Disaster Preparedness Dr Jorge Concepcion

DISASTER PREPAREDNESS Jorge M. Concepcion, MD General Surgery & Trauma

OBJECTIVES At the end of this session, the participant is expected to be able to: – Understand principles of disaster preparedness and management – Learn the Philippine Disaster Management system – Principles of “triage”

…are natural or man-made events wherein communities experience severe danger and incur loss of lives and properties causing disruption in its social structure and prevention of the fulfillment of all or some of the affected community’s essential

Disaster: 'Any occurrence that causes damage, economic disruption, loss of human life and deterioration in health and health services on a scale sufficient to warrant an extraordinary response from outside the affected area or community.‘

(WHO)

Disaster The most important aspects to remember about a disaster are: Disasters interrupt the normal functioning of a community Disasters exceed the coping mechanisms (capacity) of the community External assistance is needed to return to normal functioning of a community

Hazard A source of danger; an extreme event; possibility of incurring loss or misfortune

Natural Hazards • Earthquakes • Floods, sea surges, tsunamis (seismic sea waves) • Volcanic eruptions

• Hurricanes/typhoons, thunderstorms • Droughts • Epidemics • Fires, wildfires

Man-made Disasters • Hazardous chemicals incidents • Conventional warfare • Building collapse • Civil disturbance • Nuclear, biological or chemical incidents • Explosion • Aircraft crash Fill in the Blank

Community

Hazard + Community

= DISASTER

Multiple Casualty Incident (MCI) Any event resulting in a number of victims large enough to disrupt the normal course of emergency health care services. – Establishing a Mass Casualty Management System (PAHO-OPS, 1995, 58 p.)

Multiple Casualty Incident

“An epidemic of injuries”

But if a hospital is unable to handle day to day emergencies in the ED, it will not be able to cope with demands of multiple casualty incidents If Your Daily Emergency Management Is Bad  Don’t Expect To Be Able To Manage Disasters Properly Disaster Management Is An Escalation Of The Daily Emergency Response

The Philippine Archipelago occupies the western ring of the Pacific Ocean (Western Segment of the Pacific Ring of Fire), a most active part of the earth that is characterized by an ocean-encircling belt of active volcanoes and earthquake generators (faults).

Mt. Pinatubo The biggest volcanic eruption of the century June 1991 800 – dead P10.6B - damage

MCI RESPONSES: LEVEL I – LOCAL EMERGENCY RESPONSE PERSONNEL AND ORGANIZATION ARE ABLE TO CONTAIN THE DISASTER LEVEL II – REGIONAL EFFORTS AND MUTUAL AID FROM SURROUNDING COMMUNITIES LEVEL III – REQUIRING NATIONAL OR INTERNATIONAL ASSISTANCE

MANOR HOTEL FIRE TRAGEDY August 18, 2001 LUNG CENTER BLAZE May 17, 1998 THE OLD ORPHANAGE December 3, 1998 THE OZONE DISCO March 1996

Environmental/Technological Hazards

Payatas Dump Site Tragedy July 10, 2000 224 dead – 38 missing

Hydro-Met Hazards

Ormoc, Leyte, Nov 6, 1991 5,101 dead – 292 injured

Christmas 1987 M/V Dona Paz collided w/ oil tanker Vector. The world’s worst peacetime sea tragedy. 4,342 confirmed dead.

Valentine bombing

Rizal Day Bombings Dec 30, 2000 -10 AM 5 Bombing incidents in Metro Manila 22 dead 104 injured

February 15, 2005 Manila: Two more people have died from injuries suffered in a series of explosions in the Philippines claimed by a group linked to Al-Qaeda, police said today. The deaths bring to 12 the number of people killed in the Valentine's Day bombings in three Philippine cities, with 136 people listed as injured. The number killed when a bomb rigged to a tricycle exploded outside a mall in the southern city of General Santos yesterday, has risen to five from three. - Sapa-AFP

April 19, 2000 Air Philippines Flight 541 crashed in the mountains of Mindanao All 120 passengers and crew died

Tsunami

Tsunami response: Aceh, Indonesia

The Philippine Disaster Management System

LEGAL AUTHORITY

PD 1566 JUNE 11, 1978 Strengthening the Philippine Disaster Control Capability and Establishing the National Program on Community Disaster Preparedness

OFFICE OF CIVIL DEFENSE 

The operating arm and secretariat of the National Disaster Coordinating Council.

PD 1566, Sec. 1 Declaration of Principles RESPONSIBILITY FOR LEADERSHIP RESTS ON THE PROVINCIAL GOVERNOR, CITY MAYORS, AND MUNICIPAL MAYORS, (AND BARANGAY CHAIRMAN), EACH ACCORDING TO HIS AREA OF RESPONSIBILITY.

PD 1566, Sec. 1 Declaration of Principles IT IS THE RESPONSIBILITY OF ALL GOVERNMENT DEPARTMENTS, BUREAUS, AGENCIES AND INSTRUMENTALITIES TO HAVE DOCUMENTED PLANS OF THEIR EMERGENCY FUNCTIONS AND ACTIVITIES.

THE NDCC MEMBERS Secretary, Nat’l Defense - Chairman Secretary, Int.& Local Govt- Member Secretary, Public Works- Member Secretary, Health - Member Secretary, Social Welfare- Member Secretary, Agriculture- Member Secretary, Education- Member Secretary, Finance- Member Secretary, Labor & Employment-Member Secretary, Trade & Industry- Member Secretary, Trans. & Comm. - Member Secretary, Science & Tech. - Member Secretary, Budget- Member Secretary, Justice- Member Secretary, Natural Resources- Member Director, Phil. Info. Agency- Member Sec-Gen - Phil Nat’l Red Cross- Member Chief of Staff, AFP- Member Administrator, Office of Civil Defense Member and Executive Officer

ALL DCC LEVELS PRESIDENT DAMAGE & NEEDS ASSESSMENT

DECISION

SEARCH & RESCUE

SND EMPLOYMENT

OCD

GEOPHYSICAL

HYDROMETEOROLOGICAL TERRORISM

ASSESSMENT

EMERGENCY MEDICAL SERVICE

CONTROL

EVACUATION & RELIEF

PHIVOLCS

VOLUNTEER GROUPS & AUXILLIARIES

PAGASA AFP

EPIDEMICS

DOH

CIVIL DISTURBANCE

PNP

INFESTATION

DA

FIRE SUPPRESSION

SURVEILLANCE

FEEDBACK/ PLANS

NDCC EMERGENCY MANAGEMENT FRAMEWORK vulnerability

reduce risk, vulnerability & hazard

risk assessments, plans, arrangements, training & exercises

reduced

hazard/risk analysis

mostly back to normal

Prevention Preparedness disaster / emergency

Rehabilitation Response “healing”, repair, reconstruction & recovery

situation stabilized

no longer direct threat to life/safety and property

San Francisco, S. Leyte, Dec.15-23, 2003 207 dead – 54 injured – 1 missing P508.4M - cost of damage

• 22 Typhoons every year • 5 will be destructive

As of January 06, 2005 PROFILE

TY “UNDING”

TS “VIOLETA”

TD “WINNIE”

TY “YOYONG”

TOTAL EFFECTS

Affected Regions

3

2

5

8

Province

13

4

8

35

Mun/Cities

68

16

56

342

1,180

83

645

3,196

Families

144,553

21,151

170,036

383,575

719,315

Persons

759,045

99,461

845,429

1,939,835

3,643,770

71

31

893

73

1,068

160

187

648

168

1,163

69

17

443

24

553

Totally

36,011

369

8,889

11,322

56,591

Partially

91,803

900

12,578

61,972

160,285

No. of Brgys

Casualties Dead

Injured Missing

Damaged Houses

Estimated Cost of Damages (In Million Pesos) School Facilities

461.846

Buildings

412.065

Desk/Armchairs

5.808

Textbooks

28.334

Other Equip’t.

15.639

Transmission Facilities

NO BREAKDOWN

34.300

Health Facilities

NO BREAKDOWN

72.900

What roles do the hospitals play during disaster?

        



  

Hospital Roles in a Disaster • Provision of Disaster Medical Teams • Acting as the receiving hospital for casualties from a disaster • Triage in multiple/mass casualty incidents • Receiving hospital for patients transferred from other disaster affected health-care facilities

Disaster Management HEICS (Hospital Emergency Incident Command System)  USA MIMMS (Major Incident Medical Management Support)  UK & Europe HOPE (Hospital Preparedness For Emergencies & Disasters)  Asia & Developing Countries Specific

HOPE (Hospital Preparedness For Emergencies & Disasters) Asia & Developing Countries Specific

ACTIVE FAULTS AND TRENCHES

Geologic Hazards

• 5 quakes/day • 1,825 quakes/year

July 16, 1990; Intensity 8 1,666 dead – 3,500 injured P11B cost of damage in property P1.2B in

Components EMS System • Triage • On-site care • Initial resuscitation and treatment • Medical transport • Definitive care or Trauma Center

EMERGENCY DEPARTMENT

Triage • Assess victims’ vital signs and condition • Assess their likely medical needs • Assess their probability of survival • Assess medical care available • Prioritize the definitive management • Color tag

TRIAGE • Triage categories are: a)Immediate – RED b)Delayed – YELLOW c)Walking wounded – GREEN d)Dead and dying – BLACK

START Triage Simple Triage And Rapid Treatment Observe: Respiration Circulation Mental Status

Categories 1.

2.

3. 4.

Deceased (BLACK)

No ventilations present after clearing airway Immediate (RED) RR >30/min delayed capillary refill(>2 secs) unable to follow simple commands Delayed (YELLOW) Minor (GREEN) “Walking wounded”

Secondary Assessment of Victim Endpoint • System of triage that strives to provide care to those in the field – who are most likely to benefit when faced with extremely limited emergency medical support systems

• SAVE is used along with the START system – help triage and stratify treatment of multiple victims especially when access to definitive hospital-based care is delayed or unavailable

SAVE • The triage categories in SAVE are divided into three categories: – Victims who will die regardless of the amount of care they receive – Victims who will survive regardless of any treatment measures – Victims who will benefit tremendously from limited field interventions

BLACK

GREEN

Triage

Evacuation

Area RED

YELLOW

TRIAGE component in emergency management flow

HOSPITAL RECEPTION A&ED Red Area

Triage

Command Post RED

Operating Theatre

YELLOW

Yellow Area

GREEN

Green Area

Victims Flow

Aim of Triage

To achieve the greatest good for the greatest number of casualties “NOT FIRST COME, FIRST SERVE BASIS”

DISASTER CONTROL?

DISASTER PREPAREDNESS DISASTER MANAGEMENT!

The Key is Preparedness