Disaster

Introduction

A Disaster is a serious disruption of the functioning of a society, causing widespread

human, property or environmental losses which exceed the ability of the affected
society to cope using only its own resources. “The term disaster owes its origin to the
French word “Desastre” which is a combination of two words ‘des’ meaning bad and
‘aster’ meaning star. Thus the term refers to ‘Bad or Evil star’.

Definition

• Disaster is an event occurring in an area

• Due to natural or man made causes

• Maybe Accidental or deliberate- (negligence or intentional)

• That causes substantial loss of life or injury (either to humans or animals or both)

• Damage to property or environment

• And

• The the damage caused is beyond the coping capability

• Of the Community of the affected area

Types (classification) of disaster

Natural disaster. These are further subdivided into

• Geo-physical. (First, Earth moves). Eg Earthquake, Tsunami (sea-bed moves),

volcano

• Hydrological. (First, Water moves) Flood, mud-slide (starts with heavy rains)

• Meteorological. (First, Air moves). Cyclone

• Climatological. Weather related. Extreme heat or extreme cold, (note. draught/

famine will be in this group)

• Biological. Epidemics, Pandemics.

Manmade Disasters

• Sudden eg Rail, road, aircraft accidents, Bhopal Gas tragedy

• Slow. Climate change, Green house effect

• Wars and Civil conflicts, terrorism

Combined Natural and Man-made disaster. Earthquake damaging a nuclear plant

leading to release of radioactive material.

Impact of Disasters (Think, what all did Covid do.)

• Deaths

• Injuries

• Damage to infrastructure and property (water supply, sewerage system, hospital

building may be damaged. Lack of electricity may disrupt functionality of health
services including cold chain

• Psychological problems

• Lack of communication. Damage to mobile towers or telephone lines or roads or

railroad

• Death & injuries to animals

• Disruption of medical care of chronic patients eg cancer patients, diabetes,

 vaccination

• Damage to climate eg forest fires, radioactive material, chemical released. The

hazard may last for long time. Eg Chernobyl disaster

• Economic loss, loss of production, loss of jobs, business.

• Disruption in education of students, problems of online teaching, postponement or

cancellation of Board/University examinations eg as seen in Covid 19 pandemic.

• Social disruption (Lockdowns leading to return of migrants back to homes),

orphans, crimes, increased violence against women in prolonged lockdown

Factors on which impact of disaster depends.

• Type of hazard. In Hydrological disasters, volcanoes and avalanches number of
deaths exceed number injured.

• Location of disaster. Higher damage in urban areas.

• Geographical spread.

• Early warning. Earthquakes cannot be predicted. Cyclones can be.

• Degree of mitigation

• Degree of preparedness.

• Time disaster strikes. More serious at night.

(Factors which were responsible for COVID Pandemic

• Novel virus ie total population of the world susceptible to infection

• High secondary attack rate
• Mode of transmission. By respiratory route
• Non availability of any vaccine during initial period of pandemic
• Movement of men across country borders causing rapid spread
• Overcrowding
• Lack of awareness among masses leading to ‘not adhering to appropriate
precautions’
• Poor personal hygiene
• High co-morbidity causing more deaths
• Social media spreading rumours and false propaganda
• Lack of faith in Govt institutions
• Poor health infrastructure esp in public sector and rural areas
• Movement of migrant labour leading to spread of infection rural areas
• Mass gathering eg election rallies, Kumbh, Kisan agitation, marriages etc
• Mutation of pathogen)
• Lack of anticipation of number of cases and deaths esp during 2nd wave
• Chapter II: Phases in Disaster Disaster cycle)
A. Phases in post-disaster period (3Rs)
• Response
• Relief
• Rehabilitation
B. Phases during Pre- or Inter-disaster period
• Disaster mitigation (Reduction)
• Disaster preparedness (Readiness)
Disaster Response.

Disaster cycle starts from occurrence of a disaster (called disaster Impact). Disaster
Impact causes deaths, injuries and damage to infrastructure. Response stage starts
from time of impact to a time when outside assistance starts arriving. Activities
in this stage are:-

Step1. Search, Rescue and First-Aid. These important and life saving activities are
to be performed by healthy survivors during immediate post-disaster period. Hence,
the need for training of members of general population in First-Aid and Basic Life
Support.

Step II. Triage.Triage means to sort out.

Aim of Triage is

i. To identify priority of cases-for evaluation and for treatment

ii. To organise, streamline case management.

iii. To minimise complication and save limbs and organ

iv. To utilise resources effectively.

Objective of Triage. Maximum benefits to greatest numbers

Where is triage done

Triage is dynamic process. It starts at the site of accident and continues till definite
treatment has been done. A person who has been classified ‘green’ at site of
accident may develop some complications during evacuation to hospital and may be
classified in red category at the hospital.

Principles of Triage

1. Triage is done after Rescue and First-aid.

2. Triage is needed because in disaster or mass casualty situation, there is relative

lack of resources.

3. In Triage, the principle of FIRST COME-FIRST TREATED is not adopted. In

Triage, an individual who needs faster care (to survive) is provided definite care
earlier, than the one whose condition is unlikely or less likely to deteriorate, if
definite treatment is withheld for few hours.

Triage is done by sorting out injured in one of the following categories:-

Priority 1 Red. Immediate resuscitation and early definite treatment (surgery)

This group is likely to constitute about 10-20% of total casualties. • Rapidly

correctable mechanical respiratory defects.

• Serious crush injuries involving extremities.

• Incomplete amputations.

• Severe laceration and compound fracture.

• Involvement of upper respiratory tract needing tracheostomy.

• Active bleeding

Patients in this group usually need admission to ICU

Priority 2 Yellow. Moderate priority.

Patients whose Surgical/ definite treatment can be delayed.

The group comprises about 20% of total casualties. This group includes:

i. Multiple deep lacerations with bleeding that can be controlled by pressure

bandage.

ii. Simple closed fracture of major bones.

iii. Second degree burns of 10-15% body surface.

iv. Non Critical CNS injuries.

Patients of this nature will also need care in acute wards and constant observation.

Priority 3. Green. Ambulatory patients Those who can WALK & TALK. Usually 70%
of victims fall in this category.

Eg abrasion, sprains.

Priority 4. Black. Dead AND those unlikely to survive even with definite treatment.
Eg crush injury chest, head injury cases in deep coma etc.

Step III. Tagging. In disaster or mass casualties situation, there is usually no time to
write detail case history. So a note indicating personal identification, injuries and
treatment given (with time at which given) and priority is tagged with the injured.
Some hospitals have a pre-prepared special form for easy filling and tagging with the
casualty. Similarly, wrist bands of four colours are available for easy identification of
triage.

Step IV. Evacuation. Transfer of injured from site of injury to hospital is an important
activity. Evacuation can be done by multiple methods depending on the site. It may
be stretchers, animals, road, rail, boats or by air. Important principles are

• The condition of the injured should not be allowed to deteriorate during travel, ie
he should continue to receive intravenous fluids, antibiotics etc during travel.

• If the travel period is long, staging should be done example relief of pain and dose
of antibiotics every 4-6 hours (called 4-hourly staging)

Step IV. Disposal of the dead. Dead after certification by a doctor are removed to
mortuary or ad-hoc mortuary. Identification, as far as possible should be done.
These days sample for DNA is taken for identification.

Relief Phase

This phase starts when assistance from outside starts arriving. The supplies usually
consist of medical supplies, rations, tents, blankets, water purifiers, generators,
sanitary supplies etc. Management of these supplies involve Receiving,
Transportation, Storage and Distribution.

Role of Public Health Experts in Relief phase of Disaster Cycle

Disaster have serious health implications. Disasters cause:-

A. Deaths

B. Injuries

C. Outbreaks of Communicable diseases

The risk of outbreaks of communicable diseases is more because of:-

A. Displacement of large population

B. Overcrowding in temporary camps

C. Poor sanitation in temporary camps including sanitation in preparation/storage/

distribution of food.

D. Lack of safe water supply in temporary camps

E. Disruption of routine prevention and control measures eg immunisation, Anti-

Vector measures,

F. Ecological changes eg collection of water in floods promote mosquitoes breeding

G. Poor nutrition decreases immunity

H. Displacement of animals increases risk of zoonotic diseases

Most Common Outbreaks are

A. Gastroenteritis

B. Acute Respiratory Diseases

C. Leptospirosis (especially after floods)

D. Vector borne diseases including Rickettsial diseases

Prevention and Control of Communicable diseases (Relief phase)

A. Ensure supply of safe water. Important points are

• protect water source ie individuals should not be permitted to drink, bath, defecate
or wash clothes in or near water source. The help of police or volunteers should be
obtained. Entry of animals should also be restricted as far as possible. Fencing of
water sources can be done.

• Water should be purified to the extent possible. Sedimentation followed by super-

chlorination should (at least) must be done, even if filtration is not possible during
early post-disaster period.

• Boiling is ideal but not feasible on large scale.

• Rationing of water supply should be done if supply is inadequate.

B. Sanitary disposal of waste. Water seal latrines over dug well are best choice for
relief camps.

• Open defecation must not be permitted.

• Privacy in latrines promote use.

• Disposal of solid waste. Burning as a short term measure may be recommended.

• Removal and disposal of dead animals.

C. Nutrition.

• Till supplies are received from outside, provision of safe food is as important as
provision of energy. Nutrition of vulnerable groups infants, children, pregnant and
lactating women should be at higher priority.

D. Vector control. Should be done. Chemical measures (against larval as well as

adult stages) and use of repellents are more practical. Out breaks of following
diseases may occur:-

Mosquito-borne. Malaria, dengue

Rat-related. Leptospirosis

Flea and louse transmitted. Typhus, plague

E. Prevention of Acute Respiratory Infections. Overcrowding occurs in Relief

Camps, leading to spread of acute respiratory infections. Proper spacing between
beds (head to toe sleeping pattern), health education regarding cough etiquette,
repeated washing of hands or even use of masks should be undertaken to prevent
these infections that have higher mortality at extremes of age.
F. Role of vaccination. It is important to understand that role of vaccination during
immediate post-disaster phase is limited. Following points are pertinent:-

• WHO doesn’t recommend Typhoid or Cholera vaccines.

Reasons

• vaccines are disease specific.

• Need large numbers of health personnel to administer

• Need sterilisation conditions

• Need cold chain

• Takes time to be effective after injections

• Give a false sense of security.

• Hence, in general NOT Recommended. However, if resources are available

two vaccines that should be given are Tetanus toxoid AND measles vaccine.
Regarding Tetanus understand the following. Tetanus should be given during pre-
disaster phase. However, we know that TT does not provide herd immunity. Hence,
the vaccination of injured should be done based on vaccination status of the
injured.

• Health Promotion measures like safe water supply, sanitation, health education,
adequate nutrition, prevention of overcrowding etc are more cost-effective than
mass vaccination.

G. Providing Primary Health Care Facilities to the Residents of the Relief Camp
and Referral System

H. Establish a Disease Surveillance System.

I. Health Education

Rehabilitation .

Restoration of pre-disaster conditions. In general, the priority shifts from medical

(treatment of injured) to health (promotion, prevention, treatment and rehabilitation).

Water supply. Supply of safe water is of paramount importance. Microbial

contamination is more important than chemical contamination. Other points same as
mentioned above.

Disposal of Waste. Same as above.

Vector control. Should be done. Chemical measures (against larval as well as adult
stages) and use of repellents are more practical. Out breaks of following diseases
may occur:-
n
Mosquito-borne. Malaria, dengue

Rat-related. Leptospirosis

Flea and louse transmitted. Typhus, plague

Reconstruction. In this phase reconstruction of damaged infrastructure occurs. The

role of public health is to ensure that (at least) health care facilities as well as health-
related infrastructure (eg Water supply units) are constructed so that they are
disaster-proof [Eg earth-quake resistant and on high ground (flood-proof)].

Disaster Mitigation. Please understand that we can not prevent natural hazards to
occur BUT we can decrease the IMPACT OF HAZARDS.

Mitigation means activities to:-

• Decrease the impact of hazard. Eg we can construct earth quake proof building,
river banks can be strengthened, etc.

• Disaster mitigation measures along with Disaster-preparedness (see next) can

 reduce the impact of hazard and PREVENT disaster (ie hazard is not preventable,
but impact of hazard can decreased. So the hazard does minimal damage. Eg
Japan is earthquakes prone, but the country has upgraded its buildings and other
infrastructure so that earthquakes causes no or little damage.)

Disaster Preparedness (DP)

Defined as programme (usually long term) to improve the capacity of a community to

face the consequences of a disaster.

Objective. Appropriate systems, resources (including Human Resource’s) and

procedures are available to face the challenges of disaster.

(Note. DP includes empowering general public, because members of general public

are the ones who will save the maximum lives by taking suitable action in immediate
post-disaster period.)

Important activities in DP are:-

• Develop policy.

• Develop organisation. India: National Disaster Management Authority. Ensure

Command and Control system, hierarchy, coordination,

• Evaluation of risk (areas/ regions where which disaster? and how severe? when if
possible?)

• Plan and enforce appropriate rules and regulations eg building standards

• Plan early detection (eg floods and cyclones can be forecasted) and early warning
systems.

• Develop and implement public education program

• Undertake simulation exercises

• Establish communication systems that are disaster proof (eg due to destruction of
towers our mobile phones may not work after earthquake)

• Enact suitable legislations.(The Disaster Management Act, 2005)

• In India, overall co-ordination of disaster is by Ministry of Home Affairs.

• National Disaster Management Authority is the lead agency
• The Disaster Management Act, 2005 is related legislation
• District Commissioner is the incharge of disaster related activities in her
district
• 2nd Wednesday of October is observed as World Disaster Reduction Day

Personal Protection in different types of disasters

Instead of remembering every disaster separately, we will understand common
points. As given in Park, we will divide our answer in three parts ie Actions BEFORE,
DURING AND AFTER disaster impact.

Before

At Community level

• Active participation of community in Education, training and simulation

programmes

• Coordinations between various voluntary organisations to avoid duplication of

 efforts

• Establishment of Early warning system at local levels, eg announcements from

local gurudwara

At Individuals level
• Keep family emergency kit ready. The kit should have torches, water, essential
medicines, dressings, portable radio with batteries etc, matchbox, candles.

• Construction of houses as per local buildings standards.

During sd Disaster

• Turn off electricity

• In floods go up; in cyclones go in§(z; in earthquake go out.

• Listen to messages from local authorities. Radio is most reliable.

• Avoid using telephone unless life saving to avoid congestion of telephone lines.

• Keep calm, do not panic.

After the impact

• Follow instructions from local authorities.

• Earthquakes have after-shocks, so avoid buildings even after the first episode of
earthquake.

• In floods, every things that have come in contact of flood water are potentially
contaminated. Do not use them as eatables.

Manmade disaster

Definition. Disasters which have large element of human factor in causation. These
can be accidental eg Bhopal gas tragedy OR intentional as 9/11 Twin Tower

Types

• Sudden. Bhopal Gas Tragedy. Remember 03-12-1984. Methyl isocyanate. 3,000

deaths, 2 million exposed.

• Insidious. Eg Green house effect

• Wars and Civil Conflicts, terrorism

• Note. If question is on manmade disaster, please discuss under same headings

eg disaster cycle with similar steps