Disaster management

By

Dr Utpal Sharma

Assistant Professor

Department of Community Medicine

SMIMS, Gangtok, Sikkim

Introduction

What is a disaster ?

The dictionary meaning is calamity or

sudden or great misfortune.

It is a catastrophe causing injury or

illness simultaneously to atleast 30

people who will require

hospitalization and emergency

treatment.

Colin Grant- 1973

Cont…

Defined as “Any occurrence that causes damage, ecological

disruption, loss of human life or deterioration of health and

health services…..

….. on a scale sufficient to warrant an

extraordinary response from outside the affected community

or area.”

WHO

“Disaster needs to be declared when immediate patient load

in the emergency medical services system is greater than

normal operators can care for.”

A N Jenkins (1975)

Cont……

Disaster not confined to a particular part of the world

Many types of disasters, each event having its own special

features. E.g cyclones & floods could be predicted

beforehand but calamities like earthquakes occurs without

warning.

Relative number of injuries and deaths differs and depends

on factors such as:

Type of disaster

Density and distribution of the population

Condition of the environment

Degree of preparedness and opportunity of the warning

Cont…

Type of emergency varies with the kind of disaster and

how and when it strikes. Eg earthquakes more fatal at

the nightime, sudden floods tolls for more damages.

Morbidities in a disaster situation classified as:

Injuries

Emotional stress

Epidemic of diseases

Increase in indigenous diseases

Associated termsRisk:

Risk is a measure of the expected losses due to a hazardous event . The level of risk depends on:Nature of the HazardVulnerability of the elements which are affectedEconomic value of those elements

Vulnerability: Predisposition of a community, structure, service, and/or geographic

area to damage on account of their nature, construction and proximity to hazardous terrain or a disaster prone area”

Hazards: “Phenomena that pose a threat to people, structures, or economic

assets and which may cause a disaster.

Emergency and Disaster….

Emergency

A situation in which the

community is capable of

coping.

Generated by the real or

imminent occurrence of

an event that requires

immediate attention.

Requires immediate

attention of emergency

resources.

Disaster

A situation in which the

community is incapable

of coping.

Natural or man-made

events causing intense

negative impacts on

goods, services and/or

the environment,

Assistance of government

and international

agencies is mandate.

Classification of Disasters

1. Natural Disasters

(a) Phenomena beneath earth’s surface

(i) Earthquake

(ii) Volcanic eruptions

(iii) Tsunamis

(b) Phenomena at earth’s surface

(i) Landslides

(ii) Avalanches

Cont…

( c ) Meteorological / Hydrological Phenomena

(i) Windstorms ( Cyclones, Hurricanes )

(ii) Tornadoes

(iii) Hailstorms, snowstorms

(iv) Sea surges

(v) Floods, dam bursts

(vi) Droughts

( d ) Biological Phenomena

(i) Locust swarms

(ii) Epidemics of diseases

Cont…

2. Man Made Disasters

(a) Caused by Warfare

( i ) Conventional Warfare

( ii ) Nuclear, Biological & Chemical Warfare

(iii) Terrorism (includes Bioterrorism)

( b ) Accidents

( i ) Vehicular ( All types of transportation)

( ii ) Conflagrations, explosions, fires, building collapses.

( iii ) Deliberate explosive attacks

( iv ) Toxic gas leaks, chemical/poisoning

(v) Insidious disasters

(c) Others

Green house effect

Disaster management Disaster management is the managerial function charged

with creating the framework within which communities reduce

vulnerability to hazards and cope with disasters.

Does not avert or eliminate the threats, instead focuses on

creating plans to decrease the impact of disasters

There are three fundamental aspect of Disaster Management

Response

Preparedness

Mitigation

Disaster cycle

Management sequence of a sudden-onset

disaster

Response

Reconstruction

Mitigation

Preparedness Disaster

impact

Recovery phase after a disaster

Risk reduction phase before a disaster

Cont….

Disaster Response

Response measures are usually those which are taken

immediately prior to and following disaster impact.

Most injuries during impact; so greatest need of emergency

care during first few hours

Typical measures include :

Search, Rescue and First aid

Immediately after a disaster organized relief services

unable to cater to the need of victim owing to the great

numbers.

Mostly help comes from the existing survivors

Search and Rescue

• Most immediate help comes from uninjured

survivors

• To reduce the demand of organized relief

services

• Identification of local & specific agencies

(govt. or non govt. organizations)

Uninjured survivors helping the injured people

Cont….

Evacuation measures

Field care

All health care resources to be directed towards the new priority

Bed availability and surgical services to be maximized

Provision for food and shelter

Separate centre for dealing with enquiries by relatives

(grievance cell)

Priority to victim’s identification

and enough space in mortuary

Cont…..

Triage Rapid classification of injured on the basis of severity of

injuries and chances of survival.

High priority given to those having better prognosis by

simple intensive care

Moribund victims requiring great deal of attention and

questionable prognosis given lowest priority

Red- High priority t/t or transfer

Yellow- Medium priority

Green- Ambulatory patients

Black- Dead/ moribund patients

Cont…

Tagging

Victims to tagged with particulars like name, age, place

of origin, triage category, diagnosis and initial t/t

Taking care of the dead

Redressal mechanism to receive bereaved relatives

Removal of the dead bodies

Shifting to the mortuary

Mass cremation

Relief phaseThe disaster-stricken areas are assisted from outside in

returning to their proper level of functioning following

the event.

Type and quantity of relief supplies is determined by:

Type of disaster

Resources available

In initial phase most important of these

supplies are:

Health supplies to treat causalities

Resources to prevent

communicable diseases

Cont…

Following these, other commodities viz. food , blankets ,

shelter, sanitary engineering etc comes second.

Damage assessment to be carried out figure out the

needs and resources available

For managing the relief supplies principle components

are:

Acquisition of the supplies

Transportation of these supplies

Storage of supplied materials

Distribution

A relief camp

Planning of Relief

Management of medical Supply

Assessment of immediate health needs

Care and Shelter(Relief camps)

Environmental management

Food safety

Clothings & Utensils

Disposal of dead

Water supply

Basic Sanitation

Personal Hygiene

Vector control

Planning of relief

Epidemiologic surveillance and disease control

Increase of communicable diseases during disaster by:

Overcrowding and poor sanitation in temporary

settlements.

Migration during emergency may introduce diseases to

new areas either by man or by animals.

Disruption and damage to the water supply, sewerage

and power systems

Diversion to relief work- disruption of routine control

programmes

Cont….

Favorable ecology for breeding of vectors during

disasters

Source of provision of food, water and shelter may

itself be a source of infection

To combat communicable disease in emergency:

Implementation of all public health measures

Reliable disease reporting system to identify

outbreaks and prompt control measures

Investigate all reports of disease outbreak

Surveillance and control..

Vaccination WHO doesn’t recommend typhoid and cholera

vaccines use in routine care during disasters

Compliance poor owing to multi-dosing

Large number of workers engaged who otherwise could be utilized elsewhere.

Supervision of sterilization & injection technique impossible.

Mass vaccination may induce a false sense of security .

Cont….

Vaccination against tetanus considered prudent if RI

conducted in the camps.

Disasters causes disruption of ongoing eradication

programmes like polio and measles

Cold- chain facilities to be procured

Vaccination however is necessary for the health

workers

Best protection is maintenance of high level

immunity in general population by RI before the

disaster.

Vaccination during disaster

Nutrition

Disasters affects nutrition depending on type,

duration, extend of disaster and preexisting

nutritional condition.

Infants, pregnant, lactating mothers, & sick more

vulnerable.

Cont….

Effective food relief programmes includes:

Assessing of food supplies after disaster

Estimating the nutritional need of affected

population

Calculating daily food rations and need for large

population group.

Monitoring the nutritional status of the affected

population

Food supplies in a disaster

Energy Requirements for

Disaster Situation*

Broad Groups Age Male (kcal) Female (kcal) Combined (kcal)

Under 5s 0–4 1320 1250 1290

Children 5–9 1980 1730 1860

Adolescents 10–14 2370 2040 2210

Adolescents 15–19 2700 2120 2420

Adults 20–59 2460 1990 2230

Elderly > 60 2010 1780 1890

Preg/Lact 285/500

(extra)

285/500(extra)

Whole pop 2250 1910 2080 (2100)

*The Management of nutrition in major emergencies. Geneva, World Health Organization, 2000

Rehabilitation

Services to be restructured & reorganized as health needs changes from causality M/M to routine primary health care with time.

Priorities shifts from health care to environmental measures

Water supply

First priority of ensuring water quality in emergency is chlorination (residual chlorine about 0.2-0.5 mg/lit).

Water quality and potential contaminants have to be identified and analyzed.

Water supply cont…..

Existing & new sources require protection like:

Restricted access to people and animals

Adequate excreta disposal at a safe distance

Prohibit washing, bathing & animal husbandry

upstream

Upgrade wells so as protected from contamination

Estimate maximum yield of wells and ration water

if necessary

Water Supply in disaster

During evacuation

– 3 liters/person/day in cold & temperate climates

– 6 liters/person/day in hot climates

During relief operations

– 40-60 liters/person in field hospitals

– 20-30 liters/person in mass feeding centers

– 15-20 liters/person in temporary shelters & camps

Disinfection of water

Chlorine tablets (Halazone)

One tablet (4mg) for 1 litre of water

Granular calcium hypochlorite

One teaspoon (7gm) for 8 liters of water to make stock

solution

One part of solution to be added to 100 parts of water

Allow to stand for 30 minutes

Sodium hypochlorite bleach

10 drops for 1 litre of water

Disinfection cont….

Iodine tablets

One tablet for I litre of water

Iodine Solutions

Five drops of tincture iodine for 1 liter of water

Potassium permanganate

Dissolve 40 mg of KMnO4 in 1 liter of warm water

It will disinfect 1 cubic meter of water after 24 hrs of

contact time

Disinfection of water

Chlorine tablets

Iodine SolutionsIodine tablets

Sodium hypochlorite

bleachGranular calcium

hypochlorite

Potassium permanganate

Cont…….

Food safety

Every precaution taken to prevent food borne

diseases.

Personal hygiene to be monitored and maintained in

people involved in food preparation

Basic sanitation and personal hygiene

Ensure safe disposal of excreta.

Emergency latrines facilities to set in the camps

Washing, cleaning & bathing facilities to be provided

Food safety and hygiene in relief camps

Cont…

Vector control

Intensification of vector- borne disease control

programmes during crisis situation

Special concerns for diseases like malaria,

dengue leptospirosis , plague etc.

Disaster mitigation This involves measures designed for lessening the likely

effects of emergencies.

Includes appropriate land-use planning, flood mitigation

works, improved building codes…..

……. improving structural qualities

of schools, houses and such other buildings so that medical

causalities can be minimized.

Ensuring the safety of health facilities and public health

services including…..

……….water supply and sewerage system to reduce

the cost of rehabilitation and reconstruction.

Mitigation compliments the disaster preparedness and

disaster response activities.

Disaster preparedness

Long term development activities with goals to

strengthen…….

…… capacity and capability of a country to

manage all types of emergencies

Should bring about an orderly transition from relief

through recovery and back to sustained development.

Objective is to ensure that systems, procedures and

resources are in place to provide prompt assistance.

It is an ongoing multi-sectoral activity

Evaluate the risk of the country/region to disaster

Adopt standards and regulations

Activities cont….

Organize communication , information and warning

systems

Ensure coordination and response mechanisms

Ensure that resources are available and can be easily

mobilized in disaster for improved preparedness

Develop public education programmes

Coordinate information sessions with news media

Organize disaster stimulation exercises that test

response mechanisms.

Cont…

Reasons for preparedness at local level

Effective and appropriate preparedness programmes

can avert considerable losses

First response is from within the community, as

disruption of transport system may defer external help

Resources easily pooled at the local level

Sustained development best achieved when

communities design the assistance programme

themselves

Photographs of GEMEx 2012

Policy development

The formal statement for course of action

Policy follows the strategies:

a) Establish long term goals

b) Assign responsibilities for achieving goals

c) Establish recommended work practices

d) Determine criteria for decision making

Policies tends to be “top-down” ……

…….implementation of strategies arising from

policy tend to be “ bottom- up”.

Cont…

Six sectors required for response and

recovery strategies

– Communication

– Health

– Social welfare

– Police & security

– Search & rescue

– Transport

India’s Vulnerability to Disasters

57% land is vulnerable to earthquakes. Of these,

12% is vulnerable to severe earthquakes.

68% land is vulnerable to drought.

12% land is vulnerable to floods.

8% land is vulnerable to cyclones.

Apart from natural disasters, some cities in India are

also vulnerable to chemical and industrial disasters

and man-made disasters.

Triangle of life

Thank you