Global Disaster Global Disaster Preparedness and Preparedness and ResponseResponse

Global Disaster Global Disaster Preparedness and Preparedness and ResponseResponse

Carlos Primero D. Gundran, EMDMEMS and Disaster Management Coordinator,

Philippine College of Emergency Medicine

Objectives

• Define “Disaster”

• Define the aspects of

Disaster

• Define the characteristics

of a Disaster

• Define Hazards

• Enumerate the different

types of Hazard.

• Show the occurrence of

disaster on the following

setting: Global, US,

Philippines.

• Define a Mass Casualty

Incident.

• Who are involved in an

MCI?

Objectives

• Discuss the Basic assumptions and facts in an MCI.

• Differentiate MCI in an Urban setting from a Rural

setting.

• Discuss the EMS steps in an MCI

• Discuss the Organization of medical Treatment in MCI

• Discuss the survival statistics in an MCI.

• Overview of USAR in the West.

• Discuss the real issue in Disaster Preparedness and

Response.

• Discuss the Hyogo Framework of Action.

Disaster

• A serious disruption in the functioning of a community or society causing widespread human, material, economic or environmental losses which exceed the ability of the affected community or society to cope using its own resources.

http//:www.unisdr.org/eng/library/lib-terminology-eng%20home.htm

Disasters

The most important aspects to remember about disasters

are:

- Disasters interrupt the normal functioning of a community.

- Disasters exceed the coping mechanisms of the

community.

- External assistance is needed to return to normal

functioning of a community.

Characteristics of a Disaster

• 1. Mismatch

– Needs>capacity

• 2. Chaos

– Everybody does his

and her own thing

Hazards

• a situation that poses a level of threat to life, health

property or environment.

Increased frequency of disasters in the world today

• One disaster

everyday

somewhere in the

world.

Disasters in the US

• 23 major disasters occur every year.

• 2010, there were 81 major disaster, (1 every 4 ½ days.)

• 2010- 2 ½ times more than the annual average.

• “The term 100 year event lost its meaning this year”

– Craig Fugate- head FEMA.

US Disasters 2011

• By April 2011 more than 600 tornadoes shredded the

US, shattering the previous April record of 267.

• 312 of them came in a single 24 hour period.

• The worst of which is 20 times the usual size, tore a scar

1 mile wide and 300 miles long across Alabama and

Georgia.

• Severe flooding

deluged other parts

of the country- even

as Texas was

suffering its worst

drought since 1895.

Typhoon in the Philippines

• 1.1 From 27 typhoons during the period 2000-2003, the

number ominously increased to 39 from 2004-2007

(Table 1 ).Year

Category

TD 1/ TS 2/ TY 3/ Total

Total 43 39 66 148

2000 5 5 8 18

2001 6 7 4 17

2002 5 2 6 13

2003 8 8 9 25

2004 5 7 13 25

2005 11 1 5 17

2006 3 6 11 20

2007 0 3 10 13

Typhoon in the Philippines

• 1.2 The typhoons are getting stronger and stronger10,

especially since the late 1990s. Typhoon signal no. 4 is

of course, a fairly recent category (Figure 1).

Typhoon in the Philippines

• 1.3 Between 1947-2006, 3 of the 5 strongest tropical

cyclones in the Philippines occurred in the past decade

(Table 2).

Name Period of OccurrenceHighest Wind

Speed Recorded

Place Observed

1. REMING (Durian)November 26-December

1, 2006320 kph Virac, Catanduanes

2. SENING (Joan) October 11-15, 1970 275 kph Virac, Catanduanes

3. ROSING (Angela)October 30-November 4,

1995260 kph Virac, Catanduanes

4. ANDING (Irma) November 21-27, 1981 260 kphDaet, Camarines

Norte

5. LOLENG (Babs) October 15-24, 1998 250 kph Virac, Catanduanes

Typhoon in the Philippines

• 1.4 Total damages brought about by typhoons increased

by 408% from 2003 to 2006 (Table 3).

2006 2003

Month Typhoon

Damages

Month Typhoon

Damages

(in million PhP) (in million PhP)

May Caloy 4,312 July Harurot 3,233

Sept Milenyo 7,607 May Chedeng 538

Nov Reming 5,449 June Egay 131

Oct Paeng 1,298 July Gilas 67

Others 1,993 Others 99

20,659 4,068

Typhoon in the Philippines

• 1.5 Seven of the 20 deadliest typhoons in the Philippines

covering the period 1947-2006 occurred in 1990-2006 NAME PERIOD OF OCCURRENCE DEATHS

1. URING (Thelma)A November 2-7, 1991 5,101 (8,000+)*

2. NITANG (Ike) August 31–September 4, 1984 1,363 (3,000)*

3. TRIX October 16-23, 1952 995

4. AMY December 6-19, 1951 991

5. SISANG (Nina) November 23-27, 1987 979

6. ROSING (Angela) October 30 – November 4, 1995 936

7. UNDANG (Agnes) November 3-6, 1984 895

8. SENING (Joan) October 11-15, 1970 768

9. REMING (Durian)B November 26–December 1, 2006 754 (1,200)*

10. RUPING (Mike) November 10-14, 1990 748

11. TITANG (Kate) October 16-23, 1970 631

12. YOLING (Patsy) November 17-20, 1970 611

13. KADIANG (Flo) September 30 - October 7, 1993 576

14. KADING (Rita) October 25-27, 1978 444

15. ANDING (Irma) November 21-27, 1981 409

16. WINNIE C November 28–30, 2004 407

17. INING (Louise) November 15-20, 1964 400

18. DIDANG (Olga) May 12-17, 1976 374

19. MONANG (Lola) December 2-7, 1993 363

20. WELING (Nancy) October 11-15, 1982 309

•• 22 Typhoons every year 22 Typhoons every year •• 5 will be destructive5 will be destructive

Typhoon Typhoon SendongSendong/ “/ “WashiWashi””IliganIligan City and Cagayan De OroCity and Cagayan De OroDecember 16, 2011December 16, 201112681268–– dead dead 100,000 evacuated100,000 evacuatedP2.068 B P2.068 B -- damagedamage

July 16, 1990; Intensity 8July 16, 1990; Intensity 81,666 dead 1,666 dead –– 3,500 injured 3,500 injured P11B cost of damage in P11B cost of damage in property P1.2B in agricultureproperty P1.2B in agriculture

Geologic HazardsGeologic Hazards

•• 5 quakes/day 5 quakes/day •• 1,825 quakes/year1,825 quakes/year

Negros EarthquakeNegros EarthquakeMagnitude 6.7Magnitude 6.7February 6, 2012February 6, 20124848–– dead dead 9292-- missingmissingP266million P266million -- damagedamage

PantukanPantukan, , CompostelaValleyCompostelaValley, ,

January 5, 2012January 5, 2012

25 dead 25 dead –– 16 injured 16 injured –– 150 missing150 missing

MASS CASUALTY INCIDENTS

Mass Casualty Event

• An event in which the

number of casualties or the

rate of their arrival exceeds

the capability of the existing

medical staff to provide

quality medical treatment to

all injured.

Basic Assumptions

• Disaster and Mass Casualty Incidents occur “out of the

blue” or at a very short warning.

– ? No control

– ? Not ready in the right time and the right place.

• The name of the game- Organization, Management,

Command, Time Control.

– Planning and Training before the event.

– Planning and Management of Time

– Coordination and Transportation.

Based on experience:

• The name of the game in MCI is OCCCC:

– Organization

– Command

– Control

– Coordination between emergency agencies

– Communication

• True for most types of Mass Casualties and Disasters

except in:

– Toxicologic

• Occur unexpectedly

• Many casualties in a short time

• Bottlenecks

• Panic

• Require quick accumulation of forces and

resources.

What affects response?

• Number of casualties, severity and distribution

• Time until rescue and treatment

– Timing of the event

– Geographical location/ distance from hospital

– Evacuation Time and EMS quality of care.

• Hospital preparedness and organization

• Control and Cooperation between Emergency Agencies

Conventional Mass Casualty in Urban Areas

• Short duration

• Short distance = ambulance availability

• Scoop and Run= (AW and Bleeding)

Mass Casualty in Rural Areas

• Extended period of arrival

• Treatment according to PHTLS

• Evacuation according to medical priorities

• Helicopters- best means of transportation

EMS Steps in MCI

• First Response

• Casualty Allocation

• Triage

• PHTLS approach

• Allocation of casualties in a

designed treatment area

Gathering of commanders

and forces

• Evacuation

• Debriefing and lesson study

Flexibility

• The most important lesson:

– Work by Principles, not by Protocols.

• No two MCI’s are the same. Difference in:

– Time of Event

– Place of Event

– Number of Casualties

– Type and Severity of Casualties

– Number of Medical Teams

– Number of Hospitals in the Area

– Distance from Hospitals

– Number and Type of Evacuation Resources

Tip

• Dispatch and Control Centers and Teams should have:

• Easy to forget specific tasks when working under stress

or pressure.

Phases of Medical Activity in MCI

• 1. Immediate Phase– Provide life saving treatment

• 2. Second Phase– Gathering injured at treatment sites and concentrating

on providing care to casualties in need of urgent care.

• 3. Third Phase– Preparation of casualties for evacuation

Immediate PhaseOnly urgent and life-saving procedures

are performed.

Medical Treatment at the Scene

• Airway Management

• Ventilation or Oxygen Supplementation

• Relief of Tension Pneumothorax

• Treatment massive bleeding wounds from

extremities

Roles of Medical Manager

• Provide solutions to operational/non-

medical problems.

• Initial report to level in charge:

– Location

– Type of event

– # casualties, etc

• Coordinate with senior medical personnel

at the scene and call for medical forces

Manager’s Actions

• Remove from danger

• Utilize forces and provide first aid to

victims

• Report to level in charge

• Join medical care providers

Second PhaseMedical treatment will be provided to the severely

injured based on medically defined priorities

Organize Medical Response

• 2nd estimation of casualties; number;

location and continuing hazards.

• Define the access routes, evacuation

centers and evacuation routes.

• Divide the event area into sectors and

allocate teams to each sector.

• Perform initial search to locate casualties

Manager’s Action

• Gather casualties

• Maintain continuous

contact with medical

care providers

Organize Medical Response (2)

• Isolating the

treatment area

• Demand more teams

and equipment for

the EMS center

• Define the location

and nature of the

treatment area (if

necessary)

Third PhaseCasualties prepared for evacuation

and evacuated

Ambulance Evacuation Helicopter Evacuation

Manager’s Action

• Call Evacuation

• Land helicopter

• In all events, COORDINATION between acting agencies

is the most important factor.

• Without it, there is NO CHANCE of providing OPTIMAL

CARE

Practice makes Perfect

• Planning and practicing at calm times,

greatly increases the chance that forces

will collaborate and function well under

emergency conditions.

Testing and Plan Review

• Absolutely necessary!

– Football analogy

• Requires all participants to interact

• Identify where problems exist between different agencies

when must work together

• Does the plan work?

Survival Statistics

• 85-90% of those rescued who survive are

found within the 1st 24-48hrs.

• 90-95% of victims who survived are

rescued by civilian volunteers within the

first 24 hours.

• 10-25% of patients who die could have

been saved if reached in time.

• Preventable deaths occur in the first 6

hours.

Urban Search and Rescue teams

– Riverside County team 2 hours away by

car

– Earthquake occurs at 04:30

– Team not begin activities at site of

Northridge Meadows Apartment

collapse until 23:30

– Live victims already extricated

Urban Search and Rescue teams

• Oklahoma City Bombing 1995

• Multiple USAR teams dispatched

• Last survivor recovered from building 18

hours after explosion

• Number of survivors recovered by out-of-

state USAR teams:

• ZERO

Hyogo Framework for Action

• The first internationally accepted framework for DRR.

• Sets out an ordered sequence of objectives ( outcome-

strategic goals-priorities).

• A 10 year plan to make the world safer from natural

hazards.

Action Priorities

• Governance

• Risk Identification

• Knowledge

• Reduce the underlying risk factors

• Strengthen Disaster Preparedness

for Effective Response

Disaster

Problem

• 1. Mismatch

• 2. Chaos

Solution

• 1. Maximize your capacity

by teamwork

• 2. Bringing order by

working together as a

TEAM.

Mismatch?

carlosprimerogundran@yahoo.com