for medical profession

1. DISASTER MANAGEMENT

2. • Introduction
• Epidemiology
• Disaster cycle
• Role Emergency physician

3. • A "disaster" can be defined as "any
occurrence that causes damage, ecological
disruption, loss of human life or deterioration
of health and health services on a scale
sufficient to warrant an extraordinary
response from outside the affected
community or area"

4. EPIDEMILOGY
• More than 58.6 per cent of the landmass is
prone to earthquakes of moderate to very
high intensity;
• over 40 million hectares (12%) of its land is
prone to floods and river erosion.
• 68% of its cultivable area is vulnerable to
droughts.

9. C l a s s i f i c a t i o n o f D i s a s t e r s
Natural
Disasters
Meteorological
Topographical
Environmental
Man made
Disasters
Technological
Industrial
Warfare

10. Meteorological
Disasters
• Floods
• Tsunami
• Cyclone
• Hurricane
• Typhoon
• Snow storm
• Blizzard
• Hail storm
Topographical
Disasters
• Earthquake
• Volcanic
Eruptions
• Landslides
and
Avalanches
• Asteroids
• Limnic
eruptions
Environmental
Disasters
• Global
warming
• UVB Radiation
• Solar flare

11. Technological
• Transport
failure
• Public place
failure
• Fire
Industrial
• Chemical
spills
• Radioactive
spills
Warfare
• War
• Terrorism

12. Integrated
Disaster
Management
Prepared-
ness
Response
Recovery
Mitigation
Activities prior to a disaster.
• Preparedness plans
• Emergency exercises
• Training,
• Warning systems
Activities during a
disaster.
• Public warning
systems
• Emergency
operations
• Search & rescue
Activities following a
disaster.
• Temporary housing
• Claims processing
• Grants
• Medical care
Activities that reduce
effects of disasters
• Building codes &
zoning
• Vulnerability
analyses
• Public education
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13. • Prevention/MITIGATION—Regulatory and
physical measures to ensure that emergencies
are prevented, or their effects mitigated.
• Preparedness —Arrangements to ensure
that, should a disaster occur, all those
resources and services which may be needed
to cope with the effects, can be rapidly
mobilised and deployed.

14. • Response —Actions taken in anticipation of,
during and immediately after impact to ensure
that its effects are minimised and that people are
given immediate relief and support.
• Recovery—The coordinated process of supporting
disaster-affected communities in reconstructing
their physical infrastructure and restoration of
emotional, social, economic and physical well-
being.

15. DISASTER MEDICINE
• Preparedness
• Response

16. HOSPITAL

17. Medical Preparedness &
Mass Casualty Management
Developing and capacity building of medical team for
Trauma & psycho-social care,
Mass casualty management and Triage.
Determine casualty handling capacity of all hospitals.
Formulate appropriate treatment procedures.
Mark would be care centers that can function as a
medical units.
Identify structural integrity and approach routes.
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18. MASS CASUALITY IN HOSPITAL

19. FIELD(INDIA)

20. Preparedness
• NMDA :The National Disaster Management
Authority (NDMA) was initially constituted on
May 30, 2005 under the Chairmanship of
Prime Minister vide an executive order.

21. Disaster Management Structure in India

23. RESPONSE
• Incident Response System (IRS):
• standardised method of managing disasters,
• flexible and adaptable to suit any scale of
natural as well as man made
emergency/incidents.

24. Incident Response System (IRS)

25. ROLE OF DOCTOR

26. SITE PERSONNEL
• Establishing Medical Control command, control,
coordination and communication are vital.
• SITE ARRANGEMENTS
• Casualty Collecting Area
• Patient Treatment Post
• Ambulance Loading Point

27. • Medical Triage Officer
• Medical Team Leader
• Nurse Commander
• Ambulance Commander

29. TRIAGE
• Triage is the process by which disaster
casualties are sorted, prioritised, and
distributed according to their need for first
aid, resuscitation, emergency transportation,
and definitive medical care.
• continuing process which begins in the field
and continues into the hospitals

30. OBJECTIVE
• minimise the death and suffering that is the
result of a disaster
• ensuring that available health resources are
directed to those who will receive the greatest
benefit.

31. TIMING
• when the casualty is first seen;
• before movement from the incident site:;
• within the forward treatment area;
• before transportation to hospital;
• on arrival at the hospital before surgery. In
addition, reassessment will be necessary; and
• whenever the casualty’s condition is noted to
have altered

32. First Priority (Red)—Life threatening injuries in need of urgent
medical care, requiring priority transport, with or without
appropriate resuscitation.
• Second Priority (Yellow)—Significant injuries, condition stable
and treatment can wait. Or for casualties not expected to live, or
whose resuscitation may over-utilise available resources and
prejudice the survival of other patients.
• Third Priority (Green)—Walking wounded who may not
requireambulance transport according to priorities, to treatment
centres. Casualty will not require hospitalisation. Psychological
casualties are included in this category.
• Deceased (Black/white)—Used for the dead.

33. THE PROCESS OF TRIAGE
• follow the ‘ABCDE’ approach as outlined in the
Early Management.
• Revised Trauma Score (respiratory rate,
systolic blood pressure and GCS),
• The triage tag forms the initial medical record
and must not be removed until admission to
hospital

34. TRIAGE

35. Time Delay to Resuscitation
• seconds to minutes (usually from
unsurvivable head or major vessel damage);
• one to two hours (usually from major chest,
head or abdominal injuries, and/or major
blood loss);
• days to weeks (usually from brain death,
sepsis and organ failure).
• resuscitation in the first hour may
significantly peak of mortality.

36. Time Delay to Surgery
• for serious casualties, initial wound surgery
should be performed as soon as possible, but
certainly within the three hour limit.

37. RESUSCITATION
• airway and cervical spine care;
• breathing and oxygenation;
• circulatory support and control of
haemorrhage;
• rapid neurological assessment; and
• exposure to permit examination and
treatment.

38. BURNS
• Field priorities include the removal of burned
clothing, cooling of burned tissue, oxygen
therapy, covering of burns with clean
dressings, establishment of IV access, volume
resuscitation with N/Saline/Haemaccel, and
titrated IV analgesia, wherever possible.
Victims with respiratory burns should be
prioritised for early evacuation to hospital
because of the risks of insidious and
progressive airway obstruction.

39. HYPOTHERMIA
• Remove wet clothing, wrap in blankets and
protect from the wind whilst awaiting
transport. Depending on resources, it may be
reasonable to perform CPR on hypothermic
victims without vital signs and with no
obvious lethal injury, whilst rewarming.

40. CRUSH INJURY
• Priorities include rapid extrication and IV fluid
resuscitation. If a victim has been crushed for
a prolonged period, Medical Teams should
consider premedication with bicarbonate and
calcium chloride (to counteract
hyperkalaemia) immediately prior to
extrication.
• Forced alkaline diuresis may reduce the incidence of renal
failure

41. WOUNDS
• The management of most soft tissue injuries
can be delayed, but haemorrhage control
should be effected through direct pressure.
• Wounds older than 6 hours, and grossly
contaminated wounds should be irrigated,
cleaned, debrided and left open for delayed
primary closure at 48–72 hours.
• Booster vaccination against tetanus.

42. FRACTURES/DISLOCATIONS
• Ensure that all fractures are splinted so as to
minimise pain, reduce haemorrhage and the
risk of neurovascular damage.
• Reduce dislocations as soon as possible.
• Definitive treatment of most closed fractures
can be deferred for 24–48 hours if necessary,
provided that they have been correctly
splinted.

43. CHILDREN
• A calm reassuring approach is imperative.
• Fluid resuscitation and drug dosages should
be carefully calculated
• paediatric tertiary referral centre

44. CHEMICAL INJURY
• removal of contaminated clothing and
decontamination of exposed skin.
• continuous copious irrigation of eyes, mucus
membranes and skin if chemical burns from
acid or alkali;
• basic and Advanced life support as necessary;
• administration of specific antidotes, if
available

45. TRANSPORT
• Patient transport vehicles should equipped if
possible with at least basic resuscitation
equipment including oxygen, suction, airway
aids and a method for assisted ventilation.
• adequate lighting and temperature control,
• Transport resources should be used to their
best advantage

46. • transport of sitting patients in addition to
stretcher cases.
• The transport of living patients must take priority
over the deceased.
• Patients should be accompanied by
documentation-
• triage category;
• how the injury occurred;
• clinical assessment and time;
• treatment given; and

47. • PRINCIPLE
• The quality of patient care during transport is
usually more important than the mode of
transport.