Disaster Management

INTRODUCTION
• Disaster is a sudden, calamitous event bringing
great damage, loss and destruction and devastation
to life and property.
• The damage caused by disasters is immeasurable
and varies with the geographical location, climate
and the type of the earth surface / degree of
vulnerability.
• This influences the mental, socio-economic, political
and cultural state of the affected area.
 DISASTER
• DISASTER
• D – Destruction
• I - Incidents
• S - Sufferings
• A – Administrative, Financial failures
• S - Sentiments
• T - Tragedies
• E – Eruption of Communicable diseases
• R – Research program and its implementation
What it involves ??
Dealing with and avoiding bothnatural and
man made disasters.
Preparedness before disaster.
Rebuilding and supporting society after natural
disasters.
BACKGROUND
Enormous population pressures and
urbanization

A flood, a drought or an earthquake millions of

peoples are affected each time a disaster occurs

Large-scale displacement and the loss of life, loss of

property and agricultural crops
 BACKGROUND
➢ The reasons for this are varied including:
an increasing population pressures in urban
areas
an increase in the extent of encroachment into lands,
e.g., river beds or drainage courses, low lying areas
etc.

poor or ignored zoning laws and policies

lack of proper risk management (insurance)

➢ Predictability
➢ Controllability
➢ Speed of onset
➢ Length of
forewarning
➢ Duration of impact
➢ Scope and intensity
of impact
Disaster management is the responsibility of all spheres
of government

Disaster management should use resources that exist for

a day-to-day purpose.

Organizations should function as an extension of

their core business

Individuals are responsible for their own safety.

Disaster management planning should focus on

large-scale events.
DM planning should recognize the difference
between incidents and disasters.
DM planning must take account of the type of physical
environment and the structure of the population.

DM arrangements must recognise the involvement and

potential role of non- government agencies.
Level of disaster
Level I – if the organization, agency, or
community is able to contain the event and
respond effectively utilizing its own resources.
Level II – if the disaster requires assistance from
external sources, but these can be obtained
from nearby agencies.
Level III – if the disaster is of a magnitude that
exceeds the capacity of the local community or
origin and requires assistance from state level
or even federal assets.
 Disaster management cycle
(Phases of Disaster Management)
1.Mitigation
• mitigation includes measures to prevent disaster
damaging effects of unavoidable disasters. Effective
mitigation includes recognizing and preventing
potential technological disaster and being adequately
prepared should such events occurs.
• To plan effectively for disaster prevention the need to
have community assessment information including
knowledge of community resources (eg, emergency
services, hospital and clinics), community health
personnel (eg, nurses, doctors, pharmacists,
emergency medical teams, dentist and volunteers),
community government officials and local industry.
 Mitigation reduces the impact of disasters by
supporting protection and prevention
activities, easing response, and speeding
recovery to create better prepared and more
resilient communities

There are two types of mitigation:

(1) Structural mitigation
(2) NON-Structural mitigation
Structural mitigation – constructionprojects which reduce
economic and social impacts

i.e. dams, windbreaks, terracing and hazard

resistant buildings.
Non-structural activities – policies and
practices which raise awareness of hazards
or encourage developments to reduce the
impact of disasters
i.e:Public awareness
 different types of insurance

 family plans for some emergency situation

Reviewing building codes.
Vulnerability analysis updates.
Zoning and land-use management and
planning.
Reviewing of building use regulations and
safety codes.
Implementing preventative health measures
Political intervention and commitment
Public awareness .
 Hazard identification and vulnerability
analysis.
Various mitigation strategies or measures-
For instance, varieties of crops that are more
wind, flood or drought resistant can often be
introduced in areas prone to floods, drought
and cyclones, Economic diversification.
2. Disaster Preparedness
• The goal of preparation is to decrease emergency
response time and ensure that necessary equipment
is available and on-site after a disaster. Issues to
consider include – weather patterns, geographic
location, expectations related to public events and
gatherings, age, condition, and location of facility,
and industries in close proximity to the hospital (eg.
nuclear power plant or chemical factory).
• Preparedness include – personal preparedness
and professional prepardness.
the objectives of the disaster preparedness is to ensure that
appropriate systems, procedures and resources are in place to
provide prompt, effective assistance to disaster victims, thus
facilitating relief measures and rehabilitation services. In this
following activities are carried out –
• Evaluate the risk of the country or particular region to
disasters.
• Adopt standards and regulations.
• Organize communication, information and warning systems.
• Ensure coordination and response mechanisms.
• Adopt measures to ensure that financial and other resources
are available for increased readiness and can be mobilized in
disaster situations.
• Develop public education programs
• Coordinate information sessions with news media
• Organize disaster simulation exercises that test response
mechanisms.
 Planning, training, & educational activities
for things that cant be mitigated.

During the preparedness phase of the DM

cycle measures are taken to reduce the
minimum level possible, of loss in human life
and other damage, through the organization
of prompt and efficient actions of response
and rehabilitation such as practicing
earthquake and fire drills.
 They also involve planning, organizing, training,
interaction with other organizations and related
agencies, resource inventory, allocation and
placement, and plan testing.
Preparedness measures include:
I. Preparedness plans
II. Emergency training
III. Warning systems
IV. Emergency communications systems
V. Public information/education
 3.Response
• the response phase is the actual implementation of
the disaster plan. The best response plans use an
incident command system, are relatively simple, are
routinely practiced, and are modified when
improvements are needed. Response activities need
to be continually monitored and adjusted to the
changing situation.
• Types of information included in initial
assessment reports includes the
• followings –
• Geographical at risk or affected
• Presence of continuing hazards
• Injuries and deaths
• Availability of shelter
• Current level of sanitation
• Status of health care infrastructure
• Acute and chronic illness can be exacerbated by
the prolonged effects of disaster. The psychological
stress of clean up and moving can bring about
feeling of severe hopelessness, depression and
grief. Recovery can be impeded by short term
psychological effects eventually merging with the
long term results of living in adverse
circumstances.
• CHN must also remain alert for environmental
health hazards. Home visit may lead the nurse to
uncover situations such as faulty housing structure,
lack of water supply or lack of electricity.
The immediate aftermath of a disaster, when
business is not as usual.
The response phase includes the mobilization
of the necessary emergency services and first
responders in the disaster area
This is likely to include a first wave of core
emergency services, such as fire-fighters,
police and ambulance crews.
Healthcare intervention response starts
here
The focus in the response phase is
on meeting the basic needs of the victims
until sustainable community has been
achieved.
It also may involve initial repairs to
damaged infrastructure.
Response activities are post activities geared
towards:
Providing emergency assistance
Speeding recovery operations
Returning systems to normal level
Reducing probability of additional injuries or
damage
DISASTER TRIAGE
• The word triage is derived from the French word trier,
which means, “to sort out or choose”. The Baron
Dominique Jean Larrey, chief surgeon of Napoleon, is
credited with organizing the first triage system.

• Triage is the process of determining the priority of

patient’s treatments based on the severity of their
condition.

• Triage is the process of sorting people based on their

need for immediate medical treatment as compared to
their chance of benefiting from such care.
 Definition
• Triage is a process which places the right patient
in the right place at the right time to receive the
right level of care.
- (Rice & Abel)

• Triage is the process of prioritizing which patients

are to be treated first and is the cornerstone of
good disaster management in terms of judicious
use of resources.
- (Aduf der Heide)
Aims
• To sort patients based on needs for immediate
care
• To recognize futility
• Medical needs will outstrip the immediately
available resources.
• Additional resources will become available
given enough time.
Purpose
• Inadequate resources to meet immediate
needs
• Infrastructure limitations
• Inadequate hazard preparation
• Limited transport capabilities
• Multiple agencies responding
• Hospital resources Overwhelmed
Advantages
• Helps to bring order and organization to a
chaotic scene.
• It identifies and provides care to those who
are in greatest need.
• Helps make the difficult decision easier
• Assure that resources are used in the most
effective manner
• May take some emotional burden away from
those doing triage.
 Principles
• Every patient should receive and triaged by
appropriate skilled health care professionals.
Triage is a clinic managerial decision and must
involve collaborative planning.
• Triage process should not cause a delay in the
delivery of effective clinical care.
Types
• There are mainly two types it include
following:

i) Simple triage
ii) Advanced triage
 1. Simple triage
• simple triage is used in a scene of mass casualty, in order to
sort patients into those who need critical attention and
immediate transport to the hospital and those with less
serious injuries. This step can be started before transportation
becomes available. The categorization of patients based on
the severity of their injuries can be aided with the use of
printed triage tags or colored flagging.
• S.T.A.R.T (Simple Triage and Rapid Treatment) is a simple
triage system that can be performed by lightly trained lay and
emergency personnel in emergencies. Triage separates the
injured into 4 groups –
• 0 – The decreased who are beyond help
• 1 – The injured who can be helped by immediate
transportation
• 2 – The injured whose transport can be delayed
• 3 – Those with minor injuries, who needs help less
2. Advanced triage
• in advanced triage, Doctors may decides that
some seriously injured people should not receive
advanced care because they are unlikely to
survive. Advance care will be used on patients
with less severe injuries. It is used to divert scarce
resources away from patients with little chance of
survival in order to increase the chances of
survival of others who are more likely to survive.
• Principles of advanced triage are –
• Do not greatest good for the greatest number.
• Preservation of life takes precedence over
preservation of limbs
• Immediate threats to life : HEMORRHAGE
CLASS –I (EMERGENT) RED IMMEDIATE
Victims with serious injuries that are life threatening but has a high probability of survival if they
received immediate care. They require immediate surgery or other life-saving intervention, and
have first priority for surgical teams or transport to advanced facilities. They can not wait, but are
likely to survive with immediate treatment. (critical, life threatening – compromised airway,
shock, hemorrhage)
CLASS – II (URGENT) YELLOW DELAYED
Victims who are seriously injured and whose life is not immediately threatened, and can delay
transport and treatment for 2 hours. Their condition is stable for the moment but requires watching
by trained persons and frequent re-triage, will need hospital care (and would receive immediate
priority care under “normal” circumstances) (major illness or injury – open fracture, chest wound)

CLASS – III (NON-URGENT) GREEN MINIMAL

“walking wounded,” the casualty requires medical attention when all higher priority patients have
been evacuated, and may not require monitoring. Victims whose care and transport may be
delayed 2 hours or more. (minor injuries, walking wounded – closed fracture, sprain, strain)

CLASS IV (EXPECTANT) BLACK EXPECTANT

They are so severely injured that they will die of their injuries, possibly in hours or days (large-
body burns, severe trauma, lethal radiation dose), or in life threatening medical crisis that are
unlikely to survive given the care available (cardiac arrest, septic shock, severe head and chest
wounds). They should be taken to a holding area and given painkillers as required to reduce
suffering. (dead oe expected to die – massive head injury, extensive full-thickness burns)
 EQUIPMENT IN DISASTER MANAGEMENT
1. First aid kit –
• Sterile adhesive bandages in assorted sizes
• Assorted sizes of safety pins
• Cleansing agent / soap
• Gloves (2 pairs)
• 2 inch sterile gauze pad (4-6)
• 4 inch sterile gauze pad (4-6)
• Triangular bandages (3)
• 2 inch roller bandages (3 rolls)
• Scissors
• Syringes
• Antiseptic
• Thermometer
• Tube of petroleum jelly or other lubricants
• Non prescription drugs – aspirin or non aspirin pain reliever,
anti diarrhea, antacid, laxatives
2. Equipments
• Oxygen cylinder with mask
• Spanner for opening
• Strectures, wheelchairs and trolleys
• Splints
• I.V fluids with I.V set, blood transfusion sets for
blood collection
• Dressing and suture materials
• Instruments for dressing, gloves, face masks, color
tags and ambulance must kkep ready
• Medications – antibiotics such as ciprofloxacin,
doxycyclines, bronchodilators, fluroquinolones
3. Ambulance equipments –
• Airway management
• Ventilation device
• Suctioning unit
• Oxygen delivery
• Basic wound care supplies, splinting supplies
• Emergency medications
• Patient transfer equipment
• Personal safety equipment
• Safety boots and gloves
• Safety ear plugs
• Safety eye wear
• Safety helmets
4. Other equipment –
• Air lifting bag
• Lighting tower
• Fire extinguisher
• Fire alarm system
• Fire entry suit
• Hydraulic cutter
• Life jacket
• Industrial heat protective garments
• Metal detectors
• Bomb detection equipments
• Bomb disposal equipments
5. Color Coding –
• Black tag – indicate victims who are already dead
• Red tag – indicate top priority who have life
threatening injuries but who can stabilized and have
high probability of survival. Priority is given to injured
rescue workers, hysterical persons and children.
• Yellow tag – indicate second priority and assigned to
victims with injuries with systematic complications who
are able to withstand a wait of 45 – 60 minutes, for
medical attention, also for victims who have poor
chance of survival.
• Green tag – indicate victims with local injuries without
immediate systematic complications who can wait
several hours for treatment
 4. Recovery
• once the incident is over, the organization
and staff needs to recover. Recovery is
usually easier if, during the response,
some of the staff have been assigned to
maintain essential services while others
were assigned to the disaster response.
• Recovery begins when the disaster is
finished and serves the community,
establishing long-term medical care for
those in need after a disaster, rebuilding
and working to reduce the chance of
future similar disasters from occurring.
The long-term aftermath of a disaster, when
restoration efforts are in addition to regular
services.
The aim of the recovery phase is to restore
the affected area to its previous state.
e.g. lifelines, health and communication
facilities, as well as utility systems
the beginning of the repair of physical, social
and economic damage
continued health monitor and care,
reconstruction of vital facilities
counseling programs
grants, and it may include economic impact
studies.