2. Hearth Emergencres
s*andard #p*rativ* suideline far tr*aring comrnon
$Is*md F4*d$cm*
dr.rn*ng by Sffic*n"s
remain
vrllages
cases any
without
marooned
number people shelter.school/make
of take at shift-camps side dam. some
onroad or In
During a large
flood people to make and
drug
providers make
isto health accessible displaad marooned and
services to those or
Maior
communication. challenges health
before ts
guideirne
operative
situation' following
,*ron hearth and
emergencies communicable in constrained The
rerated diseases
t0 treat
avairabre
rogistics
to
iniended help officers such emergencies situation'
medical totreat health insuch
*f #r*w*ir"eg
&,-F4*ac"t;Eg*{t"x*nt ,,. , t. ,-:-^!! 0xygenatr0n
spasm.Ihis to ineffective
leads
water toobstruction
leads by aspiration orbylaryngeal
ofainnay either offluid
Drowning indeep shallow
both and
brain occurs'
condition than minutes' death
formore 5
vital lf brain suffers such
tothe organs. tissue from hypothermia cardiac
and(e) arrest'
cyanosis,(c) sputum'(d)
frothy
pink
features
salient patients semi-consciousness/unconsciousness,(b)
ofdrowning are:(a)
Tn*ixflrlr*ln{:
l'lAfterthedrowningpatientisrescuedtodryplace,cardiopulmonaryresuscitation(CPR)istobestarted'
of in
l'lethodsCPR Pictures:
-,i& ",1""&3 i;qutt I
i
should checkeddebris'
be for
should flatonhis and mouth
victim
The be back his
,t
r,-"
,
{
i:gLr*ll ;
lf ihe is ainray,lift back'
tilthead
viaim unconscious,openneck'and
{"
i,1-gll:'t:
1#.r*
with quick breaths'
breathing four full
". .{ara& f viaim notbreathing, artificial
is begin
; -r-iil iig*rti} .
Check carotid
for Pulse.
irg*rtf. I
sternum'
cirtulationdepressing
by
lf pulse absent, artificial
is begin
i
";uit I
ofaninfant'
resuscitation '1,r''
Mo'uth+o-mouth "' .,,
4 not water victim,s
Do attemptdrain from
to
3) Cover blanketprevent
with to
4) lf patient betransferred
can
Lasix,to pulmonary
treat
hypothermia
oedema;sodium
sub
rungs.0nry
then with
centre treat
to health
l'Y'to
bi-carbonate
presure be if any **-
diaphragmatic courd advocated foreignboot
to remove
:..o
:
II
tl
5) lf norecovery, patient higher
refer to centre'
hie*: ."ry. * *'
ffi. Fianager*e*rtclfsnalce
(CobraKrait)bite
have broadtypes snakes:(a)Elapids dwhich"-*
ofpoisonous
lnIndiawe two $t*''.m
Ho w t o k n o w t ha tth e p a ti e n ti sb i tte nbypoisonoussnake?r . *t -
ffi :
i) Localpain numbness pain spreading indicadffirotoxictitc!
and orburning with oedema
bite'
pain,oedema,oozing and p*tthitl
from site ,r,n
bite haemorrhagehaemotoxic
indicate
Local
qanosis,respiratory apPeart
snake,urtimatery
bite neurotoxic
systemic of &pharynx incase by
a) ptosis,dipropia,parsy deveropsof
rimb
snake.
mucosal haematemesis, o{bite haemotoxic
b) Haematuria, b|eeding, incase by
shock
3. :iitairtlent:
l. Rest the with
to limb snake onsplint loose
bite with bandage. bandage applied.
l,lo
tight tobe
l. Clean site povidone-iodine
bite with solution
l.0bverse casereast 24hours reassure
every at for and thepatient.
4' see signspoisoning. haemotoxicity, few ofvenous in
the of Iotest collect ml
a blood a dry, test and for20minutes. isno
clean tube keep lf there
clotting it isindication
then ofhaemotoxicity.
5' AdministerAVS sign
ifthere ofpoisoning.Before infusion,skin 0.02 ofAVS
is startingAVs testwith ml has bedone.compare srre
to wirh control
(normal injected
saline subcutaneously)minutes. isnoswelling
after
l5 lf there orerythema site AVS
attest start infusion Normal
with saline
(l: 0)ata rate | 5-20
| of drops/min may increased
which be tocomplete by|-2hours. for adult child:
infusion Dosesboth and
a) Swellingmild
and systemic feature-5-10 AVS.
vials
of
b) l'larked haemolysisfeatures_10_20
vials
ofAVS.
Incase isreaction site,keep
there attest adrenaline
andbydrocortisone startsecond
ready and a lVchannel.
6. Inj.T.Ioxoid andantibiotic.
7' Refer t0higher iftheredeterioration,
patient centre, is for
haemodialysis
orventilatory
support.
. :.-=i:,:==::: * a: * f * r;n"r * rt i r.tj ri ex"
.: r a *1 u
During patient have
flood may injuries tocollapse by
due ofhouseforce
ofwater.These blunt
are
mostly injuries
resulting
infracture injury.
orhead
Remove patienta safe
injured to place.
a) Remove and rapid ofwhole
clothing have survey body.
b) Ensure and neck lateral
air
way turn to side.
c) Check
breathing.
d) Check
bleeding; control
if present bleeding
bycompression orapplication
bandage oftourniquet.
e) Splint injured
the limb.
f) Administer
Inj.I.Toxoid
and anargesic.Avoid
sedation proper
before diagnosis.
g) Infuse toovercome loss.
lV fluid blood lf shock
ispresent, be
it shouldcorrected
promptly.
Refer tohigher incaseserious
patient centre of injury.
,'=i ::;==+.:-.s:t *f cli **"rlt**m;
. s-:
Diarrhoeaiscommonflood
in affectedpopulation due non
mainly to availability drinking absence
ofsafe water, ofhygyene sanitation,
and crowdingpeople
of
as
shelters. sare
Providing drinking and sanitation be top
warer propJr shoutdgiven priorirv help pHE
and or and
::.j]|::l:::9.1Tll':l'i:i}:::l of.However,treatment
other departments beavailed
should ofdianhoea
inflood
situation
beiomes
challenging;;ffi;;;;#H;;r#;
t"t tases death.Treatment '0,,
and
prevent ordiarrhoea ,r'rrr,nginf
becomes ;ry:i.''ir{jl#{,.:*
l:1ilil:ffiff:,ffiil::: &
(a) Replacementlost
offluid through and
stool vomitus.
(b) Continued feeding be
feeding: shouldstarted as
as
soon
{c) Rationaluse
ofdrugs.Drugs only indicaha
are
requiredin ! "
.ffi#:*;,ffi I
-T'W
,'*' a.t **?
Incasediarrhoea:
of ,'T* r
:- J ilf'
f+
6 lF I '*'l- '
l. Examine and dehydration.
the
patientassess *r
,{S ##
Thechildiscategorizedas"nodehydrati0n,,,,,someOrnyArrtion,,'*r,,r,r$,nrf,,#
*
l' lf nodehydration then 50-100ofORS each
ispresent,give ml after loocffil for
;hfidtfis thanyrru.
2 fofold,,
after stool| cup
each ( equals ml).
200 Breast ornormal tocontiffi Zinc
feed feed supplementation
to begiven.
demonstrate
[Practically preparation and
ofORS ensure family
that members
undentand.]
4. J. Incase moderate
of dehydration thechild
treat underobservation atl'|edical orPHC.)
(either Camp
Durins 4 rours ORI ml)(body
first give 75 weight kg0r
in
wetght
In
Age <4 months 4-l I months l -2years years
2-4 Above5yearsIn
-
lnml 200 400 400 600 - 600-800 1200
800- |200- 2200
. Use osmolar
low 0R5.
. occurs,wait minutes then
lfvomiting for5-10 more at minutes
and resume therapy slowly3-4
0RS interval.
. Continue feeding.
breast
dianhoea
Incase severe
of treatmentbedone
to pre{erablyat health lactate normal
centre. fluid(Ringeis
lV or of lV
saline) to beadministered.Volume
has
to infused:
fluid be
. than age-
Less I year a) 30ml/kgI hour
in
b) 70ml/kg 5 hours.
innext
. Ageyear more
I or a) 30ml/kgl/2 hour
in
b) 70ml/kg %hours.
in2
tonote:
lmoortant
a) Patients severe/moderate shouldre-examined hours. whether passed.
with dianhoea be 2
after Look urine
b) lf dehydrationnotcorrected, 0RS/II/ regime.
repeat fluid
c) Change oftreatment
plan todehydration.
according
d) Look signs
for ofoverhydration accordingly.
andtreat
e) lf fluidcannotadministered lVroute,give
be through 0RSthrough tube.
nasogastric
f) Patient continue feed
should normal (available food flood)
during
g) Anti-microbialstobe only casecholera,
used in of dyssentery, and
amoebiasis giardiasis.
f,i Suspect ina child 5 yearsage adulthe having watery
cholera above of or if is severe diarrhoeaassociated and disproportionatel
with vomiting a
dehydration.Any watery
severe caseof diarrhoea a declared ofepidemiccholera betaken cholera. sample becollected
from zone of should as Stool may and
sent lab cary medium.
to in Blair
: Anti-microbials bestarted with
should along other oftreatment.
modalities
c0mmon 0fsevere
lr,|ost cause outreakfood
diarrhoea in affected ischolera.
population
proper washing prevent
hand can diarrhoea. everyone about washing preparing ortaking
l'lake aware hand before food food.
people add
Aware to halogen orbleaching
tablets to water use.
solution drinking before
l. for
anti-microbials
Specific ofcholera
treatment
Drugscommonlyrecommended are-
forcholera
|2.5mg/kg weight/dose, for3 days
(i) Ietracyciine- body 6 hourly not in of because
(should begiven children 7 years age,
below ofchance ofteeth
starnrng).
(Il'|P)
(ii) Trimethoprim - TMP@
(SMX)
Sulfamethoxazole body 3 days.
l2 hourly,for
5mg/kg weight/dose,
'i}c.
r
'
l2.5mg/kg weight/dose,6for days.
(iii) furazolidine- body hourly 3 .'S..;
i&
.$ ,ir$:t
: '*g {!d
$r:'
(iv) Chloramphenicol- weight/dose,6for3 days.
2Omg/kgbody hourly
l2.5mg/kg weight/dose for dayl, .
(r) Erythromycin- body 6 hourly 3
for ofdysentery
treatment 'i,.
antimicrobials
ll. Specific
(i) lnmost the offirst
areas drug isNalidixic Dose'
choice acid. I
likeNorfloxacin,
(ii) tluroquinolones are
Ciprofloxacin very !erli ,l
Howeverhave widely without obvious side
they been used any *h:1
such effeetffiffimmendsJfiaTt]fi['Orugafirs{
'skofthe treated')
disease t#
20-30mg/kg/day dosef{or
cip,ofro*r,in- in2divided 5dfr. ft t t
- usuallydrug
the treatment for5 days
isgiven
(iv) 0ral followed6mg/kg daily 4 days.
Azithoromycin- once onIstday
|2mg/kg daily by once for
5. fortreatment
anti-microbials
lll. Specrfic giardiasis.
and
ofamoebiasis
Amoebiasis:
|0mg/kg/dose a day 5 days.
Metronidazole: 3 times for
Tinidazole be
can as dose doses'
orally) divided
also given asingle (50mg/kg intwo
lV Giardiasis:
i'letronidazole:5mg/kg/dose 5 days.
3 times for
a day
F. Hanage$'!entof *ther enmmunicable diseaser:
diseases, water diseases,
Communicable especially borne arecommon displacedto In cases live are in
inpopulation due food. some where stocks kept
same as
shelter cases may
occur'
people, ofleptospirosis
tever):
(|) Enteric (Iyphoid
tever
symptoms.Diagnosis atfield "typhi kit'Treatment bedone
High ofmore I week variable intestinal
fever than with gastro can done
be by dot" can with
andantipyretic.
Cifrofloxacin
Shouldreferred
be centre tobe
fever.Advice
tohigher forcontinued given hygienic offaeces safe
about disposal water.
and drinking
(2) Viral
Hepatitis:
hypochondrium byjaundia.
followed isabsolute and
Treatment of Domperidone
rest plenty glucose.Iab be
can
History mild withpain right
of fever in
given control
to sensorium, to bereferredhigher
nausea. ofaltered
lncase patient to to be about and drinking
offaeces safe
centre.Advice given disposal
water.
(l) Scabies:
communicable due mite characterised
Highly disease to and byitching secondary
and be
can by benzoate
ofBenzyl
infection.Treatmentdone application
from tofoot
head except and tab.Cetrezine prescribed.Ensurefamily
pruritus
face scalp.For canbe thatall members/persons contact treated
inclose are
with benzoate.
Benzyl
Respiratory (ARl):
(4) Acute infeaion
l. fever Cough Cold Nasopharyngiti$:
with and (Acute
. No ofrandom
need antibiotics - viral).
(maiority
. Commercialformula not
cough mostly
usually needed.Cough may needed:-
sel[limiting.Cough be
syrup
- With with
exhausting associated
cough vomiting:
severe
- e.g.dextromethorphan
cough (codein-free)
simple syrup may used
be
- Incough bronchospasm:salbutamol.
with
. Nose saline + moist
byN.
block:Clear droP wick
Nomedicated drop needed.
nasal usually
forfever
Paracetamol
feeding: fluid.
Normal Extra
Look signspneumonia.
for of
T
tr '/
ol
6. ll. CI|ILDREII2I'101{THS
AGED T05YRS.WITH 0R ICULT
C0UGH Dltf BREATI|II{G:CLllllCAL T0
CLA$ltlCATl0t{
IACIIITATE
TRIATI.iE1{T
DttlSl0l{S:
Clinical
Category Essential
Features Treatment
Strategy
very
severe
pneumonia Central
cyanosis,
Lethargy,
unconsciousness, Inpatient
care.
Convulsion Refenal
tohealth
centre
l'lot todrinkfeed,
able /
Head nodding respiratory
(severe
distress)
Severe
pneumonia Lower indrawingnasal
chest or flaring InPatient
care.
No ofabove
sign Refenal
tohealth
centre
Pneumonia Fastbreathing: Homecare.
Ag, Resp.rate/min. 0ralCo-trimoxazole, or
orAmoxycillin
2 m o - 1 2 m> 5 0
o. Ampicillin.
1 2 m o - 5 y r> .4 0
s for7 days.
Nosign severe very
of of severe
pneumonia.
Nopneumonia 0nlycough cold orwithout
and with fever. Paracetamol
forfever,
Noantibiotic.
NB:Children 2 months fast
below with breathing,chest
indrawing
etc.Should
bereferredhealth
to centre.
4.5.ACUTE RESPIMTORY
R
UPPt II{IECTIOIIS
Clinical
Condition Features Treatment
Strategy
Common cold Fever, nose-block
cough, Discussed
Acute Media
0titis Pus theear <2 wk,
from for Sudden
persistent Cotrimoxazole,Ampicillin for5
ofAmoxycillin
ear orredness
pain, & decreased of
mobility days.
ear onotoscopy.
drum
Streptococcal
pharyngitis Tender,enlarged
cervical nodes
lymph plus Ampicillin/Amoxycillin
for |0 days.
white
pharyngeal
axudate.Absence of
ofsigns
Nasopharyngitis.
DOSAGE
OICOTRIIIO)(AZOLE BY ORWEIGHT
&AI'IO)(YCILLII{
AGE TATEGORIES:
AGE
ORWEIGHT c0RTl1,l0- c0RTtl,t0- c0RItl'10-
)(AIOIT xAzotE
Adult
Tablet strength
Single Paediatric
Tablet (40mg +
Iyrup Tl{P
(80mg + 400m9
TMP Sl'1) INP,t.f,Q.$.
1z0mg lll (200mgper
St'l 5ml)
|2 months to5years
up
(10-leks)
T|'|P
:Irimethoprim,S|'|
:Sulphamethoxazole
$;
- 2 Times for - 3 Times for
C0TRI|'|0XAZ0LE daily 5-7days.A|'|0XYClLLll'| daily 5-10 ,f ,il
7. during withprescribed fordrildren rdul6.
Common to bekept
drugs flood doses ild
sL. SCHEDULE
OI ROUTE DOSE
NAl4E OI sL 0r
l{AHt i0lE0uLl
mm 0f Dott
N0. DRUGS AD14INIS- |lO. DRUGI ADI'IITIT
TRATION IMTIO}i
chilren Adult
I Paracetamol0ral to4 times
l0-l5mg/kg/dose,up Paracetamol0ral 500n'i &i05
TD5
at interval.
daily 6 houn ltaoBDPCX5oays
L Co-trimoxazole0 r a l
7 0ral
Co-trimoxazole Asnoted
) 3 Amoxycillin 0ral 500mg X5 dayr
IDS
Amoxycillin 0ral in page-
5
Ciprofloxacin0ral 20-30ms/kg/day doses
in2 divided 4 0ral
Ciprofloxacillin 500mgBDPtX5days
4
5 Norfloxacin 0ral l0-l5mg/kg/day divided
in2 doses 5 Norfloxacillin 0ral 400mgBDPCX5days
6 Domperidone 0ral 0.2-0.4mg/kg/dose, 6 Domperidone0ral lOmgltabBDACX3days
be
may siven 6-hourly I tabBDPC days
X3
1 Cetrizine 0ral
7 Cetrizine 0ral 2-6 BD
years:2.5mg,
> 6years: 0D 8 |'|etroidazole 0ral 200mgIDSX5days
Smg
Ampicillin 0ral 25mg/kg/dose,6 hourly 9 Azithromycin 0ral 500mg 3 to 5 days
0D
I
0 0ral
|'|etronidazole l0mg/kg/dose aday
3 times t0 0R5 0ral AsNoted l'lanagement
under
t0 Furazolidine 0ral lOmg/kg/dose aday
3 times ll N5/Ringers IV ofdiarrhoea
tl Azithromycin0ral l2mg/kg daily
once Lactate
forl" 5 daysthen I tabTDPC
t2 Anacid 0ral
6ms/ks for4 days
daily
t3 InjTet
vac Il,l I amp
stat
t2 0Rs- 0ral As notedunder
Hypo-osmolar ofdiarrhoea
|',|anagement t4 AVS tv under bite
noted snake
As
t3 (lV
Saline Intravenous
l'|ormal t5 lodine
Povidone applied
Locally
t4 (lV
lactateIntravenous
Ringer's Solution
washing
lllustrationhand
of
ff
I
tF
8. Some
important
guidelines disinfection:
onwater
l. Disinfeaion
ofhousehold water.
drinking
a) P r e p a r a t C h lo fr i n e s o l u t i o n : A d d 3 ( t h r eb l)e a b he n p o o lwidferron a t e r . S t i r t h e s o l u t i o n a n d
ion o e t c l i s g p n o e iw
l t f
discard sediment.This solution forhousehold it can kept covered,colored
the chlorine isready useand be in container
for month
one
b) Add dropschlorine to I liter water drinking oradd halogen The can used
3 of solution of for purpose I tablet. water be
for
drinking half
after hour.
7. Disinfeaion well well.
oftube &
Routine
disinfection
4 Disinfection not during months
isusually done winter (November
to[ebruary)
b) During monson disinfection oncemonth toJune
pre month tobedone a (l'larch / July)
Q D i s i n f e c t i o n t o b e d o n e t w i c e a m o n t h d u r i n g m oo s o n s e ms o n ( J u no b J u) y
t n Septea ber/0ct e/ er l
Suspected outbreak
diarrhea situation
a) Disinfection once week.
tobedone every Number
ofdiarrhea tobe
cases monitored increasing
(whether ordecreasing)
b) lf there increase
is in numbercases disinfection done every till numbernew is
of then to be twice week of case
controlled.
c) Inspite disinfectiondone a week,
of being twice if there report new then disinfection tobe
is of cases, daily mayneed
done.
3 l'lethod
ofdisinfection well well.
oftube &
a) Roughlymatch (normal ofbleaching (33
one box size) powder gram)needed
is todisinfect ofstandard
I well diameter
of2 meter I tube
or well.
b) l'lake ofbleaching with
paste powder water, it and allow sediment Supernatant tobeput
stir then the t0settle. solution
ina bucket.the
Dip bucket well and up&down
inthe water stir several
times. '',,,.''
"' ,.
c) Incase tube handle seat toberemoved / Panchayet.
of well, and valve byPHE Supernatant
sohltionl'as
poured the
into pipe.
d) There besmell chlorinewater the
will of in if
e) Water well tube to beconsumed
of or well
evening it is notused thedwellers
when by
done
during
daytime villagers to consum@vater
and asked # rit
,f ** I
