Non-Ambulatory patients. Step 4: - In case of fire, depending upon the nature, extinguisher should be applied by the staffs available there. - Hospital security teams should control the crowd throughout the evacuation process. Police and fire force should be informed by the security officer. - Turn off the power supply to the source if needed. Step 5: - Hospital management is responsible for passing the messages to press and media. - Once all the patients have been evacuated, all the staffs should leave the source. - Further extinguishing work should be carried out by fire force. - When situation is under control announce Code GREEN .

19. EXTERNAL DISASTER PLAN ( TEN STEPS)=> DISASTER RESPONSE PUBLIC RELATION AUTHENTICATE TRAFFIC CONTROL SOURCE PERSONAL ACTIVATION OF PROTECTION DISASTER PLAN CHEMICAL CREATION OF DECONTAMINATION ADDITIONAL SPACE AUGMENTATION OF SERVICES MAINTENANCE OF RECORD

20. Media Command center ambulance Triage First aid Evacuation team No entry Disaster Zone Public passage Wind direction

21. TYPES OF DISASTER

22. DISASTER TYPES :

23. A good state of preparedness may reduce its impact. However developed a country/State outside help beyond a district in the initial brief period will be very difficult. In the initial phase the involvement of the community is paramount in reducing the impact. Disaster awareness of the community can save the lives and reduce the impact. Forecasting and operation of the warning systems, and timely communication. IMPORTANCE OF DISASTER PREPAREDNESS

24. NEWS HEADLINES

25. RECENT HOSPITAL DISASTERS CASES IN INDIA On October 2018, a fire broke out in the dispensary of the state-run  Calcutta Medical College and Hospital . On October 2016, a major  fire broke at Bhubaneswar's Sum Hospital  which claimed 22 lives.  West Bengal's Murshidabad Medical College Hospital Fire On October 2016,two persons died and seven others were injured in the incident.  Cuttack's Shishu Bhawan Hospital Fire On November 2015. Erwadi Village Mental Home fire, Tamil Nadu on August 6. BM Hospital, Bikaner on January 2013. Kolkata's AMRI Hospital Fire, 90 of them patients, had died of asphyxiation

26. FAMOUS DISASTERS CASES IN INDIA 1999 Odisha Cyclone 2001 Gujarat Earthquake 2002 Indian Heat Wave 2004 Indian Ocean Tsunami 2007 Bihar Flood 2005 Mumbai Catastrophes 2010 Eastern Indian Storm 2013 Maharashtra Drought 2013 Uttarakhand Flash Floods 2014 Andaman boat disaster 2014 Beas River Tragedy 2014 Chennai building collapse 2014 GAIL pipeline explosion 2014 Hirakud boat disaster 2014 Malin landslide 2014 Patna stampede 2019 Karnataka Floods  2019 Cyclonic Storm Fani  2019Kerala Floods 2019 Bihar Floods 2019 Bihar Heat Wave

27. WE ARE GOING TO STUDY ABOUT FOLLOWING TYPES OF DISASTER Accidents Earthquake Flood Chemical spills Fire

28. SESSION 2 FIRE SAFETY

29. WHAT IS FIRE? fire [ˈfi(-ə)r ] noun fire is a rapid oxidation process that creates light, heat, and smoke, and varies in intensity. it is commonly used to describe either a fuel in a state of combustion (e.g., a campfire, or a lit fireplace or stove) or a violent, destructive and uncontrolled burning (e.g., in buildings ) The common term given to the combustion reaction which results from interaction of HEAT + FUEL + OXYGEN. This combination is called ‘Triangle of Fire ’. Fuels involved can be in three states: SOLID, LIQUID, GAS. HEAT, SMOKE, LIGHT, GASES are by-products of the reaction.

30. FIRE TRIANGLE

31. TIMELINES OF A FIRE

32. TYPES OF FIRE

33. STAGES OF FIRES

34. Every effort should be made to include evacuation considerations when designing or retrofitting hospital facilities. Full evacuation of a hospital should generally be considered as a last resort when mitigation or other emergency response efforts are not expected to maintain a safe care environment. Simplicity is key; the staff will need a simple plan to follow in an emergency. Self-sufficiency at the unit level is important because timely communication from hospital leaders may be difficult or even impossible; employees at every level must know immediately what to do in their area. It may be necessary to evacuate patients to holding sites before transportation resources and/or receiving destinations are available. If the medical facility cannot accommodate a horizontal safe site (a location on the same floor safe from danger), then assembly points located away from the main clinical areas should be identified and designated . KEY PRINCIPLES WILL HELP STAFF MEMBERS MAKE GOOD DECISIONS DURING A CHAOTIC EVENT .

35. Flexibility is vital because the procedures must be adaptable to a variety of situations. Safety is always the primary concern. Individual patient care units should stay together at the assembly points whenever possible (instead of the patients in these units being divided into separate groups according to their ambulatory status). This is because the unit teams familiar with their patients will be better able to manage them in a chaotic situation away from the care unit. Emergency medical system (EMS) personnel and other external patient transporters should generally not be asked to come into the hospital to load patients because of the risks, time delays, and inefficiency associated with this process when large numbers of patients are involved. Instead, evacuating patients should be taken to meet their transporting ambulances and other vehicles in rapid-throughput staging areas. When difficult choices must be made, leaders and staff must focus on the “greatest good for the greatest number.”

36. FIRE EXTINGUISHERS

37. FIRE EMERGENCY RESPONSE

38. WHY FIRE SAFETY The hospital, as an Institution is prone to fire because o f :- Having many heat-dissipating equipments, Combustible gasses /fuel, chemicals, used in different areas. A lot of electrical wiring, high voltage connections. Fire prone articles like gauze, cotton, linen, books and registrars. Heavy Equipments and electrical gadgets that are inflammable and prone to hazardous incidents. Proper precautions has to be taken while planning the infrastructure. Adequate measures need to be considered, designed and practiced to ensure safety to all. Indicators like architectural designs, interior designs , electrical wiring, appropriate equipment planning and proper waste management are considered while planning such safety measures.

39. STEPS OF EMERGENCY PREPAREDNESS

40. SOURCES OF FIRE

41. What to Do in Case of a Fire Immediately pull the nearest fire alarm pull station as you exit the building. When evacuating the building, be sure to feel doors for heat before opening them to be sure there is no fire danger on the other side. If there is smoke in the air, stay low to the ground, especially your head, to reduce inhalation exposure. Keep on hand on the wall to prevent disorientation and crawl to the nearest exit. Once away and clear from danger, call your report contact and inform them of the fire. Go to your refuge area and await further instructions from emergency personnel.

42. Fire Safety Precautions and Fire Systems Equipment Keep doorways, corridors and egress paths clear and unobstructed. Make sure that all electrical appliances and cords are in good condition and UL approved. Do not overload electrical outlets. Use surge protected multi-outlet power strips and extension cords when necessary. Never store flammable materials in your room or apartment. Do not tamper with any fire system equipment such as smoke detectors, pull stations or fire extinguishers. Doing so is a criminal offense. Raising a false alarm is a criminal offense. It endangers the lives of the occupants and emergency personnel. DO treat every fire alarm as an emergency. If the alarm sounds, exit the building immediately.

43. Fire safety equipments-

44. ANY QUESTIONS?

45. SESSION 2 (A) - FLOOD SAFETY & MEASURES

46. INTRODUCTION Floods are natural disaster resulting from rainfall in certain seasons because water levels of rivers and lakes overflowed and went into the surroundings . Floods can create various of damage to property and loss of life is significant. Scenario flooding and destruction from flooding throughout the world. According to the World Meteorological Organization (WMO), the flooding is three worst natural disasters in the world and has claimed thousands of lives and destruction of property valuation hundred thousand million

47. Impact of floods on health services Flooding can either damage hospital facilities directly or disrupt access to them. Damage may be direct costs such as losses in infrastructure, expensive medical equipment, hospital furniture, lifeline installations and medical supplies. Indirect costs are unforeseen expenses after emergencies such as increased risk of outbreaks due to loss of laboratory and diagnostic support, temporary solutions like field hospitals and the loss income normally generated by health care services.

48. Planning Having an evacuation plan in place before a flood occurs can help avoid confusion and prevent injuries and property damage. A thorough evacuation plan should include: Conditions that will activate the plan Chain of command Emergency functions and who will perform them Specific evacuation procedures, including routes and exits Procedures for accounting for personnel, customers and visitors Equipment for personnel Review the plan with workers Warning Systems Flood Watch:  Flooding is possible. Monitor radio and television stations for more information. Flash Flood Watch:  Flash flooding is possible. Be prepared to move to higher ground; monitor radio and television stations for more information. Flood Warning:  Imminent threat - Flooding is occurring or will occur soon; if advised to evacuate, do so immediately. Flash Flood Warning:  Imminent threat - A flash flood is occurring or will occur soon; seek higher ground on foot immediately. Equipping Get emergency supply kits and keep them in shelter locations Training and Exercises Ensure that all workers know what to do in case of an emergency. Practice evacuation plans on a regular basis. Update plans and procedures based on lessons learned from exercises.

49. Here are some guidelines for being prepared for disasters. Organization is Key In order to prepare for disasters, natural and other, it is important that healthcare organizations have a disaster plan that is well documented and that they practice the steps they will take. The most important piece of disaster preparedness is making sure the patients are properly taken care of including their diagnosis, treatment, and follow up. For this to happen, healthcare organizations must have a method of entering the patient into their “system” so the procedures and care process can begin. During disaster scenarios, typical procedures such as looking up patients in the master index will not be possible, especially if the individual comes in unconscious.  Instead, a numbering system can be used as a temporary measure to get the patient entered.  The patient access and financial services personnel will be able to follow up once crisis has subsided. Collaborative Efforts Needed Staffing needs will increase during a disaster.  A properly prepared disaster plan for a healthcare organization includes having access to a backup or reserve medical and administrative staff network. The credentialing committee can implement a policy for temporary privileges during emergency or disaster situations.

50. Prepare, Plan, Practice, Repeat Advanced planning and practice is necessary so that when an emergency arises the healthcare staff is prepared for it.  Organizing flood disaster preparedness drills similar to the practice for fire drills.  Walking through an emergency operations plan in advance of a real situation allows the personnel to encounter problems that could occur during a real disaster and allows for further refinement of the processes. Executive leadership should consider allocating funds in advance for additional resources during disasters.  Think outside of the box when anticipating needs.  For example, if the area is flooding and water has been contaminated and power is off for a lengthy period, the people nearby may depend on the nearest hospital to provide for their basic needs, especially if that hospital is one of the highest points in the area.  This may require bringing in a tractor-trailer with a tank full of water. (Disaster planning should also include situations where the healthcare facility itself is the victim of a disaster rather than the place where the victims can come for treatment and refuge.)

51. ANY QUESTIONS ???

52. (B) EARTHQUAKE SAFETY & MEASURES

53. An   earthquake  (also known as a  quake ,  tremor  or  temblor ) is the shaking of the surface of the Earth resulting from a sudden release of energy in the Earth's lithosphere that creates seismic waves. Earthquakes can range in size from those that are so weak that they cannot be felt to those violent enough to propel objects (and people) into the air, and wreak destruction across entire cities. The  seismicity, or  seismic activity , of an area is the frequency, type, and size of earthquakes experienced over a period of time. What is Earthquake?

54. Earthquakes are associated with significant mortality and morbidity within the community. Fatal injuries commonly occur within the first minutes to 24 h of the earthquake. The most common causes of deaths are usually head and/or chest injuries. Other causes of death include asphyxia, crush syndrome and hemorrhagic shock . Injured survivors usually have lower limb fractures. Time is precious, as every minute could mean saving or losing lives. Delays in the transport of victims to the nearest referral hospital by land ambulance due to blocked roads directly impacts the chances of survival and recovery of the injured victims. Air transportation obviously provides the best option for expeditious evacuation and reduction of fatalities. Earthquake Associated Morbidity & Mortality

55. Hospitals located within or near the epicenter, or in a region close to the affected area, may serve as referral treating centers. In case of an earthquake, the referral hospital should be well-prepared to respond quickly and healthcare planners should consider following elements: Geography — The location of the referral hospital should be chosen with great care. It should be away from the seaside, volcanic regions, and mountains, and should be near to and accessible by main roads . Building Structure — Infrastructural developments have made available highly developed materials capable of absorbing seismic waves during earthquakes and greatly decreasing the risk of sudden collapse and giving occupants ample time to evacuate a building. This technology should be used in hospitals located in high risk zones. In addition, such hospitals should have its own well-maintained power and water resources and a helipad. Medical and Paramedical Staff — The medical and paramedical staff should be qualified and well-trained in responding to different types of injuries, including burns. There should be enough staff members available 24 x 7 . Communication — An effective and proven network of satellite or cable communication should be available to connect locally, nationally and internationally. Hospital Preparedness

56. Cont…. 5 . Transportation —Air transportation is the method of choice. Therefore, special arrangements should be made to plan for helicopter and aircraft transportation. 6 . Education, Training, and Drills —Education and training are key. All staff members should understand the nature and consequences of an earthquake. They should be familiar with all scientific terms used internationally. Drills should be conducted frequently, and a regional drill should occur biannually. Continuous training enables hospital staff to be prepared to respond quickly and appropriately. A ready, well-informed, and well trained hospital staff is associated with drastic reduction in fatalities during such a disaster. 7 . Coordination Network- National , Regional, and International Coordination and Cooperation—Local hospitals can become overwhelmed with quake victims. Therefore, it is essential to establish a network of coordination at regional, national and even international levels between different healthcare providers or organizations. The coordinating network members must meet and interact regularly, as meeting for the first time during a disaster may cause confusion and delay in providing need-based services for victims 8. Aftermath — Regular follow-up of the cases is important as many of the victims as well as medical and paramedical staff may experience post traumatic stress disorder (PTSD) and require psychological counseling . 9 .Documentation- All details of events should be well documented for extraction of data and facts to draw lessons that can be presented at a latter day debrief and improve hospital response in future catastrophes

57. Cont… 10 . Research – Research is vital, especially in preventing or reducing risks and injuries. Hospital Incident Command System (HICS) must be evolved to coordinate action during a major disaster . The HICS is a standardized on-scene emergency management organization specifically designed to provide for the demands of single or multiple incidents, without being hindered by jurisdictional boundaries. It is the combination of facilities, equipment, personnel, procedures, and communications operating within a common organizational structure, designed to aid in the management of resources during incidents. The system includes defined responsibilities and reporting channels and uses common language to promote internal and external communication and integration with community responders.

58. Establishing a clear chain of command to manage all routine and planned events of any size or type. Integrating personnel from different agencies or departments into a common command structure that effectively addresses issues and delegates responsibilities Providing needed logistical and administrative support to operational personnel Eliminating duplication of efforts . Using clear language – eliminating industry codes/terms while managing an emergency situation . Communication with the Medical Director of a hospital about the following. Type and location of incident Number and condition of expected patients and/or expected patients for evacuation Estimated arrival time or departure time from facility Unusual or hazardous environmental exposure Requesting staffing assistance from the labor pool to determine hazard and safety information critical to treatment and evacuation of patients. Ensuring that patient identification and tracking practices are being followed. Communicating and coordinating with logistics department to determine medical care equipment and supply needs, transportation availability and needs (carts, cribs, wheel chairs, etc.) and ensuring that appropriate standards of care are being followed in the clinical areas as appropriate for the emergency. Ensuring that all attempts have been taken to reach patient family members if not on site to notify them of the evacuation. Liaising with media and public information domains to provide details of evacuation process. The core principles of an Incident Command System are as follows:

59. There are several critical issues that need to be considered when evacuating a hospital : Nature of threat Risk to patients Risk to staff and visitors Need for continuing acute care Demands for supplies Demands for resources In the event of a major quake, the hospital’s maintenance supervisor must assess the impact and initiate corrective action to restore any damaged system to normal operational modes expeditiously. If the building or a portion of the building is deemed unsafe a partial or total evacuation will be decided upon and the evacuation plan implemented. Individual departments have the responsibility to report all life threatening situations to the administrative staff immediately for assessment and corrective action. Hospital Evacuation

60. The intensity of the seismic activity will determine the type of evacuation required as follows: Horizontal - to an adjacent, safer site OR/AND Vertical - Down ramps or stairs using cribs, stretchers, wheeled trolleys, vest pockets and physical carriage methods. Moving the most severely ill patients first, offers the advantage of lessening the burden on hospital staff, since the patients who are the most seriously ill require the most resources. Since resources are rapidly depleted after an earthquake, it makes sense to start by transferring the patients whose care requires the greatest resources. In the event of an immediate threat to patients' safety fearing the collapse of hospital buildings, efficient evacuation is mandatory when the healthiest patients may be preferably evacuated first, as this strategy permits the evacuation of large numbers of patients in a short time. Evacuation of the healthiest patients first is an effective strategy when speed is essential, moving all patients through the stairwells using improvised transport devices such as blankets, backboards, and mattresses. Using these low cost alternatives, it may not be necessary to purchase specialized devices as stair chairs, infant carriers, and earthquake slides. Building inspectors may be consulted to confirm the integrity of hospital structures prior to evacuation and before moving back in. Evacuation Modes Evacuation Protocols

61. A general approach to be followed in the event of an earthquake is as follows : 1. Remain calm. Do not panic or run through or outside the building. The greatest point of danger is just outside doorways and close to outer structure walls due to the hazard of falling debris. 2 . If you are in the building, remain where you are. If possible, take cover under a desk, table, or bench, or in doorways, hallways, or against inside walls. These areas are the most sound structurally during an earthquake. 3 . Keep visitors, patients, and other employees out of stairwells and elevators. 4 . Reassure and assist patients and visitors. 5 . DO NOT ABANDON YOUR PATIENTS. 6 . If you are outside, stay away from the building. Stay clear of walls, electric poles, downed wires, and trees. Check all utilities and electrical equipment and use telephones only for emergencies. 7 . Above all, use good judgment. 8. Following the earthquake employees shall assess damages specific to their assigned areas and report all hazards to their supervisor. This information shall be reported to administration for revaluation and corrective action.

62. A specific approach for patient evacuation is as follows:- Move the least acute, most stable first . Apply identity tags for all those being shifted . Bag ventilate those dependent on ventilator and administer oxygen using portable oxygen cylinders for those who need continuous oxygen administration. Disconnect non essential I/V fluids or hand push i/v fluids using large syringe in transit Improvisation during the disaster following the loss of electrical power includes patient ventilation using Ambu bags, monitoring electrocardiograms of unstable patients using defibrillator paddles, titrating IV rates using IV flow-rate devices like dial-a-drip etc, using cell phones as light sources, using piston syringes fitted with cannulae for suctioning . Monitor by hand or auscultation or utilize battery powered monitoring devices in transit Wean I/V fluids where possible . Connect chest tubes to an underwater seal drain assembly. Gastric decompression can be maintained by aspiration with a syringe . Drape infants with bonnets and blankets / aluminum foil. For infants requiring additional thermoregulation, chemical warming mattresses can be used. This should be covered with a blanket prior to placing infant on it.

63. Major risk areas of earthquake in world

64. ANY QUESTIONS ?

65. (C) ACCIDENT & CHEMICAL SPILLS

66. WHAT IS ACCIDENT ? An  accident  is an unplanned event that sometimes has convenient or undesirable consequences, other times being inconsequential. The term implies that such an event may not be preventable since its antecedent circumstances go unrecognized and unaddressed.  Chemical spills commonly result from the unsafe handling of chemicals, improper chemical storage, chemical storage tank ruptures, improper containers for chemical disposal, and failure to dispose of chemicals in a timely manner.  The successful management of a spill is dependent upon the information about the chemical and its ability to immediately impact human health, groundwater, surface water, and soils that the responders possess. WHAT IS CHEMICAL SPILLS ?

67. Types Of Accidents : Physical Physical examples of accidents include unintended motor vehicle collisions or falls, being injured by touching something sharp, hot, dropping a plate, accidentally kicking the leg of a chair while walking, unintentionally biting one's tongue while eating, accidentally tipping over a glass of water, contacting electricity or ingesting poison . N on-physical Non-physical examples are unintentionally revealing a secret or otherwise saying something incorrectly, accidental deletion of data, forgetting an appointment etc . Accidents By activity Accidents during the execution of work or arising out of it are called work accidents Accidents By vehicle

68. ISSUES TO BE ADDRESSED BY HOSPITAL Surge capacity for additional space for treatment and evaluation. Medication and supply stockpiles Structural integrity Trained staff Response protocol and proper disaster response procedures. 6. Functional hospital based disaster plan Role of Hospital in Disaster Management • A disaster will involve the entire hospital there will be increased demands upon equipment and personnel • The hospital’s response will have to be managed and coordinated • Staff will need to be supported throughout response and recovery . Steps in MCI Management 1 . Triage 2 . Primary Survey 3 . Secondary Survey 4. Treatment 5 . Documentation

69. Definition- A method of quickly identifying victims who have immediately life-threatening injuries AND who have the best chance of surviving. • Aim of triage : To achieve the greatest good for the greatest number of casualty Types of Triage M.A.S.S . Triage : based on patients ability to move S.T.A.R.T . Triage : determines severity of injuries Advanced Triage : More fully assess injury priority Concept of “Golden Hour” • Golden Hour is a concept of trauma care developed by Dr Adams Cowley • Refers to the amount of time from injury to definitive care that should be allotted to maximize survival from traumatic injury. • Most studies have shown, if care given within first hour of injury morbidity and mortality can be reduced .

70. Primary Survey • The first survey done to assess the life threatening injuries and simultaneous treatment. • Primary survey must be performed in no more than 2-5 minutes. Component of Primary survey : ABCDE • A = Airway with C spine • B = Breathing • C = Circulation • D = Disability • E = Exposure

71. Secondary survey When the primary survey is completed, resuscitation efforts are well established, and the vital signs are normalizing, the secondary survey can begin. The secondary survey is a head-to-toe evaluation of the trauma patient, including a complete history and physical examination, including the reassessment of all vital signs. Each region of the body must be fully examined. X-rays indicated by examination are obtained. If at any time during the secondary survey the patient deteriorates, another primary survey is carried out as a potential life threat may be present. The person should be removed from the hard spine board and placed on a firm mattress as soon as reasonably feasible as the spine board can rapidly cause skin breakdown and pain while a firm mattress provides equivalent stability for potential spinal fractures

72. EXAMPLES OF ACCIDENTS

73. Disasters: Chemical Accidents and Spills By their nature, the manufacture, storage, and transport of chemicals are accidents waiting to happen. Chemicals can be corrosive, toxic, and they may react, often explosively. The impacts of chemical accidents can be deadly, for both human beings and the environment . The source of many of these chemicals is petroleum, which is refined into two main fractions: fuels and the chemical feedstock's that are the building blocks of plastics, paints, dyes, inks, polyester, and many of the products we buy and use every day. Of the more than forty thousand chemicals in commercial use, most are subject to accidental spills or releases. Chemical spills and accidents range from small to large and can occur anywhere chemicals are found, from oil drilling rigs to factories, tanker trucks to fifty-five-gallon drums and all the way to the local dry cleaner or your garden tool shed . Some of the most common spills involve tanker trucks and railroad tankers containing gasoline, chlorine, acid, or other industrial chemicals. Many spills occur during the transportation of hazardous materials

74. This boy is looking at a Greenpeace poster, which expresses solidarity for the victims of the Union Carbide chemical disaster in Bhopal, India, eighteen years after the incident.(Photograph by Indranil Mukherjee. © AFP/Corbis. Reproduced by permission .) One of the worst industrial chemical disasters occurred without warning early on the morning of December 3, 1984, at Union Carbide's pesticide plant in Bhopal, India. While most people slept, a leak, caused by a series of mechanical and human failures, released a cloud of lethal methyl isocyanate over the sleeping city. Some two thousand people died immediately and another eight thousand died later. Health officials, not informed about chemicals at the factory, were completely unprepared for the tragedy.

75. A train derailment near Milligan, Florida. The train carried chemicals, which were spilled at the site.

76. To help emergency responders know what they are dealing with, the Department of Transportation (DOT) has established a hazardous materials placard system . The placard system is as follows : Hazard class 1 : Explosives (class 1.1-1.6, compatibility groups A–L) Hazard class 2 : Gases (nonflammable, flammable, toxic gas, oxygen, inhalation hazard) Hazard class 3 : Flammable liquids Hazard class 4 : Flammable solids (flammable solid, spontaneously combustible, dangerous when wet) Hazard class 5 : Oxidizer and organic peroxide Hazard class 6 : Toxic/poisonous and infectious substances labels (PG III, inhalation hazard, poison, toxic ) Hazard class 7 : Radioactive (I, II, III, and fissile ) Hazard class 8 : Corrosive Hazard class 9 : Miscellaneous dangerous goods

77. Rail cars and trucks carrying toxic or dangerous materials must display a diamond-shaped sign having on it a material identification number, which can be looked up to determine what hazardous materials are on board, and a hazard class number and symbol that tells whether the contents are flammable, explosive, corrosive, etc. Color codes also convey instant information : blue (health), red (flammability), yellow (reactivity), white (special notice). REASONS FOR CHEMICAL DISASTER Human Error  Improper Training Manufacturing Defects Improper Maintenance Equipment Failure Ignoring Warning Signs

78. How Are Chemical Accidents Handled? Emergency response personnel are involved in assessing the risk of hazardous material releases and working to avoid any harmful effects. Teams of workers evaluate the concentrations of the chemicals, where and how people might be exposed, and potential toxic effects on the exposed people. If rapid spill cleanup is necessary, the emergency response team designs and implements cleanup measures to protect exposed populations and ecosystems from toxic responses . chemical incident zoning

79. Legal/Institutional framework • Regulatory provision/governance on labeling of hazardous substances/chemicals are needed. • Reporting system for chemical storage/handling and accidents/release has to be harmonized and in common format in all the districts of the states, and in all the states/ UTs in the country. • Legal framework for management of chemicals is already existing, the implementation is main challenge. • Need to dovetail the existing regulatory provisions with Disaster Management Act, 2005. 2 . Tools and techniques in CDM • Integration of safety risk assessment provisions in all environmental appraisal and site clearance tools/process and developmental planning process • Emphasis on health risk assessment of product and process to be given adequate significance and practice • A web based Chemical Accident Information and Reporting System developed by the NIC with the support of MoEF needs wider demonstration for creating the data base on chemical accident

80. 3 . Risk Management Integration to Development • Integration of chemical accident risk in multi-hazard risk assessments, land-use planning, impact assessment studies, State/District DM plans, and visualization of total chemical risk at spatial scales • Consideration of chemical risk hotspots and vulnerability in urban management and environmental governance of commercial, semi-urban and industrial areas 4 . Capacity building needs and Options • Strengthening the offices of the CIF/DISH and their Regional Offices responsible for implementing the provisions of MSIHC Rules 1989 . • Strengthening of the National Institutes/agencies for training/education, research and dissemination of information pool with a nationwide network • Capacity strengthening of the Ministry of Environment with a dedicated Directorate/ Division on Disaster Management 5 . Information management & Knowledge networking • Need for a common Information Management System on hazardous chemicals, location/ mapping, processes, storage, handling, decontamination, etc. • A knowledge center to be created as a pool of relevant information resources including failure data, reports, accident analysis records, etc. • The Phase-Ill of GTS based Emergency Planning and Response System which involves application of remote Sensing and GIS for vulnerability assessments and risk mapping be extended to cover all districts having MAH units.

81. ANY QUESTIONS ?????