Disaster management involves preparing for, responding to, and recovering from disasters. The disaster management cycle includes pre-disaster mitigation and preparation, response during a disaster, and rehabilitation and reconstruction after a disaster. Hospitals must be prepared to handle mass casualty incidents by having disaster management plans, training staff, and conducting drills. Key aspects of response include incident command, triage, treatment, and evacuation to maximize lives saved during emergencies.

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