Disaster Management.docx

What is a disaster??? Disaster is a sudden, calamitous event bringing great damage, loss, destruction and devastation to life and property. -Oxford Dictionary. The damage caused by disaster is immeasurable and varies with the geographical location, climate and the type of the earth surface. This influences the mental, socio-economic, political and cultural state of the affected area.

Need:   

Asia-pacific region: 60% of major natural disasters. India manifests many natural disasters like floods, cyclones, landslides, earthquakes etc. due to vast variation of geographical terrain and climatic conditions. INDIA: 2.4% of world’s land area. 7th largest country of the world with 15% of the world’s population.

Definition It may also be termed as “a serious disruption of the functioning of society, causing widespread human, material or environmental losses which exceed the ability of the affected society to cope using its own resources.”

Generally, disaster has the following effects 1. It completely disrupts the normal day to day life.

in

the

concerned

areas:

2. It negatively influences the emergency systems. 3. Normal needs and processes like food, shelter, health, etc. are affected and deteriorate depending on the intensity and severity of the disaster.

Types of Disaster

Disaster

Natural

Minor

Manmade

Major

Minor

Major

HAZARD A natural or human made event that threatens to adversely affect human life, property or activity to the extent of causing a disaster.

RISK Disaster Risk = Hazard +Vulnerability Risk is a measure of the expected losses due to a hazardous event of a particular magnitude occurring in a given area over a specific time period. •

Nature of the Hazard.

•

Vulnerability of the elements which are affected.

•

Economic value of those elements.

VULNERABILITY It is defined as “the extent to which a community, structure, service, and/or geographic area is likely to be damaged or disrupted by the impact of particular hazard, depending on their nature, construction and proximity to a disaster prone area”.

EFFECTS: 

Physical:

Infrastructure damage.



Economic:

Power disruption, Water problems, Agricultural damage.



Social:

Telecommunication loss, poverty.



Emotional:

Mortality.



Health:

Injuries, morbidity, epidemic.



Environmental:

Damage to inland and coastal environments, Flooding, Landslides



Cultural:

Disruption of standard of living,

lifestyle.

The loss during the actual event is not necessarily be high, but, the losses become very high due to inability to manage the situation in a timely manner and inability to properly manage and secure the utilities, like: electricity, gas, water etc.

The Disaster Management Cycle

MITIGATION Mitigation= prevention + preparedness. Mitigation refers to all the actions taken before a disaster to reduce its impacts on nation or community. Four sets of tools that could be used to prevent or mitigate disasters: a)

Hazard management and vulnerability reduction

b)

Economic diversification

c)

Political intervention and commitment

d)

Public awareness

PREPAREDNESS Measures which enable government, organizations, communities and individuals to respond rapidly and effectively to disaster situation Includes:

•

Emergency exercises/training

•

Warning systems

•

Emergency communications systems

•

Evacuations plans and training

•

Emergency personnel/contact lists

•

Mutual aid agreements

•

Public information/education

Disaster drills/ Mock tests •

Well planned, organized and coordinated.

•

Can be scheduled periodic or unannounced.

Disaster prevention, mitigation and preparedness The first important steps towards reducing disaster impact are to correctly analyze the potential risk and identify measures that can prevent, mitigate or prepare for emergencies. Information and Communication Technology can play a significant role in highlighting risk areas, vulnerabilities and potentially affected populations by producing geographically referenced analysis through, for example, a geographic information system (GIS). Channels Used for Disaster Warning:

Disaster Warning Disaster Reduction identifies several key parties that play major roles in the disaster management process, especially in disaster warning. National governments Are responsible for policies and frameworks that facilitate early warning, in addition to the technical systems necessary for the preparation and issuance of timely and effective hazard warnings for their respective countries. Role of govt:  Ministry of disaster mx  Levels

International bodies 

Should provide support for national early warning activities and foster the exchange of data and knowledge between individual countries.



Support may include the provision of advisory information, technical assistance, and policy and organizational support necessary to ensure the development and operational capabilities of national authorities or agencies responsible for early warning practice.



Non-governmental organizations (NGOs)



Play a critical role in raising awareness among individuals and organizations involved in early warning and in the implementation of early warning systems, particularly at the community level.



In addition, they play an important advocacy role to help ensure that early warning stays on the agenda of government policy makers.

The private sector 

Has a diverse role to play in early warning, including developing early warning capabilities in their own organizations.



The private sector is also essential as they are usually better equipped to implement Information and Communication Technology-based solutions.



The private sector has a large untapped potential to help provide skilled services in the form of technical manpower, know-how, or donations of goods or services (in-kind and cash), especially for the communication, dissemination and response elements of early warning.

The media Plays an important role in improving the disaster consciousness of the general population and in disseminating early warnings. The media can be the critical link between the agency providing the warning and the general public.

The scientific community 

Has a critical role in providing specialized scientific and technical input to assist governments and communities in developing early warning systems.



Their expertise is critical to analysing the risks communities face from natural hazards, supporting the design of scientific and systematic monitoring and warning services, fostering data exchange, translating scientific or technical information into comprehensible messages, and disseminating understandable warnings to those at risk.

GIS and Remote Sensing in Disaster Management GIS can be loosely defined as a system of hardware and software used for storage, retrieval, mapping and analysis of geographic data.

TRIAGE



It is the process of determining the priority of patient’s treatments based on the severity of their condition.



Useful for rapid evaluation, allotment of priority for treatment and/or evacuation of patients.



Also used in emergency departments.

Triage scales: 

Different scales in peace and war situations.



Consider factors such as extent of injury, time and distance to designated trauma centres.



Protocols should be sensitive and specific.



1989 scale developed by Fitzgerald known as ‘Ipswich scale’

5 LEVELS OF TRIAGE

1. Life threatening condition 2.Emergency condition

3. Urgency condition 4. Less urgency condition 5. Non urgency condition

CODE

Rx. REQUIRE

TRIAGE SCALE

SYMPTOMS

1

immediately

Resuscitation

Unconscious, convulsing, extreme dyspnoea, CR arrest/ shock

(critically ill) 2

Within 10 min

Emergency (at risk)

3

Within 30 min

Urgent (significant illness/injury)

4

Within 1hr.

Semi urgent (sub-acute)

5

Within 2 hrs.

Severe pain due to any cause- MI, pul. embolism, abdominal pain, dyspnoea, altered consciousness, trauma, sepsis Moderate pain due to any cause-renal colic, infection, head injury with transient loss of consciousness

Mod./ chronic symptoms- corneal foreign body, migraine headache

Non urgent

Symptoms of > 1wk. Duration

(chronic illness)

URTI, LBP

Principles:

  

Every pt. should be received and triaged by appropriate, skilled health care professionals. Triage process shouldn’t cause a delay in the delivery of effective clinical care. Triage is a clinical managerial decision and must involve COLLABORATIVE planning.

Objectives: 

Ensure immediate medical intervention in life threatening situations.



Expedite the care of patients through a systemic initial assessment.



Ensure that patients are prioritized for treatment in accordance with the severity of their condition.



Decrease the morbidity associated with medical conditions through early intervention.



Assist patients requiring treatment in another department and health care institutions.



Improve public relations by COMMUNICATING appropriate information to people accompanying the pt.



Improve patient flow.



Assist in performance measurement.

COMPONENTS: 

Personnel:Responsible, knowledgeable, critical thinking, relevant history, phy. Assessment skills. Eg. Drs., physio, nurses.



Space requirement: Large enough to hold supplies, equipments and pts.Easily accessible.



Equipment and supplies: Tailored Protocols. Diagnostic assessment tools



Communication and information:

made

for

specific

triage

Rx.

•

Direct link between incoming ambulances and other emergency vehicles.

•

Closed circuit TV monitoring.

•

Computerized information storage.

•

Important phone nos.

Documentation: Pt’s complaints, history, objective assessment, vital

findings.

Acuity rating: life threatening, urgent, semi- urgent, referral

SPECIAL CONSIDERATIONS Children are up triaged routinely. IN NUCLEAR EXPLOSIONS: •

The most seriously injured with multiple injuries and irradiation > 400 rads should get last priority.

•

1st priority is given to those who have a reasonable chance of survival.

RESPONSE    

Disaster response is the sum total of actions taken by people and institutions in the face of disaster. The focus in the response phase is on meeting the basic needs of the people until more permanent and sustainable solutions can be found. One of the main goals of disaster management is the promotion of sustainable livelihoods and their protection. Where this goal is achieved, people have a greater capacity to deal with disasters and their recovery is more rapid and long lasting.

Aims of disaster response 

To ensure the survival of the maximum possible number of victims, keeping them in the best possible health in the circumstances.



To re-establish self-sufficiency and essential services as quickly as possible for all population groups.



To repair or replace damaged infrastructure and regenerate viable economic activities.



In situations of civil or international conflict, the aim is to protect and assist the civilian population, in close collaboration with the International Committee of the Red Cross (ICRC) and in compliance with international conventions.

Disaster Response Activities Warning: Evacuate or secure property Evacuation and migration Search and rescue

Post-disaster assessment: relief needs Relief: material aid and emergency medical care Logistics and supply communication and information management Survivor response and coping: new and special needs Security: rights and safety Emergency operations management:

Policies and procedures Rehabilitation: resume functioning, assist victim’s self-help efforts. Reconstruction: Permanent construction, services Revitalization of the economy.

Recovery

Returning the community to normal

As the emergency is brought under control growing number of activities aimed at restoring their lives and the infrastructure that supports them

Short-term recovery  Restore interrupted utility services, clear roads, temporary housing, public information, health and safety education, provide food and shelter for those displaced by the disaster.  (few weeks)

Long-term recovery  Complete re-development of damaged areas for the community to return to a state that is equal to or even better than it was before.  (months- years)

Steps of recovery 

Gathering basic information



Organizing recovery



Mobilizing resources for recovery



Administering recovery



Regulating recovery



Coordinating recovery activities



Evaluating recovery

Lifesaving tools AND techniques VICTIM EVACUATION METHODS: 

Required to evacuate injured person from an emergency scene to a location of safety.



Manual carries are tiring for the rescuer and involve the risk of increasing the severity of the casualty's injury.



Choose the evacuation techniques that will be least harmful, both to rescuer and the victim.



Crawl underneath a low structure.



Victim heavier than you, unconscious.



Head is not supported.



Longer distances to lift a victim safely.

One Person Arm Carry

One Person Pack-Strap Carry

Fire Man Carry

Two Person Carry ( by arms & legs) •

Longer distances.

Chair Carry Carrying victims up and down stairs or through narrow or uneven areas.

Ankle Pull Fastest method for moving a victim a short distance over a smooth surface.

Shoulder Pull Preferred over the ankle pull. Requires the rescuer to bend over at the waist while pulling.

Blanket Drag Preferred method for dragging a victim from confined area. Keep your back as straight as possible. Use your legs, not your back.

Two Handed Seat

Four Handed Seat

Three Person Carry This technique is for lifting a patient into a bed or stretcher, or for transporting to short distances.

Improvised Stretcher Blanket Stretcher

CARDIO PULMONARY RESUSCITATION (Basic life support)  Aims to restore  Airway,  Ventilation  Circulation of the victims in cases of airway obstruction, cardiac arrest, with or without using equipments.

IMPORTANT STEPS IN BLS (2010)  Initial assessment to determine unresponsiveness. 

Activation of EMS



C: Circulation With Ext. Chest Compression



A: Opening And Maintaining An Airway



B: Providing Ventilation Through Rescue Breathing



D: Defibrillation with A.E.D



Advance care STEPS IN C.P.R



Determine unresponsiveness



Call for emergency dial



Use supine position/ log roll

C: Restoring Circulation  Assess pulselessness palpating major artery.  Determine pulse lessness-Palpating major artery

like carotid artery. In infant brachial artery

PULSE ABSENTExt. chest compression. Serial, rhythmic pressure application over the lower half of the sternum. (100 bpm, 1.5 to2 inch)

A: Restore Airway Head tilt chin lift technique Jaw thrust manoeuvre

Foreign body removal

ABDOMINAL THRUSTS: Heimlich manoeuvre: Forceful thrust applied to an epigastrium to dislodge an obstruction. With fist deliver quick upward and inward thrust.

B: Breathing 

Look for chest movements.



Listen for air escaping during exhalation.



Feel for the flow.



Restore ventilation by Providing artificial ventilation:



Determine breathlessness



Providing artificial ventilation



Mouth to mouth ventilation



Mouth to nose ventilation



Mouth to stoma ventilation



Mouth to mouth ventilation Mouth to mouth applied to child with nose seal



Cricoid pressure/ Sellick technique

 Providing chest compression: Must be delivered to all Pulseless patients.  Place victim on firm surface.  Expose the chest.  Identify the lower half of the sternum. Place two fingers on the junction and the heel of the other hand next to two fingers. Then place other hand on top of the hand on the sternum and lock your elbows.

Identifying sternum:

Chest compression: 

Perform compression with weight of the body exerting force on the outstretched arms, elbows straight.



Compression sternum 1- 2 inches. Apply the compressions regularly rhythmically and without bouncing or rolling the patient at a rate of 80-100/min

 D: Defibrillation (AED) Universal steps of AED operation. 

Step 1: Power ON 



Step 2: Attach electrode pads; one pad over upper Right sternal border and other lateral to Left nipple. Step 3: Clear the victim & press SHOCK button.

REFERENCES:  

Apurv Shimpi ; Disaster management: Physiotherapy treatment aspects for improvement in functioning & lifestyle in the community. Sunday, 8 March 2015. Rosalind M. Harrison, BSc (Hons) Physiotherapy; Coventry University, Coventry, United Kingdom; Preliminary Investigation into the Role of Physiotherapists in Disaster Response; 11 October 2007.