Disaster - Sudden
misfortune
or great
DISASTER
MANAGEMENT
Minakshi Gautam, Assistant
Professor, IIHMR
Introduction
• ‘Disaster
–
–
–
–
Originated from a french word
Combination of two terms
Des and astre
‘Des’ meaning bad or evil and ‘astre’
meaning star
– The expression of term disaster is
bad or evil star.
Disaster is a………
• “A major incident arising with little
or no warning”
• Affecting in high magnitude
• Calls for special mobilization and
organization of services
Disaster is a calamity of sudden
occurrence, a catastrophe causing
injury and death to a large number of
people during a short span of time.
Disaster – WHO definition
“WHO defines a disaster as any
occurrence that causes damage,
economic disruption, loss of human
life and deterioration of health and
health services on a scale sufficient
to warrant an extraordinary response
from outside the effect community
or area.”
Disaster – UNISDR* Definition - 2004
“A serious disruption of the
functioning of a community or a
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.”
*United Nations International Strategies for Disaster
Reduction
Definition
• Situation or event, which overwhelms
local
capacity,
necessitating
a
request to national or international
level
for
external
assistance
(CRED*).
* Centre for Research on Environmental Decisions
Disaster Management
• For centuries, examined and treated as an
expression of supernatural
• Scientific explanation and knowledge
based on ‘Cause and Effect’
• This helped in disaster preparedness and
mitigation
Disaster Management in India
• Both
central
responsibility
and
state
governments
share
• Basic responsibility of relief and rescue operations is
of state government
• Central government plays a supportive role in terms of
financial and other resources
• Many countries have detailed policy and legislations
giving comprehensive direction to prevention,
preparedness and response.
• The focus of current contingency action plan is relief
activities but modifications are being made
Disaster Management in India
• 10th Five Year Plan – a detailed chapter of Disaster
Management
• 12th Finance Commission mandated to review financial
arrangements for Disaster Management –abolished
national fund for calamity relief and created national
calamity contingency fund with initial corpus of 500
crores
• Department of Agriculture and Cooperation of
Ministry of Agriculture is nodal department in
Disaster Management
• Central Relief
operations
Commissioner
coordinates
relief
International relief* under the aegis of the League of
Nations in 1927
Beginning in the late 1960’s and early 1970’s the international
community became increasingly aware of inadequacies of
international relief assistance
One of the outgrowths of these debates in early 1970’s was
creation of UNDRC** in 1971 by UN General Assembly
Under this government of disaster stricken country bears
primary responsibility
In the federal Set up of India, both the central and State
governments share the responsibility
*United Nations Disaster Relief Organization. WHO, International Red Cross
** United Nations Disaster Relief Coordination
Contingency Action Plan for Natural Calamities issued
by the Ministry of Agriculture, GoI in 1990
High Power Committee 1999
Earthquake in Gujarat (26 Jan 2001) resulted in creation of Nation
Disaster Commission and formulation of National Disaster Policy
2002-2009 national initiative namely Disaster Risk Management
Programme was implemented in collaboration with State Governments
by Government of India and UNDP (reduce vulnerabilities of
communities in some of the most hazard prone districts of India)
23rd Dec 2005 GoI envisaged NDMA*** headed by PM and
SDMA^ headed by CM for holistic and integrated approach
In India – Act is ministerial level document, not a comprehensive
document which has functional, informational and operational linkages
*United Nations Disaster Relief Organization. WHO, International Red Cross
** United Nations Disaster Relief Coordination
****national Disaster Management Authority
^ State Disaster Management Authority
Agencies in Disaster Management
• Central and State Government
• District Administration
• Armed Forces
• Paramilitary Forces (BSF, CRPF, Assam Rifles, national
security guard, etc.
• NGOs
• International agencies including UN agencies
• Media
Organizational Structure at National Level
Apex level – Cabinet Committee under chairmanship of PM
National Crisis Management Committee under the
chairmanship of Cabinet Secretary
Crisis Management Group
CMG under chairmanship of Central Relief Commissioner and
Additional Secretary, Ministry of Agriculture meet regularly
*United Nations Disaster Relief Organization. WHO, International Red Cross
** United Nations Disaster Relief Coordination
Agencies in Disaster Management
• At national level depending on type of disaster, nodal
ministries are assigned the task
•
•
•
•
Natural Disaster – Ministry of Agriculture
Railway Disaster – Ministry of Railways
Air Disaster – Ministry of Civil Aviation
Biological Disaster – Ministry f Health
Transmission of Information
Indian Meteorological Department and Central Water Commission
informs Central Relief Commissioner about forecast of natural
disasters
CRC informs Secretary (Agriculture and Cooperation)
Informs Cabinet Secretary
CS informs Prime Minister, Agriculture Minister, National
Crisis Management Committee
CRC informs other concerned central and state government
departments including Mohfw through Emergency Medical
Relief Division (EMRD) of DGHS
Transmission of Information
• Present state of warning system in country
includes
– 158 flood forecasting stations
– 56 seismic stations
– Disaster warning system – INSAT Satellite
Disaster Management at State Level
• Each state has its own organization pattern, policies
and plan
• Broad pattern based on guidelines by GoI
• Each state has Relief Commissioner and Chief
Secretary
• Primary responsibility – relief operations,
preparedness and rehabilitation instead of
comprehensive plan encompassing prevention
• District is the basic unit
• District administration prepares contingency plans
Committees and various organizations
• Cabinet Committee
• National Crisis Management Committee
• Commando Force – professional well equipped
specialized in calamity specific operations
• Disaster High Power Committee 1999
• Crisis management Group
• State Crisis Management Group
• District Administration
• District Relief Committee
• district collector has the authority for requisition
to the Armed Forces
Committees and various organizations
• National Centre for Disaster Management
• International consortium known as Prevention
Consortium (coalition of World Bank, Insurance
companies, government, universities, NGOs)
Group Activity : 30 minutes
• Activity 1: Classification of Disasters
• Activity 2: Difference and relationship between
risk, vulnerability and disaster
• Activity 3: action to be taken at health centre
when casualties reach there
• Activity 4: health problems related to disasters
• Activity 5: What is triage? Discuss
• Activity 6: Public health measures to prevent
vector borne and communicable diseases
Classification of Disasters
• Natural Disasters
– Earthquakes
– Floods and famines
– Cyclones, hurricane, typhoons (cyclones –
Indian and pacific Oceans, Hurricane –
Northeast Pacific, typhoons – northwest
Pacific)
– Tsunami, tidal waves
– Landslides and Avalanches
– Volcanic eruptions
• Man-made Disasters
– Nuclear, Biological, Chemical Disaster (NBC)
– Accidents
Earthquakes
• Earthquakes have caused huge damage to life and
property worldwide
• Significant threat to India also because of falling of
almost 59% of its geographical area in earthquake
vulnerable zones.
• Impacts of an earthquake are the loss of human lives
and property, economic & social losses and
environmental degradation.
• Over the last century, about 75% of fatalities
attributed to earthquakes have been caused by the
collapse of buildings.
Earthquakes
• A great number of victims die in the collapse of nonengineered weak masonry buildings
• absence of knowledge in earthquake resistant
construction & retrofitting techniques at the
grassroots and
• non-compliance of appropriate building regulations and
town planning legislations for earthquake safe guided
physical development in towns.
Earthquakes
• Besides, ignorance of basic tips of earthquake
survivability
• Further, least expertise by rescuers in search &
rescue
• Deaths almost more than 10% of population
• The ratio of dead to injured approx 1:3 resulting from
primary shock
• Use of thermal imaging, sniffer dogs, multiple sensors
Destructive Winds
• Unless complicated by secondary disasters such as
floods or sea surge cause relatively few deaths and
injuries
Flash Floods and Sea Surge
• Deaths mainly due to drowning
• Commonest amongstt weakest members of population
Floods
• Slow flooding causes limited immediate morbidity and
mortality
• Slight increase in deaths from venomous snake bites
• Traumatic injuries caused by flooding requires limited
healthcare
Hurricane
Earthquake
Floods
Thunderstorm Indonesia
Landslides and Avalanches
• Landslides & Avalanches are among the major hydrogeological hazards that affect large parts of India,
especially the Himalayas, the Northeastern hill ranges,
the Western Ghats, the Nilgiris, the Eastern Ghats
and the Vindhyas, in that order.
• Landslides in the Darjeeling district of West Bengal as
also those in Sikkim, Tripura, Meghalaya, Assam,
Nagaland and Arunachal Pradesh pose chronic
problems causing recurring losses.
Nuclear, Biological and
Chemical Warfare
• In 1995, the Japanese religious cult, Aum Shinrikyo,
released the nerve gas, Sarin, in the Tokyo Subway.
• 12 persons were killed and several thousands suffered
illness
• Investigation disclosed
aerosols of anthrax
attempts
to
disseminate
• Unsuccessful as he used weakened strain of Anthrax
Salient features in medical management
of NBC causalities
• The lack of experience and skills of professionals will
adversely affect the medical management
• Healthcare workers may themselves suffer significant
damage
• Triage protocol during NBC scenario is different –
difficult to save victims with burns of more than 30%
total body surface area (TBSA) and exposure to more
than 450 rads of ionising radiations
Salient features in medical management
of NBC causalities
• Nuclear Warfare
– Segregated and monitored casualty evacuation, separately for
radioactive, biologically contaminated and non contaminated
cases.
– Significant numbers are burn casualties which are caused due
to ‘flash’, ‘fire’ or ‘beta’particles
– Immediately after a nuclear explosion temperature may go
upto 106 degree C and pressure 105 atmospheres
– 50% energy due to blast, 35% heat and 15% nuclear radiation
after detonation
Salient features in medical management
of NBC causalities
– All casualties of nuclear warfare must be regarded as radiation
victims unless proven otherwise.
– Use of dosimeters and PPE
Salient features in medical management
of NBC causalities
• Chemical Warfare
– Potent means of mass destruction
– Lethal agents like Sarin or incapacitating agents like Distilled
Mustard
– Blister agents, nerve agents, blood agents, choking agents, tear
agents (riot control agents)
– Blister agents were used by Germans against the British during
1st world war
– Phosgene (choking agent) accounted for 85% of deaths
attributable to chemical weapons during the 1st world war.
Bhopal Gas Tragedy memorial
Salient features in medical management
of NBC causalities
• Biological Warfare
– Use of living organisms or their toxic products to cause
disability, damage and death.
– Recipes for making biological weapons are now available on
internet.
– 14th century – targets besieging the Italian in a fortress in
Cremea threw over walls bodies of plague victims
– Red Indians in North America were given smallpox infected
blankets
– Use of mycotoxins in Afganisthan
Salient features in medical management
of NBC causalities
• Biological Warfare
– In 1972, Biological and Toxic Weapons Convention attended by
almost all the countries agreed to cease bio-weapons research
programs
– Also the agreed to destroy all stocks
– Despite this reported fact is that during 1990s countries had
stockpiled tons of dried spores of Anthrax, smallpox, plague,
etc
– Indicators of biological attack – number of persons affected,
time relationships, sharply defined geographical boundaries and
clinical profile
Salient features in medical management
of NBC causalities
• Biological Warfare
– Lab diagnosis by antigen-antibody detection
– Application of fluorescent antibody technique (FAT)
– PPE – Ultra high efficient filter masks which are capable of
filtering more than 99% particles of 1-5 microns
– Isolation of cases- negative pressure isolation
– Immunoprophylaxis – vaccines during Gulf War to protect from
Anthrax
– Chemoprophylaxis
Short term effects of major
natural disaster
Effect
Earthquakes
High Winds
Tidal waves
Floods
Death
Many
Few
Many
Few
Severe injuries
requiring
extensive care
Overwhelming
Moderate
Few
Few
Increased risk
of communicable
diseases
Food Scarcity
Potential risk following all major disasters (Probability
rising with overcrowding and deteriorating sanitation)
Rare
Rare
Common
Common
Common
Common
May occur due to factors
other than food shortage
Major
Population
Movements
Rare
Rare
May occur in heavily
damaged urban areas
Health Problems related to Disasters
•
•
•
•
Pre-existent level of disease
Ecological changes
Population displacement
Sewage disposal, water and other public utilities
may be interrupted
• Interruption of basic public health services
Types of Diseases
Disease
A
Water and Food Borne
1. Typhoid
2. Food Poisoning
3. Sewage Poisoning
4. Cholera
5. Leptospirosis
B
Public health measures
Adequate disposal of faeces and urine
Safe water for drinking and washing
Sanitary food preparation
Fly and pest control
Disease Surveillance
Isolation and treatment of early cases
Immunisation (typhoid and cholera)
Person to Person Spread
Contact and respiratory
diseases
1. Shigellosis
2. Streptococcal
infections
3. Scabies
4. Small pox
5. Measles
6. Infectious hepatitis
Reduce Crowding
Adequate Washing Facilities
Public Health Education
Disease Surveillance in Clinics
Treatment of clinical cases
Immunisation (typhoid fever,cholera,
smallpox, measles)
Types of Diseases
Disease
Public health measures
7. Whooping cough
8. Diptheria
9. Influenza
10. Tuberculosis
Isolation of cases (chicken pox)
Primary immunization of infants
(diptheria, whooping cough, tetanus)
C
Vector Borne Diseases
1. Louse borne typhus
2. Plague
3. Relapsing fever
4. Malaria
5. Vital encephalitis
Disinfection (except malaria and
encephalitis)
Vector control
Disease surveillance
Isolation and treatment
D
Wound Complications
TT injection
Post exposure tetanus antitoxin
Global Scenario
• Second major human problem after war
• In terms of monetary damage and number
of people killed or effected.
• Greatest economic and social impact in
poorest countries
Global Scenario
• An event that causes deaths of 125 people in a
high income economy tends to cause 33,000
deaths in low-income economy*.
• Average per event mortality per 1000 population
was 69 in low income, 28 in middle income and one
in a high income economy*
* Debrati, Guha, Sapir, Michal F Lechat. Disaster Management. Report of Workshop
organised by Directorate General of Health Services, Mohfw, GoI, 1986
Global Scenario
• Estimated that disaster events globally cost
about 50,000 million US dollar each year*
• Results in approx 2,50,000 deaths in a year*
• Nearly 20 major disaster strike the world every
year
* Carter W Nick. Disaster Management. A disaster management handbook.
Asian development bank, Manila, 1991
Global Scenario
• Amongst the major disasters are floods, cyclones
and earthquakes
• World Disaster Report 1999 indicates 89,546
people were killed in 542 disaster events with
average estimates of 71.9 million dollors.
• Nearly 80% of deaths were due to Natural
Disasters*
* IFRC World disaster report 1999
Global Scenario
• Asia-pacific region witnesses a large
number of natural disasters due to
geographical location
• 60% of major natural disasters reported
in the world occur in this region.
Global Scenario
• World’s worst disaster occur in regions
between Tropic of Cancer in north and
Tropic of Capricon in south
• It has approx 20 major disasters annually
Global Scenario
• This region includes poorest nations of
world
• 90% of all deaths from disasters,
therefore, occur in developing countries
Global Scenario
• Asia is the continent hit hardest by
disasters according to figures from
Belgian WHO collaborating centre for
Research on Epidemiology of Disasters
(CRED)- (2007 database)
Global Scenario – natural disaster
occurrence by continent
Asia
74.80%
Africa
6.10%
Americas
12.20%
Europe
Oceania
5.10%
1.40%
0.00%
20.00%
40.00%
Series1
60.00%
80.00%
Total number of reported disasters
Continent
Droughts
Earthquakes
Floods
Volcanic
Eruptions
windstorms
Industria
Accidents
Africa
13
24
442
7
86
57
America
56
43
357
23
343
27
Asia
60
170
686
19
398
406
Europe
11
35
256
2
149
51
Source: EM-DAT, CRED, University of Lovain, Belgium
Global Scenario – floods and
windstorms have maximum impact
250
206
200
150
103
100
50
0
10
19
10
18
6
Source International strategy for Disaster Reduction (UN/
ISDR – www.unisdr.org)
Indian Scenario
• Frequency distribution of disasters in the
Asian region between 1964 and 1986
showed that India is one of the most
disaster prone country.
• Natural disasters like floods, earthquakes,
cyclone and drought are major causes
Indian Scenario
• This is due to vast variation of geographical
terrain and climatic conditions.
• India with 2.4 % of world land area, seventh
largest country in the world, 15% of world
population, and population density of 273 persons
per square km makes disaster effects more
serious.
Indian Scenario
• Most flood prone countries in world
• Area affected by flood annually on an average is 9
million hectares.
• Accounts for one fifth of global death counts due to
floods.
• Out of 96 internationally recognized natural disasters
country experienced between 1960 and 1981, 28 were
due to floods*.
* Jain PC. Flood Mitigation Practices in India, Disaster Management. IIPA.
New Delhi, 1984
Indian Scenario
• 56.3% of its total area (amounting to 3.3
million square kilometers) is vulnerable to
seismic activities of different intensity*.
• Entire northern part of India from
Hindukush to Eastern Himalayas lies in
earthquake prone belt.
* Parischa UP. Natural Disaster Management in India. Disaster
Management in Asia and Pacific. ADB, Manila, 1991
Indian Scenario
• From Kashmir to North East the geological
processes of rock formation and uplifts makes
area earthquake prone.
• These areas have witnessed over 31 major
earthquakes in last century.
• 5700 km long coastline of India is vulnerable to
tropical cyclones arising in Bay of Bengal and
Arabian Sea.
Indian Scenario
• Havoc caused by cyclone is mostly due to
strong winds, accompanied by rains, tidal
waves
• Every year 5-6 cyclones occur out of which
2-3 are severe
• More cyclones in Bay of Bengal than
Arabian Sea and the ratio is about 4:1.
Indian Scenario
• India has been witnessing increasing incidence of man
made disasters.
• Worst man made disaster so far – Bhopal Gas Tragedy
on 3rd Dec 1984 (Union Carbide India Limited (UCIL)
pesticide plant. A leak of methyl isocyanate gas and
other chemicals from the plant)
• Resulted in the exposure of hundreds of thousands of
people. 3000 died within a week and 8000 ever since
the incidence
• A government affidavit in 2006 stated 558,125
injuries including approximately 3,900 severely
and permanently disabling injuries.
• Five fold increase in the frequency of disasters during last
30 years.
• Some of the major disasters were;
– Cyclones along the coast of Andhra Pradesh and Orissa at
interval of every few years (claimed 25,000 lives)
– Earthquake in Uttarkashi in 1990
– Earthquake in Latur in Maharashtra in 1993
– Many train accidents off and on
– Earthquake in Gujarat – Jan 2001
– Tsunami, Southern Indian Coastline – 26 Dec 2004. 10273
dead, 2,39,024 families homeless, 27,22,000 population
affected.
Disaster Results from
• Earthquakes, heavy rainfall, typhoons, storms,
chemical accident, drought or armed conflict.
(primary cases)
• Flooding, fires, famine and multitude of refugees
(secondary cases)
• In general, primary cases of disasters are not
preventable.
• Secondary effects, however are amenable to
prevention, or at least mitigation.
• Disaster have the tendency to;
– Interrupt the normal functioning of
community
– Exceed the coping mechanisms of the
community
– Require external assistance to return to
normal functioning of a community
Definitions
• Hazard:
A source of danger; an extreme event; possibility of incurring loss or
misfortune.
A potentially damaging physical event, phenomenon or human activity
that may cause the loss of life or injury, property damage, social and
economic disruption or environmental degradation.
Hazards include latent conditions that may represent future threats
Modes of Hazard
• Dormant – potential to be hazardous but no life
harmed
• Potential – hazard in position to affect persons
• Active – certain to cause harm, as no intervention is
possible or planned
• Mitigated – potential hazard identified and reverted
Risk, Hazard, Vulnerability
Risk:
Probability that loss will occur as the result of an
adverse event
Risk = hazard x vulnerability
Vulnerability:
Extent to which a community’s structure,
services, or environment is likely to be damaged
or disrupted
Risk, Hazard, Vulnerability
Resilience
“The capacity of a system, community or society potentially
exposed to hazards to adapt, by resisting or changing in
order to reach and maintain an acceptable level of
functioning and structure.
This is determined by the degree to which social system
is capable of organizing itself to increase this capacity
for learning from past disasters for better future
protection and to improve risk reduction measures.
Hazards vs. Disasters
• Disaster = interaction between a hazard and a community
• Potential for disaster is based on:
• Hazards present in community
• Vulnerabilities of the community
• Disaster preparedness of the community
PICE* System in Mass Casualty Incidents
A. Potential
Casualties
B. Resources
C. Geographical
Involvement
D. PICE Stage
Static
Controlled
Local
0
Dynamic
Disruptive
Regional
I
Dynamic
Paralytic
National
II
Dynamic
Paralytic
International
III
* Potential Illness Creating Event
Column A : Potential for Additional Casualties
Column B:describes whether resources are overwhelmed
(augmentation or reconstitution needed)
Column C: describes extent of geographical involvement
Source: Koeing K, et al: Disaster Nomenclature – a functional impact approach: the
PICE System: Acad Emeg Med, 1996, 3:723-727
PICE* System in Mass Casualty Incidents
• It is a method for consistency in Disaster Classification
based on the likelihood that outside medical assistance will
be needed
• Stage 0 means little or no chance
• Stage I means there is small chance
• Stage II means there is moderate chance
• Stage III means local medical resources are clearly
overwhelmed
Incident Command System
Incident Commander
Information
Safety
Liaison
Operations
Planning
Logistics
http://www.emsa.ca.gov/HICS/default.asp
Finance/
Administratio
n
References
• http://ndma.gov.in/ndma/index.htm
Disaster Management
• Spectrum of disaster management involves:
–
–
–
–
–
Prevention
Mitigation
Preparedness
Response
Reconstruction or Recovery
• Each of these are interlinked and mutually
dependent
• Three important aspects of disaster management
are – Prediction, Prevention and Planning
• Similarly, three important operational aspects are
rescue, relief and rehabilitation
Disaster Management
• Prevention concerns – formulation and implementation of
long-range policies and programs to prevent or eliminate
the occurrence of disaster
• Disaster Mitigation includes all those measures aimed at
reducing the impact
• It spans the broad spectrum of prevention and
preparedness
• Disaster preparedness aims at measures, which enables
governments, organizations, communities and individuals
to respond rapidly and effectively
Disaster Management
• It is supported by necessary legislation, resource
planning, training, etc
• Disaster Response are measures that are taken
immediately prior to and following disasters
• These are directed towards saving property, lives
• Disaster Recovery is the process by which communities
and nations are assisted in returning to their proper level
of functioning following a disaster
Hospital Disaster Management Plan
• Preparedness is the central issue
• It is based on risk assessment, hazard assessment and
vulnerability analysis
• All disasters inevitably have health consequences
• A well-planned health delivery system is most important
preparedness for a catastrophe
• Planning, organizing and coordinating healthcare in
advance
Hospital Disaster Management Plan
• Aim –
The aim of disaster management plan is to provide
prompt and effective medical care to the maximum
possible in order to minimize morbidity and mortality
• Objectives – optimally prepare the staff
– Optimally prepare institutional resources
– Make community aware of sequential steps that should be taken
Hospital Disaster Management Plan
• Principles of Disaster Management Plan
–
–
–
–
–
Simple
Flexible
Concise – specify roles and responsibilities
Comprehensive – pre and post hospital components
Adaptive and anticipatory- hospital provides aid and when itself
the site of disaster
– Part of regional plan – fire brigade, police and administrative
components
Hospital Disaster Management Plan Phases of a Disaster
•
•
•
•
•
Pre-disaster phase
Alert Phase
Impact Phase
Post-impact Phase
Reconstruction and rehabilitation phase
– Reconstruction and rehabilitation phase lasts the longest
Hospital Disaster Management Plan-Predisaster Phase
• Risk assessment
– Awareness about nature
– Readiness to respond promptly
– Meant to demonstrate the risk factors required to be
addressed in order to mitigate the effects of disaster.
– Local hospital has an active role to play both before and after
disaster
• Training
– Key to successfully deal with disasters
– Training for skills related to;
• Effective personal protection from falling debris.
• Prompt rescue of the wounded
• Triage of the wounded
• Resuscitation and first aid for injured victims
• Pre-positioning of relief supplies needed for the post
impact phase such as surgical equipment, essential
medicines, blankets, tents
• Establishment of temporary water supplies.
• Allocation of responsibilities for different relief activities
to avoid unnecessary chaos.
Hospital Disaster Management Plan - Alert
Phase
• Refers to period when a disaster is
developing
• Duration varies according to type of
disaster
– For e.g. nonexistent for earthquakes, short but
crucial for typhoons and quite long in case of
draught and famine.
Hospital Disaster Management Plan - Impact
Phase
Needs of community depends on characteristics
of disaster and degree of preparedness.
– Earthquakes are very unpredictable and highly lethal
whereas cyclones are more predictable.
– Priorities of a relief effort should reflect these
realities.
– The immediate response should not await a detailed
assessment of impact.
– The effectiveness of relief effort will depend entirely
on local efforts and preparedness of community.
– During this phase, planning includes activation of
response mechanism, daily monitoring, updating of
response measures and coordinating outside assistance.
Hospital Disaster Management Plan - Postimpact Phase
•
•
•
•
•
•
This phase may vary between few days and several
months following the initial impact. Actions required;
Evacuating the survivors to safe areas
Provide shelters to homeless
Providing food and water
Continuing the triage and transportation of the
injured to appropriate facilities.
Re-establishing primary health care services.
Re-establishing sanitary measures to prevent outbreak
of epidemics.
Health implications in such situations are manifested
as food and water borne disease.
Hospital Disaster Management Plan –
essential requisites
• Situation Analysis – administrative and medical
set up, topographical, demographical, disaster
mapping, industries
• Effective Networking
• Unified Medical Command
• Comprehensive Disaster Plan and Manual
Disaster Management in
Hospitals
Types Of Disaster
• External Disaster
• Internal Disaster
CODES
Blue:
Individual disaster
Grey:
earthquakes
Red:
Fire
Pink:
Baby disaster (Abduction)
Purple:
Fight likely
Orange : Hazardous material spill
HOSPITAL PREPAREDNESS
PLANNING
•
Should address both External and Internal
emergencies.
•
Resources may often be depleted quickly in both
circumstances
•
Internal incident requires major adaptation from
SOPs due to disruption in physical plant by
events such as loss of structural integrity,
utilities or hazard exposures.
HOSPITAL PREPAREDNESS
PLANNING
•
Hospital plan should be integrated with other
community preparedness plans
•
It is important that the hospital be able to
maintain its basic functions
ROLES AND RESPONSIBILITIES OF
PLANNING COMMITTEE
•
•
•
•
•
Steps in the planning
Developing written preparedness and response
plans
Identifying training needs
Organizing tests/exercises or drills at regular
intervals
Liaising with other emergency management
agencies
The Elements of the plan
•
•
•
•
•
•
Incident Commander, who will take command of
the entire hospital and its resources.
Hospital Medical Operations Chief will be
responsible for the hospital medical response
Command centre staffing
Lines of authority within the hospital and
departments
Roles and responsibilities of key personnel
Information detailing responsibilities and tasks
The Planning Process
•
•
•
•
•
•
•
•
Determine the authority to plan
Establish the planning committee
Conduct Risk Assessment
Set Planning objectives – based on RiSK
ANALYSIS
Analyse Resources
Develop systems and procedures –strategies for
prevention, mitigation, preparedness, response
and recovery
Write the plan
Train personnel
The Planning Process
•
•
•
Test the plan, personnel and procedures
Review the plan
Amend the plan
–
Hospital
planning
committee
should
include
representatives of each department, representatives
of community health system like public and mental
health, as well as external emergency services like
ambulance, police, fire services, etc.
The Planning Process
•
Significant part of planning process is “What if”
Analysis
•
Ponders on Questions like what if such and such
happened, what would we do, what would we
need, what would be the implications, etc.
ACTIVATION OF PLAN
•
Activation should specify circumstances for
which the plan can be activated
Should identify those responsible for activation
Activation stages;
•
•
–
–
–
–
ALERT – possible hazard impact
STAND BY- hazard impact probable (staff need to be
ready for immediate action)
IMPLEMENT – hazard impact has occurred
(deployment has occurred)
STAND DOWN- response operation has ended,
situation contained
Internal Disaster
Internal Disaster is an emergency
situation that occurs within the institution
interrupting services, threatening lives of
staff, patients, and visitors and sometimes
necessitating mass evacuation. Fire,
building collapse, an explosion, chemical
spills, strikes etc. can cause Internal
Disasters
Procedure in case of fire
If smoke detector or the sprinkler
system gets activated
Alarm in fire command
room gets activated
with active zone flashed
Parallel Alarm in LT panel in
the engineering gets activated
with active zone flashed
Verifies the Zone
Informs the Security
Supervisor
Security personnel to
reach the site
Informs engineering control
room supervisor
Engineering personnel to
reach the site
Site checked
In case of fire
In case of false Alarm
Contacts engineering and
Security for additional help,
if required
Control room informs
Chief Engineer/ CSO/
GM
Assessing the gravity of fire,
fire brigade is informed with
approval from COO/MD/GM
Engineering and
Security control room is
informed and entry is
made
Types Of Internal
Disaster
1
Fires: Implement the R-A-C-E plan.
2
Bomb Threat: Contact Security immediately.
3 Chemical Spills: Contain the spill if possible,
contact HAZMAT team.
This action shall be taken immediately without
waiting for declaration of CODE for activation of
Internal Disaster Plan.
Disaster due to fire
The Principle of R.A.C.E.
• When faced by a Fire Situation, always remember the
principle of R.A.C.E. while taking any action in the matter:
• R-escue - Remove everyone from the area. If a fire has
occurred in a patient room the staff shall immediately
remove the patient from the area.
• A-larm – Activate the Fire Alarm by pulling down the
nearest Manual Call Point. Manual Call Points (MCP) are
located throughout the building, several on each floor. By
activating the Fire Alarm a fire action plan is set into
motion where Security receives the signal and initiates the
emergency response. The Engineering department is also
alerted to act immediately to cut off AHUs and Electrical
Power wherever necessary to retard the spread of fire.
Disaster due to fire
• C-onfine – Once the room or area has been cleared of
patients the door shall be closed thus confining the fire,
which enables the fire response team the time needed to
arrive.
• E-xtinguish or Evacuate - When practical and only when an
employee has been properly trained in the safe and proper
use of a fire extinguisher, extinguishing shall be attempted
using one fire extinguisher. Evacuate if you are not
comfortable using a fire extinguisher or if more than one
extinguisher is needed.
CLASSES OF FIRE
•
•
•
•
“A”
“B”
“C”
“D”
CLASS
CLASS
CLASS
CLASS
FIRE FIRE FIRE FIRE -
GENERAL FIRE
flammable liquids
electric fire
Metallic Fire
Know your fire extinguishers
1) Pressurized Water – 2 ½ gallons
–
–
Range : 30-35 feet
To be used on class A fire (wood, paper, trash,
bedding, etc.)
2) Carbon-di-oxide
–
–
–
5-15 lbs
Range: 4-6 feet
To be used on class B fires (flammable liquids) and
on class C fires (Electrical)
Know your fire extinguishers
3) Dry chemical (ABC)
–
–
Range : 5-10lbs
Used in Class ABC all
–
–
4) Halon Type
Bromochlorodiflouromethane (BCF Cylinder for
sophisticated equipments etc.)
BCF Cylinders
Disaster due to fire
• In deciding to fight a fire, you need to determine a few
things:
i)
If there is a fire extinguisher with the proper fire rating
and classification available
ii) The size of the fire; anything more than a wastebasket is
probably too large
iii) The amount of firefighting ability needed to address the
situation. If you are not completely confident, close the
door to the fire area and evacuate.
iv) Fourth, Remember the Acronym P.A.S.S.
–
–
–
–
Pull the Pin.
Aim the Extinguisher nozzle at the base of the Fire.
Squeeze the handle while holding the Extinguisher upright.
Sweep from side to side covering the fire with extinguishing agent.
Responsibilities
Fire Fighting Team:
• Trained Fire Fighting Guard on rolls of the Security staff and on duty
shall head the Fire Fighting Team at the time of the incidence of Fire.
• There shall be at least 4 trained Fire Fighting Guards on duty in
each shift and shall be stationed at each floor at all times.
• The Fire Fighting Guards shall take action as per Fire Fighting
Manual of the hospital.
• The Fire Fighting Guards shall reach the site of Fire on activation of
the Fire Alarm, communication from the Fire Command Room or on
telephonic or verbal intimation by any personnel of the hospital
Responsibilities
• Rescue Team:
• The Security Supervisor on duty shall head the Rescue
Team. The Rescue Team shall be trained to handle
rescue operations at the site of incident.
• All Security Staff shall be trained in rescue
operations in case of Fire, Chemical Spills, and Building
Collapse etc.
• The Rescue Team shall be activated by the Chief
Security Officer immediately after assessing the
need based on the nature of the incident
TRANSPORTING HANDICAPPED PERSONS
• Backpack lift by
one rescuer
• Seat Carry by 2
rescuers
• Mattress drag
technique
Safety Manual
• Defines steps and procedure (SOPs)
• Policies for response to both internal
or external disaster
• Identifies responsibility of
individuals & departments
Purpose of Manual
• Identification of disaster
• Policy and procedure in case of
external and internal disaster
• Policy for involving networked
hospitals
• Training procedures and mock drills
STRUCTURE OF THE MANUAL
• Policy and procedures for internal and
external disaster
• Policies and procedures for hospital
networking
• Training techniques and guidelines
• Roles and Responsibilities
• Reporting Mechanism
Policies in Manual
•
•
•
•
•
•
•
•
•
•
•
•
Communication system in case of external/ internal disaster
Responsibilities of administrative staff
Responsibilities of clinical staff and departments
Mandatory equipments and medicines
Storage of dead bodies
Components required for hospital Networking
Procedure for hospital networking
Allocation of staff
Classification of casualties
Policy on operations of lift in fire
Policy on Smoking Control
Policy on fire safety and fire doors
Contd……
• Manual should also have annexures
–
–
–
–
–
–
–
–
–
–
–
–
Telephone numbers
List of ambulance services
List of emergency services
List of mortuary services
List of network hospitals
List of blood banks
List of crash cart locations
List of crash cart contents
List of emergency kits content
List of 24 hrs pharmacies
List of blood groups of all hospital employees
Sample assessment sheet for mock drills
Disaster Management Team
ADMINSTRATION
DAY TEAM
• General Manager
• Chief of Medical
Services
• Chief of Nursing
• CMO
• Customer Care
Manager
• Support Services
Manager
• Facilities Manager
• Bio Medical
Engineer
CLINICAL
DAY TEAM
•
•
•
•
•
•
Consultant ER
Medical Officers ER
Physicians on duty
Nurses
Technicians
Blood Bank staff
SUPPORT
SERVICES
DAY TEAM
• Security Officer
• Housekeeping
Manager
• Materials Manager
• Pharmacy Manager
• IT Team
Disaster Management Team
ADMINSTRATION
NIGHT TEAM
6pm – 8am
CLINICAL
NIGHT TEAM
6pm – 8am
Manager on Duty
Nursing Supervisor
ER Duty Doctor
Customer Care
Assistant
• Housekeeping
Supervisor
• Facilities Technician
• ER Duty Doctor
• All Duty Registrars
• All Junior
Consultants
• Nursing staff
• Technicians
•
•
•
•
SUPPORT
SERVICES
NIGHT TEAM
6pm – 8am
• Security supervisor
on duty
• Store assistant
• Pharmacy assistant
• IT support staff
ESCALATION MATRIX
CUSTOMER CARE/ER
General Manager
Coordination with
External Agencies
Internal Communication
and Coordination
Chief of Medical Services
Chief of Nursing
Consultants
Communication to CEO/
COO
Communication with
Media and Press
Staff of ER
COMMAND NUCLEUS
S.No.
Designation
Extensi
on No.
Mobile No.
+91----------
1.
Chief Operating Officer
Head Of Command Nucleus
4120
2.
Medical Director
4105
3.
GM Administration
4943
4.
Head Emergency
4086
5.
Chief Engineer
4901
6.
Chief Security Officer
4975
7.
Support Services:- F& B
H.K.
4959
4982
8.
Nursing Superintendent
4013
Response of hospital personnel to
internal emergencies
•
•
•
•
•
•
•
Remove individuals from areas of risk. Remove
equipment if appropriate.
Ring up No.XX and report the incident.
Contact your supervisor before leaving your work
area if possible.
The Command Nucleus, shall be established as per
location of the incident.( Board Room/ Gate No.1)
Security shall secure the Hospital exits &
entrances as necessary and direct media to the
Public Information Center established at Training
room/Gate No 1.
Report to your department heads for instructions.
Assist in damage control if possible.
COMMAND NUCLEUS
In the event a situation causes disruption to normal
activities an Internal/External Disaster may be declared
by any member of the Command Nucleus.
The internal/External disaster shall be Communicated by
announcement of code grey/red on the hospital public
address system by the operator on duty.
Contact number for declaration of code e.g. grey/red is:
XX.
Contd.
The first available member of the Command
nucleus shall be authorized to declare CODE
GREY/Red depending upon the enormity of
the incident.
About Command Nucleus
All members of Command Nucleus present in the
hospital shall meet immediately in board room and in
case of any emergency in that area, from Gate no. 1, at
the security gate of the Hospital, on declaration of
CODE for external disaster.
Activation of contingency plan
for internal/external disasters
Information for any Internal Disasters shall be received at the
EPABX through Hospital internal phone no say extension56
On receiving information of an Internal or external Emergency from
any individual the operator on duty shall identify the person giving
the information and inquire about the location, nature and
magnitude of the emergency.
THE OPERATOR ON DUTY will then immediately inform any of
the members of the Command Nucleus in the following order:
Chief Security Officer, Medical Director, COO, Chief
Engineer, Head Administration, Nursing Superintendent, Director
Emergency and Head Support Services Facilities.
COMMUNICATION OF
CODE GREY
The EPABX is the HUB for all communications
Internal Contact Number for CODE for external disaster
is e.g. XX
Operator On Duty (OOD) after declaration of CODE will
inform the security control room to announce CODE over
the Public Address System (PA) of the hospital.
The announcement shall be made 3 times at a time
after every 30 seconds, at least thrice.
Contd.
After announcement of CODE on the PA system, the Operator on
Duty shall ring up each member of the Command Nucleus on
extension as well as cell numbers .
The Operator on Duty shall ring up Senior Medical Officer
(Emergency) on duty after informing the members of the
Command Nucleus.
The following Department Heads shall then be informed so that
they can perform the assigned duties in case of Internal Disasters.
Blood Bank, Pharmacy, Biomedical, House Keeping, F&B,
Marketing, Transport, Nursing, Lab Medicine, Radiology.
PUBLIC INFORMATION
CENTER
•
Hospital shall set up a Public Information Center (PIC)
headed by Senior Manager Media & Communications which
shall be activated in case of any Internal Disaster. The
PIC shall operate from (specify the room in the hospital)
Training Room First Floor if that area is affected than
from the Gate 1. The Center shall have the following
telephone numbers:
Internal Number:
External Number:
5139
2547000
Responsibilities of administrative staff
& Administrative Departments
• General Manager
–
–
–
–
Check with local authorities
Obtain additional information
Ask for help with local police, volunteer organizations
Facilitate administrative support
• Chief of Nursing
– GM’s function in his/her absence
– Inform all department heads
– Ensure information reaches victim’s family
Responsibilities of administrative staff
& Administrative Departments
• Nursing Supervisor on duty
– Identify extent of disaster
– Set up Command Center
– Adequate number of nurses
• Admission Office
• Public Relations
Responsibilities
Chief Operating Officer:
• The COO of the hospital is the overall Administrative Head
for the implementation of plan Internal Disasters. He has
the following broad responsibilities:
• Clearance of information to be released to the Press,
relations of effected and outside agencies.
• Periodic review of arrangements.
• Overall direction and leadership in the matter
Responsibilities
• Chief Engineer:
• The Chief Engineer shall be responsible for ensuring cutting off of
power to the effected areas if required.
• Ensuring that Fire Pump House is manned. Ensuring that water
supply source remains intact.
• Maintaining water and power supply to the areas that are not
affected.
• Maintaining proper ventilation of the Casualty Triage.
• Cutting off medical gas supplies to the areas that are affected.
• Maintaining interruptions free Medical Gas Supplies to the areas
that are not affected.
• Controlling CSSD operations.
Contd.
•
Ensuring sufficient stock of HSD for Boilers & DG Sets.
•
Overlooking Biomedical Equipment maintenance, availability and
checks.
•
Recalling all off duty/ on leave staff.
•
Ensuring that lifts are not used in case of fire.
•
Ensuring that there is no unauthorized entry in the Utility, Medical
Gases, and CSSD and Water Supply areas.
•
Providing support for Fire fighting, if required, on request from CSO.
•
Providing technical support for rescue and evacuation
Senior Manager Media &
Communications/ Head Marketing:
• The Senior Manager Media & Communications/ Head Marketing shall be
responsible for:
• Setting up Public Information Center on declaration of CODE GREY.
• Taking care of all activities pertaining to the Public Information Center.
• Establishing Information Services for attendants of the casualties.
• Centralizing information about the casualties and updating Casualty List.
• Deploying Marketing Team for Public Information activities.
• Keeping a close communication with the Command Nucleus.
• Liaising with the Press and outside agencies for releasing information and
data after clearance by the Command Nucleus.
• Organizing Press Conference, if required.
Responsibilities
Medical Director:
• The Medical Director (MD) shall be overall in charge of all
Medical Operations in case of Internal Disasters. He shall:
• Interface with medical staff, nursing and ancillary disciplines to
ensure the appropriate level of medical response.
• Take over all administrative duties in the absence of the COO.
• Ask for help from local police and volunteer organizations as
deemed necessary.
• Liaise with government agencies and public hospitals for inter
hospital transfer of patients if necessary.
• Have the telephone numbers of nearby & other private &
government hospitals to coordinate the efforts.
Responsibilities
Nursing Superintendent:
The Nursing Superintendent of hospital in case of Internal Disasters
shall:
•
•
•
•
•
•
•
Identify nursing needs.
Help in Evacuating patients if required.
Allocate extra nursing staff in essential areas.
Re-deploy existing staff and Recall of off duty staff.
Ensure assistance in providing Basic Life Support.
Periodically review nursing arrangements.
Ensure arrangement of drugs, medical oxygen cylinders, linen etc. in
co-ordination with support departments.
Responsibilities of Support Service
Department
•
•
•
•
•
•
•
•
•
•
•
•
Nursing personnel assigned to Disaster Victims
Imaging Services
Laboratory
Blood Bank
Maintenance
Housekeeping & Laundry
Materials department
Pharmacy
IT
Infection Control
CSSD
Security
Responsibilities
• Chief Security Officer:
• The Chief Security Officer of hospital shall be responsible for
Leading operations of Fire Fighting, Rescue & Evacuation Teams.
• Cordoning off the Casualty/ Emergency area.
• Regulating entry & exit of personnel to ensure smooth functioning
of Emergency Services.
• Ensuring Ambulance and other emergency services vehicles are
allowed exit and entry freely.
• Controlling of unwanted traffic and public gathering by Security till
local police help available.
• Ensuring that Security Guards deployed at Critical Areas have
Walkie -Talkie sets.
Contd.
•
Ensuring regular communication between Security Guards
stationed at Casualty Triage through Walkie –Talkie sets.
•
Ensuring regular testing of Walkie –Talkie sets so that they
remain in good working order.
•
•
Ensuring safeguarding of belongings of Disaster Victims.
Calling in police if required.
•
Providing separate parking to attendants of the victims and
regulating parking.
•
Earmarking area for transfer of dead bodies and safe & efficient
transfer of dead bodies to the morgue.
Contd.
•
Maintenance of Morgue Register with proper identification, time of
arrival, name & identification of the person taking the body,
signatures of a witness to the release of the body, destination of the
body, name of the security guard on duty and his signatures, and time
of release of the body.
•
Ensuring that personal valuables are collected from the dead bodies
& sealed.
•
•
Ensuring that enough lady guards are deployed for handling ladies.
Requisitioning of additional transport in consultation with MD/GM
Admin & Engineer
•
•
Identifying a vehicle marshalling area.
Training two senior supervisors for coordinating the security
operations in his absence.
•
Ensuring that press is directed to the Public Information Center.
Mandatory Medicines & Equipments
• Define medicines and equipments
• Can be stored or procured from other
departments – define
• Spell quantity in policy
• MEDICINES
– Analgesics, antibiotics, antiseptics, bandages,
cotton, suture material
– Inj Ceftriaxone
– Inj Metrogyl
– Inj TTD
– Inj Tramazac
– Inj Diclofenac
– Silverex burn ointment
– IV fluids RL, NS, DNS, FFP
• EQUIPMENT
–
–
–
–
–
–
–
–
–
–
–
–
–
–
–
• EQUIPMENT
Splints- all sizes
IV stands
Ventilators
Heart Monitors
Crash Carts
Dressing Sets
Wheel Chairs
Trolleys
Pulse Oxymeter
Defebrilators
Syringe pumps
Pacemakers
Suction apparatus
Incubators
Invasive and non-invasive
pressure monitors
– Oximeters
– Glucometers
• Vacuum mattress
fitted
• Spine board
• Stretcher
• Aero medical
stretchers
Procedure to be followed for hospital
Networking
• Effective and efficient communication system with network
hospital.
• Mobile Medical Assistance.
• Mobile vehicle with life saving drugs.
• Mobile blood bank.
• Defined number of disaster victims.
• GM, Head Emergency or Senior Manager Operations
authorized to activate.
• Maintained list of networked hospitals and their contact
numbers.
Classification of Casualties
• Care of Priority 1- Immediate Care (approx 20%)
– Major hemorrhages
– Severe smoke inhalation
– Thoracic and cervico-maxillo facial injuries
– Cranial trauma with coma and rapidly progressive shock
– Compound fractures
– Burns (more than 30%)
– Crush injuries
– Any type of shock
– Spinal cord injuries
Classification of Casualties
• Care of Priority2 – Delayed Care (Approx 40%)
–
–
–
–
–
Non-asphyxiating thoracic trauma
Closed fractures of the extremities
Limited burns (<30%)
Cranial trauma without coma and shock
Injuries to soft parts
Classification of Casualties
• Care of Priority 3- Minor Care Casualties (Approx 40%)
• Dead on arrival and subsequent death
Qualified medically trained person to start triaging.
Victims moved from triage area to more appropriate holding area
Triage Tags
Sections of triage tags
• 4 colors of triage
– Black
– Red
-
– Yellow
-
– Green
-
Deceased
Immediate care (Critical Patients- life
threatening injuries)
Delayed Care (Urgent Patients -non-life
threatening injuries)
Minor (entails minor injuries)
• Patients demographics
• Section with pictorial view of human body
Reception of Causalities
• Reception or sorting area should be earmarked for
receipt of causalities
• Preliminary sorting out carried out by nature of
injuries or illness
• Existing Casualty and Emergency department would
mostly be unsuitable because of size.
• Area should allow for retention, segregation, and basic
documentation of incoming casualities.
• The sorting staff should be directed and supervised
by an experienced physician or surgeon.
• Sufficient equipment, supplies and apparatus should be
made available in this area to permit prompt and
efficient patient movement.
Task at Reception
• Personnel:
– Doctor I/C (1)
– Nurses (2)
– Clerical (1)
– Attendants (2)
• Tasks:
– Check Priority
– Check Documentation
– Valuables of the
patient
– Reassurance
– Medical Comforts
(water, tea, coffee,
etc)
– Information to
relatives
– Directing the casualty
Minimum Documentation
• General data like name, age, sex, etc.
• Medical data: prepare inpatient card or
outpatient card
• Check general conditions, splints
• Admission register : only preliminary
diagnosis
References - DMP
• Distributed text books
• Emergency Medical Services and
Disaster Management – A holistic
Approach – P K Dave pg 266-280
• Maharashtra Multi-hazard Disaster
Management Plan
Activity
In groups prepare the Disaster
Management Plan for 200 bedded
hospital – 15 marks
QUESTIONS