DISASTER MANAGEMENT

30 July 2012 - One of the coaches of the Chennai-bound Tamil Nadu Express (New Delhi - Chennai) caught fire early on 30 July morning, near Nellore in Andhra Pradesh.

47 people have died and 25 others have been injured

OBJECTIVE

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DISASTER

Any incident in which number, severity and types of injuries

Requires extraordinary responseFrom outside of that community or region

SOME RECENT DISASTERS….. Earthquake in Pakistan – 2005 Earthquake and tsunami in the Indian coast - 2004 Gujarat Earthquake - 2001 Floods in Mumbai, West Bengal Cyclone: Rita, Wilma etc….. Fire: Kumbakonam, Dabwali Terrorist attack: Chechnya

And the list goes on and on……………

Disasters occur in varied forms

Some are predictable in advanceSome are annual or seasonal Some are sudden and unpredictable

Floods Days and weeksEarthquakes Seconds/minutesCyclones DaysDroughts Months

WHY IS DISASTER MANAGEMENT IMPORTANT TO US?

57% of the land area is prone to Earthquakes57% of the land area is prone to Earthquakes 12% to Floods12% to Floods 8% to Cyclones8% to Cyclones 70% of the cultivable land is prone to drought70% of the cultivable land is prone to drought 85% of the land area is vulnerable to number of 85% of the land area is vulnerable to number of

natural hazardsnatural hazards 22 states are prone to multi hazards.22 states are prone to multi hazards.

WHY? And WHAT about Man made Disasters?WHY? And WHAT about Man made Disasters?

TYPES OF DISASTERS

Natural Disasters• Earthquakes• Cyclones• Floods• Tidal waves• Land-slides• Volcanic eruptions• Tornadoes• Fires• Hurricanes• Snow Storms• Heat Waves• Famines

Man-made Disasters• Toxicological accidents• Severe Air pollution• Epidemics• Building collapse• Nuclear accidents• Warfare

WHAT IS DISASTER MANAGEMENT• Disasters not only affect health &

well being of people but also large number of people are displaced, killed or injured or subjected to greater risk of epidemics.

• Economic loss• Not confined to particular part of

world.• Unpredictable

Seismic Disturbances uptoMagnitude 4.9

Zone II

Moderate Risk Quakes uptoMagnitude 6.9

Zone III

High Risk Quakes uptoMagnitude 7.9

Zone IV

Very High Risk Quakes of Magnitude 8 and greater

Zone V

MagnitudeZone

Source: IS 1893 (Part 1) : 2002 (BIS)

POTENTIAL HAZARDS OF DISASTER• Number of injuries & deaths differ depending

upon type of disaster, the density & distribution of population, condition of environment, degree of preparedness & opportunity of warning.

• Injuries exceeds death in explosions, earthquakes, typhoons, hurricanes, fires, tornadoes

• Death frequently exceeds injuries in landslides, avalanches, volcanic eruptions, tidal waves, floods etc.

• In earthquake there is high number of mortality(Even deadlier @ night).

POTENTIAL HAZARDS OF DISASTERCONTD….

• In volcanic eruptions mortality is high in case of mudslides( 23000 deaths in Columbia in 1985 ) & glowing clouds.(30000 deaths at Saint-pierre in Martinique)

• In floods high mortality only in sudden flooding…e.g. Flash floods, collapse of dams or tidal waves.

• Otherwise fractures, injuries & bruises may occur

• In cyclones & hurricanes mortality is not so much high.

POTENTIAL HAZARDS OF DISASTERCONTD….

• In draught mortality may increase where there is famines in which case there is protein-calorie malnutrition & vitamin deficiencies.

• Vit A def. leading to xerophthalmia & blindness• Also measles, respiratory infections,

diarrhea with dehydration leads to increase in infant mortality.

• When people migrate & settle down on outskirts of famine hit areas, there is spread of endemic communicable diseases.

Post disaster morbidity & mortality Injuries Epidemics Emotional disorders

Injuries- nature & severity varies in different types of disasters

Epidemics- Common belief associated with disaster is that

epidemics of communicable disease is inevitable. This happens only if insanitation conditions are

allowed to prevail.

Emotional Stress Disorders

Disaster syndrome- Shock stage- Victims are stunned, dazed and

apathy Suggestible stage- Individual are passive &

open to suggestions. Recovery stage- Individuals have accepted the

event and willing to start all over again.Methods to relieve stress are : Meditation Supportive psychological therapy Rest

DISASTER MANAGEMENT CYCLE

DISASTER IMPACT & RESPONSE

• Search, rescue & first-aid• Field care• Triage-

• Highest priority should be given to victims whose immediate or long term prognosis can be dramatically affected by simple intensive care

Flow of Patients one triaged. Please note how both walking wounded (green) and non-salvageable (black) stay out side the treatment area. Also note that as patient’s status can change, triage should be dynamic in an effort to asses changes categories.

3

Walking

Yes Injured

Survival reception center

Not Injured

Delayed priority-3 green

No

Breathing Yes

No

Dead-Black

Open airway Breathing Yes

Immediate priority-p1

Red

No

Breathing present

10 or less30 or more

Count RR

11 to 29 RRCount Pulse

< 120

>120

Priority- p2

Yellow

Immediate Priority- P1

Red

TAGGING•Complements Triage•Rapid Identification of patient•Color Coded / Bar Coded system•Plastic “bands” can substitute tags

IDENTIFICATION OF DEAD• Proper respect and care of the dead is

en essential part of disaster management

Care of the dead includes:1.Removal of dead from the disaster

scene2.Shifting to mortuary3. Identification4.Reception of bereaved relativesHazards associated with cadavers:

Relief Phase

Immediately following disaster the most critical health supplies are those needed for treating casualties, and preventing spread of communicable diseases.

Food, blankets, clothings, shelter, sanitary engineering equipment & construction material

Four principles in managing humanitarian supplies.a) Acquisition of suppliesb) Transportationc) Storaged) Distribution

EPIDEMIOLOGICAL SURVEILLANCE & DISEASE CONTROL1. Overcrowding & poor sanitation2. Population displacement3. Disruption & contamination of water supply,

damage to sewerage system & power systems4. Disruptions of routine control programmes5. Ecological changes6. Displacement of domestic & wild animals7. Provision of food, water & shelter from different or

new source may itself a source of infectious diseases

Vaccination The best protection is maintenance of high level of

routine immunization in general population before disaster occurs

Nutrition Infants, children, pregnant women, nursing

mothers & sick persons are more prone to nutritional problems.

REHABILITATION

Starts from the very first moment of the disaster.

Aim is to restore the pre-disaster conditions.

Water supplyFood safetyBasic sanitation & personal hygieneVector control

Emergency prevention & mitigation involves measures designed either to prevent hazards from

causing emergency or to lessen likely effect of emergencies.

flood mitigation works, appropriate land use planning, improved building codes reduction or protection of vulnerable population &

structure.

DISASTER MITIGATION

Aim of mitigation is to reduce the vulnerability of the system.

Medical casualties can be drastically reduced by improving the structural quality of house, schools & other public & private buildings.

long-term measures for reducing or eliminating risk.

DISASTER PREPAREDNESSDefinition:

“ A programme of long term development activities whose goals are to strengthen the overall capacity & capability of a country to manage efficiently all types of emergency. It should bring about an orderly transition from relief through recovery, and back to sustained development”

Objective: To ensure that appropriate systems,

procedures & resources are in place to provide prompt effective assistance to disaster victims, thus facilitating relief measures & rehabilitation of services.

Disaster preparedness is ongoing multisectoral activity.

1.Evaluate the risk (Hazard mapping!)2.Adopt standards & regulations3.Organize communication, information & warning system4.Ensure coordination and response mechanisms5.Ensure that financial & other resources are available & can be mobilized in disaster situation6.Develop public education programmes7.Coordinate information sessions with media8.Organize disaster simulation exercises (mock drill)

Community preparedness- Individuals are responsible for their well-being. Community members, resources, organizations

and administration should be cornerstone of an emergency preparedness programme.

The reasons for community preparedness are1. Members of the community have the most to lose

from being vulnerable to disaster.2. Those who first respond to an emergency3. Resources are most easily pooled at the

community level.4. Sustained development is best achieved by

allowing emergency affected communities to design, manage, and implement internal & external assistance programme.

NATIONAL ORGANIZATIONS IN INDIA

In India, the role of emergency management falls to National Disaster Management Authority of India, a government agency subordinate to the Ministry of Home Affairs.

In recent years there has been a shift in emphasis, from response and recovery to strategic risk management and reduction, and from a government-centred approach to decentralized community participation.

Survey of India, an agency within the Ministry of Science and Technology, is also playing a role in this field, through bringing the academic knowledge and research expertise of earth scientists to the emergency management process.

INTERNATIONAL ORGANIZATIONS

International Association of Emergency Managers

Red Cross/Red Crescent United Nations World Bank European Union International Recovery Platform

Recently the Government has formed the Emergency Management and Research Institute (EMRI).

Some of the groups' early efforts involve the provision of emergency management training for first responders (a first in India), the creation of a single emergency telephone number, and the establishment of standards for EMS staff, equipment and training.

TABLE 2 - Some major natural disasters and related outbreaks in India

Year Type Place Death Injuries Outbreak (if any)

2004 Tsunami

Andhra Pradesh, Kerala, Tamil Nadu, A&N Islands, Pondicherry,

10,749 (5,640 missing)

N.A.

focal outbreak of measles in coastal Tamilnadu.

increase incidence of malaria cases in known endemic areas of southern group of A&N islands.

2004 Flood Assam , Bihar, Gujarat

N.A. N.A. Sporadic incidence of diarrhoeal diseases

2001 Earthquake Bhuj, Gujarat

19,800 1.66 lakhs

Sporadic incidence of water borne diseases

1999 Super Cyclone

Orissa N.A. N.A. Leptospirosis

  Cyclone Andhra Pradesh

N.A. N.A.  

POST-DISASTER PUBLIC HEALTH INTERVENTIONS

Public health interventions to prevent disease outbreaks after disaster should essentially focus on:

a) Post disaster sanitation measures for: Safe water supply Food hygiene Proper sewage systems/disposal of excreta Vector/rodent control. Public health education.

In post-disaster phase, important epidemic-prone diseases can

be grouped as under:

Water-borne diseases (eg. acute diarrhoeal diseases including cholera, enteric fever, viral hepatitis A & E)

Vector-borne diseases (eg. malaria, dengue, acute encephalitis)

Vaccine-preventable diseases (eg. measles)

Others (eg. meningitis, leptospirosis,plague)

GUIDELINES FOR CONTROL OF EPIDEMIC-PRONE DISEASES IN DISASTER SETTINGS

a) Guidelines for prevention and control of water borne diseases

1. Setting up of control rooms Control rooms to be set up at district and state level Nodal officers should be identified at the state and district

levels for collecting data and analyzing relevant surveillance reports and ensuring appropriate follow up action.

For technical assistance and help in investigation of outbreaks, control room of National Institute of Communicable Diseases (NICD) and Directorate General of Health Services may be contacted.

2. Surveillance of Acute Diarrhoeal Diseases (ADD) Information on occurrence of ADD is to be collected from all the

health facilities including temporary/mobile health units.

3. Identify source of contamination of water and remedial measures

Identify source(s) of contamination of drinking water and ensure repairing of water pipes (if indicated), make it safe for use or make alternative arrangements for safe drinking water by supplying through 'Tankers'.

Check water for chlorination, and if possible for bacteriological contamination.

If surface water/hand pump water is found contaminated, it should not be used for drinking purposes.

Boiling will kill or inactivate V.cholerae and other common organisms that cause diarrhoea. Boiling is, however, expensive and may not be practical in areas having fuel shortages.

6. Safety of food Avoid raw and uncooked food. Cook food thoroughly and eat it while still hot. Cooked food should not be stored for a long time.

Keep the food covered and reheat it thoroughly before consuming.

7. Information Education & Communication (IEC)

Increase awareness in the community about personal hygiene and sanitation including the importance of hand washing with soap after defecation and before preparing or eating food.

8. Case management Treatment facilities should be readily available and accessible. Manage dehydration and electrolyte imbalance due to acute

watery diarrhoea by using ORS (Oral Rehydration Salt) solution.

Monitor the clinical condition of the patients during and after rehydration until diarrhoea stops.

IV fluids (Ringer lactate solution) should be used only for the initial rehydration of patients with severe dehydration. Plain glucose solutions are ineffective and should not be used.

Antimicrobials are unnecessary for the treatment of ordinary diarrhoeas; the anti-diarrhoeal preparations are contraindicated. In case of suspected cholera cases, tetracycline and norfloxacin may be given.

9. Community participation Community must be encouraged to participate in activities for

the prevention and control of outbreaks including taking appropriate action for storage of water at household level and personal hygiene.

They must be aware of danger signals of dehydration and when to seek immediate medical care

PREVENTION AND CONTROL OF VECTOR-BORNE DISEASES

1. Active surveillance of Acute Fever cases

2. Vector Surveillance 3. Vector Control 4. Community participation

Thank You