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DISASTER MANAGEMENT
Professor Syed Amin TabishFRCP(London), FRCP(Edin.), FAMS, MD
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Disasters: the scenario A global problem: a major disaster
occurs somewhere in the world almost on a daily basis
Affects the advances being achieved health & socioeconomic development
Increased vulnerability to natural disasters due to environmental degradation, industrialization, pollution, threat to biodiversity
Rapid climate change Population explosion (overexploitation
of resources)
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Disasters Ecological disruption Loss of human life Military expenditures: 6 month’s of world’s
arms spending would pay for a 10-year program proving food & health services in developing countries
Deterioration of health services to warrant an extraordinary response
from outside the affected community or area. Result in significant morbidity
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Diversity of the Planet The vastness and diversity of the planet
makes it difficult to build up an overall picture of what needs to be done and the impact of what has been done.
The same vast distances make it hard to react rapidly and effectively to sudden events - an earthquake - in parts of the world with shifting populations and poor communications.
New technology - fast bandwidth reliable communications, the internet, high resolution satellite imagery - can provide support in these situations.
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Classifying Disasters Natural: earthquakes, floods, fires, hurricanes Technological (number of nuclear arsenals
has exceeded 50,000), deadlier weapons, laser-guided missiles, carpet bombs, etc ……Hiroshima (Aug 6,1945) & Nagasaki (Aug 19, 1945); Nuclear reactor Accident in Chernobyl (Ukraine); Toxic gas leak in Bhopal (India)…..improper management of industrial technologies
Chemical & Biological Weapons Complex Emergencies (conflict-related):
Afghanistan (2.5 m), Iraq (1991, 2004-6) – hi-tech war [2,10,000 tons of bombs in 43 days dropped in 1991
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Disaster Planning
Pre-disaster: the identification, understanding & analysis of natural & other hazards
Disaster Management System: to reduce the vulnerability of people to damage (disaster prevention), injury and loss of life & property resulting from catastrophes; to prepare for prompt & efficient rescue, care and treatment of victims; response & recovery
Disaster planning starts with community awareness
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Disaster Management Disaster Preparedness: activities that are
carried out prior to the advance notice of a catastrophe to facilitate the use of available resources, relief & rehabilitation
Disaster mitigation: ongoing effort to lesson the impact disasters have on people & property
Disaster Management: the process of addressing an event that has the potential to seriously disrupt the social fabric of commun.
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Pre-hospital Emergency Preparedness
Efficient system of providing prompt medical care to injured to save many lives or limbs by beginning treatment before the patient reached the hospital: CPR, ATLS, ACLS, closed chest cardiac compression
Emergency Medical Services Individual Protective Equipment
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Natural Events
AvalanchesCyclonesDroughtsEarthquakesDustSand StormEpidemic Diseases
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Natural Disaster
FaminesFloods Heat wavesHail StormsHurricanes (Katrina, Rita)
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Natural Disasters
Land Slides Severe StormsTornadosTsunamisVolcanic Eruptions
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Man-made DisastersAir SafetyFire EmergenciesNuclear Accidents & Radiation
(blast, heat)Hazardous material (chemical &
biological)BioterrorismConflict / Terrorism
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BCW: possible weapons against humans
Biological Agents: Bacteria Bacillus Anthracis Brucella Species Bartonella QuintanaVibrio Cholerare Plague
Fungi- Coccidiodes immitis
Viruses- Hanta virus- Ebola virus- Smallpox
Protozoa- Naeglaeria fowleri
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BCWRoutes of exposure Inhalation hazard (Respiratory System) Contact hazard (Skin) Digestive system (contaminated food or drinking
water)Degree of hazard will depend on the agent &
amount released/method by which agent is disseminated
Biological agents have the ability to multiply in the host
Chemical agents may be harassing agents, incapacitating agents or lethal agents
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Recent Outbreaks & Incidents
Hurricane (the USA) Avian Flu ( Earthquakes (Pakistan) Floods (Bangladesh) Mad Cow Disease (the UK) Marburg Virus Hemorrhagic Fever Anthrax (the USA) Tsunamis (Indonesia, Sri Lanka) SARS (30 countries)
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EarthquakesSurviving an earthquake and
reducing its health impact requires preparation, planning, and practice.
Far in advance, you can gather emergency supplies, identify and reduce possible hazards in your home, and practice what to do during and after an earthquake.
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How are avian, pandemic, and seasonal flu different?
Avian Flu is caused by avian influenza viruses, which occur naturally among birds.
Pandemic Flu is flu that causes a global outbreak, or pandemic, of serious illness that spreads easily from person to person.
Seasonal Flu is a contagious respiratory illness caused by influenza viruses
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What Injuries Occur Most Often?
The most severe injuries in mass casualty events are fractures, burns, lacerations, and crush injuries. However, the most common injuries are eye injuries, sprains, strains, minor wounds, and ear damage.
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Impact of DisastersDisasters have a major impact on the
living conditions, economic performance and environmental assets and services of affected countries or regions.
Consequences may be long term and may even irreversibly affect economic and social structures and the environment
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Impact In industrialized countries, disasters cause
massive damage to the large stock of accumulated capital while losses of human life are limited due to the availability of effective early warning and evacuation systems, as well as better urban planning and the application of strict building codes and standards.
In developing countries, on the other hand, fatalities are usually higher owing to the lack or inadequacy of forecast and evacuation programmes.
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Impact Whether disasters are essentially natural or
man-made in origin, their consequences derive from a combination of human action and interaction with nature’s cycles or systems.
Disasters can lead to widespread loss of life, directly and indirectly (primarily or secondarily) affect large segments of the population and cause significant environmental damage and large-scale economic and social harm
the deterioration in the social well-being of the population
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Disaster Management
EMERGENCY PREPAREDNESS
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Goal of Emergency Preparedness
To reduce:loss of livesdamage to propertyimpact on environmentimpact on community
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Activation of External Disaster Plan Information from the Red
Crescent Ambulance authoritiesArrival of casualties without prior
warningDoctor on Duty to inform ED ChiefED Chief to contact the Disaster
Executive Committee (Hospital Director, Executive Director, Medical Director, Nursing Director)
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Activation of External Disaster Plan
Disaster Executive Committee [DEC] will assess the situation & determine the activation of the plan
DEC to initiate Code Black/Green through the Switchboard
Switchboard will start Page announcement for Code Black, Bleep 555 for all concerned
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Activation of DM Plan
Beep to Transport Department for arranging 2 Ambulances
Advise Transport Section to send Ambulances around the hospital housing to alert residents about disaster
To send cars to commute staff Contact all other DM personnel Inform Nursing Director to arrange
nurses
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Activation of the plan Chief of each department to arrange
return of off-duty personnel Ambulance to commute 2 medical teams
(disaster Site triage team) to site of disaster
Other departments (radiology, Labs, Blood Bank, Pharmacy, Medical Records, Patient Services, Security, Emergency Supplies, Nutrition, etc will activate their DM plan
Security personnel to regulate traffic to & from the Reception area
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Main Disaster Teams
RESPONSIBILITIES
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Disaster Executive Committee
Coordination all Disaster Management activates
Coordinate all aspects of clinical management
Notify local authorities Receive regular updated progress of DM Media management To announce ‘All Clear’ at the end of
Disaster
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Coordination Team
Assess the number of casualties & Beds available
Maintain contact with Triage teams, Treatment teams & wards
Allocate Medical staff in different teams
Give updated info to Disaster & Executive Committee
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Disaster Site Triage Team
Triaging patients (Red, Yellow, Green, Black) to give priorities for evacuation
Inform the Disaster Executive Committee about the situation to take decision for activation of Disaster Plan
Give frequent updates on the situation at the scene
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Hospital Triage Team
Receiving the Disaster Patients
Screening (Triaging)Transferring all incoming disaster patients to different treatment areas
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Red Area Team
To resuscitate, stabilize patients on red area and shifting them to definitive care areas
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Yellow Area Team
To resuscitate and stabilize patients with serious non life-threatening injuries
Provide care to those patients who are seriously injured and likely to die
Transferring resuscitated patients to definitive care areas
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Green Area Team
Care of patients with minimal injuries
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ED Patients Team
Treating of the normal ED patients
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Evacuation Team
Making beds available for casualties from the disaster by bed expansion and discharging current cold patients
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Evaluation Team
Monitoring the management of the disaster and forward a final report to the Chief of the Disaster Management Committee.
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Triage TeamHospital triage is team
responsible for:receiving the disaster
patientsscreening the disaster
patientstransferring all incoming
disaster patients to different treatment areas
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Responsibility of the Yellow area team
to resuscitate patients with serious non-life threatening injuries
stabilize patients with serious non-life threatening injuries
to provide care to those patients who are seriously injured and likely to die
transferring resuscitated patients to definitive care areas
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National Policy-making
Risk and vulnerability assessment
Development of training programmes
Public health in disasters The management of programmes
involving refugees and internally displaced people
Shelter needs in disasters
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National Policy-making The development of disaster management
policy and plans Aspects of the management of disasters
resulting from conflict The role of the military in disaster
management The management of civil emergencies and
transport accidents Co-ordination in disaster management The establishment of control rooms
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National Policy-making
Leadership and decision making in disaster management
Managing incidents involving terrorism or civil unrest
Crowd management The development context of
disaster management Disaster relief logistics
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CBW Identify the hazard Evaluate the hazard Introduce risk reduction strategies
(control contamination) Chemical detection & identification (lab
dx. By DNA based & othe molecular methods)
Risk communication & dissemination of information
Contamination control (entry & exit control)
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BCWDecontaminate both materials &
personsTriageMedical care & evaluation of
casualtiesDefinitive decontamination (a
final decontamination of the site)Command, control &
communication
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Taste of Tears
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THE CHANGING FACE OF DISASTER MANAGEMENT
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The confirmed death toll from the 7.6-magnitude earthquake that was centered near Muzaffarabad, the capital of Pakistan-controlled Kashmir (PcK) on October 8 stands at over 73,000 in Pck and in NWFP, while the unconfirmed death toll has climbed to over 86,000. (Nov-8, AP, Dawn) Over 79,000 people injured and estimated 3 million displaced or homeless. The earthquake affected nine districts in total: Abbottabad, Batagram, Mansehra, Shangla, and Kohistan in the North West Frontier Province (NWFP) and Muzaffarabad, Neelum, Poonch and Bagh in PcK.
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India
The latest official death toll is 1,309 in Indian-controlled Kashmir (IcK). Officially, 6,622 people reportedly injured and 150,000 displaced (Oct-17, AFP). Worst-hit areas are around Tangdhar and Uri towns in Kupwara and Baramulla districts respectively, along the disputed Line of Control (LoC). Third worst-hit area is Poonch district.
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Tsunami The overall focus of attention is on rebuilding and long-term recovery
and rehabilitation for the December 26, 2004 earthquake and tsunami disaster. The dead and missing toll from tsunamis triggered by the undersea earthquake measuring 9.0 on the Richter scale off the west coast of Indonesia’s Sumatra Island was estimated to be some 232,000 people along the coastal areas of 12 countries in the Indian Ocean, although a true toll will likely never be known. At least 1.7 million are reported to be homeless with estimates over 2 million. Tsunami-related deaths were recorded in Indonesia, Sri Lanka, India, Thailand, Malaysia, Myanmar, Maldives, Bangladesh, Somalia, Tanzania, Kenya and the Seychelles. The loss of life was particularly severe in Indonesia, Sri Lanka, India and Thailand. Nearly 166,000 dead and missing are from worst-hit Aceh province in Indonesia. The dead and missing toll in Sri Lanka is nearly 39,000. In India, at least 10,672 died in Tamil Nadu State and the Andaman and Nicobar Islands. The death toll in Thailand is around 5,400, including about 1,953 foreigners from at least 36 countries. More than 400 combined deaths have been reported in the other countries.
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South Asia Earthquake January 2005
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South Asia earthquake (India)
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Natural Disaster
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Villages wiped out
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Bodies recovered
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Grim situation
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Tsunami Catastrophe 2004-05
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Tsunami: Satellite photos
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Tsunami December 26 2004
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Tsunami 2004/5: Indian Ocean
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Tsunami: Indonesia
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Tsunami
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Tsunami Disaster of Indian Ocean 2005
It is said that some kids were playing on a bridge when suddenly the earthquake came, the bridge broke down into 2 pieces, all those kids went down inside the bridge and died. The mothers of those kids were standing besides the bridge and helplessly watching their kids die.
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Iraq Tsunami: body in mortuary
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Iraq: legs oeaten by dogs
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Iraq: a dead woman covered