Disaster management

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  • 1. Professor Syed Amin Tabish FRCP(London), FRCP(Edin.), FAMS, FACP, MHA (AIIMS)
  • 2. 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)
  • 3. 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
  • 4. 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.
  • 5. 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
  • 6. 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
  • 7. 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.
  • 8. 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
  • 9. Natural Events        Avalanches Cyclones Droughts Earthquakes Dust Sand Storm Epidemic Diseases
  • 10. Natural Disaster      Famines Floods Heat waves Hail Storms Hurricanes (Katrina, Rita)
  • 11. Natural Disasters  Land Slides  Severe Storms  Tornados  Tsunamis  Volcanic Eruptions
  • 12. Man-made Disasters  Air Safety  Fire Emergencies  Nuclear Accidents & Radiation (blast, heat)  Hazardous material (chemical & biological)  Bioterrorism  Conflict / Terrorism
  • 13. BCW: possible weapons against humans Bacteria  Bacillus Anthracis  Brucella Species  Bartonella QuintanaVibrio Cholerare  Plague Fungi - Coccidiodes immitis Viruses - Hanta virus - Ebola virus - Smallpox Protozoa - Naeglaeria fowleri
  • 14. 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
  • 15. 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)
  • 16. 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.
  • 17. 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
  • 18. 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.
  • 19. 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
  • 20. 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 programs
  • 21. Impact  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 largescale economic and social harm  the deterioration in the social well-being of the population
  • 22. Disaster Management EMERGENCY PREPAREDNESS
  • 23. Goal of Emergency Preparedness To reduce:  loss of lives  damage to property  impact on environment  impact on community
  • 24. 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)
  • 25. 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
  • 26. 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 Supdt to arrange nurses
  • 27. 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
  • 28. Main Disaster Teams RESPONSIBILITIES
  • 29. 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
  • 30. 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
  • 31. 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
  • 32. Hospital Triage Team  Receiving the Disaster Patients  Screening (Triaging)  Transferring all incoming disaster patients to different treatment areas
  • 33. Red Area Team  To resuscitate, stabilize patients on red area and shifting them to definitive care areas
  • 34. Yellow Area Team  To resuscitate and stabilize patients with serious non lifethreatening injuries  Provide care to those patients who are seriously injured and likely to die  Transferring resuscitated patients to definitive care areas
  • 35. Green Area Team  Care of patients with minimal injuries
  • 36. ED Patients Team  Treating of the normal ED patients
  • 37. Evacuation Team  Making beds available for casualties from the disaster by bed expansion and discharging current cold patients
  • 38. Evaluation Team  Monitoring the management of the disaster and forward a final report to the Chief of the Disaster Management Committee.
  • 39. 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
  • 40. Responsibility of the Yellow area team  to resuscitate patients with serious non-life threatening injuries  stabilize patients with serious nonlife threatening injuries  to provide care to those patients who are seriously injured and likely to die  transferring resuscitated patients to definitive care areas
  • 41. National Policy-making  Risk and vulnerability     assessment Development of training programmes Public health in disasters The management of programs involving refugees and internally displaced people Shelter needs in disasters
  • 42. 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
  • 43. 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
  • 44. Biochemical Weapons  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)
  • 45. BCW  Decontaminate both materials &     persons Triage Medical care & evaluation of casualties Definitive decontamination (a final decontamination of the site) Command, control & communication
  • 46. Pak Earthquake  The death toll from the 7.6-magnitude earthquake that was centered near Muzaffarabad, on October 8 stands at over 86,000 in Pck and in NWFP.  Over 79,000 people injured and estimated 3 million displaced or
  • 47. 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.
  • 48. SouthAsia Earthquake Jan 2005
  • 49. South India earthquake
  • 50. Asian Earthquake 2005
  • 51. Asian Earthquake 2005
  • 52. Asian Earthquake 2005
  • 53. Asian Earthquake 2005
  • 54. Asian Earthquake 2005
  • 55. Asian Earthquake 2005
  • 56. Asian Earthquake 2005
  • 57. Pakistan: Villages wiped out
  • 58. Bodies recovered
  • 59. Asian Earthquake: Grim situation
  • 60. Tsunami Catastrophe 2004-05
  • 61. 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.