DISASTER MANAGEMENT

Professor Syed Amin TabishFRCP(London), FRCP(Edin.), FAMS, MD

Disasters: the scenario A global problem: a major disaster

occurs somewhere in the world almost on a daily basis

Affects the advances being achieved health & socioeconomic development

Increased vulnerability to natural disasters due to environmental degradation, industrialization, pollution, threat to biodiversity

Rapid climate change Population explosion (overexploitation

of resources)

Disasters Ecological disruption Loss of human life Military expenditures: 6 month’s of world’s

arms spending would pay for a 10-year program proving food & health services in developing countries

Deterioration of health services to warrant an extraordinary response

from outside the affected community or area. Result in significant morbidity

Diversity of the Planet The vastness and diversity of the planet

makes it difficult to build up an overall picture of what needs to be done and the impact of what has been done.

The same vast distances make it hard to react rapidly and effectively to sudden events - an earthquake - in parts of the world with shifting populations and poor communications.

New technology - fast bandwidth reliable communications, the internet, high resolution satellite imagery - can provide support in these situations.

Classifying Disasters Natural: earthquakes, floods, fires, hurricanes Technological (number of nuclear arsenals

has exceeded 50,000), deadlier weapons, laser-guided missiles, carpet bombs, etc ……Hiroshima (Aug 6,1945) & Nagasaki (Aug 19, 1945); Nuclear reactor Accident in Chernobyl (Ukraine); Toxic gas leak in Bhopal (India)…..improper management of industrial technologies

Chemical & Biological Weapons Complex Emergencies (conflict-related):

Afghanistan (2.5 m), Iraq (1991, 2004-6) – hi-tech war [2,10,000 tons of bombs in 43 days dropped in 1991

Disaster Planning

Pre-disaster: the identification, understanding & analysis of natural & other hazards

Disaster Management System: to reduce the vulnerability of people to damage (disaster prevention), injury and loss of life & property resulting from catastrophes; to prepare for prompt & efficient rescue, care and treatment of victims; response & recovery

Disaster planning starts with community awareness

Disaster Management Disaster Preparedness: activities that are

carried out prior to the advance notice of a catastrophe to facilitate the use of available resources, relief & rehabilitation

Disaster mitigation: ongoing effort to lesson the impact disasters have on people & property

Disaster Management: the process of addressing an event that has the potential to seriously disrupt the social fabric of commun.

Pre-hospital Emergency Preparedness

Efficient system of providing prompt medical care to injured to save many lives or limbs by beginning treatment before the patient reached the hospital: CPR, ATLS, ACLS, closed chest cardiac compression

Emergency Medical Services Individual Protective Equipment

Natural Events

AvalanchesCyclonesDroughtsEarthquakesDustSand StormEpidemic Diseases

Natural Disaster

FaminesFloods Heat wavesHail StormsHurricanes (Katrina, Rita)

Natural Disasters

Land Slides Severe StormsTornadosTsunamisVolcanic Eruptions

Man-made DisastersAir SafetyFire EmergenciesNuclear Accidents & Radiation

(blast, heat)Hazardous material (chemical &

biological)BioterrorismConflict / Terrorism

BCW: possible weapons against humans

Biological Agents: Bacteria Bacillus Anthracis Brucella Species Bartonella QuintanaVibrio Cholerare Plague

Fungi- Coccidiodes immitis

Viruses- Hanta virus- Ebola virus- Smallpox

Protozoa- Naeglaeria fowleri

BCWRoutes of exposure Inhalation hazard (Respiratory System) Contact hazard (Skin) Digestive system (contaminated food or drinking

water)Degree of hazard will depend on the agent &

amount released/method by which agent is disseminated

Biological agents have the ability to multiply in the host

Chemical agents may be harassing agents, incapacitating agents or lethal agents

Recent Outbreaks & Incidents

Hurricane (the USA) Avian Flu ( Earthquakes (Pakistan) Floods (Bangladesh) Mad Cow Disease (the UK) Marburg Virus Hemorrhagic Fever Anthrax (the USA) Tsunamis (Indonesia, Sri Lanka) SARS (30 countries)

EarthquakesSurviving an earthquake and

reducing its health impact requires preparation, planning, and practice.

Far in advance, you can gather emergency supplies, identify and reduce possible hazards in your home, and practice what to do during and after an earthquake.

How are avian, pandemic, and seasonal flu different?

Avian Flu is caused by avian influenza viruses, which occur naturally among birds.

Pandemic Flu is flu that causes a global outbreak, or pandemic, of serious illness that spreads easily from person to person.

Seasonal Flu is a contagious respiratory illness caused by influenza viruses

What Injuries Occur Most Often?

The most severe injuries in mass casualty events are fractures, burns, lacerations, and crush injuries. However, the most common injuries are eye injuries, sprains, strains, minor wounds, and ear damage.

Impact of DisastersDisasters have a major impact on the

living conditions, economic performance and environmental assets and services of affected countries or regions.

Consequences may be long term and may even irreversibly affect economic and social structures and the environment

Impact In industrialized countries, disasters cause

massive damage to the large stock of accumulated capital while losses of human life are limited due to the availability of effective early warning and evacuation systems, as well as better urban planning and the application of strict building codes and standards.

In developing countries, on the other hand, fatalities are usually higher owing to the lack or inadequacy of forecast and evacuation programmes.

Impact Whether disasters are essentially natural or

man-made in origin, their consequences derive from a combination of human action and interaction with nature’s cycles or systems.

Disasters can lead to widespread loss of life, directly and indirectly (primarily or secondarily) affect large segments of the population and cause significant environmental damage and large-scale economic and social harm

the deterioration in the social well-being of the population

Disaster Management

EMERGENCY PREPAREDNESS

Goal of Emergency Preparedness

To reduce:loss of livesdamage to propertyimpact on environmentimpact on community

Activation of External Disaster Plan Information from the Red

Crescent Ambulance authoritiesArrival of casualties without prior

warningDoctor on Duty to inform ED ChiefED Chief to contact the Disaster

Executive Committee (Hospital Director, Executive Director, Medical Director, Nursing Director)

Activation of External Disaster Plan

Disaster Executive Committee [DEC] will assess the situation & determine the activation of the plan

DEC to initiate Code Black/Green through the Switchboard

Switchboard will start Page announcement for Code Black, Bleep 555 for all concerned

Activation of DM Plan

Beep to Transport Department for arranging 2 Ambulances

Advise Transport Section to send Ambulances around the hospital housing to alert residents about disaster

To send cars to commute staff Contact all other DM personnel Inform Nursing Director to arrange

nurses

Activation of the plan Chief of each department to arrange

return of off-duty personnel Ambulance to commute 2 medical teams

(disaster Site triage team) to site of disaster

Other departments (radiology, Labs, Blood Bank, Pharmacy, Medical Records, Patient Services, Security, Emergency Supplies, Nutrition, etc will activate their DM plan

Security personnel to regulate traffic to & from the Reception area

Main Disaster Teams

RESPONSIBILITIES

Disaster Executive Committee

Coordination all Disaster Management activates

Coordinate all aspects of clinical management

Notify local authorities Receive regular updated progress of DM Media management To announce ‘All Clear’ at the end of

Disaster

Coordination Team

Assess the number of casualties & Beds available

Maintain contact with Triage teams, Treatment teams & wards

Allocate Medical staff in different teams

Give updated info to Disaster & Executive Committee

Disaster Site Triage Team

Triaging patients (Red, Yellow, Green, Black) to give priorities for evacuation

Inform the Disaster Executive Committee about the situation to take decision for activation of Disaster Plan

Give frequent updates on the situation at the scene

Hospital Triage Team

Receiving the Disaster Patients

Screening (Triaging)Transferring all incoming disaster patients to different treatment areas

Red Area Team

To resuscitate, stabilize patients on red area and shifting them to definitive care areas

Yellow Area Team

To resuscitate and stabilize patients with serious non life-threatening injuries

Provide care to those patients who are seriously injured and likely to die

Transferring resuscitated patients to definitive care areas

Green Area Team

Care of patients with minimal injuries

ED Patients Team

Treating of the normal ED patients

Evacuation Team

Making beds available for casualties from the disaster by bed expansion and discharging current cold patients

Evaluation Team

Monitoring the management of the disaster and forward a final report to the Chief of the Disaster Management Committee.

Triage TeamHospital triage is team

responsible for:receiving the disaster

patientsscreening the disaster

patientstransferring all incoming

disaster patients to different treatment areas

Responsibility of the Yellow area team

to resuscitate patients with serious non-life threatening injuries

stabilize patients with serious non-life threatening injuries

to provide care to those patients who are seriously injured and likely to die

transferring resuscitated patients to definitive care areas

National Policy-making

Risk and vulnerability assessment

Development of training programmes

Public health in disasters The management of programmes

involving refugees and internally displaced people

Shelter needs in disasters

National Policy-making The development of disaster management

policy and plans Aspects of the management of disasters

resulting from conflict The role of the military in disaster

management The management of civil emergencies and

transport accidents Co-ordination in disaster management The establishment of control rooms

National Policy-making

Leadership and decision making in disaster management

Managing incidents involving terrorism or civil unrest

Crowd management The development context of

disaster management Disaster relief logistics

CBW Identify the hazard Evaluate the hazard Introduce risk reduction strategies

(control contamination) Chemical detection & identification (lab

dx. By DNA based & othe molecular methods)

Risk communication & dissemination of information

Contamination control (entry & exit control)

BCWDecontaminate both materials &

personsTriageMedical care & evaluation of

casualtiesDefinitive decontamination (a

final decontamination of the site)Command, control &

communication

Taste of Tears

THE CHANGING FACE OF DISASTER MANAGEMENT

The confirmed death toll from the 7.6-magnitude earthquake that was centered near Muzaffarabad, the capital of Pakistan-controlled Kashmir (PcK) on October 8 stands at over 73,000 in Pck and in NWFP, while the unconfirmed death toll has climbed to over 86,000. (Nov-8, AP, Dawn) Over 79,000 people injured and estimated 3 million displaced or homeless. The earthquake affected nine districts in total: Abbottabad, Batagram, Mansehra, Shangla, and Kohistan in the North West Frontier Province (NWFP) and Muzaffarabad, Neelum, Poonch and Bagh in PcK.

India

The latest official death toll is 1,309 in Indian-controlled Kashmir (IcK). Officially, 6,622 people reportedly injured and 150,000 displaced (Oct-17, AFP). Worst-hit areas are around Tangdhar and Uri towns in Kupwara and Baramulla districts respectively, along the disputed Line of Control (LoC). Third worst-hit area is Poonch district.

Tsunami The overall focus of attention is on rebuilding and long-term recovery

and rehabilitation for the December 26, 2004 earthquake and tsunami disaster. The dead and missing toll from tsunamis triggered by the undersea earthquake measuring 9.0 on the Richter scale off the west coast of Indonesia’s Sumatra Island was estimated to be some 232,000 people along the coastal areas of 12 countries in the Indian Ocean, although a true toll will likely never be known. At least 1.7 million are reported to be homeless with estimates over 2 million. Tsunami-related deaths were recorded in Indonesia, Sri Lanka, India, Thailand, Malaysia, Myanmar, Maldives, Bangladesh, Somalia, Tanzania, Kenya and the Seychelles. The loss of life was particularly severe in Indonesia, Sri Lanka, India and Thailand. Nearly 166,000 dead and missing are from worst-hit Aceh province in Indonesia. The dead and missing toll in Sri Lanka is nearly 39,000. In India, at least 10,672 died in Tamil Nadu State and the Andaman and Nicobar Islands. The death toll in Thailand is around 5,400, including about 1,953 foreigners from at least 36 countries. More than 400 combined deaths have been reported in the other countries.

South Asia Earthquake January 2005

South Asia earthquake (India)

Natural Disaster

Villages wiped out

Bodies recovered

Grim situation

Tsunami Catastrophe 2004-05

Tsunami: Satellite photos

Tsunami December 26 2004

Tsunami 2004/5: Indian Ocean

Tsunami: Indonesia

Tsunami

Tsunami Disaster of Indian Ocean 2005

It is said that some kids were playing on a bridge when suddenly the earthquake came, the bridge broke down into 2 pieces, all those kids went down inside the bridge and died. The mothers of those kids were standing besides the bridge and helplessly watching their kids die.

Iraq Tsunami: body in mortuary

Iraq: legs oeaten by dogs

Iraq: a dead woman covered