DISASTER MGMNT 2. DISRUPTIONINDUCEDSITUATIONAFTERSEVERETRANSFORMATIONOFECOLOGICALRESPONSE 3. WHAT IS DISASTERDISASTER- French word,(Des-bad & Astre -star)W.Nick carterdefined:“An Event, Natural/ Manmade, Sudden/Progressive,which impacts with such severitythat the community hasto respond taking exceptional Measures.”2.It is a phenomenon involvingextensiveecological disruption leading risk to life,property and health to an extentwarrantingextra ordinary response from outside theaffected area. 4. 8 natural Highly disaster prone country MAJOR DISASTERS IN INDIA 5 fold increasein the frequency of disastersduring last calamities /yr Cyclones (AP) Bhopal gastragedy. 30yrs.& Earthquake in Orissa. Uttarkashi in 1990,latur .1993,Gujarat 2001. SkkimBomb blasts in Delhi and Mumbai Train accidents. Tsunami,2004. 2011 5. TYPES OF DISASTER • Aircrash• Flood • Sinking ship• Cyclone • Train accidents•Earthquake • Building collapse• Volcanic eruption • Bridge collapse• Epidemics • Bombblasts•Tsunami • Warfare (conventional, chem. bio, nuclear) 6. DISASTER MANAGEMENT PRE HOSPITALPLANNING HOSPITAL DISASTERMANAGMENT OFF HOSPITAL 7. DISASTER MANAGEMENTPredict RescuePrevent ReliefPrepare Rehabilitation 8. DISASTER MANAGEMENT PLANNING 9. 1.PLANNING 10. Measures for efficient forecasting and A.PREDICT Developing GIS for early detectionand warningsystems Information Technology for effective warning Pro-active measures fordisaster preparedness communicationnetwork. andmitigation – administrative, financial,Legislative &techno- Developing public awareness to build up society‟sstrength to face legalEmphasis National networking for immediate medical response disasters. on risk reduction,mitigation & awareness,while strengthening response. 11. B.PREVENT-Evoke existing system of response mechanism in the wake ofnatural andman-made disasters at all levels of government andsteps to minimize the response time througheffectivecommunication & measures to ensure adequacy of reliefoperations.- Develop strategiesfor inclusion of disaster reductioncomponents in the on-going plan/ non – plan schemes.-Preparethe community to face the challenge and respond in caseof impending disaster-Lay stress onpreparedness including prevention/ mitigation ofChemical Industrial Disasters whilestrengthening their emergencyresponse.-Stay up to date with the latest international bestpractices andrecent developments within the country-Highlight the salient gaps evaluated basedupon the critical reviewof the present status for future action. 12. C.PREPARE 13. PREPARE DISASTER ACTION PLANIt is planned and systematic approachtowardsunderstanding and solving the disaster to minimize theeffect.• The approach should bemulti sectoral.• Plan should be realistic and easily adoptable• Plan should be clearly laid downdefining the role andresponsibility of different agencies.• Should be exercised in between toevaluate it.• It should be prepared at the country, state, district andinstitutional level.• Nationaldisaster management authority(NDMA) facilitatestate with support and advice while plan andimplementationby SDMA Creation of trained Medical First 14. CAPACITY DEVELOPMENT Initiation of training ofparamedics for Response Teams Creation of detection, decontamination disastermanagement.
Uniform Causality Profile and Classification facilities. Proper Casualty Risk Inventory andResources Inventory. ofCasualties. Mobile Hospitals/ Crisis Management Plan atHospitals. Treatment Kits. Psychosocial Care Medical Response to Long TermEffects. Mobile Teams . Issues related to for management of communitybehavior and response. public health response and medicalrehabilitation and harmful effects on Efficient transportsystem the environment. 15. D.ORGANISATIONAL DEVELOPMENTNational Disaster Management Authority(NDMA)Constituted in Dec 2005 ,DM Act.•NDMA Chairman PM•SDMA are constituted thereafter•SDMA Chairman CM•DDMA Constituted CABINATE SECRETARY NDMASECRETARIATE•DDMA Chairman DM/ DC DM-I DM-II • MITIGATION • CAPACITYDEV. • PREPAREDNESS • TRAINING • PLANS • KNOWLEDGE • RECONSTRUCTIONMANAGEMENT • COMMUNITY AWARENESS • FINANCIAL ASPECTS 16. 2. PRE-HOSPITAL PLAN 17. DDMADISTRICT DISASTER COMITTE•Head Local Administration• Representativesof Police• Representatives of Fire services• Representatives of CATS• Representatives ofCorporate body• Representatives of Voluntaryorganization• Representatives of Media• Hospitalrepresentatives.•Army should be called into action as andwhen required 18. Allocation of adequate Preparation of Action Plan GUIDELINES FOR DDMA Layingdown role and responsibilities Ensure implementation resources Code ofPractices, Regulatory framework. of different services Statutory Inspection, Safety Auditingand Procedures and Standards. Technical and technological information and Testing ofEmergency Plans. Creation of DDMA Education and Training. Preparedness. AwarenessGeneration Capacity Development of all teams. Infrastructure. Networking and InstitutionalFramework at all levels. among Public. Research and Medical Preparedness by medicalTeams. Information sharing. Evacuation plan and Response, Relief andRehabilitation. Development. Mock drill Instantaneous instruction for 19. RESPONSE BY DDMA forthwith movement of rescueteam with personal protective equipment Simultaneously, QRMT(Quick ResponseMedical (PPE) Team) with PPE on will reach to Mishap site immediately along withResuscitation, protection, detection and decontamination equipment and materials.Decontamination , Resuscitation, triage and evacuation work must be DDMA will immediatelyinform State and National done as per SOPs. Disaster Management Authorities appraising aboutsituation and extent of damage so that SDMA & NDMA can plan to send relief teams andsupports. 20. HOSPITAL DISASTER PLAN 21. HOSPITAL Hospital Disaster plan is prepared to reduce the DISASTER PLANpressureon the hospital management when a large number ofcasualties arriving suddenly in thehospital at a time,requiring different level of The plan should be activated immediately toprovideefficient care care. Mock drill to be conducted to the patients within a short span oftime. The action periodically to acquaint thestaff to meet any eventuality Keeping adequatestorage plan begins with formation of Disastercommittee Keeping disaster SOP in the ofsupplies in the emergencydepartment. casualty. 22. HOSPITAL DISASTER ACTION PLAN CARE IN HOSPITALCARE AT THE SITE 23. HOSPITAL DISASTER COMMITTEEEach hospital must have a hospital disastercommittee 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) •NursingSupdt. •Officer I/C TPS SISTER I/C •CMO (store) •Officer I/C Maintain. •Dietician •CPWDRep. OTHER PARAMED. STAFF 24. 1.CARE AT THE SITE• Do not allow Golden hour to expire,, 1st hour•It is best if servicescan be provided in first 10 minutes (Platinum minute)• BLS ABC= Air way. Breathing.Circulation• ALS DEF= Defibrillator. ET intubation, ECG . Fluid & electrolyte• Constitute thefield team: 1.Ambulance 2.Anesthetist To be identified and roaster made on daily, 3.OT TechWeekly and monthly basis. 4.Bearers 5.Drivers • Dispatch the team to site • Assess the situationin 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 effectedindisaster. Action plan should clearly mention:• Alternate site(dharmashala,Temple,Schools,Playgroundnearby)• Folding tents, cots, trolleys for temporaryshelters• Identify a nearby tent house to provide beds,blankets• TPT for transportation of cases toalternate sites or hospital• First aid and drug kits, potable lights.• Portable communicationsystem.• 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 STEP 1 ONECASUALTY RESPONSE: - Approach using normal STEP 2 TWO CASUALTIES - Approachwith caution, procedures consider all options i).Report STEP 3 THREE CASUALTIES orMORE Do NOT wait on arrival, update control. i).Evoke Disaster action plan ii).Call forspecialist help.Disaster response depends on:• Time available between the first information andarrival ofcasualties.• Type of preparedness and training of staff.• Accessibility to disastermanual.• Role played by different category of staff. 28. STEP 1 ONE CASUALTY 3.EXTERNAL DISASTER PLAN3.1.DISASTERRESPONSE: - Approach using normal STEP 2 TWO procedures CASUALTIES - Approachwith caution, consider all options i).Report on arrival, update STEP 3 THREE CASUALTIES orMORE Do NOT wait control. i).Evoke Disaster action plan ii).Call for specialist help.Disasterresponse depends on:• Time available between the first information and arrival ofcasualties.•Type of preparedness and training of staff.• Accessibility to disaster manual.• Role played bydifferent category of staff. 29. 3.2. AUTHENTICATE SOURCE OF INFORMATION:•Media, Telephone, Police, CATSon 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 oAll the dept & designated staff get into INITIAL ALERT o readiness to attend casualties Crisisexpansion 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 INVESTIGATIONPersonnel o Material and supply eg: antidotes o Transportation means ICU TRIAGETREATMENT DUCUMENTATION OT IN DOOR DECONTAMINATION OPD DEATHARRIVAL OF DISCHARGE PATIENT MORTURY
31. 3.3. On confirming about the information the ACTIVATION OF DISASTER PLAN:MSshould be informed and others to be informedthrough hospital The CMO on duty isresponsible foractivation of the disaster exchange. All the available doctors and staff tobealerted about the plan. incidence. 32. 3.4. CREATION OF ADDITIONAL SPACE:A. Triage/shorting area:This is the areawhere the specialists will be there to categorize the patients as per priority.• Primary treatmentarea 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 communicationarea• Traffic control 33. TRIAGE/SHORTINGPriority I: Serious cases Red band Resus. ICU.Priority II: operationYellow band Resus. OT Ward O U TPriority III: Requiring admission Blue band First aidWardPriority IV: Minor injuries Green band First aidPriority V: Dead Black band IdentificationMorgue 34. 3.5. AUGMENTATION OF SERVICES:•All supporting and utility services to beaugmented.• 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 beaugmented• Continuous supply of electricity and water.• Communication service to run roundthe clock(Tel.Exchange)• Medical record section to be augmented.• Investigation services to runround the clock.•Medical store to be opened round the clok 35. 3.6. MAINTENANCE OF MLC to Proper record of all cases to be made foridentification. RECORD: be made in all cases with name, address, injuriesand treatment Allrecords to be preserved for future compensation andLegal given. A copy of the list to be handedover to police and evidence Documentation, follow up and research programsshouldbe inquirycounter. used as feedback for future improvement and lessonslearnt. 36. An inquiry counter be opened round the clock 3.7. PUBLIC RELATION: Media briefingto be made by forinformation of public and relatives. Public announcement be made forvoluntary Med. Supdt. Only Information centre displaying information topublic, blooddonation. torelatives of victims and media with warning guidelines,“DOs andAdequate place for DON‟Ts” and condition of patients in thehospital. waiting relatives, toiletand drinkingfacilities. 37. 3.8. Adequate This is very essential in a disaster situation TRAFFIC CONTROL: Thereshould be cle measures to be made to control the trafficar area Necessary arrangement shouldbe for off loading patientsfrom Ambulances made for VIP visitsAssistance of local police andvolunteers may be short. 38. PERSONAL PROTECTION PPE, when 3.9A. PPE: decontamination, of specific agents,diagnosis& immediate management PPE will of chemical incidents, radiationfacts, emergencycontacts. protect you, the patient, and other patients andcolleagues from infection and from otherhazards, but only ifselected, worn, and Remove PPE as you have been instructed in discardedcorrectly. For advice on choosing and using PPE contact yourinfection training. control team(infection hazards) or for chemical/radiation, Health Protection Team If your hands are 39. 3.9B.HAND HYGIENE: visibly dirty, or contaminated with blood orbody fluids, usesoap and If your hands are not visibly dirty, use an water to clean your handsAlways clean your hands:– alcohol-based hand rub, or soap andwater Before any patientcontact (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 ortouching any contaminated item or equipment (eg bed pan,suction apparatus, toilet flush-button)– After removing your gloves– After Never try to clean leaving an isolation room– Afterusing the lavatory visibly soiled disposable gloves by cleaning your glovedhands: it doesn‟twork. Remove gloves, clean your hands, and reglove 40. Decontaminate according to protocols for 3.10.CHEMICAL DECONTAMINATION:Decontamination of the clinical, emergency ormass decontamination. injured and emergencydecontamination isled and managed by the Ambulance Removing the casualty from the sourceand promptdecontamination Service may be life-saving; as may prompt administrationof thespecific antidotes that are available for some chemicals (egcyanide, Decontamination to be doneby shower jet with plenty organophosphates) Record any treatment given on the triage tagattached to of water. Feedback relevant information regularly to MIO/Ambulance thecasualtyEnsure that you and your equipment remain in the Control Collect samples and send forLab contaminatedarea until decontaminated. test for confirmation of the 41. OFF HOSPITAL 42. POST DISASTER MANAGEMENT 43. Emergency Management at the incident Site: RESCUE •Personal Protective Equipmentwill be made available • Temporary decontamination facility Safe • On-Site Triage,Resuscitation. Evacuation Plans for transportation of the casualties in ALS ambulancesEarmarking of health care facilities able nearby affected communities. to cater differenttypes ofcasualties like chemical burns, respiratory Hospital to be informed to initiatedisaster problemsetc. managementplans to deal with mass casualty events caused due toPreparation of Trained Medical First CBRNdisasters. Identification of CasualtyProfile Responders. & their Risk and Resource Inventories and supplies classificationfortransfer. augmentation. 44. DISASTER ZONES PUBLIC PASSAGEMEDIACOMAND CENTREAMBULANCEWIND DIRECTION TRIAGE FIRST-AIDDECONTAMINATIO N EVACUATION TEAMDANGE R ZONE NO ENTRY 45. RELIEF1. Prime responsibility of Public Health authorities.2. They must ensure safe watersupply, clean food availability.3. Maintenance of hygiene and sanitation by proper bio- wastedisposal.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 sitehas to be carried out in the Post-disaster Scenario and their disposal.7. It also involves restoringlife of victims to normalcy in resettlement colonies. It 46. 3. REHABILITATION involves providing temporary shelters with minimalhygienesanitation to the affected, restoring “normalcy” through ensuringresumption ofPsychological impact of chemical family‟s daily living patterns. disaster manifested asposttraumatic stress disorders (PTSD) in displaced people due lo disaster,needs care by apsychologist and In post-disaster scenario some of the casualties will psychiatrist. These casesmay need developsequel due to chemical/Radiation injuries. regular follow-up, medicalcare,reconstructive surgery and Close monitoring is required to see any long termhealth rehabilitation. effects likeblindness, interstitial lung fibrosis and neurological deficienciesetc.,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 offood, water and essential items. Decreased efficiency of system. Collapse of civil managementand lack of essential services. 48. POST DISASTER DOCUMENTATION AND Information will ANALYSIS Duringresponse in hospital an be prepared by a medical administrator. information centre will provideinformation to public, to relatives of victims and Warning guidelines, “DOs and DON‟Ts” andcondition media of Dissemination of information to patients in the hospital. electronics andprints media will also be carried out by medical team. Documentation, follow up and researchprograms should be used as feedback for future improvement and lessons learnt. 49. MEDICAL RESPONSE TO LONG TERM EFFECTS1. In post-disaster scenario some ofthe casualties will develop sequel due to chemical/Radiation injuries.2. These cases may needregular follow-up, medical care, reconstructive surgery and rehabilitation.3. Close monitoring isrequired to see any long term health effects like blindness, interstitial lung fibrosis andneurological deficiencies etc., and need to be treated as well.