Pgs 506 class-notes_


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Pgs 506 class-notes_

  1. 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. 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. 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. 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. 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.