3. WHAT IS DISASTERDISASTER- French word,(Des-bad & Astre -star)W.Nick carter defined:“An Event, Natural/ Manmade, Sudden/Progressive,which impacts with such severity that the community hasto respond taking exceptional Measures.”2.It is a phenomenon involving extensiveecological disruption leading risk to life,property and health to an extent warrantingextra ordinary response from outside theaffected area.
4. MAJOR DISASTERS IN INDIAHighly disaster prone country8 natural calamities /yr5 fold increase in the frequency of disastersduring last 30yrs.Bhopal gas tragedy.Cyclones (AP)& Orissa.Earthquake in Uttarkashi in 1990,latur .1993,Gujarat 2001. Skkim 2011Tsunami,2004.Train accidents.Bomb blasts in Delhi and Mumbai
10. A.PREDICTMeasures for efficient forecasting and warningsystemsDeveloping GIS for early detection and warningInformation Technology for effective communicationnetwork.Pro-active measures for disaster preparedness andmitigation – administrative, financial, Legislative &techno- legalDeveloping public awareness to build up society’sstrength to face disasters.National networking for immediate medical responseEmphasis on risk reduction, mitigation & awareness,while strengthening response.
11. B.PREVENT-Evoke existing system of response mechanism in the wake ofnatural and man-made disasters at all levels of government andsteps to minimize the response time through effectivecommunication & measures to ensure adequacy of reliefoperations.- Develop strategies for inclusion of disaster reductioncomponents in the on-going plan/ non – plan schemes.-Prepare the community to face the challenge and respond in caseof impending disaster-Lay stress on preparedness including prevention/ mitigation ofChemical Industrial Disasters while strengthening their emergencyresponse.-Stay up to date with the latest international best practices andrecent developments within the country-Highlight the salient gaps evaluated based upon the critical reviewof the present status for future action.
13. PREPARE DISASTER ACTION PLANIt is planned and systematic approach towardsunderstanding and solving the disaster to minimize theeffect.• The approach should be multi sectoral.• Plan should be realistic and easily adoptable• Plan should be clearly laid down defining the role andresponsibility of different agencies.• Should be exercised in between to evaluate it.• It should be prepared at the country, state, district andinstitutional level.• National disaster management authority(NDMA) facilitatestate with support and advice while plan and implementationby SDMA
14. CAPACITY DEVELOPMENTCreation of trained Medical First Response TeamsInitiation of training of paramedics for disastermanagement.Creation of detection, decontamination facilities.Uniform Causality Profile and Classification ofCasualties.Risk Inventory and Resources Inventory.Proper Casualty Treatment Kits.Crisis Management Plan at Hospitals.Mobile Hospitals/ Mobile Teams .Medical Response to Long Term Effects.Psychosocial Care for management of communitybehavior and response .Issues related to public health response and medicalrehabilitation and harmful effects on the environment. Efficient transport system
15. D.ORGANISATIONAL DEVELOPMENTNational Disaster Management Authority (NDMA)Constituted in Dec 2005 ,DM Act.•NDMA Chairman PM•SDMA are constituted there after•SDMA Chairman CM•DDMA Constituted CABINATE SECRETARY NDMA SECRETARIATE•DDMA Chairman DM/ DC DM-I DM-II • MITIGATION • CAPACITY DEV. • PREPAREDNESS • TRAINING • PLANS • KNOWLEDGE • RECONSTRUCTION MANAGEMENT • COMMUNITY AWARENESS • FINANCIAL ASPECTS
16. 2. PRE-HOSPITAL PLAN
17. DDMADISTRICT DISASTER COMITTE•Head Local Administration• Representatives of Police• Representatives of Fire services• Representatives of CATS• Representatives of Corporate body• Representatives of Voluntaryorganization• Representatives of Media• Hospital representatives.•Army should be called into action as andwhen required
18. GUIDELINES FOR DDMAPreparation of Action Plan Allocation of adequate resources Ensure implementationLaying down role and responsibilities of different servicesRegulatory framework.Code of Practices, Procedures and Standards.Statutory Inspection, Safety Auditing and Testing of Emergency Plans.Technical and technological information and Preparedness.Education and Training.Creation of DDMA Infrastructure.Capacity Development of all teams.Awareness Generation among Public.Institutional Framework at all levels.Networking and Information sharing.Medical Preparedness by medical Teams.Research and Development.Response, Relief and Rehabilitation.Evacuation plan and Mock drill
19. RESPONSE BY DDMA Instantaneous instruction for forthwith movement of rescue team with personal protective equipment (PPE) Simultaneously, QRMT(Quick Response Medical Team) with PPE on will reach to Mishap site immediately along with Resuscitation, protection, detection and decontamination equipment and materials. Decontamination , Resuscitation, triage and evacuation work must be done as per SOPs. DDMA will immediately inform State and National Disaster Management Authorities appraising about situation and extent of damage so that SDMA & NDMA can plan to send relief teams and supports.
20. HOSPITAL DISASTER PLAN
21. HOSPITAL DISASTER PLANHospital Disaster plan is prepared to reduce the pressureon the hospital management when a large number ofcasualties arriving suddenly in the hospital at a time,requiring different level of care.The plan should be activated immediately to provideefficient care to the patients within a short span of time.Mock drill to be conducted periodically to acquaint thestaff to meet any eventualityThe action plan begins with formation of DisastercommitteeKeeping adequate storage of supplies in the emergencydepartment. Keeping disaster SOP in the casualty.
22. HOSPITAL DISASTER ACTION PLAN CARE IN HOSPITALCARE AT THE SITE
23. HOSPITAL DISASTER COMMITTEEEach hospital must have a hospital disaster committee to giveeffect to the disaster action plan as and when required.CMO I/C CASUALTY •ALL HODS ECRO (Surg,Med,Ortho,Neuro,Lab, Radio)CMO(CASUALTY) • DD(A) •Nursing Supdt. •Officer I/C TPS SISTER I/C •CMO (store) •Officer I/C Maintain. •Dietician •CPWD Rep. OTHER PARAMED. STAFF
24. 1.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.
25. 2.INTERNAL DISASTER PLANIt is activated when the hospital buildings are effected indisaster. Action plan should clearly mention:• Alternate site (dharmashala,Temple,Schools,Playgroundnearby)• 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 provideservices of care,food and water.
26. 3.EXTERNAL DISASTER PLAN (TEN STEPS)• 3.1.DISASTER RESPONSE • 3.7. PUBLIC RELATION• 3.2. AUTHENTICATE • 3.8. TRAFFIC CONTROL SOURCE • 3.9.PERSONAL• 3.3. ACTIVATION OF PROTECTION DISASTER PLAN • 3.10.CHEMICAL• 3.4. CREATION OF DECONTAMINATION ADDITIONAL SPACE• 3.5. AUGMENTATION OF SERVICES• 3.6. MAINTENANCE OF RECORD
27. 3.EXTERNAL DISASTER PLAN3.1.DISASTER RESPONSE:STEP 1 ONE CASUALTY - Approach using normal proceduresSTEP 2 TWO CASUALTIES - Approach with caution, consider all options i).Report on arrival, update control.STEP 3 THREE CASUALTIES or MORE Do NOT wait i).Evoke Disaster action plan ii).Call for specialist help.Disaster response depends on:• Time available between the first information and arrival ofcasualties.• Type of preparedness and training of staff.• Accessibility to disaster manual.• Role played by different category of staff.
28. 3.EXTERNAL DISASTER PLAN3.1.DISASTER RESPONSE:STEP 1 ONE CASUALTY - Approach using normal proceduresSTEP 2 TWO CASUALTIES - Approach with caution, consider all options i).Report on arrival, update control.STEP 3 THREE CASUALTIES or MORE Do NOT wait i).Evoke Disaster action plan ii).Call for specialist help.Disaster response depends on:• Time available between the first information and arrival ofcasualties.• Type of preparedness and training of staff.• Accessibility to disaster manual.• Role played by different category of staff.
29. 3.2. AUTHENTICATE SOURCE OF INFORMATION:•Media, Telephone, Police, CATS on arrival ofcasualties.• Authenticate the information received.• Try to know the type of disaster, time ofoccurrence.• Estimate number or type of casualty expected.
30. DISASTER MANAGEMENTNOTIFY KEY PERSONS INITIATE PREPARATION o All the dept & designated staff get into INITIAL ALERT o readiness to attend casualties Crisis expansion of hospital beds. (POLICE, TV, o Preparation for decontamination area TELEPHONE ,PATIENT)RESUSCITATION COLLECT MOBILIZATION OF RESOURCES o Manpower: Disaster Management INFORMATION Team medical , nursing and other INVESTIGATION Personnel o Material and supply eg: antidotes o Transportation means ICU TRIAGE TREATMENT DUCUMENTATION OT IN DOOR DECONTAMINATION OPD DEATH ARRIVAL OF DISCHARGE PATIENT MORTURY
31. 3.3. ACTIVATION OF DISASTER PLAN:On confirming about the information the MSshould be informed and others to be informedthrough hospital exchange.The CMO on duty is responsible foractivation of the disaster plan.All the available doctors and staff to bealerted about the incidence.
32. 3.4. CREATION OF ADDITIONAL SPACE:A. Triage/shorting area:This is the area where the specialists will be there to categorize the patients as per priority.• Primary treatment area Resuscitation• Secondary treatment area Stabilization & treatment (Disaster ward)• Evacuation area First aid To wards & discharge /death• Control room and information center• Volunteer reception area (porter services)• Relatives waiting area• Media and communication area• Traffic control
33. TRIAGE/SHORTINGPriority I: Serious cases Red band Resus. ICU.Priority II: operation Yellow band Resus. OT Ward O U TPriority III: Requiring admission Blue band First aid WardPriority IV: Minor injuries Green band First aidPriority V: Dead Black band Identification Morgue
34. 3.5. AUGMENTATION OF SERVICES:•All supporting and utility services to be augmented.• Staff strength in different areas to be increased.• OTs to run round the clock.• CSSD, Laundry, Kitchen time to be extended tocompensate• Sanitation & Security services to be augmented• Continuous supply of electricity and water.• Communication service to run round the clock(Tel.Exchange)• Medical record section to be augmented.• Investigation services to run round the clock.•Medical store to be opened round the clok
35. 3.6. MAINTENANCE OF RECORD:Proper record of all cases to be made for identification.MLC to be made in all cases with name, address, injuriesand treatment given.All records to be preserved for future compensation andLegal evidenceA copy of the list to be handed over to police and inquirycounter.Documentation, follow up and research programs shouldbe used as feedback for future improvement and lessonslearnt.
36. 3.7. PUBLIC RELATION:An inquiry counter be opened round the clock forinformation of public and relatives.Media briefing to be made by Med. Supdt. OnlyPublic announcement be made for voluntary blooddonation.Information centre displaying information to public, torelatives of victims and media with warning guidelines,“DOs and DON’Ts” and condition of patients in thehospital.Adequate place for waiting relatives, toilet and drinkingfacilities.
37. 3.8. TRAFFIC CONTROL:This is very essential in a disaster situationAdequate measures to be made to control the trafficThere should be clear area for off loading patientsfrom AmbulancesNecessary arrangement should be made for VIP visitsAssistance of local police and volunteers may be short.
38. PERSONAL PROTECTION 3.9A. PPE:PPE, when decontamination, of specific agents, diagnosis& immediate management of chemical incidents, radiationfacts, emergency contacts.PPE will protect you, the patient, and other patients andcolleagues from infection and from other hazards, but only ifselected, worn, and discarded correctly.Remove PPE as you have been instructed in training.For advice on choosing and using PPE contact yourinfection control team (infection hazards) or for chemical/radiation, Health Protection Team
39. 3.9B.HAND HYGIENE:If your hands are visibly dirty, or contaminated with blood or body fluids, usesoap and water to clean your handsIf your hands are not visibly dirty, use an alcohol-based hand rub, or soap andwaterAlways clean your hands:– Before any patient contact (even if you are ‘only’ going to examine them)– Before any clinical procedure– Before you eat– After any patient contact– After completing a clinical procedure– After handling or touching any contaminated item or equipment (eg bed pan,suction apparatus, toilet flush-button)– After removing your gloves– After leaving an isolation room– After using the lavatoryNever try to clean visibly soiled disposable gloves by cleaning your glovedhands: it doesn’t work. Remove gloves, clean your hands, and reglove
40. 3.10.CHEMICAL DECONTAMINATION:Decontaminate according to protocols for clinical, emergency ormass decontamination.Decontamination of the injured and emergency decontamination isled and managed by the Ambulance ServiceRemoving the casualty from the source and promptdecontamination may be life-saving; as may prompt administrationof the specific antidotes that are available for some chemicals (egcyanide, organophosphates)Decontamination to be done by shower jet with plenty of water. Record any treatment given on the triage tag attached to thecasualtyFeedback relevant information regularly to MIO/Ambulance ControlEnsure that you and your equipment remain in the contaminatedarea until decontaminated.Collect samples and send for Lab test for confirmation of the
41. OFF HOSPITAL
42. POST DISASTER MANAGEMENT
43. RESCUEEmergency Management at the incident Site: •Personal Protective Equipment will be made available • Temporary decontamination facility • On-Site Triage, Resuscitation.Safe transportation of the casualties in ALS ambulancesEvacuation Plans for nearby affected communities. Earmarking of health care facilities able to cater differenttypes of casualties like chemical burns, respiratory problemsetc.Hospital to be informed to initiate disaster managementplans to deal with mass casualty events caused due to CBRNdisasters.Preparation of Trained Medical First Responders.Identification of Casualty Profile & their classification fortransfer.Risk and Resource Inventories and supplies augmentation.
44. DISASTER ZONES PUBLIC PASSAGEMEDIACOMAND CENTREAMBULANCE WIND DIRECTION TRIAGE FIRST-AIDDECONTAMINATIO N EVACUATION TEAM DANGE R ZONE NO ENTRY
45. RELIEF1. Prime responsibility of Public Health authorities.2. They must ensure safe water supply, clean food availability.3. Maintenance of hygiene and sanitation by proper bio- waste disposal.4. Water testing and food inspection must be carried out.5. Decontamination of the area, equipment, vehicles and disposal of left over contaminants.6. Removal of dead bodies from site has to be carried out in the Post-disaster Scenario and their disposal.7. It also involves restoring life of victims to normalcy in resettlement colonies.
46. 3. REHABILITATIONIt involves providing temporary shelters with minimal hygienesanitation to the affected, restoring “normalcy” through ensuringresumption of family’s daily living patterns.Psychological impact of chemical disaster manifested as posttraumatic stress disorders (PTSD) in displaced people due lo disaster,needs care by a psychologist and psychiatrist.In post-disaster scenario some of the casualties will developsequel due to chemical/Radiation injuries.These cases may need regular follow-up, medical care,reconstructive surgery and rehabilitation.Close monitoring is required to see any long term health effects likeblindness, interstitial lung fibrosis and neurological deficiencies etc.,and need to be treated as well.
47. EFFECTS OF IMPACT Psychological vulnerability and Neuropsychological Sequel Fear of unknown calamities. Fleeing of affected community. Exponential spread of disaster victims. Over crowding of hospitals by people believing themselves to be affected. Hoarding of food, water and essential items. Decreased efficiency of system. Collapse of civil management and lack of essential services.
48. POST DISASTER DOCUMENTATION AND ANALYSIS Information will be prepared by a medical administrator. During response in hospital an information centre will provide information to public, to relatives of victims and media Warning guidelines, “DOs and DON’Ts” and condition of patients in the hospital. Dissemination of information to electronics and prints media will also be carried out by medical team. Documentation, follow up and research programs should be used as feedback for future improvement and lessons learnt.
49. MEDICAL RESPONSE TO LONG TERM EFFECTS1. In post-disaster scenario some of the casualties will develop sequel due to chemical/Radiation injuries.2. These cases may need regular follow-up, medical care, reconstructive surgery and rehabilitation.3. Close monitoring is required to see any long term health effects like blindness, interstitial lung fibrosis and neurological deficiencies etc., and need to be treated as well.
50. hospiad Hospital Administration Made Easy http//hospiad.blogspot.com An effort solely to help students and aspirants in their attempt to become a successful Hospital Administrator. DR. N. C. DAS