General Concepts and DefinitionsGeneral Concepts and Definitions

Leaders courseLeaders courseJamaicaJamaica

February 11, 2003February 11, 2003

““Knowledge comes, but wisdom lingers”( Tennyson)Knowledge comes, but wisdom lingers”( Tennyson)

General ConceptsGeneral Concepts

• Disasters:Disasters: low probability-high impact events low probability-high impact events ““Sudden ecological phenomenon of sufficient Sudden ecological phenomenon of sufficient

magnitude to require external assistance” (WHO)magnitude to require external assistance” (WHO) ““I know a disaster when I see one”I know a disaster when I see one”

• Risk Management vs. Disaster ManagementRisk Management vs. Disaster Management• Attitude Change vs. Product ImprovementAttitude Change vs. Product Improvement

General ConceptsGeneral Concepts• Risk:Risk: Probability of harmful consequence or expected Probability of harmful consequence or expected

loss of lives/property resulting from interaction loss of lives/property resulting from interaction between natural or human induced hazards and between natural or human induced hazards and vulnerable conditions.vulnerable conditions.

• Hazard:Hazard: Probability of occurence of a given threat Probability of occurence of a given threat• Vulnerability:Vulnerability: Degree of susceptibility of the Degree of susceptibility of the

element exposed.element exposed. • Capacity:Capacity: Ability of people to cope with the situation.Ability of people to cope with the situation.

• Risk = H x V/CRisk = H x V/C

The Disaster CycleThe Disaster Cycle

Mitigation

Preparedness

Prevention

Rehabilitation

Reconstruction

ResponseResponse

BEFOREBEFORE AFTERAFTERDURINGDURING

DefinitionsDefinitions

• PreparednessPreparedness - - Pre-disaster activities aimed at Pre-disaster activities aimed at strengthening the capacity for rescue, relief, and strengthening the capacity for rescue, relief, and rehabilitation.rehabilitation.

• PreventionPrevention - - Measures designed to provide complete Measures designed to provide complete protection from natural disasters by controlling effects protection from natural disasters by controlling effects of natural phenomena.of natural phenomena.

• MitigationMitigation - - Prevention in an imperfect world!Prevention in an imperfect world!Reduction of the impact! (Structural, non-structural and Reduction of the impact! (Structural, non-structural and functional)functional)

Disasters and Health EffectsDisasters and Health Effects• World-wide:World-wide: 3.4 mil deaths due to 3.4 mil deaths due to natural natural

disasters in 25 yearsdisasters in 25 years• Japan:Japan: 63 deaths/event 63 deaths/event• Peru:Peru: 2,900 deaths/event 2,900 deaths/event• Population:Population: 6 bil increase = 1.33% yearly 6 bil increase = 1.33% yearly

increase (the poor outnumber the rich)increase (the poor outnumber the rich)• Trends:Trends:

Increase in # of hazardsIncrease in # of hazards Deaths toll per event reduced Deaths toll per event reduced Financial toll increasedFinancial toll increased

• What Matters More??What Matters More??

Global TrendsGlobal Trends

Climate change and variables –Climate change and variables – El NiñoEl Niño

• Poverty Poverty • IIgnorancegnorance• Environmental degradationEnvironmental degradation• Urban growth Urban growth • Increasing un-sustainabilityIncreasing un-sustainability• Increasing obstacles to developmentIncreasing obstacles to development• Increased value of constructed environmentIncreased value of constructed environment

EXTREME EVENTSEXTREME EVENTS

VULNERABILITYVULNERABILITY

Disaster impacts

0

1

2

3

1970-79 1980-89 1990-99

0

500

1,000

1,500

2,000

Dead Affected population

in million in million

Dead

Aff

ecte

d p

op

ula

tio

n

Source: OFDA/CRED International Disaster Database

Current TrendsCurrent Trends

0

1,000

2,000

3,000

4,000

5,000

6,000

1970-79 1980-89 1990-99

0100200300400500600700800

Number of disasters Economic losses

in million

Economic losses related to number of disasters

Eco

no

mic

lo

sses

Nu

mb

er

of

dis

aste

rs

Source: OFDA/CRED International Disaster Database

Current TrendsCurrent Trends

Disasters and Health EffectsDisasters and Health Effects

• General Effects on HealthGeneral Effects on HealthNatural vs TechnologicalNatural vs Technological Potential Effects vs. Inevitable Threat (ex. BCR)Potential Effects vs. Inevitable Threat (ex. BCR) Sudden vs Creeping/Slow Development Sudden vs Creeping/Slow Development Requirements for food, shelter and primary Requirements for food, shelter and primary

health care vary with type & length of event.health care vary with type & length of event.

Disasters and Health EffectsDisasters and Health Effects• General Effects on SocietyGeneral Effects on Society

Deaths and Injuries Deaths and Injuries Damage to Health InfrastructureDamage to Health Infrastructure Water Supply and SanitationWater Supply and Sanitation Communicable Diseases (overcrowding, vectors, Communicable Diseases (overcrowding, vectors,

water supply, waste management, PH programs)water supply, waste management, PH programs) Social Burden (poverty, age and gender) Social Burden (poverty, age and gender) Food ShortageFood Shortage Population DisplacementPopulation Displacement Mental Health ImpactMental Health Impact

Disasters and Health EffectsDisasters and Health Effects

• FloodsFloods Most Frequent Natural HazardMost Frequent Natural Hazard Most Deaths (flash floods) 146/year in USAMost Deaths (flash floods) 146/year in USA

Drowning - 77%Drowning - 77%Cardiac arrest - 10%Cardiac arrest - 10%Trauma - 10%Trauma - 10%Hypotermia - 3%Hypotermia - 3%

Public Health: water quality, waste disposal, Public Health: water quality, waste disposal, vectors, diseasevectors, disease

Associated Hazards: electrical, chemicalAssociated Hazards: electrical, chemical

Disasters and Health EffectsDisasters and Health Effects

• Volcanic EruptionVolcanic Eruption Most DeadlyMost Deadly

Pyroclastic flows - 70% from blast, heat or asphyxiationPyroclastic flows - 70% from blast, heat or asphyxiationRock fall injuries, BURNSRock fall injuries, BURNS

Difficult Access for First RespondersDifficult Access for First Responders Damage to Health InfrastructureDamage to Health Infrastructure Water ContaminationWater Contamination

Disasters and Health EffectsDisasters and Health Effects

• TsunamiTsunami Water and Debris = Damage to StructuresWater and Debris = Damage to Structures More deaths then injured (50-80%) More deaths then injured (50-80%)

Drowning -Vulnerable GroupsDrowning -Vulnerable Groups

Trauma Injuries Trauma Injuries Dehydration Dehydration SunburnSunburn

Disasters and Health EffectsDisasters and Health Effects

• HurricanesHurricanes Most DeadlyMost Deadly

Hurricane Flora 1963 - Haiti & Cuba Hurricane Flora 1963 - Haiti & Cuba → → 8,0008,000 Hurricane Fifi 1974 -Honduras Hurricane Fifi 1974 -Honduras → → 10,000 10,000 Hurricane Mitch 1998 - Central America Hurricane Mitch 1998 - Central America → → 11,00011,000

InjuriesInjuries Lacerations - 80% (during the clean up phase)Lacerations - 80% (during the clean up phase)

Damage to Infrastructure and Public Health Damage to Infrastructure and Public Health SystemsSystems

Disasters and Health EffectsDisasters and Health Effects

• EarthquakesEarthquakes Most Costly - Life and PropertyMost Costly - Life and Property No WarningNo Warning Evacuation Not PossibleEvacuation Not Possible Initial Medical Response - Delayed Initial Medical Response - Delayed Health Infrastructure - DamagedHealth Infrastructure - Damaged Most Deaths - Collapsed BuildingsMost Deaths - Collapsed Buildings 95% Survivers are Rescued in First 24 hours95% Survivers are Rescued in First 24 hours Injuries - Simple fractures to crush injuryInjuries - Simple fractures to crush injury

Disasters and Health EffectsDisasters and Health Effects

• TechnologicalTechnological Biological, Chemical, RadiologicalBiological, Chemical, Radiological

Accidental or Intentional ReleaseAccidental or Intentional Release Terrorist ThreatTerrorist Threat

Possible? Plausible? Probable?Possible? Plausible? Probable?

Effective Use of ResourcesEffective Use of ResourcesPersonnelPersonnelFundingFundingInfrastructureInfrastructure

Disasters and Health EffectsDisasters and Health Effects

• TechnologicalTechnological Enhancing CapabilitiesEnhancing Capabilities

TrainingTrainingInfrastructureInfrastructure

Shifting Priorities in PreparednessShifting Priorities in PreparednessCost EffectiveCost EffectiveSocial ConsequencesSocial ConsequencesReality or PerceptionReality or Perception

Health SectorHealth Sectorandand

Disaster ManagementDisaster Management

Recurring IssuesRecurring Issues

• Success is Difficult to QuantifySuccess is Difficult to Quantify• Management of International AssistanceManagement of International Assistance• Information ManagementInformation Management• More Actors on the Scene More Actors on the Scene

Recurring IssuesRecurring Issues• Mass Casualty ManagementMass Casualty Management• Care for VictimsCare for Victims• Dual Wave PhenomenonDual Wave Phenomenon

Walking Patients - 30 min Walking Patients - 30 min Priority 1 Patients - 2 hoursPriority 1 Patients - 2 hours

• Geographic Effect (closest facilities most Geographic Effect (closest facilities most impacted)impacted)

• BABEL Effect (communication, people, or BABEL Effect (communication, people, or equipment problem??)equipment problem??)

Recurring IssuesRecurring Issues

• Laymen EnthusiasmLaymen Enthusiasm• Disaster Supply ManagementDisaster Supply Management

Local Sources Local Sources DonationsDonations

• TetanophobiaTetanophobia• Fear of EpidemicsFear of Epidemics• Management of Human and Animal RemainsManagement of Human and Animal Remains• Field HospitalsField Hospitals

Planning AssumptionsPlanning Assumptions

• NO “Best Option”NO “Best Option”• Plans Plans

Adapted to Disaster Adapted to Disaster Improvisation Can Be CostlyImprovisation Can Be Costly First Responders Are Not Always FirstFirst Responders Are Not Always First

• Infrastructure CapacityInfrastructure Capacity• Specialized Care May Be NeededSpecialized Care May Be Needed

Planning AssumptionsPlanning Assumptions

• Local Capacity Response CapabilityLocal Capacity Response Capability• Stockpile of Equipment & SuppliesStockpile of Equipment & Supplies• Shortage or Flood of Supplies and StaffShortage or Flood of Supplies and Staff• Decentralization of AuthorityDecentralization of Authority• Private Business/Organization SupportPrivate Business/Organization Support

Health Sector ActorsHealth Sector Actors

• Government Sector: Min of Health, Min of Government Sector: Min of Health, Min of Foreign Affaires, Min of Finance, Min of Foreign Affaires, Min of Finance, Min of Environment, Water Authorities, Fire Services, Environment, Water Authorities, Fire Services, Police, Defense Force, Public Works, National Police, Defense Force, Public Works, National Disaster Office, Airport Managers, MEDIA……..Disaster Office, Airport Managers, MEDIA……..

• Private Sector: Hospitals, Ambulances, Doctors, Private Sector: Hospitals, Ambulances, Doctors, Manufacturers,……..Manufacturers,……..

• Local Authorities: Mayors, Community Local Authorities: Mayors, Community Groups….Groups….

Health Sector TaskHealth Sector Task

• Promotion of Disaster Reduction ActivitiesPromotion of Disaster Reduction Activities• Include Risk Management Concept in Include Risk Management Concept in

Development ProjectsDevelopment Projects• Staff, Fund, and Prepare Response Resources Staff, Fund, and Prepare Response Resources

Care of Victims Care of Victims Enviromental Needs (water, food, vector control)Enviromental Needs (water, food, vector control) Inform PublicInform Public

Health Sector TaskHealth Sector Task

• Coordinate With All SectorsCoordinate With All Sectors• Plan for RehabilitationPlan for Rehabilitation

Window of Opportunity for ReformWindow of Opportunity for Reform

Ministry of HealthMinistry of Health Disaster Reduccion Program Disaster Reduccion Program

• Mandate:Mandate: Promote, Coordinate, and Support Efforts of the Promote, Coordinate, and Support Efforts of the

Entire Health Sector to Reduce Impact of Disasters Entire Health Sector to Reduce Impact of Disasters

• Scope:Scope: Multi-Hazard and Inter-DisciplinaryMulti-Hazard and Inter-Disciplinary

Functional Areas of ResponsibilityFunctional Areas of Responsibility

• Promote Health & Social Issues with Other Promote Health & Social Issues with Other SectorsSectors

• Include Reduction/Mitigation Measures into Include Reduction/Mitigation Measures into Development ActivitiesDevelopment Activities

• Equitable Access to HealthcareEquitable Access to Healthcare• Public AwarenessPublic Awareness

Normative FunctionsNormative Functions

• Develop Construction Standards Develop Construction Standards • Develop Contingency Planning, Response, and Develop Contingency Planning, Response, and

Simulation Standards/GuidelinesSimulation Standards/Guidelines• Develop Criteria for Disaster Preparedness and Develop Criteria for Disaster Preparedness and

Safety Accreditation of Health FacilitiesSafety Accreditation of Health Facilities• Develop Communications ProtocolDevelop Communications Protocol• Develop Standards/Guidelines for Registration Develop Standards/Guidelines for Registration

of Humanitarian Assistance Organizations of Humanitarian Assistance Organizations (NGO´s, external military forces)(NGO´s, external military forces)

Educational FunctionsEducational Functions

• In-Service Training of Health StaffIn-Service Training of Health Staff• Include Disaster Management into Pre- and Include Disaster Management into Pre- and

Post-Graduate Curriculum Medical SchoolPost-Graduate Curriculum Medical School• Presentation of Health Related Topics in Presentation of Health Related Topics in

Training of Other SectorsTraining of Other Sectors

Coordination/LiaisonCoordination/Liaison

• National Disaster Office (Civil Protection) National Disaster Office (Civil Protection) • Disaster Focal Points of Other Agencies Disaster Focal Points of Other Agencies • Disaster Programs in Neighboring CountriesDisaster Programs in Neighboring Countries• Humanitarian and Developmental Humanitarian and Developmental

Organizations (national, international)Organizations (national, international)

Operational FunctionsOperational Functions

• Mobilize and Coordinate Immediate Response Mobilize and Coordinate Immediate Response • Coordinate Health Sector AssessmentCoordinate Health Sector Assessment• Formulate Priorities and Assign ResourcesFormulate Priorities and Assign Resources• Mobilize External ResourcesMobilize External Resources• Contribute to Formulation of Rehabilitation Contribute to Formulation of Rehabilitation

Plans (include mitigation)Plans (include mitigation)• Compile and Disseminate Lessons LearnedCompile and Disseminate Lessons Learned

Reporting ChannelsReporting ChannelsStaff and BudgetStaff and Budget

• Highest Decision-Mmaking Level in the MOHHighest Decision-Mmaking Level in the MOH• Access to All Administrative Areas and Access to All Administrative Areas and

Technical Departments in HealthTechnical Departments in Health• Funds to be Assigned Specifically for Risk Funds to be Assigned Specifically for Risk

Reduction ProgramReduction Program• Staff Trained, Qualified/Certified, and Full- Staff Trained, Qualified/Certified, and Full-

TimeTime

General Concepts and DefinitionsGeneral Concepts and Definitions

Leaders courseLeaders courseJamaicaJamaica

February 11, 2003February 11, 2003

““Knowledge comes, but wisdom lingers”( Tennyson)Knowledge comes, but wisdom lingers”( Tennyson)