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  1. 1. DISASTER MANAGEMENT Professor Syed Amin Tabish FRCP(London), FRCP(Edin.), FAMS, MD HA (AIIMS) Postdoc Fellowship, Bristol University (England) Doctorate in Educational Leadership (USA)
  2. 2. Definition  The WHO defines disaster as 'any occurrence that causes damage, economic destruction, loss of human life and deterioration in health and health services on a scale sufficient to warrant an extraordinary response from outside the affected community or area'.
  3. 3. 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)
  4. 4. Impact of 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
  5. 5. 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.
  6. 6. 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
  7. 7. 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
  8. 8. 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.
  9. 9. 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
  10. 10. Natural Events  Avalanches  Cyclones  Droughts  Earthquakes  Dust  Sand Storm  Epidemic Diseases
  11. 11. Natural Disaster  Famines  Floods  Heat waves  Hail Storms  Hurricanes (Katrina, Rita)
  12. 12. Natural Disasters  Land Slides  Severe Storms  Tornados  Tsunamis  Volcanic Eruptions
  13. 13. Man-made Disasters  Air Safety  Fire Emergencies  Nuclear Accidents & Radiation (blast, heat)  Hazardous material (chemical & biological)  Bioterrorism  Conflict / Terrorism
  14. 14. BCW: possible weapons against humans Biological Agents: Bacteria  Bacillus Anthracis  Brucella Species  Bartonella QuintanaVibrio Cholerare  Plague Fungi - Coccidiodes immitis Viruses - Hanta virus - Ebola virus - Smallpox Protozoa - Naeglaeria fowleri
  15. 15. 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
  16. 16. 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)
  17. 17. 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.
  18. 18. 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
  19. 19. 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.
  20. 20. 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
  21. 21. 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 programmes.
  22. 22. Impact  Whether disasters are essentially natural or man-made in origin, their consequences derive from a combination of human action and interaction with nature’s cycles or systems.  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 large-scale economic and social harm  the deterioration in the social well-being of the population
  23. 23. Disaster Management EMERGENCY PREPAREDNESS
  24. 24. Goal of Emergency Preparedness To reduce:  loss of lives  damage to property  impact on environment  impact on community
  25. 25. 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)
  26. 26. 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
  27. 27. 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 Director to arrange nurses
  28. 28. 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
  29. 29. Main Disaster Teams RESPONSIBILITIES
  30. 30. 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
  31. 31. 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
  32. 32. 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
  33. 33. Hospital Triage Team  Receiving the Disaster Patients  Screening (Triaging)  Transferring all incoming disaster patients to different treatment areas
  34. 34. Red Area Team To resuscitate, stabilize patients on red area and shifting them to definitive care areas
  35. 35. Yellow Area Team  To resuscitate and stabilize patients with serious non life- threatening injuries  Provide care to those patients who are seriously injured and likely to die  Transferring resuscitated patients to definitive care areas
  36. 36. Green Area Team Care of patients with minimal injuries
  37. 37. ED Patients Team Treating of the normal ED patients
  38. 38. Evacuation Team  Making beds available for casualties from the disaster by bed expansion and discharging current cold patients
  39. 39. Evaluation Team  Monitoring the management of the disaster and forward a final report to the Chief of the Disaster Management Committee.
  40. 40. 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
  41. 41. Responsibility of the Yellow area team  to resuscitate patients with serious non-life threatening injuries  stabilize patients with serious non- life threatening injuries  to provide care to those patients who are seriously injured and likely to die  transferring resuscitated patients to definitive care areas
  42. 42. National Policy-making  Risk and vulnerability assessment  Development of training programmes  Public health in disasters  The management of programmes involving refugees and internally displaced people  Shelter needs in disasters
  43. 43. 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
  44. 44. 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
  45. 45. CBW  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)
  46. 46. BCW  Decontaminate both materials & persons  Triage  Medical care & evaluation of casualties  Definitive decontamination (a final decontamination of the site)  Command, control & communication
  47. 47. Taste of Tears
  49. 49.  The confirmed death toll from the 7.6-magnitude earthquake that was centered near Muzaffarabad, the capital of Pakistan-controlled Kashmir (PcK) on October 8 stands at over 73,000 in Pck and in NWFP, while the unconfirmed death toll has climbed to over 86,000. (Nov-8, AP, Dawn) Over 79,000 people injured and estimated 3 million displaced or homeless. The earthquake affected nine districts in total: Abbottabad, Batagram, Mansehra, Shangla, and Kohistan in the North West Frontier Province (NWFP) and Muzaffarabad, Neelum, Poonch and Bagh in PcK.
  50. 50. 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.
  51. 51. Tsunami  The overall focus of attention is on rebuilding and long-term recovery and rehabilitation for the December 26, 2004 earthquake and tsunami disaster. The dead and missing toll from tsunamis triggered by the undersea earthquake measuring 9.0 on the Richter scale off the west coast of Indonesia’s Sumatra Island was estimated to be some 232,000 people along the coastal areas of 12 countries in the Indian Ocean, although a true toll will likely never be known. At least 1.7 million are reported to be homeless with estimates over 2 million. Tsunami-related deaths were recorded in Indonesia, Sri Lanka, India, Thailand, Malaysia, Myanmar, Maldives, Bangladesh, Somalia, Tanzania, Kenya and the Seychelles. The loss of life was particularly severe in Indonesia, Sri Lanka, India and Thailand. Nearly 166,000 dead and missing are from worst-hit Aceh province in Indonesia. The dead and missing toll in Sri Lanka is nearly 39,000. In India, at least 10,672 died in Tamil Nadu State and the Andaman and Nicobar Islands. The death toll in Thailand is around 5,400, including about 1,953 foreigners from at least 36 countries. More than 400 combined deaths have been reported in the other countries.
  52. 52. South Asia Earthquake January 2005
  53. 53. South Asia earthquake (India)
  54. 54. Asian Earthquake 2005
  55. 55. Asian Earthquake 2005
  56. 56. Asian Earthquake 2005
  57. 57. Asian Earthquake 2005
  58. 58. Asian Earthquake 2005
  59. 59. Asian Earthquake 2005
  60. 60. Asian Earthquake 2005
  61. 61. Asian Earthquake 2005
  62. 62. Asian Earthquake 2005
  63. 63. Asian Earthquake 2005
  64. 64. Asian Earthquake 2005
  65. 65. Asian Earthquake 2005
  66. 66. Natural Disaster
  67. 67. Pakistan: Villages wiped out
  68. 68. Bodies recovered
  69. 69. Asian Earthquake: Grim situation
  70. 70. Tsunami Catastrophe 2004-05
  71. 71. Tsunami: Satellite photos
  72. 72. Tsunami December 26 2004
  73. 73. Tsunami 2004/5: Indian Ocean
  74. 74. Tsunami: Indonesia
  75. 75. Tsunami
  76. 76. 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.
  77. 77. Iraq Tsunami: body in mortuary
  78. 78. Iraq: legs eaten by dogs
  79. 79. Iraq: a dead woman covered