Disaster Management Cycle

Venugopalan P P DA,DNB,MNAMS

Chief, Emergency medicine Site Director –Masters program in EM under GWU –USAExecutive Director –Angels International Foundation

What is a DISASTER?

• Disaster- dis·as·ter (noun) An occurrence causing widespread destruction & distress; A catastrophe.

• A grave misfortune.

Hazard

• Any phenomenon that has the potential to cause disruption or damage to people and their environment

AIMS OF DISASTER MANAGEMENT

• Reduce (Avoid, if possible) the potential losses from hazards.

• Assure prompt and appropriate assistance to victims when necessary.

• Achieve rapid and durable recovery.

Natural Disasters

• Natural Disasters For some natural disasters like floods and volcanoes, advance warning may be there; for others like earth quakes, tsunami – NO WARNING

Man Made

Man-made Disasters

Man-made Disasters • Chemical Plant

Explosion• Industrial Accident• Building Collapse • Acts of Terror

What is it?

• Disaster scenarios once seemed merely theoretical have become a disturbing reality

Just like apples

• Just like apples• Disasters in the communities come

in all shapes and sizes

Small

• Small Some impact a small number of people

• Intense demands on the health system for a short period E.g. Hooch Tragedy

Large

• Large Others involve a large number of casualties

• Reach a plateau only after a latent period

• Placing heavy continuing demands on the system

Why important?

• Hospitals can quickly be overwhelmed in the event of a disaster

Developed or not

• For example, after the terrorist bombing in Bali in 2002,15 patients requiring mechanical ventilation were sent to an Australian hospital

Why we are not prepared?

• Traditional approach fail• Need equipment• Need training • Needs Rs Rs Rs Rs Rs• Fear of the unknown “It can’t

happen here” “Not interested”• Inherent lethargy

So what?

• Planning and preparedness, would allow for a better, more efficient use of material and human resources

Key Points:

• Mitigation involves Structural and Non-structural measures taken to limit the impact of disasters

Disaster Management Fundamental aspects

• Disaster response• Disaster Preparation• Disasters Mitigation

Disaster Nut shell

 

 

DURING DISASTER

DISASTER MANAGEMENT CYCLE

PRE-DISASTER                 

 

PO

ST-

DIS

AS

TER

Stages of DisasterCyclone

Well Before Weeks-Months

Just Before - Hours

Actual Time Period

Rescue

Rehabilitation

Relief Reconstruction

BEFORE AFTERDURING

Jan - Apr MAY June- Oct

Need for Training

• Training of a new volunteer group for such eventualities is difficult;

• Training of existing medical and paramedical staff is more realistic

Hospitals need to be prepared

• Hospitals need to be prepared• First institutions to be affected after

any form of disasters, are the hospitals; whether natural or man-made.

• Preparing nurses is important

Mass Casualty Incident

• Any incident that exceeds the responder’s or receiving hospital’s capability to treat or transport is a Mass Casualty Incident

Multiple Casualty Incident

• Resources are not overwhelmed • Multiple victims

Disaster Management Plan

• A well documented and tested disaster management plan (DMP) is needed for each disaster

Systematic Approach

• Command and Control

• Safety -

• Communication

• Assessment

• Triage , Treatment, Transport

Self-Scene-Survivors

METHANE

D – I – S – A – S – T – E – R

PARADIGM

• This is a mnemonic which can help rescuers remember critical information about disaster response and triage

Disaster Paradigm

D: Detection

I: Incident Command

S: Safety & Security

A: Assess Hazards

S: Support

T: Triage ,Transport & Treatment

E: Evacuation

R: Reallocation & Redeployment

D-I-S-A-S-T-E-R Detection

• Internal • External• Simple clear plan for notification of

administration of the presence of a disaster

Disaster

• Stand by• Declared

In

Gold

Silver

Bronze

Incident

D-I-S-A-S-T-E-R Incident Command

• Born in Fire Service • Uniform structure• Clearly delineated roles

/responsibilities• Clear chain of command /

communication

Incident Command System – Basics

• Unified Command Planning Operations

• Finance Logistics • “Commander” “Thinkers” “Getters”

“Doers” “Payers”

Incident Command System

• Incident Command System Chief of Operations

• Chain of command under the Operations Chief.

• Note the distribution of Branches under COO

D-I-S-A-S-T-E-R Support

• State Ministry and the public health departments like DHS and DME;

• Fire departments• Law enforcing agencies

 D-I-S-A-S-T-E-R Assess Hazards

• Be Aware of Secondary Devices!

• Bombs,• Incapacitating

Devices,• Multiple

Snipers/Terrorists,• Delay Devices

D-I-S-A-S-T-E-R Safety and Security

• Ensure protection of staff handling disasters using personal protective equipment, decontamination and isolation protocols

D-I-S-A-S-T-E-RTriage

• For any hospital while responding to a mass casualty event; the goal is to save as many lives as possible with the available resources

Triage

• This could mean application of the principles of field triage in casualty;

• The purpose of which is to determine who gets what kind of care

Triage

• The term comes from the French verb trier,

• Meaning to separate, sort, sift or select

Triage - Definition

• A process of prioritizing patients based on the severity of their condition, in order to treat as many as possible when resources are insufficient

What to do?

• All to be treated immediately is impossible, so one has to select the suitable patients for immediate care based on certain criteria

Triage Sieve

Triage Nurse

• The triage nurse should be in view of the waiting area of the casualty at all times and prioritize the waiting patients periodically

Triage – Badge

• It is selected by the Triage Nurse and worn on each patient involved.

• It helps for any other staff to immediately identify seriousness of the case

Triage Tape

• Instead of the triage badge, one may use triage tape to be worn around the wrist

Triage Tag

Triage Nurse

• Greeting patients and families in a warm, empathetic manner performing brief visual assessments

• Documenting the assessments triaging patients into priority groups using appropriate guidelines

Triage Nurse

• Ensuring necessary treatment to deserving patients, returning to the triage area

• Transporting patients to treatment areas

• Giving reports to the emergency physician, who is treating the patient

D-I-S-A-S-T-E-R Treatment

• Measuring the relevant vital signs for appropriate determination of triage level

• Reassessment of patients remaining in the waiting room

D-I-S-A-S-T-E-R Treatment

• Notifying patients and their families of any unavoidable delays instructing patients and families

• Triage staff of any change in their condition

D-I-S-A-S-T-E-R Treatment

• Medications • Antidotes• Antibiotics• Immunizations • Prophylaxis • Chelation

D-I-S-A-S-T-E-R Evacuation

• A hospital might need to be evacuated either partially or wholly to accommodate casualties; quarantine or divert incoming patients

Flooding

• The ground floor services may need to be shifted to higher floors or a make shift operation theatre arranged

It could mean

• Minor surgical procedures in victims may have to be undertaken in these areas as it could mean altered level of asepsis

It could mean

• Creating alternate care sites in the waiting area or the hospital lobby or corridors which are not normally designed to provide medical care

It could also mean

• Changing roles and strategies for who provides various kinds of care enhancing the scope of nurses, nursing assistants and paramedics

D-I-S-A-S-T-E-RReallocation

• Allocating scarce equipment in a way that saves the largest number of lives in contrast to the traditional focus on saving individual lives

D-I-S-A-S-T-E-R Redeployment

• Re-allocating non emergency and non-clinical doctors to emergency areas & recruiting retired or unemployed persons for temporary service

D-I-S-A-S-T-E-R Recovery

• Re-establish infrastructure• Psychological Support/”Local

Debriefings” • Economic recovery• Insurance claims

One key component

• It is ensuring adequate supplies of qualified health care providers who are available and willing to serve in a Mass Casualty event

Periodic Checks

• A hospital's emergency response plan shall undergo periodic assessment and evaluation whether the plan addresses all issues

Hospital Disaster Drills

• An effective and economical way to improve clinicians' knowledge of hospital disaster procedures is computer simulation

Drill at Kannur KAP

Hospital Disaster Drills

• To make new hospital staff aware of procedures in disaster response and to train hospital staff to respond to a unexpected Mass Casualty

Communication is the key word

• Internal and external communications were the key to effective disaster response

• Updated phone numbers for key players were vital

METHANEM- My Call sign

Major Incident Stand by or Declared

E - Exact location

T- Type of Incident

H- Hazards , Present / Potential

A – Access to Scene

N – Number and Severity

E -Emergency Services -Present and Required

Media

Should be Addressed properly

Ambulance Network

Table Top Exercise

• Motivate hospital staff to learn more about disaster preparedness video demonstrations can educate a large

In India

India and probably in many other countries of the developing world, no statutory body to regulate and accredit this requirement

Agencies supporting Disasters

Thank You for the Patient Listening 

drvenugopalpp@gmail.com

www.mimsindia.comwww.emergencymedicinemims.comwww.angelsindia.orgwww.drvenu.net