This document discusses the importance of disaster preparedness plans for healthcare institutions. It notes that disasters, both natural and man-made, are inevitable in every country. Hospitals will be on the front lines of responding to mass casualty events. Effective disaster preparedness plans are needed at the institutional level to efficiently manage large numbers of victims during an emergency situation. The plans should identify available local resources and coordinate with external support. Proper triage, treatment, and record-keeping of victims are essential components of institutional disaster response.

1. Vol. 33 No. 18 29th April - 05th May 2006
Managing Disaster Victims
There is no country in the world that is free
from disasters - whether it is natural or man
made. Even though disasters itself and its’
death and destruction is inevitable, timely in-tervention
will greatly reduce damages.
Apart from the tsunami, there were a number
of instances where the healthcare system in the
country had to handle casualties in large num-bers.
During the last two decades terrorist
attacks has conferred new means to surgical
casualty services in Sri Lanka and is the first in
line where handling of such large number of
casualties is experienced. In addition mass
transport by surface and air, construction of
high rise buildings may result in accidents
which can cause a sudden influx of a large
number of seriously injured persons to nearby
hospitals. Therefore the preparedness for dis-asters
is a current issue that should be ad-dressed
by all healthcare institutions in the
country.
Where preparedness for disasters is concerned,
health institutions will be the centre point in
the initial management of casualties. The main
challenge in such a situation is to manage a
large number of casualties within a short pe-riod
of time. In addition, the presence of a
large number of unwanted sightseers and me-dia
personnel may complicate things further.
As such, an advanced plan is essentially impor-tant
to minimize the damage suffered by vic-tims.
Several major hospitals have their own disas-ter
preparedness and management plans; like-wise
it is advisable for all healthcare institu-tions
to have a similar comprehensive plan.
The available resources at a given institution
may not be adequate to address the needs. In
such a situation, getting support from the ac-cessible
close by institutions also should be
included in the plan.
With the current situation in the country, an
effective hospital based disaster preparedness
plan, at least in all major healthcare institu-tions
is mandatory. While preparing such a
plan, the available resources – availability of
materials, personnel and services at the insti-tution
level and at the easily accessible closer
institutions should also be taken into account.
For instance, preparation of a check list on the
availability and number of consultants, medical
officers, paramedical staff, ambulances and
availability of other facilities such as operating
theatre and intensive care units would be suit-able
to identify required resources.
It is obvious that a single disaster prepared-ness
plan will not be universally applicable to
all institutions. It should be prepared and
documented according to the need and the
resource availability of each facility. However,
all major areas relevant to an emergency pre-paredness
plan should be addressed.
The primary consideration of an emergency
preparedness plan should be on the manage-ment
of casualties brought to the institution.
One of the other important steps would be
maintenance of communication with the public
and media. They will be anxious to know the
(Continued on page 2)
Contents Page
1. Leading Article - Managing Disaster Victims
2. Surveillance of vaccine preventable diseases & AFP (22nd - 28th April 2006)
3. Summary of diseases under special surveillance (22nd - 28th April 2006)
4. Summary of Selected notifiable diseases reported (22nd - 28th April 2006)
1
3
3
4

2. Page 2
(Continued from page 1)
victims by number and also by individual identification.
Provision of reliable information to the media and to the
public will be the responsibility of the Head of the Institu-tion.
Establishment of the identity of victims, both alive and
dead should have to be done parallel to the management of
casualties. Collection of information about patients and the
deceased can be done by an officer. Names and other details
of patients and deceased should be displayed outside the
hospital for public information. Mass gathering at the hos-pital
disturbs the management procedures and will affect
the patients’ security also. Therefore, visitors should be
limited to a minimum. Other medico-legal activities will
have to be attended to subsequently. Security of victims and
their valuable personal belongings also will be a responsibil-ity
of the hospital authorities. Protection of hospital proper-ties
should also be considered.
In a healthcare setting the declaration of an emergency is
not a simple task. It will greatly disrupt the routine operat-ing
activities of the hospital to a greater extent. The routine
theatre lists and clinics have to be cancelled. Patients in
surgical wards have to be shifted to non-surgical wards. As
much as possible inward patients have to be discharged and
ordinary patients seeking admission should be encouraged
to enter other hospitals. Therefore, arriving at the decision
to declare an emergency should be made very carefully.
This is the responsibility of the Head of the Institution or in
his absence of the person acting on his behalf. Before the
declaration of an emergency, the authenticity of the infor-mation
should be established by inquiring from responsible
personnel such as the Police. Efforts should also be made to
assess the severity of the damage and the number of possi-ble
casualties.
Each and every member of the hospital staff has a distinct
duty in emergency management. Responsibilities will be
delegated by superiors and the overall coordination will be
made by the Head of the Institution who will also be the
team leader of the emergency management effort. Supervi-sory
officers and section heads should call up all of their
subordinates. For example, the Matron is responsible in
organising Nursing Officers, the Head of the Institution and
Consultants are responsible in coordinating with other
Medical Officers. If there is any transport disruption, special
transport has to be arranged to bring down additional staff
from their residence.
Knowing the limitations of resources in the institution is
very important in resource management. The Team Leader
can promptly call for assistance and reinforcements from
other closer institutions. Transferring of stable patients to
closer institutions is also an alternative method to overcome
the limitation of facilities. Utilization of facilities in private
sector also can be considered.
An emergency is not an excuse for not keeping records on
patient management. In fact, to minimize various confusions
good record keeping is essential. Use of previously pre-pared,
serially numbered plastic folders is an effective
method in treating a large number of patients within a short
period of time. A folder usually consists of printed Bed Head
Ticket, continuation sheets, laboratory investigation re-quest
form, X-ray request form, a tag with the patient iden-tification
number (serial number) and a plastic bag to store
patient’s personnel belongings. The identification number
should be clearly written on top of the folder and in all con-tents
of the folder. Identification of patients by identification
numbers rather than their names is very important at the
initial phase of emergency management since some patients
may not be in a state to furnish their details. As well there
may be confusions if there is more than one person by a
similar or closely similar name. Numbering system will also
minimize delays and confusions at the time of admission.
In an emergency, victims are usually frightened and con-fused.
They may act irrationally. Shouting, wailing and de-manding
the attention has to be expected from the victims.
However, most vociferous and demanding are those with
trivial injuries or only panicked with no injuries. Those who
need attention may be so weak to shout or may be uncon-scious.
Therefore, some form of sorting is essential at the
time of admission. The accepted method dealing in such a
situation is called ‘triage’. This should be done by an experi-enced
person who should have the skills in identifying the
level of severity of a patient with minimal examination. If
available, this should be done by a senior surgeon and he
should be involved only in this task since this is a decisive
task which is hard to be substituted. A colour code system
can be used for categorizing patients: red for the life threat-ening
injuries, yellow for serious injuries, green for trivial
injuries and black for deceased. Priority can be given ac-cording
the colour code. Those who are having trivial inju-ries
(with green colour code) can be sent to a ward for total
care at the ward.
Maintaining an adequate stock of drugs and dressings is
also an essential component in an effective disaster prepar-edness
plan. The amount of stocks that should have to be
maintained is determined by the level of the disasters ex-pected
and the capacity of the institution. A cupboard to
stock drugs, surgical dressings and other emergency items
exclusively to be used in emergencies should be maintained
in Out Patients’ Departments, Emergency Treatment Units
and in each and every ward including medical wards. Emer-gency
packs can also be maintained at Operating Theatres
to be used only in disasters. Items with an expiry date
should be changed regularly.
(Continued on page 3)
WER Sri Lanka - Vol. 33 No. 18 29th April - 05th May 2006

3. Table 1: Vaccine-preventable diseases & AFP 22nd - 28th April 2006 (17th Week)
Disease
W C S NE NW NC U Sab
Acute Flaccid
Paralysis
00 00 01
Diphtheria 00 00 00 00 00 00 00 00 00 00 00 01 -100.0%
Measles 00 00 00 00 00 00 00 00 00 01 07 28 -75.0%
Tetanus 01
CB=1
Whooping
Cough
01
GM=1
Tuberculosis 259 00 15 00 00 00 00 24 298 140 3537 3450 -02.5%
Table 2: Diseases under Special Surveillance 22nd - 28th April 2006 (17th Week)
Disease
W C S NE NW NC U Sab
DF/DHF* 73 17 11 01 04 01 04 22 133 69 3348 1077 +210.9%
Encephalitis 02
GM=1
KL=1
Human Rabies 00 00 00 00 00 00 00 00 00 01 21 21 00.0%
*DF / DHF refers to Dengue Fever / Dengue Haemorrhagic Fever; Details by districts are given in Table 3.; NA= Not Available
Source : Weekly Return of Communicable Diseases :Diphtheria, Measles, Tetanus, Whooping Cough, Human Rabies, Dengue Haemorrhagic
Fever, Japanese Encephalitis
Special Surveillance : Acute Flaccid Paralysis
National Control Program for Tuberculosis and Chest Diseases : Tuberculosis
Key to Tables 1 and 2 :
Provinces :W=Western, C=Central, S=Southern, NE=North & East, NC=North Central, NW=North Western, U=Uva, Sab=Sabaragamuwa.
DPDHS Divisions :CB=Colombo, GM=Gampaha, KL=Kalutara, KD=Kandy, ML=Matale, NE=Nuwara Eliya, GL=Galle, HB=Hambantota, MT=Matara, JF=Jaffna,
KN=Killinochchi, MN=Mannar, VA=Vavuniya, MU=Mullaitivu, BT=Batticaloa, AM=Ampara, TR=Trincomalee, KM=Kalmunai, KR=Kurunegala,
PU=Puttalam, AP=Anuradhapura, PO=Polonnaruwa, BD=Badulla, MO=Moneragala, RP=Ratnapura, KG=Kegalle.
(Continued from page 2)
No. of Cases by Province
GL=1
00 01
PU=1
00 00 00 02 03 45 40 +12.5%
00 00 00 00 00 00 01
00 01
MT=1
00 00 00 00 00 02 02 28 20 +40.0%
No. of Cases by Province
00 00 00 00 00 00 01
In developed countries, medical management of casualties
and sorting them according to the level of injury is carried
out by visiting medical and supporting teams at the very
place of the incident. Initiation of treatment at the very site of
the disaster improves patient survival. Practising triage at
the disaster site itself will prevent overburdening hospitals
with unwanted admissions. Possibilities in the initiation of a
similar practice should be explored in Sri Lanka also at least
in areas where mass casualties is mostly expected; for exam-ple
in the Capital City of the country.
Once an emergency preparedness plan is designed, it should
be reviewed by all concerned personnel for example, the Head
of the Institution, Consultants, the Matron etc. In addition it
should be reviewed by experts and experienced personnel in
Page 3
Number
of cases
during
current
week in
2006
Number
of cases
during
same
week in
2005
Total
number
of cases
to date in
2006
Total
number
of cases
to date in
2005
Difference
between the
number of
cases to date
between 2006
& 2005
RP=1
02 02 19 12 +58.3%
Number
of cases
during
current
week in
2006
Number
of cases
during
same
week in
2005
Total
number
of cases
to date in
2006
Total
number
of cases
to date in
2005
Difference
between the
number of
cases to date
between 2006
& 2005
RP=1
03 00 44 21 +109.5%
disaster management. This will elicit any deficiencies in the
plan thereby enabling correction before encountering the
problem in the midst of the disaster.
The other important aspect of the disaster preparedness plan
is conducting drills and getting familiar with all components
of the plan. All the relevant staff in the disaster management
should be involved in the drills. However, this should be done
without much disturbance to the routine work in the institu-tion.
As well, to refresh the memory, similar drills should be
conducted regularly with reasonable time intervals.
The Editor, WER wishes to thank Dr Hector Weeras-inghe,
Director, National Hospital of Sri Lanka and Dr
Anura Jayasinghe for their contributions in preparation
of this article.
WER Sri Lanka - Vol. 33 No. 18 29th April - 05th May 2006

4. WER Sri Lanka - Vol. 33 No. 18 29th April - 05th May 2006
Table 3: Selected notifiable diseases reported by Medical Officers of Health
22nd - 28th April 2006 (17th Week)
DPDHS
Division
Dengue
Fever / DHF*
Typhus
Fever
PRINTING OF THIS PUBLICATION IS FUNDED BY THE UNITED NATIONS CHILDREN’S FUND (UNICEF).
Comments and contributions for publication in the WER Sri Lanka are welcome. However, the editor reserves the right to accept or reject items
for publication. All correspondence should be mailed to The Editor, WER Sri Lanka, Epidemiological Unit, P.O. Box 1567, Colombo or sent by E-mail
chepid@sltnet.lk
ON STATE SERVICE
Dr. M. R. N. ABEYSINGHE
EPIDEMIOLOGIST
EPIDEMIOLOGICAL UNIT
231, DE SARAM PLACE
COLOMBO 10
Dysentery Encephalitis Enteric
Fever
Food
Poisoning
Leptos-pirosis
Viral Hepatitis Returns
Received
Timely**
A B A B A B A B A B A B A B A B %
Colombo 34 926 02 97 00 02 03 28 00 09 04 42 00 03 01 24 69
Gampaha 20 601 01 107 01 05 02 22 00 57 11 75 00 04 01 42 86
Kalutara 19 307 05 111 01 03 03 27 02 17 01 29 01 06 01 09 90
Kandy 13 232 09 179 00 02 05 48 00 16 02 26 04 36 05 54 77
Matale 04 56 00 103 00 03 00 05 00 07 02 06 00 02 00 06 67
Nuwara Eliya 00 07 12 73 00 00 01 55 01 07 00 05 01 14 00 16 71
Galle 00 120 02 50 00 01 00 05 00 06 01 16 00 03 00 01 44
Hambantota 02 53 00 18 00 02 01 14 00 10 01 25 00 31 00 15 90
Matara 09 195 00 40 00 05 02 29 00 22 06 52 03 80 01 04 100
Jaffna 01 33 00 47 00 01 06 109 00 12 00 03 00 123 01 51 50
Kilinochchi 00 01 00 06 00 00 01 04 00 00 00 00 00 00 01 04 75
Mannar 00 00 02 06 00 00 04 103 00 00 00 01 00 00 00 06 80
Vavuniya 00 02 01 31 00 04 00 23 00 16 00 02 00 00 00 05 50
Mullaitivu 00 02 00 09 00 01 00 27 00 00 00 00 00 00 01 07 100
Batticaloa 00 47 02 23 00 03 00 27 00 00 00 02 00 00 08 89 80
Ampara 00 07 00 38 00 00 00 04 00 00 00 04 00 02 01 10 43
Trincomalee 00 16 04 33 00 01 00 22 00 04 00 00 00 03 00 84 67
Kurunegala 04 158 05 60 00 01 02 31 00 11 02 12 02 09 01 17 76
Puttalam 00 59 00 60 00 00 00 66 00 02 00 03 00 02 02 110 67
Anuradhapura 01 46 02 46 00 00 00 15 00 03 03 24 01 13 00 42 53
Polonnaruwa 00 27 00 24 00 01 00 02 00 00 00 11 00 01 00 13 100
Badulla 02 40 12 214 00 01 03 44 00 13 01 07 11 49 00 29 93
Monaragala 02 16 05 85 00 00 03 27 00 03 00 17 02 39 09 41 60
Ratnapura 14 241 10 266 01 07 03 46 01 19 02 25 00 23 06 45 53
Kegalle 08 130 03 92 00 01 00 14 00 03 07 71 01 26 11 194 73
Kalmunai 00 26 03 29 00 00 00 33 00 00 00 00 00 01 05 180 58
SRI LANKA 133 3348 80 1847 03 44 39 830 04 237 43 458 26 470 55 1098 71
Source : Weekly Returns of Communicable Diseases ( WRCD ).
*Dengue Fever / DHF refers to Dengue Fever / Dengue Haemorrhagic Fever
**Timely refers to returns received on or before 06th May 2006. Total number of reporting units = 283. Number of reporting units data provided for the current week: 202.
A = Cases reported during the current week; B = Cumulative cases for the year;