Subject:- Community

Health Nursing

Topic:- Scenario Disaster, Disaster

Classification & Phases of Disaster

PRESENTED BY,
MR. KAILASH NAGAR
ASSIST. PROF.
DEPT. OF COMMUNITY HEALTH NSG.
DINSHA PATEL COLLEGE OF NURSING, NADIAD
 WHO defines Disaster

• "any occurrence, that causes damage, ecological disruption,

loss of human life, deterioration of health and health
services, on a scale sufficient to warrant an extraordinary
response from outside the affected community or area“

Disaster in hospital
“Arrival with little or no warning of a large no of causalities than
the hospital is used to handle
 Other definitions

• ¨A disaster is an overwhelming ecological disruption

occurring on a scale sufficient to require outside
assistance
• A disaster is an event located in time and space
which produces conditions whereby the continuity of
structure and process of social units becomes
problematic
• ¨It is an event or series of events which seriously
disrupts normal activities
 Some premises
• Deaths and illnesses caused by disasters are
preventable health risks

• Disaster management is the responsibility of

every institution

• The Health Sector has a key role to play,

although it is not the lead sector
Responsibilities of the Health Sector

• Reduce Deaths, Disability & Diseases

• Reduce the vulnerability of its own
infrastructure: Hospital Mitigation
• Raise awareness on health impacts of
disasters
– health staff, allied personnel & community
• Increase preparedness of the health staff
and the community
 Role of hospital
• Hospitals have multiple missions:• patient
care,• clinical education,• clinical research,
and• community service.
• Two of these missions come together when a
community prepares for and faces an
emergency or disaster: patient care and
community service
 Classification

Natural Man Made

• Cyclone, • Toxicological accidents
• Fires (e.g. release of hazardous
•   Hurricanes Cyclone,(Sea) substances),
•   Floods / Sea Surges / • Nuclear accidents,
Tsunamis • Explosions
• Snow storms, • Civil disturbances,
•  Earthquakes, • Water contamination
• Landslides, • Existing or anticipated
• Lava food shortages.
 CRISIS NODAL MINISTRY
Natural disaster (except drought) and Ministry of Home Affairs
Civil Strife
 Drought Min. of Agriculture

Biological Disaster Ministry of Health

Chemical Disaster Ministry of Environment

Nuclear accidents and leakages Dept. Of Atomic Energy

Railway accidents Ministry of Railways

Air accidents Ministry of Civil Aviation

 EFFECTS OF MAJOR
DISASTERS
• Deaths
• Severe injuries, requiring extensive treatments
• Increased risk of communicable diseases
• Damage to the health facilities
• Damage to the water systems
• Food shortage
• Population movements
Health problems common to all Disasters

•  Social reactions
•  Communicable diseases
•  Population displacement
• Climatic exposure
•  Food and nutrition
•  Water supply and sanitation
•  Mental health
•  Damage to health infrastructure
Top Natural Disasters by Lives Lost, 1945-1990*
Year Location Type # of Deaths
1970 Bangladesh Tropical cyclone 300,00
1976 China Earthquake 242,000
1991 Bangladesh Tropical cyclone 132,000
1948 Soviet Union Earthquake 110,000
1970 Peru Earthquake 67,000
1949 China Flood 57,000
1990 Iran Earthquake 40,000
1965 Bangladesh Tropical cyclone 36,000
1954 China Flood 30,00
1965 Bangladesh Tropical cyclone 30,000
]1968 Iran Earthquake 30,000
1971 India Tropical cyclone 30,000
* Based on estimated number of fatalities.

• Source: Cutter, Susan. 1996. Societal vulnerability to environmental hazards. International Social Science Journal 48,4: 525.
Oxford, UK: Blackwell Publishers. © 1996 United Nations Educational, Scientific, and Cultural Organization (UNESCO).
Reprinted by permission of Blackwell Publishers.
 Top Natural Disasters by Economic Losses,
1985-1995
Year Location Event Losses (US$bn)
1995 Kobe, Japan Great Hanshin Earthquake 50.0
1992 Florida, USA Hurricane Andrew 30.0
1994 California, USA Northridge Earthquake 30.0
1993 Midwest, USA Mississippi Floods 12.01989 Caribbean, USA Hurricane Hugo
9.0
1990 Europe Winter storm Daria 6.8
1989 California, USA Loma Prieta Earthquake 6.0
1991 Japan Typhoon Mireille 6.0
1993 Northeast, USA Blizzard 5.0
1987 Western Europe Winter gale 3.7
1990 Europe Winter storm Vivian 3.25
1992 Hawaii Hurricane Iniki 3.0
1995 Florida, USAHurricane Opal 2.8
1990 Europe Winter storm Wiebke 2.25
1991 USA Forest Fire 2.0
Europe Winter storm Herta 1.91991
 India’s Disaster Ridden  History

• About 60% of India’s land mass is prone to Earth Quakes

• Over 40 million Hectares are prone to Floods
• Nearly 3 lakh  sq. km are at risk of Cyclones
• The Earth quake in Bhuj killed 14,000 people
• Cyclone in Orissa took away 10,000 lives.
• Between 1990 and 2000 an average of about 3400
people lost their lives annually.
• About 3 crore people were affected by Disasters every
year.
• About 17,000 people perished by the Tsunami on 26
Dec.04
The fundamental aspects of Disaster
Management Program

• Disaster Prevention
• Disaster preparedness
• Disaster response
• Disaster mitigation
• Rehabilitation
• Reconstruction
 First responder to health impacts:
THE COMMUNITY
• Awareness and Capacity of the community is critical
for Effective Response
• AWARENESS ON HEALTH IMPACTS AND THEIR HANDLING
• FIRST AID TRAINING
• WATER DISINFECTION
• HYGIENE & SANITATION
• ENSURING ADEQUATE NUTRITION
– Of Children, Pregnant & Lactating women, Chronically Ill, Elderly
• PSYCHO-SOCIAL COUNSELLING
 Mass Casualty Management

Triage • Triage
• Definitive
Treatment

Disaster Area Transportation

Hospitalization
 BEYOND COMMUNITY RESPONSE:
Mass Casualty Management

• TRIAGE AT SITE

• TRANSPORT TO HOSPITAL

• TREATMENT AT HOSPITAL
 Mass Casualty Management
Is a multi sectoral effort
POLICE
• Security -At disaster site & At hospital
• Traffic Control
• Crowd Control
• Incident Investigation
FIRE SERVICE
• Search and Rescue
• Fire Control
• Hazardous material Control
AMBULANCE SERVICE
• First responder
• Transportation of Victims to the Health Care
Facility
HOSPITAL & EMERGENCY DEPARTMENT
 TRIAGE

“Goal is to do the greatest good for the

greatest number of people”
 Triage

Principles of Triage
• “Dynamic Process”
• Establishing priorities for treatment /
evacuation
• Determines the future of the victim being
triaged and other victims
• Must be as unemotional as possible
 TRIAGE CATEGORIES
Military / Color
Patient Status START Priority
International Code
Critical /
Immediate Immedi Immediate Red 1
ate
Delayed Minor Delayed Yellow 2
Urgent /
Hold Minimal Green 3
Delayed
Dead /
Deceased Expectant Black 4
Dying
Contaminated
(NBC Hazard)
 MCM: Transport / Evacuation

Principles:
• Strict control of the evacuation rate
• Victim must be in the most stable condition possible
before moving
• Victim must be adequately equipped for the transfer
• Receiving facility must be informed and prepared for
transfer
• The best possible vehicle must be used
Disaster Management in Health
Sector is bigger than MCM
Mitigation & Risk reduction of facilities,
Health Care in Relief & Recovery Phases
Disease Surveillance & Control,
Water & Sanitation,
Environment,
Vector control Mass
Nutritional Security of special groups, Casualty
Mental Health, Management
Resources & Logistics
Training & Capacity building
Inter-sectoral coordination,
Damage and Needs Assessment
 Water

Hazard protection
Garbage disposal
Surveillance
Environmental
Vector Control
Health
Temporary
Toxicology Includes… Settlement

Sanitation
Personal Hygiene

Food
 RESPONSE TO DISASTERS [EVENTS]

RESCUE AND IMMEDIATE RELIEF (One to three Months)

• Rescue
• Food
• Water Shelter Predominantly
External Agents
• Clothing
• Emergency Medical Aid Welfare
• Communication
• Census
 SHORT-TERM REHAB (One to two years)

• Health
– Continuing Medical Aid External Agencies
– Environmental Sanitation/ Safe Drinking Water +Community
• Economic
– Food / Money for Work
• Re-Establish Local Industry
• Social
– Find missing persons
– Start Comm. Organization
• Shelter / Bunds / Schools / Religious Community
• INVOLVEMENT
Institutions.
 LONG-TERM REHAB (Two years beyond)

• COMMUNITY ORGANISATION
Predominantly
For Social / Economic / Health community

• Development
Community
• Preparing to face next disaster participation

PLANNING SHOULD IDEALLY AIM AT SELF-SUFFICIENCY OF COMMUNITY IN TACKLING

DISASTERS FROM PHASE-I ITSELF
 Risk of Communicable Disease
• Supply of drinking water is severely affected
• Food contamination may take place
• Overcrowding and poor sanitation in shelters
The emphasis of response must be on effectiveness of routine
measures rather than on adoption of high visibility new
measures:
• chlorinating water, food protection, latrines and hygiene may
have saved more lives than emergency surgery in the
aftermath of earthquakes
• Improvised mass immunizations are counterproductive
 DISASTER MITIGATION IN THE HEALTH
SECTOR

• Identify areas exposed to natural hazards

• Coordinate the work of multidisciplinary
teams
• Identify the priority hospitals and critical
health facilities
• Inform, sensitize, and train those personnel
• inclusion of disaster mitigation in the
curricula
Disaster Mitigation in Hospitals

• Vulnerability analysis

• Improved design of new facilities

• Retrofitting existing facilities

• Norms, guidelines, and training

 COMPONENTS OF DISASTER MITIGATION IN
HOSPITALS
• Structural Elements - building load bearing
components, such as beams, supporting columns, walls
• Non Structural elements –
 architectural elements
 life line systems – water, power, communication
 the building contents – medicine, supplies,
equipment, furnishings
• Functional elements –
 physical design, maintenance, administration,
operational aspects, plans, performance,
simulation exercises
 Disaster preparedness
The objective is to:
• Ensure that appropriate systems are in place to provide
prompt and effective assistance to disaster victims.
• Prepare the community to handle the disaster in the first 48
hours or so when outside help has not reached and the local

administration is itself affected by the disaster.

 Health Sector Contingency Planning

• Preparedness, Response, Mitigation

• Emphasis on Planning, Coordination and Advocacy
• Training & Capacity building is key
• Covering all types of disasters – natural & manmade
• Addressing issues at various levels
– Village, Panchayat, Block, District, State, Country
• In collaboration with the entire gamut of health providers
– Government, PSU, Voluntary, Private, Professional Assoc.
• Involving agencies like Civil Defense, Red Cross, St. John
Ambulance
• In coordination with other line departments
– ICDS, RWSS/PHE
• Integrated with overall Disaster Management Plan
MYTHS AND REALITIES OF NATURAL DISASTERS

• Myth: Foreign medical volunteers with any kind of

medical background are needed.
• Reality: The local population almost always covers
immediate lifesaving needs.
• Myth: Epidemics and plagues are inevitable after
every disaster.
• Reality: Epidemics do not spontaneously occur after
a disaster
• Myth: The affected population is too shocked and
helpless
• Reality: many find new strength during an
emergency,
• Myth: Locating disaster victims in temporary
settlements is the best alternative.
• Reality: It should be the last alternative.
• Myth: Things are back to normal within a few
weeks.
• Reality: The effects of a disaster last a long time.
 References
• Natural Disasters, Protecting the Public’s Health - Pan
American Health Organization
• Establishing a Mass Casualty Management System -
Pan American Health Organization
• Resource material from the First International
Training course on “Disasters and Development”
organised by the Asian Disaster Preparedness Center
Bangkok, Thailand
• Public health action in emergencies caused by
epidemics - WHO