1. The document discusses medical preparedness and response for chemical disasters. It identifies gaps in current emergency response systems and provides guidance on improving preparedness at various levels. 2. Key recommendations include establishing quick response medical teams, developing treatment protocols and stockpiling antidotes, creating decontamination facilities, and preparing integrated disaster plans for hospitals. 3. The document emphasizes training of medical staff, establishing communication systems, and ensuring resources for evacuation and long-term care are in place to effectively manage chemical casualty incidents.

1. @National Level Training Programme on On-Site and Off-Site Emergency ManagementPlanning;Guhawati,23 rd
December,2008 Dr.RAKESH KUMAR SHARMA Division ofCBRN Defence,Institute of Nuclear Medicine and Allied
Sciences,Brig SK Mazumdar Road, Delhi 110 054 (rks@inmas.drdo.in) EmergencyMedical Preparedness and
Response to Chemical Disasters
2 Assessing the Risk MIC Gas Leak in Bhopal- accounts for nearly 20000 casualties till date.1,20,000 still suffering
Equally importantare the ‘peripheral emergencies’ which results in mass casualtyevents resulting in 10s to 100s of
casualties.Due to increase in growth of chemical industry,the risk of occurrence of chemical disaster associated with
Hazardous Chemicals (HAZCHEM) has gone up. The recent incidences ofchemical Attacks by extremists in Iraq has
now put the importance ofpreparedness for chemical disasters in the forefront
5 Mass CasualtyIncidentAny event resulting in number ofvictims large enough to disruptthe normal course of
emergencyand health care services is called as a mass casualityevent (WHO)
6 CIDM Managementof mass casualtyincidences due to incidences/man-made accidents involving them or
overt/covert attacks involving chemical agents,needs overall preparedness and risk reduction atall levels, including
contingencyplanning and capacity developmentfor an efficient response.
7 National Vision for ManagementofChemical Disasters
9 1.To prevent Chemical Disasters
10 National Vision for Managementof Chemical Disasters 1.To preventChemical Disasters
11 National Vision for Managementof Chemical Disasters 2.In the event of occurrence of CD, various stakeholder
shall under take certain pre- planned and established Structural and Non- structural measures so as to minimize risks
to health, life and environmentSomething maygo wrong in spite of bestsystem.History repeats itselfas we don't
learn from it. Many big mishaps have apparentlysmall causes behind,which are likelyto be overlooked.
12 Scale of Disasters:Factors affecting Inventory; geographic and demographic factors Vulnerabilityof population
Frequency of occurrence Public awareness Intensity– distance relations Energyfactor(release,mode & rate) Time
factor (release rate and warning time) Exposure factor (nature, duration & extent) Type of response mechanisms
13 Contained release with local environmental effectand pollution problem 1 Qualitative Severity/ Consequence
CriteriaGrades Injuries requiring first-aid only Chances offire and explosion 2  Uncontained release with
potential for minor environmenteffects  Injuries requiring a physician’s care  Uncontained release with potential for
moderate environmenteffects 3  Severe injuries or potential for a fatality  Uncontained release with potential for
major environmenteffects 4  Multiple life threatening injuries and /or fatality Scale for Grading of Chemical
Disasters
14 Sequel of Major Chemical Disasters Fire & violent Explosion Uncontrolled Reaction Leakage ofhighlytoxic cloud
of gaseous and particulate material,which spreads to neighboring habitations Environmental (Air release,ground spill
to water bodies,cultivated land, waste disposal etc.) Dissemination ofaerosolized chemical warfare agents or liquid
toxicant/poisons to contaminate the environmentor food productby terrorists
15 Chemical Burns (strong acids,strong bases) HeatBurns (flammable materials) Poisoning (manychemicals are
damaging or fatal if taken internally, whether by swallowing,injection,or leaching through skin) Chronic illness (long-
term exposure to even low doses ofcertain chemical agents can lead to chronic health conditions ) Etc. Modes of
Chemical Injury
16 General Signs and Symptoms Cough Chestpain Lacrimation Eyelid oedema and Unconsciousness Leads to
Acute lung injury Cardiac arrestDEATH
17 Corrosiveness Erythemas Irritations Corneal OpacityRetinal Damage Sensitization Pneumoconiosis Fibrosis
Adenomas Asphyxiation Miscarriage Neonatal death Fetal abnormalities Behavior Changes Peripheral neuro
degeneration Locomotion rigidityNarcosis or Depression RespiratoryParalysis MFO induction Choleostasis
Carcinogenesis Necrotic/Cirrhotic liver Defense system loss Aminoacid urea Uremia Renal failure Bone marrow

2. depression Anaemia Cancer Met hemoglobinemia Osteoporosis Arthritis Immuno Suppression TARGET ORGANS
AND EFFECTS INDUCED BY CHEMICALS
18 Gather information regarding:place,time and type of emergencyalso type of chemical,chemical toxicity, route o f
exposure Mobilization of Resources o Manpower:Disaster ManagementTeam medical,nursing and other Personnel
o Material and supplyeg: antidotes o Transportation means Transportto the critical patients for medical care /
hospitals Decontamination done atdecontamination area in the hospital Triage Documentation done atreception
Treatmentto the patient (EmergencyDept.) OT IPD / ICU OPD Discharge Getting initial alertfrom: Police,casualty
and telephone On site treatment/ operations o Mass decontamination o Transported in a safe place o Provide
necessarytreatment,firstaid and antidote administration to chemical contaminated patients Notifyto Key Personnel
Initiate preparation o All the dept & designated staffgetinto readiness to attend casualties o Crisis expansion of
hospital beds.o Preparation for decontamination area o Diagnostic Services o Other supportservices Chemical
Disaster Action Plan
19 Respond – In an appropriate manner.Establish Command Post/Lines of Communication /Control of the site /
Safety of the People in the Area / Own Safety. Assess the Situation – Fire / Spill / Leak / Weather conditions /
Terrain like / At risk,people,property, environment/ evacuation necessary/ what to be done right away.  Identify
Products – Placards /Labeling for the hazard.  Approach with Care – No Blind Rushing,Approach upwind.  Secure
the Area – To keep Non-EmergencyResponse Personnel outof danger. Five steps to EmergencyResponse
20 Managementof Chemical accidentPre-hospital Hospital Post-hospital Preventive
21 PREHOSPITAL RESPONSE Services Involved POLICE FIRE MEDICAL VOLUNTARY PrimaryHealth Centre
CommunityHealth Centre First Referral Unit Civil Hospital Medical Colleges Rapid Response Team After the initial
managementofthe victims Triage Red will get the firstpriority. All events mustbe coordinated with the doctors of the
receiving hospital.While shifting patients back,neck and airway need to be protected.Keep the facilities till the last
victim is transported.
22 Medical Preparedness 1.Medical Preparedness will be based on regular practice ofmedicine and should include
recognition ofthe impactof chemical disaster 2.It should focus on injuries,illness and public health problems
including psychosocial trauma and should address integration ofmedicine and public health 3.It mustalso focus on
Disaster managementonsite plan,offsite plan and crisis managementatthe hospital
23 Medical Preparedness (Contd./..) 4.Medical preparedness should also address necessityof planning and
practice, exercises involving local,district, state,central governmentand voluntary agencies 5.It mustinclude
problem solving,based on the pastexperience of disasters 6.Specialized firstresponder and specialized medical
first responder of NDRFneed to be prepared to handle chemical disaster
24 Doctor ChemistNursing Asst.Mobile Van Resuscitative EquipmentProtective Clothing Detection Equipment&
Decontamination Material Regular Rehearsal/Exercises Readyto move at very shortnotice QUICK REACTION
MEDICAL TEAM (QRMT)
25 Knowledge ofexact nature of chemical will facilitate proper antidote administration Aseparate team of
chemists is needed to analyze the exact type of chemical (mobile lab fitted with chemical analyzer).  & effective
treatmentfor early recovery
26 O 2 Cylinder O 2 Concentrator Suction Apparatus Laryngoscope Endotracheal Tube Ventilator Airway Pulse
Oxymeter Defibrillator IV fluid Emergency Drugs Dressing material Resuscitation Equipment& Drugs
27 Chemical CasualtyTreatmentKit Autoinjectors (Obidoxime x3) Obidoxime,bottles,x3 Atropine sulphate injection,
bottles,x10, ampoules,x20 Pyridostigmine bromide tablets,packs,x10 Dimercaprol injection,ampoules,x10 Sodium
thiosulphate,bottles,x4 Syringes, hypodermic disposable,5 ml,x5 Guedel airways,2 sizes General surgical scissors
Bandage,gauze, 5 cm, x5 Bandage,gauze, 7.5 cm, x5
28 Capacity Building (Manpower) The selection ofdedicated team is the first step in capacity building.Manpower
from Govt., NGOs, specialized response team,etc.Formulation ofQRMT consisting ofDoctor,Nursing Asst.&
ChemistChemical trained team ofmedics and paramedics atthe hospitals as partof integrated Disaster
ManagementPlan.

3. 29 Training of Medics & Paramedics Basic knowledge ofChemical substances and their properties Handling
Detection and Protective EquipmentDecontamination procedure Symptoms and treatmentofChemical casualties
Medical care at site,during evacuation and in hospital
30 Public Awareness Put on NBC mask/wetcloth to protect nose and eyes in case of Chemical disaster Move away
from incidence site Report incidence to nearestauthorized agency under disaster managementplan Avoid contact
with Chemical agents Do noteat, drink or smoke in contaminated area Reportto nearestmedical facility
31 Capacity Building (Material) Effective communication is very importantFacilities for evacuation by Ambulance,
train, helicopters and sea etc.Medical equipmentfor QRMT & hospital treatmentMobile Hospital for Casualties
Managementat Site to Decrease the load on Hospitals Resuscitative Equipmentlike O 2 Cylinder, Suction
Apparatus,Laryngoscope,Endotracheal Tube,Ventilator, Defibrillator,EmergencyDrugs Protective Clothing
Detection Equipment& Decontamination Material
32 Protective Devices NBC Protective suitCharcoal underwear Protective boots Protective gloves NBC Protective
mask Disposable Plastic protective suitDecontamination equipmentDecontamination sprayer Hot Air
Decontamination system Contamination Clearance Module
33 PERSONAL PROTECTIVE SUITS
34 Charcoal – Underwear
37 Chemical Agents Detectors Chemical AgentMonitor (CAM) Haz-chem detector Ticket. Chemical Agentwarning
InstrumentHazmatVehicle Ground Area Reconnaissance Detection System
38 Preparedness for Evacuation By road in Ambulance By Helicopter ifwarranted Stretcher & Life supportsystem
Casualtyevacuation bag SOPs for Resuscitation,Decontamination,Triage & Evacuation
39 Chemical Casualties Evacuation Bags
40 . GUIDELINES – Medical Preparedness & Response.Medical Preparedness shall stress upon : –Creating
awareness –Creation oftrained specialized medical firstresponders –Creation ofDecontamination facilities –Uniform
casualtyprofile and classification ofcausalities and illness –Risk Inventory and resources inventory –Plans for
Evacuation –Proper chemical casualtytreatmentkits –Crisis ManagementPlan atthe Hospitals –Mobile
hospital/medical team –Preparedness for public health and environmental effectresponse EmergencyMedical
Response & PostDisaster Phase –Chemical related issue during,Rescue,Reliefand Remedial measures –Quick
Response Medical Team –Materials and Logistics requirement –Post-disaster Public Health Response –Postdisaster
documentation and Research –Medical response to long term effects Medical Rehabilitation –Psychosocial trauma –
PTSD Care Salientfeatures
41 GUIDELINES – Medical Preparedness & Response Section-4 ofthis documentlays down the Guidelines for
medical preparedness and response
42 GUIDELINES – Medical Preparedness & Response Section-6 ofthis documentlays down the Guidelines for
Medical Preparedness for CBRN Management
43 Managementof Medical Emergencies The managementofmedical emergencies during On- Site and Off-Site
emergencies is a priorityarea. Medical Preparedness is the weakestlink in the emergencyresponse system and at
hospitals.There is a need to address & update medical preparedness comprehensivelyat all levels. Keeping in view
specific preparedness and response requirements ofchemical disasters gaps in the existing Medical Emergency
Managementhave been identified
44 Managementof Medical Emergencies Itis essential to address mechanisms for creating awareness,creation of
trained medical firstresponders,decontamination facilities,risk and resource inventory, trauma care, plans for
evacuation, mechanism to maintain uniform causalityprofile,availability of proper chemical casualtytreatmentkits,
mobile teams/hospitals,hospital disaster managementplan and preparedness for public health and environmental
effect response.

4. 45 Non-availabilityof specific antidotes for chemicals Inadequacyof infrastructure for trained medical and
paramedical staff.The standard operating procedures for EmergencyMedical Response atincidentsite are not laid
down.Absence of separate Medical EmergencyPlan in the DistrictOff-Site Plan Lack of documentation ofuniform
procedures to be followed during chemical emergencies ManagementofMedical Emergencies ImportantGaps
46 Gross inadequacies in terms oftrained manpower and capacityin Poison Information Center and regional
laboratories lying in proximity with disaster prone areas with detection facilities for hazchem Absence of mechanism
for medical surveillance Medical Response to long term effects and at present,there are inadequacies in terms of
studies on long-term effects and research Mechanisms for Medical Rehabilitation need addressals Managementof
Medical Emergencies ImportantGaps
47 Evacuation Plan 1.PatientEvacuation Plan with flow chart mustbe made,keeping the meteorological conditions
in view 2.Resources for special ambulance helicopters,ambulance trains,etc,will be strengthened atall levels and
proper resources inventorywill be prepared for the purpose 3.The ambulance should have SOPs for treatment
procedures and listofspecific antidotes 4.Acute health risks mustbe defined and known to para-medical staffs,who
are accompanying the patients in ambulance 5.Ambulances are to be fitted with resuscitation equipmentto maintain
vital parameters during evacuation to hospital.
48 Preparing Integrated Hospital Disaster Managementplan including Chemical casualties management
facilitiesPreparing Integrated Hospital Disaster Managementplan including Chemical casualties management
facilities Creation ofDecontamination Room & FacilitiesCreation ofDecontamination Room & Facilities Surgical &
Medical Team readinessSurgical & Medical Team readiness Stocking & rotation of antidotes and essential
drugs.Stocking & rotation of antidotes and essential drugs.Plan for Beds expansion by discharging sub-acute and
chronic patients and activating crisis mngt.beds.Plan for Beds expansion bydischarging sub-acute and chronic
patients and activating crisis mngt.beds.Documentation & Research for future improvement.Documentation &
Research for future improvement.Appointing a PRO to deal with patients relatives,press,media,for regular medical
bulletin.Appointing a PRO to deal with patients relatives,press,media,for regular medical bulletin.Hospitals
Preparedness
49 Preparedness byEarmarked Hospitals 1.Hospitals mustnominate an incidence officer for coordinating
managementofchemical casualties 2.A decontamination room is to be established.All chemical casualties have to
be taken first to decontamination room 3.Contamination,clearance module,a very effective tool for dry & prompt
decontamination can be utilized for walking casualties 4.Surgical team is to be kept ready to handle blastand heat
injuries
50 Preparedness byEarmarked Hospitals (Contd./..) 5. A group of specialists like Neurologist,Hematologist,
Gastroenterologist,chestphysician,ophthalmologist,burn specialist& dermatologistetc. mustbe available to handle
immediate and long term effects of chemical disaster 6.Stocking & rotation of antidotes needs to be maintained 7.
Special lab for chemical analysis is to be established 8.Contingencyplan be made ready for bed expansion by
discharging chronic patients 9.Availability of oxygen, continuous positive air pressure (C PAP) Ventilators,dialysis
facilities,blood and IV fluid for transfusion mustbe stocked
51 NBC Filter Fitted Ward 1.Ward in isolated places maybe earmarked for NBC casualty managementso thatother
parts of the hospital is notcontaminated 2.Ideallya special ward for chemical casualties treatmentis to be
established in the basementofthe Hospital 3.A ward shall be fitted with NBC filtration units to provide purified air with
a positive pressure inside,so that NBC contaminated air will never enter from out side.Ward musthave bio-waste
disposal facilities also
52 Mobile Hospital/Medical Team Mobile hospital/medical team should be catered in health care delivery system of
DDMA so that pressure can be relieved from hospital.Capacities ofmobile hospital depend on the magnitude of
disaster and population to be treated.
53 Activation of Hospital Chemical Disaster Plan Declared bysenior nursing staffor senior casualtyofficer. Inform
the key personnel and arrange for the deployment oftrained staff for the reception,triage,decontamintion and
managementofvictims.
54 Preparedness ofPublic Health Response 1.Preparation ofdevelopmentof toxicology database with information
on specific chemicals 2.Information on specific antidotes and other medication and where theyare stockpiled mustbe
made available 3.The public health response team mustconsists ofphysician,toxicologist,environmental specialists,

5. public information experts,communityand medical representatives 4.Creation ofknowledge ofsafe water, standard
of proper hygiene and sanitation,availabilityof food and nutrition
55 Health Care at Industrial Sites Factories Act, 1948~ parentAct dealing with welfare,occupational health,safety
and medical emergencyservices ~ also in context with various hazardous processes Amended Factories Act, 1987
or so.. ~ specified dangerous processes !- Schedule 87 Rules made for medical examination,once in a period of 6
months in respectofOccpational Health Services Essential- employone full-time medical officers in factories with
500 workers and additionallyfor every 1000 workers or part there off Schedule also gives listof the minimal
equipments to be maintained for Occupational Health Services Legal Requirements
56 Action by Industry in case of Chemical Disaster 1.Onsite team FirstResponders muststartrescue and reliefwork
as per the laid down SOPs and drill carried out during preparedness 2.Onsite plan musthave triggering mechanism
inbuilt.Industry should earmarked the officer,who will activate the plan and will inform well established,disaster
managementsystem 3.Collector musthe immediatelyinformed aboutthe accident.Offsite plan team mustbe
immediatelyalerted to swing into action 4.Postdisaster surveillance,documentation and res earch should form
integral part of onsite plan for proper recovery and rehabilitation
57 Action by local Disaster ManagementAuthority Ensuring proper Pre-Planning and Preparedness Sounding an
alarm immediatelyon mishap Instantaneous instructions to various Rescue Agencies for forthwith action Ensuring
proper rescue work Alerting hospitals for receiving casualties Mobilising resources from other places
58 Direction of Movement of People CHEMICAL DISASTER Gas leak noticed Wind direction
59 Response byDDMA in a Post-Disaster Scenario 1.Instantaneous instruction for forthwith movementof rescue
team with personal protective equipment(PPE) 2.Simultaneously,QRMT with PPE on will reach to Mishap site
immediatelyalong with Resuscitation,protection,detection and decontamination equipmentand material.
Resuscitation,triage and evacuation work mustbe done as per sops.3.DDMA will immediately inform State and
National Disaster ManagementAuthorities appraising aboutsituation and extent of damage so thatSDMA & NDMA
can plan to send reliefteams
60 Response byDDMA in a Post-Disaster Scenario (contd) 4.Hospitals mustbe alerted to be ready to receive
casualties 5.If there is a major chemical disaster and managementis beyond the capacity of District resources.In
that situation DC can requestfor help from adjacentdistrict,state DMA and NDRF6. Simultaneously,DDMA will
instructother agencies to plunge into action as per the responsibilities assigned to them
61 Standard Operating Procedures for Disaster Site Rescue & Quick Reaction Medical Team mustputon full
protective gear Cordon off the Disaster Site Do not allow Entry within five kms of Disaster site Find outthe wind
direction & Clear the down wind side immediatelyDetect& Identify the Chemical Substance Demarcate the area of
Contamination Do notcrowd near the victim to avoid further contamination CarryoutRescue,Resuscitation &
Evacuation work properly
62 Response byIncidentCommander 1.Cordon offthe area and restrictentry into the cordoned area except the
designated response personnel 2.Use the Detection Team to identify all hazardous substances or conditions present.
3.Designate sites for setting up decontamination centers.4.Designate locations for triage and emergencytreatment.
5.Arrange to provide directions and instructions to the population on the public address system
63 Cardoning off the Chemical Disaster area Wind direction No incoming traffic except for disaster managementNo
incoming traffic Site of Disaster Medical Aid Post Control HQrs POLICE CHECK POST Outer Cardon Inner Cardon
64 Key issues in Managing Mass CasualityChemical disasters Golden Hour/Platinum Minutes Triage Basic Life
SupportAdvance Life Support Decontamination Transportation Training ofMedical Personnel Education of
communityEstablishmentofNational and Regional poison Centre Dissemination ofInformation
65 Casualties ManagementProtocol Resuscitation Protection Detection Decontamination Evacuation Hospital Rx
Antidotes Administration
66 NBC Cas ManagementQRMT Protective EquipmentSpecific Hospital RxFacilities Radio-Biodosimetry
Decorporation agents Neurologist,ChestPhysician,Ophthalmologist,Dermatologist,Biowaste Disposal Antidotes &

6. Vaccines Specific Training for Medical,& para medical staffProtection Detection Decontamination Resuscitation
Triage Evacuation
67 Augmentation of Incident Site ManagementCapabilities Detection/Protection Equipment(conditioned to be useful
in Indian climatic conditions) Decontamination MANAGEMENT OF CONTAMINATION PROTECTION DETECTION
DECONTAMINATION
68 On-Site EmergencyMedical Care Health Care Centers ~ Two in perpendicular directions Inhabited with Qualified
Medical Officer and male nurses ~ 24X 7 services Dedicated well equipped Ambulance with driver~ safe
transportation ofvictim 10 bedded clinic Equipments- Oxygen Cylinders,masks,Ambu bags,Firstaid box, essential
medicines,antidotes specific to particular hazard Minor O.T. and small laboratoryto analyze routine blood sampl es
Legal Requirements
69 Off-Site Medical Preparedness EmergencyManagementatthe incidentSite: –Personal Protective Equipmentwill
be made available – Temporarydecontamination facility– On-Site Triage, Resuscitation and safe transportation Safe
transportation ofthe chemical casualties in ambulances fitted with chemical filters Evacuation Plans from Plants and
nearby affected communities
70 Off-Site Medical Preparedness Earmarking ofhealth care facilities able to cater different types of chemical
casualties like chemical burns,respiratoryproblems etc.Hospital disaster managementplans to deal with mass
casualtyevents caused due to chemical disasters Creation ofTrained Medical FirstResponders Uniform Casualty
Profile & their classification Risk and Resource Inventories
71 Off-Site EmergencyMedical Care Proper Chemical CausalityTreatmentKits including essential medicines and
antidotes Dedicated Group of Specialists to manage multi- organ dysfunctions caused bychemical exposures
Provisions for mobile hospitals and teams,ifneeded National and Regional Poison Information Centers for
information aboutvarious antidotes and treatmentprofiles Preparedness for Public Health and Environmental Effect
Response Mechanism to follow up the long term medical care to the numerous victims
72 Crisis ManagementPlan 1.The crisis managementplan will be prepared for all earmarked hospitals in the offsite
plan 2.Responsibilityof preparation and implementation ofthe plan solelylies on the medical superintendentofthe
Hospital 3.Establishing decontamination facilities,training ofmedical personnel,creating awareness oftoxicants. and
their antidotes and collection ofbiological samples like blood,urine (to be frozen) should form the part of disaster
managementplan 4.Emergencymedical response,documents,follow up and research programme in post- disaster
phase should also form the part of Disaster managementplan
73 Large amounts ofwater DECONTAMINATION Staff allocated to the decontamination area will done protected
suits. Hypochlorite 
74 Rinse – wipe – rinse procedure in the warm zone in the shelter.After decontamination patientwill be enter the
cold zone by secondarytriage team.Secondary triage team – Triage decontaminated casualties according to the
disaster managementplan and hand over the victims to the clinical team for definitive treatment.
75 Guidelines for Preparedness Creating awareness to the type of illness,injuries,burns and other health problems
caused by various toxicants to all the medical teams and communityat large Creation of trained specialized medical
first responders for firstaid and resuscitation measures atthe incidentsite and during transportation ofcasualties.All
members ofmedical and paramedical staffteam will carryoutregular exercises based on the SOPs laid down by
respective DistrictMedical ManagementAuthorities (DMMA) Contd./..
76 Guidelines for Preparedness (Contd./…) Decontamination facilities are required to be established ataccidentsite
but outside the risk area Uniform casualtyprofile and classification ofcausalities and illness should he attempted for
various groups so thatthe treatment can largely be standardized Risk Inventory and resources inventory mustbe
prepared at all levels of medical managementplan including both onsite plan and offsite plan
77 Guidelines for Preparedness Creating awareness to the type of illness,injuries,burns and other health problems
caused by various toxicants to all the medical teams and communityat large Creation of trained specialized m edical
first responders for firstaid and resuscitation measures atthe incidentsite and during transportation ofcasualties.All
members ofmedical and paramedical staffteam will carryoutregular exercises based on the SOPs laid down by
respective DistrictMedical ManagementAuthorities (DMMA)

7. 78 Guidelines for Preparedness (contd) Decontamination facilities are required to be established ataccidentsite but
outside the risk area Uniform casualtyprofile and classification ofcausalities and illness should he attempted for
various groups so thatthe treatment can largely be standardized Risk Inventory and resources inventory mustbe
prepared at all levels of medical managementplan including both onsite plan and offsite plan
79 Guidelines for public during chemical disaster Reportaboutmishap to police or fire station Stay upwind & uphill
Self protection by stopping breathing immediatelyand closing eyes Then put on the NBC protective mask Avoid
contact with chemical agents Seek qualified medical advice for those persons who have been harmed by chemicals
Do not eat, drink or smoke on contaminated terrain
80 Direction of Movement of People CHEMICAL DISASTER Gas leak noticed Wind direction
81 Response & ReliefResponse and reliefwill form the part of onsite and offsite plan in postdisaster scenario.All
responsible parties should ensure thatmanpower,equipment(including communication equipmentand personal
protective equipment),and financial and other resources necessaryto carry out emergencyplans are readily
available for immediate activation in the event, or imminentthreatof an accident
82 Post-Disaster EmergencyMedical Response 1.Activate resuscitation,firstaid and triage system.2.Provide
immediate reliefto seriouslyill and injured. 3.Carry out resuscitation 4.Collectbiological samples ofcasualties and
sample from environmentas well.5.Carry out proper diagnosis and proper antidote administration.6.Carry out
simultaneous documentation ofthe patients.7.Provide accurate information to public health authority and public.
83 Medical Response atHospital 1.In hospital casualtywill be finally decontaminated and keptin a clean special
NBC ward 2.Initially based on early symptoms,type of chemical is assumed,accordinglyan antidote is given 3.Blood
is to be analyzed to find out the exact chemical agents and further treatmentmustbe modified accordingly4.Hospital
casualtyroom is to be equipped with resuscitation equipmentlike oxygen cylinder, suction apparatus,airways,
laryngoscope,ventilator,pulse oxymeter, defibrillator,life saving drugs,antidotes auto injectors & dressing material
84 POST TRAUMATIC STRESS DISORDER & ITS MANAGEMENT PTSD is a psychological response to the
experience of intense trauma due to Disaster.PTSD is characterized by Intrusive symptoms include distressing
memories or images nightmares sweating,heartracing or muscle tension Avoidance symptoms ofPTSD trying to
avoid any reminders ofthe trauma,such as thoughts,feelings,conversations,activities,places and people.Arousal
symptoms ofPTSD include sleep disturbances,anger and irritability,concentration problems,constantlyon the
lookoutfor signs ofdanger
85 Post-disaster Public Health Response 1.Prime responsibilityof medical authorities 2.They mustensure safe
water supply,clean food availability 3.Maintenance of hygiene and sanitation byproper bio- waste disposal 4.Water
testing and food inspection mustbe carried out
86 Post-disaster Epidemiological Study1.It mustinclude accurate estimation ofchemical exposure ofeffected
population,correlation ofenvironmentand human exposure data,relationship ofchemical and dose to the observed
effect, 2.Sub clinical effects,morbidityand mortalitymustalso be analyzed 3.Epidemiological studies be conducted
for assessmentofpsychosocial effectof disaster 4.Analysis to find out the success and failure ofDis aster
ManagementPlan and failure mustbe addressed 5.Epidemiological studies team should have Clinician,
Epidemiologist,Toxicologist,Pathologist,Environmental scientists and reps from Industry
87 Medical Response to Long Term Effects 1.In post-disaster scenario some ofthe casualties will develop sequel
due to chemical injuries 2.These cases mayneed regular follow-up,medical care,reconstructive surgeryand
rehabilitation 3.Close monitoring is required to see any long term health effects like blindness,interstitial lung fibrosis
and neurological deficiencies etc.,and need to be treated as well
88 Post Disaster Documentation and Analysis 1.Information will be prepared bya medical administrator 2.During
response in hospital an information centre will provide information to public,to relatives of victims and media
3.Warning guidelines,“DOs and DON’Ts” and condition of patients in the hospital 4.dissemination ofinformation to
electronics and prints media will also be carried outby medical team 5.Documentation,follow up and research
programs should be used as feedback for future improvementand lessons learnt

8. 89 Rehabilitation Itinvolves providing temporary shelters with minimal hygiene sanitation to the affected, restoring
“normalcy” through ensuring resumption offamily’s dailyliving patterns Psychological impactofchemical disaster
manifested as posttraumatic stress disorders (PTSD) in displaced people due lo disaster,needs care by a
psychologistand psychiatrist
90 Recovery Decontamination ofthe area, equipment,vehicles and disposal ofleft over contaminants,removal of
dead bodies from site has to be carried out in the Post- disaster Scenario.Italso involves restoring life of victims to
normalcy.
91 Post-Disaster EmergencyMedical Response 1.Activate resuscitation,firstaid and triage system.2.Provide
immediate reliefto seriouslyill and injured.3.Carry out resuscitation followed bydecontamination 4.Collectbiological
samples ofcasualties and sample from environmentas well.5.Carryout proper diagnosis and proper antidote
administration.6.Carryout simultaneous documentation ofthe patients.7.Provide accurate information to public
health authority and public.