Global disaster preparedness and response 2012 03 25 [compat
Global DisasterPreparedness andResponse Carlos Primero D. Gundran, EMDM EMS and Disaster Management Coordinator, Philippine College of Emergency Medicine
Objectives• Define “Disaster” • Show the occurrence of• Define the aspects of disaster on the following Disaster setting: Global, US,• Define the characteristics Philippines. of a Disaster • Define a Mass Casualty• Define Hazards Incident.• Enumerate the different • Who are involved in an types of Hazard. MCI?
Objectives• Discuss the Basic assumptions and facts in an MCI.• Differentiate MCI in an Urban setting from a Rural setting.• Discuss the EMS steps in an MCI• Discuss the Organization of medical Treatment in MCI• Discuss the survival statistics in an MCI.• Overview of USAR in the West.• Discuss the real issue in Disaster Preparedness and Response.• Discuss the Hyogo Framework of Action.
Disaster• A serious disruption in the functioning of a community or society causing widespread human, material, economic or environmental losses which exceed the ability of the affected community or society to cope using its own resources. http//:www.unisdr.org/eng/library/lib-terminology-eng%20home.htm
DisastersThe most important aspects to remember about disasters are:- Disasters interrupt the normal functioning of a community.- Disasters exceed the coping mechanisms of the community.- External assistance is needed to return to normal functioning of a community.
Characteristics of a Disaster• 1. Mismatch – Needs>capacity• 2. Chaos – Everybody does his and her own thing
Hazards• a situation that poses a level of threat to life, health property or environment.
Increased frequency of disasters in the world today• One disaster everyday somewhere in the world.
Disasters in the US• 23 major disasters occur every year.• 2010, there were 81 major disaster, (1 every 4 ½ days.)• 2010- 2 ½ times more than the annual average.• “The term 100 year event lost its meaning this year” – Craig Fugate- head FEMA.
US Disasters 2011• By April 2011 more than 600 tornadoes shredded the US, shattering the previous April record of 267.• 312 of them came in a single 24 hour period.• The worst of which is 20 times the usual size, tore a scar 1 mile wide and 300 miles long across Alabama and Georgia.• Severe flooding deluged other parts of the country- even as Texas was suffering its worst drought since 1895.
Typhoon in the Philippines• 1.1 From 27 typhoons during the period 2000-2003, the number ominously increased to 39 from 2004-2007 (Table 1 ). Category Year 1/ 2/ 3/ TD TS TY Total Total 43 39 66 148 2000 5 5 8 18 2001 6 7 4 17 2002 5 2 6 13 2003 8 8 9 25 2004 5 7 13 25 2005 11 1 5 17 2006 3 6 11 20 2007 0 3 10 13
Typhoon in the Philippines• 1.2 The typhoons are getting stronger and stronger10, especially since the late 1990s. Typhoon signal no. 4 is of course, a fairly recent category (Figure 1).
Typhoon in the Philippines• 1.3 Between 1947-2006, 3 of the 5 strongest tropical cyclones in the Philippines occurred in the past decade (Table 2). Highest Wind Name Period of Occurrence Speed Place Observed Recorded November 26-December 1. REMING (Durian) 320 kph Virac, Catanduanes 1, 2006 2. SENING (Joan) October 11-15, 1970 275 kph Virac, Catanduanes October 30-November 4, 3. ROSING (Angela) 260 kph Virac, Catanduanes 1995 Daet, Camarines 4. ANDING (Irma) November 21-27, 1981 260 kph Norte 5. LOLENG (Babs) October 15-24, 1998 250 kph Virac, Catanduanes
Typhoon in the Philippines• 1.4 Total damages brought about by typhoons increased by 408% from 2003 to 2006 (Table 3). 2006 2003 Damages Damages Month Typhoon Month Typhoon (in million PhP) (in million PhP) May Caloy 4,312 July Harurot 3,233 Sept Milenyo 7,607 May Chedeng 538 Nov Reming 5,449 June Egay 131 Oct Paeng 1,298 July Gilas 67 Others 1,993 Others 99 20,659 4,068
Typhoon in the Philippines• 1.5 Seven of the 20 deadliest typhoons in the Philippines covering the period 1947-2006 occurred in 1990-2006 NAME PERIOD OF OCCURRENCE DEATHS 1. URING (Thelma)A November 2-7, 1991 5,101 (8,000+)* 2. NITANG (Ike) August 31–September 4, 1984 1,363 (3,000)* 3. TRIX October 16-23, 1952 995 4. AMY December 6-19, 1951 991 5. SISANG (Nina) November 23-27, 1987 979 6. ROSING (Angela) October 30 – November 4, 1995 936 7. UNDANG (Agnes) November 3-6, 1984 895 8. SENING (Joan) October 11-15, 1970 768 9. REMING (Durian)B November 26–December 1, 2006 754 (1,200)* 10. RUPING (Mike) November 10-14, 1990 748 11. TITANG (Kate) October 16-23, 1970 631 12. YOLING (Patsy) November 17-20, 1970 611 13. KADIANG (Flo) September 30 - October 7, 1993 576 14. KADING (Rita) October 25-27, 1978 444 15. ANDING (Irma) November 21-27, 1981 409 16. WINNIE C November 28–30, 2004 407 17. INING (Louise) November 15-20, 1964 400 18. DIDANG (Olga) May 12-17, 1976 374 19. MONANG (Lola) December 2-7, 1993 363 20. WELING (Nancy) October 11-15, 1982 309
• 22 Typhoons every year • 5 will be destructive
Typhoon Sendong/ “Washi” Sendong/ “Washi”Iligan City and Cagayan De OroDecember 16, 2011 1268– dead 1268–100,000 evacuatedP2.068 B - damage
Geologic Hazards • 5 quakes/day • 1,825 quakes/yearJuly 16, 1990; Intensity 81,666 dead – 3,500 injuredP11B cost of damage inproperty P1.2B in agriculture
Mass Casualty Event• An event in which the number of casualties or the rate of their arrival exceeds the capability of the existing medical staff to provide quality medical treatment to all injured.
Basic Assumptions• Disaster and Mass Casualty Incidents occur “out of the blue” or at a very short warning. – ? No control – ? Not ready in the right time and the right place.• The name of the game- Organization, Management, Command, Time Control. – Planning and Training before the event. – Planning and Management of Time – Coordination and Transportation.
Based on experience:• The name of the game in MCI is OCCCC: – Organization – Command – Control – Coordination between emergency agencies – Communication
• True for most types of Mass Casualties and Disasters except in: – Toxicologic • Occur unexpectedly • Many casualties in a short time • Bottlenecks • Panic • Require quick accumulation of forces and resources.
What affects response?• Number of casualties, severity and distribution• Time until rescue and treatment – Timing of the event – Geographical location/ distance from hospital – Evacuation Time and EMS quality of care.• Hospital preparedness and organization• Control and Cooperation between Emergency Agencies
Conventional Mass Casualty in Urban Areas• Short duration• Short distance = ambulance availability• Scoop and Run= (AW and Bleeding)
Mass Casualty in Rural Areas• Extended period of arrival• Treatment according to PHTLS• Evacuation according to medical priorities• Helicopters- best means of transportation
EMS Steps in MCI• First Response• Casualty Allocation• Triage• PHTLS approach• Allocation of casualties in a designed treatment area Gathering of commanders and forces• Evacuation• Debriefing and lesson study
Flexibility• The most important lesson: – Work by Principles, not by Protocols.• No two MCI’s are the same. Difference in: – Time of Event – Place of Event – Number of Casualties – Type and Severity of Casualties – Number of Medical Teams – Number of Hospitals in the Area – Distance from Hospitals – Number and Type of Evacuation Resources
Tip• Dispatch and Control Centers and Teams should have:• Easy to forget specific tasks when working under stress or pressure.
Phases of Medical Activity in MCI• 1. Immediate Phase – Provide life saving treatment• 2. Second Phase – Gathering injured at treatment sites and concentrating on providing care to casualties in need of urgent care.• 3. Third Phase – Preparation of casualties for evacuation
Immediate PhaseOnly urgent and life-saving proceduresare performed.
Medical Treatment at the Scene• Airway Management• Ventilation or Oxygen Supplementation• Relief of Tension Pneumothorax• Treatment massive bleeding wounds from extremities
Roles of Medical Manager• Provide solutions to operational/non- medical problems.• Initial report to level in charge: – Location – Type of event – # casualties, etc• Coordinate with senior medical personnel at the scene and call for medical forces
Manager’s Actions• Remove from danger• Utilize forces and provide first aid to victims• Report to level in charge• Join medical care providers
Second PhaseMedical treatment will be provided to the severelyinjured based on medically defined priorities
Organize Medical Response• 2nd estimation of casualties; number; location and continuing hazards.• Define the access routes, evacuation centers and evacuation routes.• Divide the event area into sectors and allocate teams to each sector.• Perform initial search to locate casualties
Manager’s Action• Gather casualties• Maintain continuous contact with medical care providers
Organize Medical Response (2)• Isolating the treatment area• Demand more teams and equipment for the EMS center• Define the location and nature of the treatment area (if necessary)
Ambulance Evacuation Helicopter Evacuation Third Phase Casualties prepared for evacuation and evacuated
Manager’s Action• Call Evacuation• Land helicopter
• In all events, COORDINATION between acting agencies is the most important factor.• Without it, there is NO CHANCE of providing OPTIMAL CARE
Practice makes Perfect• Planning and practicing at calm times, greatly increases the chance that forces will collaborate and function well under emergency conditions.
Testing and Plan Review• Absolutely necessary! – Football analogy• Requires all participants to interact• Identify where problems exist between different agencies when must work together• Does the plan work?
Survival Statistics• 85-90% of those rescued who survive are found within the 1st 24-48hrs.• 90-95% of victims who survived are rescued by civilian volunteers within the first 24 hours.• 10-25% of patients who die could have been saved if reached in time.• Preventable deaths occur in the first 6 hours.
Urban Search and Rescue teams– Riverside County team 2 hours away by car– Earthquake occurs at 04:30– Team not begin activities at site of Northridge Meadows Apartment collapse until 23:30– Live victims already extricated
Urban Search and Rescue teams• Oklahoma City Bombing 1995• Multiple USAR teams dispatched• Last survivor recovered from building 18 hours after explosion• Number of survivors recovered by out-of- state USAR teams:• ZERO
Hyogo Framework for Action• The first internationally accepted framework for DRR.• Sets out an ordered sequence of objectives ( outcome- strategic goals-priorities).• A 10 year plan to make the world safer from natural hazards.
Action Priorities• Governance• Risk Identification• Knowledge• Reduce the underlying risk factors• Strengthen Disaster Preparedness for Effective Response
DisasterProblem Solution• 1. Mismatch • 1. Maximize your capacity• 2. Chaos by teamwork • 2. Bringing order by working together as a TEAM.