Lecture given at MG University Kottayam

1. Disaster Management
Cycle
Venugopalan P P DA,DNB,MNAMS
Chief, Emergency medicine
Site Director –Masters program in EM under GWU –
USA
Executive Director –Angels International Foundation

2. What is a DISASTER?
• Disaster- dis·as·ter
(noun) An occurrence
causing widespread
destruction & distress; A
catastrophe.
• A grave misfortune.

3. Hazard
• Any phenomenon that has the potential to
cause disruption or damage to people and
their environment

4. AIMS OF DISASTER
MANAGEMENT
• Reduce (Avoid, if
possible) the potential
losses from hazards.
• Assure prompt and
appropriate assistance to
victims when necessary.
• Achieve rapid and
durable recovery.

7. Natural Disasters
• Natural Disasters For some natural
disasters like floods and volcanoes,
advance warning may be there; for others
like earth quakes, tsunami – NO
WARNING

8. Man Made

9. Man-made Disasters
Man-made Disasters
• Chemical Plant
Explosion
• Industrial Accident
• Building Collapse
• Acts of Terror

10. What is it?
• Disaster scenarios once seemed merely
theoretical have become a disturbing
reality

11. Just like apples
• Just like apples
• Disasters in the communities come in all
shapes and sizes

12. Small
• Small Some impact a
small number of
people
• Intense demands on
the health system for
a short period E.g.
Hooch Tragedy

13. Large
• Large Others involve
a large number of
casualties
• Reach a plateau only
after a latent period
• Placing heavy
continuing demands
on the system

14. Why important?
• Hospitals can quickly be overwhelmed in
the event of a disaster

15. Developed or not
• For example, after the terrorist bombing in
Bali in 2002,15 patients requiring
mechanical ventilation were sent to an
Australian hospital

16. Why we are not prepared?
• Traditional approach fail
• Need equipment
• Need training
• Needs Rs Rs Rs Rs Rs
• Fear of the unknown “It can’t happen
here” “Not interested”
• Inherent lethargy

17. So what?
• Planning and preparedness, would allow
for a better, more efficient use of material
and human resources

18. Key Points:
• Mitigation involves Structural and Non-structural
measures taken to limit the
impact of disasters

19. Disaster Management
Fundamental aspects
• Disaster response
• Disaster Preparation
• Disasters Mitigation

22. DISASTER MANAGEMENT CYCLE
DURING DISASTER
PRE-DISASTER

23. Stages of Disaster
BEFORE DURING AFTER
Jan - Apr MAY June- Oct
Well Before
Weeks-Months
Just Before
- Hours
Actual Time
Period
Rescue Relief Rehabilitation Reconstruction

24. Need for Training
• Training of a new volunteer group for such
eventualities is difficult;
• Training of existing medical and
paramedical staff is more realistic

25. Hospitals need to be prepared
• Hospitals need to be prepared
• First institutions to be affected after any
form of disasters, are the hospitals;
whether natural or man-made.
• Preparing nurses is important

26. Mass Casualty Incident
• Any incident that exceeds the responder’s
or receiving hospital’s capability to treat or
transport is a Mass Casualty Incident

27. Multiple Casualty Incident
• Resources are not overwhelmed
• Multiple victims

28. Disaster Management Plan
• A well documented and tested disaster
management plan (DMP) is needed for
each disaster

29. Systematic Approach
• Command and Control
• Safety -
Self-Scene-Survivors
• Communication
• Assessment
METHANE
• Triage , Treatment, Transport

30. D – I – S – A – S – T – E – R
PARADIGM
• This is a mnemonic which can help
rescuers remember critical information
about disaster response and triage

31. Disaster Paradigm
D: Detection
I: Incident Command
S: Safety & Security
A: Assess Hazards
S: Support
T: Triage ,Transport & Treatment
E: Evacuation
R: Reallocation & Redeployment

32. D-I-S-A-S-T-E-R
Detection
• Internal
• External
• Simple clear plan for notification of
administration of the presence of a
disaster

33. Disaster
• Stand by
• Declared

34. In
Bronze
Silver
Gold
Incident

35. D-I-S-A-S-T-E-R
Incident Command
• Born in Fire Service
• Uniform structure
• Clearly delineated roles /responsibilities
• Clear chain of command / communication

36. Incident Command System –
Basics
• Unified Command Planning Operations
• Finance Logistics
• “Commander” “Thinkers” “Getters” “Doers”
“Payers”

37. Incident Command System
• Incident Command System Chief of
Operations
• Chain of command under the Operations
Chief.
• Note the distribution of Branches under
COO

40. D-I-S-A-S-T-E-R
Support
• State Ministry and the public health
departments like DHS and DME;
• Fire departments
• Law enforcing agencies

41. D-I-S-A-S-T-E-R
Assess Hazards
• Be Aware of Secondary
Devices!
• Bombs,
• Incapacitating Devices,
• Multiple
Snipers/Terrorists,
• Delay Devices

42. D-I-S-A-S-T-E-R
Safety and Security
• Ensure protection of staff handling
disasters using personal protective
equipment, decontamination and isolation
protocols

43. D-I-S-A-S-T-E-R
Triage
• For any hospital while responding to a
mass casualty event; the goal is to save
as many lives as possible with the
available resources

44. Triage
• This could mean application of the
principles of field triage in casualty;
• The purpose of which is to determine who
gets what kind of care

45. Triage
• The term comes from the French verb
trier,
• Meaning to separate, sort, sift or select

46. Triage - Definition
• A process of prioritizing patients based on
the severity of their condition, in order to
treat as many as possible when resources
are insufficient

47. What to do?
• All to be treated immediately is impossible,
so one has to select the suitable patients
for immediate care based on certain
criteria

48. Triage
Sieve

50. Triage Nurse
• The triage nurse should be in view of the
waiting area of the casualty at all times
and prioritize the waiting patients
periodically

51. Triage – Badge
• It is selected by the Triage Nurse and worn
on each patient involved.
• It helps for any other staff to immediately
identify seriousness of the case

52. Triage Tape
• Instead of the triage badge, one may use
triage tape to be worn around the wrist

53. Triage Tag

54. Triage Nurse
• Greeting patients and families in a warm,
empathetic manner performing brief visual
assessments
• Documenting the assessments triaging
patients into priority groups using
appropriate guidelines

55. Triage Nurse
• Ensuring necessary treatment to
deserving patients, returning to the triage
area
• Transporting patients to treatment areas
• Giving reports to the emergency physician,
who is treating the patient

56. D-I-S-A-S-T-E-R
Treatment
• Measuring the relevant vital signs for
appropriate determination of triage level
• Reassessment of patients remaining in the
waiting room

57. D-I-S-A-S-T-E-R
Treatment
• Notifying patients and their families of any
unavoidable delays instructing patients
and families
• Triage staff of any change in their
condition

58. D-I-S-A-S-T-E-R
Treatment
• Medications
• Antidotes
• Antibiotics
• Immunizations
• Prophylaxis
• Chelation

59. D-I-S-A-S-T-E-R
Evacuation
• A hospital might need to be evacuated
either partially or wholly to accommodate
casualties; quarantine or divert incoming
patients

60. Flooding
• The ground floor services may need to be
shifted to higher floors or a make shift
operation theatre arranged

61. It could mean
• Minor surgical procedures in victims may
have to be undertaken in these areas as it
could mean altered level of asepsis

62. It could mean
• Creating alternate care sites in the waiting
area or the hospital lobby or corridors
which are not normally designed to
provide medical care

63. It could also mean
• Changing roles and strategies for who
provides various kinds of care enhancing
the scope of nurses, nursing assistants
and paramedics

64. D-I-S-A-S-T-E-R
Reallocation
• Allocating scarce equipment in a way that
saves the largest number of lives in
contrast to the traditional focus on saving
individual lives

65. D-I-S-A-S-T-E-R
Redeployment
• Re-allocating non emergency and non-clinical
doctors to emergency areas &
recruiting retired or unemployed persons
for temporary service

66. D-I-S-A-S-T-E-R
Recovery
• Re-establish infrastructure
• Psychological Support/”Local Debriefings”
• Economic recovery
• Insurance claims

67. One key component
• It is ensuring adequate supplies of
qualified health care providers who are
available and willing to serve in a Mass
Casualty event

68. Periodic Checks
• A hospital's emergency response plan
shall undergo periodic assessment and
evaluation whether the plan addresses all
issues

69. Hospital Disaster Drills
• An effective and economical way to
improve clinicians' knowledge of hospital
disaster procedures is computer
simulation

70. Drill at Kannur KAP

71. Hospital Disaster Drills
• To make new hospital staff aware of
procedures in disaster response and to
train hospital staff to respond to a
unexpected Mass Casualty

72. Communication is the key word
• Internal and external communications
were the key to effective disaster response
• Updated phone numbers for key players
were vital

73. METHANE
M- My Call sign
Major Incident Stand by or Declared
E - Exact location
T- Type of Incident
H- Hazards , Present / Potential
A – Access to Scene
N – Number and Severity
E -Emergency Services -Present and Required

74. Media

75. Ambulance Network

76. Table Top Exercise
• Motivate hospital staff to learn more about
disaster preparedness video
demonstrations can educate a large

77. In India
India and probably in many other countries
of the developing world, no statutory body
to regulate and accredit this requirement

78. Agencies supporting Disasters

79. drvenugopalpp@gmail.com
www.mimsindia.com
www.emergencymedicinemims.co
m
www.angelsindia.org
www.drvenu.net