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DISASTER MANAGEMENT
1. DISASTER
MANAGEMENT
Professor Syed Amin Tabish
FRCP(London), FRCP(Edin.), FAMS, MD HA (AIIMS)
Postdoc Fellowship, Bristol University (England)
Doctorate in Educational Leadership (USA)
2. Definition
The WHO defines disaster as 'any
occurrence that causes damage,
economic destruction, loss of
human life and deterioration in
health and health services on a
scale sufficient to warrant an
extraordinary response from
outside the affected community
or area'.
3. Disasters: the scenario
A global problem: a major disaster
occurs somewhere in the world almost
on a daily basis
Affects the advances being achieved
health & socioeconomic development
Increased vulnerability to natural
disasters due to environmental
degradation, industrialization, pollution,
threat to biodiversity
Rapid climate change
Population explosion (overexploitation of
resources)
4. Impact of Disasters
Ecological disruption
Loss of human life
Military expenditures: 6 month’s of world’s
arms spending would pay for a 10-year
program proving food & health services in
developing countries
Deterioration of health services
to warrant an extraordinary response
from outside the affected community or
area.
Result in significant morbidity
5. Diversity of the Planet
The vastness and diversity of the planet
makes it difficult to build up an overall
picture of what needs to be done and the
impact of what has been done.
The same vast distances make it hard to
react rapidly and effectively to sudden
events - an earthquake - in parts of the
world with shifting populations and poor
communications.
New technology - fast bandwidth reliable
communications, the internet, high
resolution satellite imagery - can provide
support in these situations.
6. Classifying Disasters
Natural: earthquakes, floods, fires,
hurricanes
Technological (number of nuclear
arsenals has exceeded 50,000), deadlier
weapons, laser-guided missiles, carpet
bombs, etc ……Hiroshima (Aug 6,1945) &
Nagasaki (Aug 19, 1945); Nuclear reactor
Accident in Chernobyl (Ukraine); Toxic
gas leak in Bhopal (India)…..improper
management of industrial technologies
Chemical & Biological Weapons
Complex Emergencies (conflict-related):
Afghanistan (2.5 m), Iraq (1991, 2004-6) –
hi-tech war [2,10,000 tons of bombs in 43
days dropped in 1991
7. Disaster Planning
Pre-disaster: the identification,
understanding & analysis of natural &
other hazards
Disaster Management System: to
reduce the vulnerability of people to
damage (disaster prevention), injury and
loss of life & property resulting from
catastrophes; to prepare for prompt &
efficient rescue, care and treatment of
victims; response & recovery
Disaster planning starts with community
awareness
8. Disaster Management
Disaster Preparedness: activities that are
carried out prior to the advance notice of a
catastrophe to facilitate the use of available
resources, relief & rehabilitation
Disaster mitigation: ongoing effort to lesson
the impact disasters have on people &
property
Disaster Management: the process of
addressing an event that has the potential to
seriously disrupt the social fabric of commun.
9. Pre-hospital Emergency
Preparedness
Efficient system of providing
prompt medical care to injured to
save many lives or limbs by
beginning treatment before the
patient reached the hospital:
CPR, ATLS, ACLS, closed chest
cardiac compression
Emergency Medical Services
Individual Protective Equipment
15. BCW
Routes of exposure
Inhalation hazard (Respiratory System)
Contact hazard (Skin)
Digestive system (contaminated food or
drinking water)
Degree of hazard will depend on the agent &
amount released/method by which agent is
disseminated
Biological agents have the ability to multiply
in the host
Chemical agents may be harassing agents,
incapacitating agents or lethal agents
16. Recent Outbreaks & Incidents
Hurricane (the USA)
Avian Flu (Hong Kong)
Earthquakes (Pakistan)
Floods (Bangladesh)
Mad Cow Disease (the UK)
Marburg Virus Hemorrhagic Fever
Anthrax (the USA)
Tsunamis (Indonesia, Sri Lanka)
SARS (30 countries)
17. Earthquakes
Surviving an earthquake and
reducing its health impact
requires preparation, planning,
and practice.
Far in advance, you can gather
emergency supplies, identify and
reduce possible hazards in your
home, and practice what to do
during and after an earthquake.
18. How are avian, pandemic, and seasonal flu
different?
Avian Flu is caused by avian influenza
viruses, which occur naturally among
birds.
Pandemic Flu is flu that causes a global
outbreak, or pandemic, of serious illness
that spreads easily from person to
person.
Seasonal Flu is a contagious respiratory
illness caused by influenza viruses
19. What Injuries Occur Most Often?
The most severe injuries in
mass casualty events are
fractures, burns, lacerations,
and crush injuries. However,
the most common injuries
are eye injuries, sprains,
strains, minor wounds, and
ear damage.
20. Impact of Disasters
Disasters have a major impact on
the living conditions, economic
performance and environmental
assets and services of affected
countries or regions.
Consequences may be long term and
may even irreversibly affect
economic and social structures and
the environment
21. Impact
In industrialized countries, disasters cause
massive damage to the large stock of
accumulated capital while losses of human
life are limited due to the availability of
effective early warning and evacuation
systems, as well as better urban planning
and the application of strict building codes
and standards.
In developing countries, on the other
hand, fatalities are usually higher
owing to the lack or inadequacy of
forecast and evacuation programmes.
22. Impact
Whether disasters are essentially natural or
man-made in origin, their consequences
derive from a combination of human action
and interaction with nature’s cycles or
systems.
Disasters can lead to widespread loss of life,
directly and indirectly (primarily or
secondarily) affect large segments of the
population and cause significant
environmental damage and large-scale
economic and social harm
the deterioration in the social well-being of the
population
25. Activation of External
Disaster Plan
Information from the Red
Crescent Ambulance authorities
Arrival of casualties without prior
warning
Doctor on Duty to inform ED Chief
ED Chief to contact the Disaster
Executive Committee (Hospital
Director, Executive Director,
Medical Director, Nursing
Director)
26. Activation of External
Disaster Plan
Disaster Executive Committee
[DEC] will assess the situation &
determine the activation of the
plan
DEC to initiate Code Black/Green
through the Switchboard
Switchboard will start Page
announcement for Code Black,
Bleep 555 for all concerned
27. Activation of DM Plan
Beep to Transport Department for
arranging 2 Ambulances
Advise Transport Section to send
Ambulances around the hospital
housing to alert residents about
disaster
To send cars to commute staff
Contact all other DM personnel
Inform Nursing Director to arrange
nurses
28. Activation of the plan
Chief of each department to arrange
return of off-duty personnel
Ambulance to commute 2 medical teams
(disaster Site triage team) to site of
disaster
Other departments (radiology, Labs,
Blood Bank, Pharmacy, Medical Records,
Patient Services, Security, Emergency
Supplies, Nutrition, etc will activate their
DM plan
Security personnel to regulate traffic to
& from the Reception area
30. Disaster Executive
Committee
Coordination all Disaster Management
activates
Coordinate all aspects of clinical
management
Notify local authorities
Receive regular updated progress of DM
Media management
To announce ‘All Clear’ at the end of
Disaster
31. Coordination Team
Assess the number of casualties
& Beds available
Maintain contact with Triage
teams, Treatment teams & wards
Allocate Medical staff in different
teams
Give updated info to Disaster &
Executive Committee
32. Disaster Site Triage Team
Triaging patients (Red, Yellow,
Green, Black) to give priorities
for evacuation
Inform the Disaster Executive
Committee about the situation to
take decision for activation of
Disaster Plan
Give frequent updates on the
situation at the scene
33. Hospital Triage Team
Receiving the Disaster
Patients
Screening (Triaging)
Transferring all incoming
disaster patients to
different treatment areas
34. Red Area Team
To resuscitate, stabilize
patients on red area and
shifting them to
definitive care areas
35. Yellow Area Team
To resuscitate and stabilize
patients with serious non life-
threatening injuries
Provide care to those patients
who are seriously injured and
likely to die
Transferring resuscitated
patients to definitive care areas
38. Evacuation Team
Making beds available for
casualties from the
disaster by bed expansion
and discharging current
cold patients
39. Evaluation Team
Monitoring the
management of the
disaster and forward a
final report to the Chief of
the Disaster Management
Committee.
40. Triage Team
Hospital triage is team
responsible for:
receiving the disaster
patients
screening the disaster
patients
transferring all incoming
disaster patients to different
treatment areas
41. Responsibility of the Yellow area team
to resuscitate patients with serious
non-life threatening injuries
stabilize patients with serious non-
life threatening injuries
to provide care to those patients
who are seriously injured and likely
to die
transferring resuscitated patients
to definitive care areas
42. National Policy-making
Risk and vulnerability assessment
Development of training
programmes
Public health in disasters
The management of programmes
involving refugees and internally
displaced people
Shelter needs in disasters
43. National Policy-making
The development of disaster management
policy and plans
Aspects of the management of disasters
resulting from conflict
The role of the military in disaster
management
The management of civil emergencies and
transport accidents
Co-ordination in disaster management
The establishment of control rooms
44. National Policy-making
Leadership and decision making
in disaster management
Managing incidents involving
terrorism or civil unrest
Crowd management
The development context of
disaster management
Disaster relief logistics
45. CBW
Identify the hazard
Evaluate the hazard
Introduce risk reduction strategies
(control contamination)
Chemical detection & identification (lab
dx. By DNA based & other molecular
methods)
Risk communication & dissemination of
information
Contamination control (entry & exit
control)
46. BCW
Decontaminate both materials &
persons
Triage
Medical care & evaluation of
casualties
Definitive decontamination (a
final decontamination of the site)
Command, control &
communication
54. The confirmed death toll from the 7.6-magnitude
earthquake that was centered near Muzaffarabad,
the capital of Pakistan-controlled Kashmir (PcK) on
October 8 stands at over 73,000 in Pck and in
NWFP, while the unconfirmed death toll has climbed
to over 86,000. (Nov-8, AP, Dawn) Over 79,000
people injured and estimated 3 million displaced or
homeless. The earthquake affected nine districts in
total: Abbottabad, Batagram, Mansehra, Shangla,
and Kohistan in the North West Frontier Province
(NWFP) and Muzaffarabad, Neelum, Poonch and
Bagh in PcK.
55. India
The latest official death toll is 1,309 in Indian-
controlled Kashmir (IcK). Officially, 6,622
people reportedly injured and 150,000
displaced (Oct-17, AFP). Worst-hit areas are
around Tangdhar and Uri towns in Kupwara
and Baramulla districts respectively, along
the disputed Line of Control (LoC). Third
worst-hit area is Poonch district.
56. Tsunami
The overall focus of attention is on rebuilding and long-term recovery
and rehabilitation for the December 26, 2004 earthquake and tsunami
disaster. The dead and missing toll from tsunamis triggered by the
undersea earthquake measuring 9.0 on the Richter scale off the west
coast of Indonesia’s Sumatra Island was estimated to be some 232,000
people along the coastal areas of 12 countries in the Indian Ocean,
although a true toll will likely never be known. At least 1.7 million are
reported to be homeless with estimates over 2 million. Tsunami-related
deaths were recorded in Indonesia, Sri Lanka, India, Thailand,
Malaysia, Myanmar, Maldives, Bangladesh, Somalia, Tanzania, Kenya
and the Seychelles. The loss of life was particularly severe in
Indonesia, Sri Lanka, India and Thailand. Nearly 166,000 dead and
missing are from worst-hit Aceh province in Indonesia. The dead and
missing toll in Sri Lanka is nearly 39,000. In India, at least 10,672 died
in Tamil Nadu State and the Andaman and Nicobar Islands. The death
toll in Thailand is around 5,400, including about 1,953 foreigners from at
least 36 countries. More than 400 combined deaths have been reported
in the other countries.
88. Tsunami Disaster of Indian
Ocean 2005
It is said that some kids were
playing on a bridge when
suddenly the earthquake came,
the bridge broke down into 2
pieces, all those kids went down
inside the bridge and died. The
mothers of those kids were
standing besides the bridge and
helplessly watching their kids
die.