Gastric Cancer: Сlinical Implementation of Artificial Intelligence, Synergeti...
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1. Disaster
Definition:
A serious disruption of the functioning of a community or a society involving widespread
human, material, economic or environmental losses and impacts, which exceeds the ability
of the affected community or society to cope using its own resources.
Biological Disaster
Definition: Process or phenomenon of organic origin or conveyed by biological vectors, including
exposure to pathogenic micro-organisms, toxins and bioactive substances that may cause loss of life,
injury, illness or other health impacts, property damage, loss of livelihoods and services, social and
economic disruption, or environmental damage.
Examples of biological hazards include outbreaks of epidemic diseases, plant or animal contagion,
insect or other animal plagues and infestations.
Biological hazards can be important sources of ill health in agriculture. Biological agents can be defined
as any micro-organism, cell culture, or human endoparasite, which may cause any infection, allergy,
toxicity or otherwise create a hazard to human health. These include viruses and bacteria which can cause
infection and disease, dangerous plants and animals (for example parasites or insects), biologically
contaminated dusts, or wastes from humans and animals. Most biological agents are micro-organisms,
among which are bacteria, viruses, fungi, microscopic parasites, and the microscopic infectious
forms of larger parasites.
Agricultural workers may come into contact with these biological agents through routine exposures, such
as from contact with animals, animal carcasses, working in or near livestock houses and stabling areas, or
contaminated water. Examples include: anthrax, tetanus, bovine tuberculosis
Measures for handling biological agents
1. Risk assessment measures to eliminate prevent or reduce biological risks.
2. Control and testing of animals, in accordance with veterinary standards and national law
and practice, for diseases transmissible to humans;
3. Protective measures for the handling of animals and, where appropriate, provision of
protective equipment and clothing;
4. Protective measures for the handling of biological agents and, if necessary, provision of
appropriate protective equipment and clothing;
5. Immunization of workers handling animals, as appropriate;
6. Provision of disinfectants and washing facilities, and the maintenance and cleaning of
personal protective equipment and clothing;
7. Provision of first aid, antidotes or other emergency procedures in case of contact with
poisonous animals, insects or plants;
8. Safety measures for the handling, collection, storage and disposal of manure and waste;
2. 9. Safety measures for the handling and disposal of carcasses of infected animals, including
the cleaning and disinfection of contaminated premises; and
10. Safety information including warning signs and training for those
After extensive discussion with experts from all over the country, Govt. of India has outlined
detailed guidelines and activities at different levels of administration - Central, State and District.
DISASTER MANAGEMENT STRUCTURE IN HEALTH SECTOR
National Level
The Emergency Medical Relief Division of Directorate General of Health Services in the
Ministry- of Health & Family Welfare is the technical unit exclusively meant for management of
crisis situations. The Division is headed by Director, Emergency Medical Services and Relief.
For the purpose of the crisis situations, he reports/receives instructions directly from the
technical chief (Director General of Health Services) and Administrative Head of the Ministry
(Secretary Health & Family Welfare). The Secretary, Health & Family Welfare has empowered
Director, EMR to represent the Dept. for crisis situations in different Crisis Management Groups.
Disaster Management requires multisectoral and multidisciplinary approach, which needs
coordination at various levels from Central to District Level. In the Ministry of Health & F.W
(Govt. of India) the mechanism of coordination is done through the office of the Director,
Emergency Medical Services & Relief (EMR). The objective of the coordination is to review
crisis situations from time to time and meet those needs, which State Governments cannot meet.
For this purpose, continuous dialogue and communication are maintained with the Director of
Health Services of the States, Stores Division under the Federal Government, vaccine producing
institutes and National Institute of Communicable Diseases and Director, Malaria Unit.
State level:
Usually a Joint Director or a Deputy Director of Health Services under Director of Health
Services in the state, is responsible for crisis management, coordination, monitoring and
implementation. He has detailed information about key personnel involved in disaster
management at State, District and Central level.
District/PHC level:
At district level, the chief medical officer/Civil Surgeon is responsible to implement and
coordinate health sector activities. He has details of information about officer involved in
disaster management at PHCS, District and State level.
NON-GOVERNMENTAL ORGANIZATIONS:
There are number of NGOs which are functioning in the field of disaster management. Most of
them are small and work locally. However, Indian Red Cross Society and Ramakrishna Mission
are the two organizations, which take very active part in disaster management. As a matter of
fact these two organizations supplement government efforts. They have sufficient infrastructure
to provide immediate facilities within shortest possible time.
a) Indian Red Cross Society:
3. The Indian Red Cross Society was established in the year 1920 to render medical and other
assistance to the sick and injured during war and peace time and to manage the funds and gifts
received from public for such purposes. Its activities include mother and child welfare scheme
including nutrition programme, arrangements of relief to the victims of epidemics,
earthquakes, cyclones, droughts, floods and natural and industrial calamities in India and
abroad. They also provide paramedical education in fields like first aid, nursing and blood
banking. Promotion of voluntary blood donation is one of the prime targets of the society and
the Government is providing grants-in-aid to help such programs. There is a network of 51 blood
banks run by the Red Cross in 11 States.
Medical relief is extended to the community through their static and mobile units. Ambulance
service is another activity of many branches. Some branches run Centers for physically and
visually handicapped institutions for mentally retarded and maintain a pool of beds in
specialized hospital for treatment of cancer and tuberculosis patients.
b) Ramakrishna Mission
This organization has network of branches throughout the country through which they provide
timely assistance to the affected population. Their dedication as well as quality of response has
made them one of the most respectable organizations in the field. Their expertise lies primarily in
the social sector. During normal period they are involved in providing educational services,
employment generation activities and providing support to the old infirm and poor.
c) Other organizations
There are a large number of voluntary organizations out of which only a few have backup
sustainable resources like Oxfam (India), Lutheran etc. However, during crisis period many
others become visible for a short period.
GUIDING PRINCIPLES FOR PLANNING
1.1 Biological Disaster & epidemic:
Biological disaster is one of the technological disasters caused by Microorganisms leading to
spread of diseases by pathogenic organisms or toxins. With the advancement in technology of
genetic engineering possibilities of release of causative agents in the environment may create a
crisis situation which may not be possible to be handled by the affected population (Disaster
Situation). Such possibilities could be accidental or otherwise.
1.2 Microorganisms Producing Crisis Situation
Microorganisms causing war-fare or disaster could be:
1. Bacteria
2. Viruses
3. Toxins produced by plants, animals and Bacteria.
1.3 Sources
Contamination with these pathogenic organisms could start from human and animal sources.
Similarly, the bio-toxins could arise from microbia, plant and animal sources. All pathogenic
agents of biological origin are capable of multiplication in the environment, which eventually may
affect man through food chain, water source or direct exposure.
4. They could affect the population also through fish and crabs. To illustrate the example, casualties
resulted in. coastal Karnataka few years back by crabs affected by pesticides from neighboring
fields, highlights the mode of spread of toxins in human population. Food items, in addition,
could also be affected during food processing, storage.
Microorganisms are also handled widely in medical, agricultural, veterinary fields and research
laboratories. They are also used for preparation of enzymes, sera and reagents which have
commercial values and handled exclusively by commercial manufacturers. Any contingency plan
would, therefore, remain incomplete unless its all such organisation/institutions where they are
handled are also brought into its purview.
1.4 Information about harmful affects:There are certain bacteria about which well documented information against effective measures
are available. Some of these are Anthrax, Tularemia, Plague and Botulism. After development of
techniques of genetic engineering recently; there are large number of bacteria and viruses which
are produced in the research laboratories. In most of the cases, detail information about the
diseases caused by these bacteria is not known. Whatever information is available is confined to
these laboratories. Experiments are going on about newer strains of viruses and bacteria about
which information would be available in future. With the above facts in view the safeties against
the Microorganisms require updating from time to time.
1.5 Latent Period:
The process of poisoning or appearance of a disease in a number of cases is slow. Effects may
become, apparent only after considerable lapse of time and more so at places other than places of
initial exposure due to mobility and density of population. Early detection becomes in such a
situation very difficult.
SPECIAL CONSIDERATIONS FOR BIO TOXINS:
As far as bio-toxins are concerned they are slow to manifest. On the other hand, manifestations
may not be uniform in symptoms, time and place of occurrence. One of the important
consideration in dealing with Biological disasters as a result of toxins is that toxin could be easily
implanted in large population through water and food. Therefore it may be necessary to have
sufficient checks at these places where they are located. There should be adequate on site
contingency plan to detect any escape and arrangement for warning. Places which should be
covered under contingency plan should include:
(a) Food processing plants
(b) Storage warehouses
(c) Potable water and reservoirs
(d) Research laboratories
(e) Agricultural areas
Existing arrangements for Toxicological investigations:
5. At present there is hardly any facility available in the country that could undertake the
responsibility of investigations and development of antidotes, except Industrial Toxicology
Research Centre functioning under CSIR. Department of Forensic Medicine in each Medical
College, though are responsible to guide in this area, remain occupied with Medico-Legal
responsibilities. The existing, infrastructure in the form of ITRC and Forensic Medicine
Department could be developed as poison control centers with information on Bio toxins,
immunobiology, diagnosis, prevention and treatment. The ITRC, in close cooperation of
State health authorities could develop these centers.
PLANNING APPROACH FOR BIOLOGICAL DISASTER:
Due to resource constraints as well as continuation of old practices sudden change in disaster
management is possible through a phase wise plan for improvement. With this intention
following priorities of activities is suggested.
Short Term Planning:
The aim of short term planning would be early detection of a crisis situation caused by
Microorganisms (organisms and toxins) with existing resources and infrastructure. Briefly the
aim could be achieved by following measures:
• Identification of the nodal officer at the state/district level to provide regular attention.
• Constitution of an expert group for guidance at Central and State level.
• Improvement in existing surveillance system for early detection and crisis situation
caused by Microorganisms.
• Identification of medical and referral institutions for investigation & management.
• Delegation of the responsibilities (administrative and technical) to undertake
investigative, diagnostic and administrative responsibilities.
Long-term measures:
A long term plan would be put into operation as soon as the existing inadequacies are overcome.
Salient features would be:
• Improvement in existing laboratories in terms of physical facilities for search of
Microorganisms and their handling in different types of laboratories.
• Improvement in diagnosing and investigative facilities for micro level estimation.
• Establishment of Toxicological Centers at District, Medical Colleges, State Referral
Centre and ITRC with all facilities.
• Detailed information about institutions (Government and Private) handling
Microorganisms
• Research activities to find out control measures about, relatively unknown
Microorganisms. Development of counter measures.
• Updating of contingency plan depending upon the level of improvement in. the existing
infrastructure.