3. WHAT IS DISASTER
DISASTER- French word,
(Des-bad & Astre -star)
W.Nick carter defined:
“An Event, Natural/ Manmade, Sudden/Progressive,
which impacts with such severity that the community has
to respond taking exceptional Measures.”
2.It is a phenomenon involving extensive
ecological disruption leading risk to life,
property and health to an extent warranting
extra ordinary response from outside the
affected area.
4. MAJOR DISASTERS IN INDIA
Highly disaster prone country
8 natural calamities /yr
5 fold increase in the frequency of disasters
during last 30yrs.
Bhopal gas tragedy.
Cyclones (AP)& Orissa.
Earthquake in Uttarkashi in 1990,latur .
1993,Gujarat 2001. Skkim 2011
Tsunami,2004.
Train accidents.
Bomb blasts in Delhi and Mumbai
11. A.PREDICT
Measures for efficient forecasting and warning
systems
Developing GIS for early detection and warning
Information Technology for effective communication
network.
Pro-active measures for disaster preparedness and
mitigation – administrative, financial, Legislative &
techno- legal
Developing public awareness to build up society’s
strength to face disasters.
National networking for immediate medical response
Emphasis on risk reduction, mitigation & awareness,
while strengthening response.
12. B.PREVENT
-Evoke existing system of response mechanism in the wake of
natural and man-made disasters at all levels of government and
steps to minimize the response time through effective
communication & measures to ensure adequacy of relief
operations.
- Develop strategies for inclusion of disaster reduction
components in the on-going plan/ non – plan schemes.
-Prepare the community to face the challenge and respond in case
of impending disaster
-Lay stress on preparedness including prevention/ mitigation of
Chemical Industrial Disasters while strengthening their emergency
response.
-Stay up to date with the latest international best practices and
recent developments within the country
-Highlight the salient gaps evaluated based upon the critical review
of the present status for future action.
14. PREPARE DISASTER ACTION PLAN
It is planned and systematic approach towards
understanding and solving the disaster to minimize the
effect.
• The approach should be multi sectoral.
• Plan should be realistic and easily adoptable
• Plan should be clearly laid down defining the role and
responsibility of different agencies.
• Should be exercised in between to evaluate it.
• It should be prepared at the country, state, district and
institutional level.
• National disaster management authority(NDMA) facilitate
state with support and advice while plan and implementation
by SDMA
15. CAPACITY DEVELOPMENT
Creation of trained Medical First Response Teams
Initiation of training of paramedics for disaster
management.
Creation of detection, decontamination facilities.
Uniform Causality Profile and Classification of
Casualties.
Risk Inventory and Resources Inventory.
Proper Casualty Treatment Kits.
Crisis Management Plan at Hospitals.
Mobile Hospitals/ Mobile Teams .
Medical Response to Long Term Effects.
Psychosocial Care for management of community
behavior and response .
Issues related to public health response and medical
rehabilitation and harmful effects on the environment.
Efficient transport system
16. D.ORGANISATIONAL DEVELOPMENT
National Disaster Management Authority (NDMA)
Constituted in Dec 2005 ,DM Act.
•NDMA Chairman PM
•SDMA are constituted there after
•SDMA Chairman CM
•DDMA Constituted
CABINATE SECRETARY
NDMA SECRETARIATE
•DDMA Chairman DM/ DC
DM-I DM-II
• MITIGATION • CAPACITY DEV.
• PREPAREDNESS • TRAINING
• PLANS • KNOWLEDGE
• RECONSTRUCTION MANAGEMENT
• COMMUNITY AWARENESS
• FINANCIAL ASPECTS
19. DDMA
DISTRICT DISASTER COMITTE
•Head Local Administration
• Representatives of Police
• Representatives of Fire services
• Representatives of CATS
• Representatives of Corporate body
• Representatives of Voluntary
organization
• Representatives of Media
• Hospital representatives.
•Army should be called into action as and
when required
20. GUIDELINES FOR DDMA
Preparation of Action Plan
Allocation of adequate resources
Ensure implementation
Laying down role and responsibilities of different services
Regulatory framework.
Code of Practices, Procedures and Standards.
Statutory Inspection, Safety Auditing and Testing of Emergency Plans.
Technical and technological information and Preparedness.
Education and Training.
Creation of DDMA Infrastructure.
Capacity Development of all teams.
Awareness Generation among Public.
Institutional Framework at all levels.
Networking and Information sharing.
Medical Preparedness by medical Teams.
Research and Development.
Response, Relief and Rehabilitation.
Evacuation plan and Mock drill
21. RESPONSE BY DDMA
Instantaneous instruction for forthwith movement of
rescue team with personal protective equipment
(PPE)
Simultaneously, QRMT(Quick Response Medical
Team) with PPE on will reach to Mishap site
immediately along with Resuscitation, protection,
detection and decontamination equipment and
materials.
Decontamination , Resuscitation, triage and
evacuation work must be done as per SOPs.
DDMA will immediately inform State and National
Disaster Management Authorities appraising about
situation and extent of damage so that SDMA &
NDMA can plan to send relief teams and supports.
23. HOSPITAL DISASTER PLAN
Hospital Disaster plan is prepared to reduce the pressure
on the hospital management when a large number of
casualties arriving suddenly in the hospital at a time,
requiring different level of care.
The plan should be activated immediately to provide
efficient care to the patients within a short span of time.
Mock drill to be conducted periodically to acquaint the
staff to meet any eventuality
The action plan begins with formation of Disaster
committee
Keeping adequate storage of supplies in the emergency
department.
Keeping disaster SOP in the casualty.
25. HOSPITAL DISASTER COMMITTEE
Each hospital must have a hospital disaster committee to give
effect to the disaster action plan as and when required.
CMO I/C CASUALTY
•ALL HODS
ECRO (Surg,Med,Ortho,Neuro,Lab, Radio)
CMO(CASUALTY) • DD(A) •Nursing Supdt.
•Officer I/C TPS
SISTER I/C •CMO (store) •Officer I/C Maintain.
•Dietician •CPWD Rep.
OTHER PARAMED. STAFF
26. 1.CARE AT THE SITE
• Do not allow Golden hour to expire,, 1st hour
•It is best if services can be provided in first 10 minutes (Platinum minute)
• BLS ABC= Air way. Breathing. Circulation
• ALS DEF= Defibrillator. ET intubation, ECG . Fluid & electrolyte
• Constitute the field team:
1.Ambulance
2.Anesthetist To be identified and roaster made on daily,
3.OT Tech Weekly and monthly basis.
4.Bearers
5.Drivers
• Dispatch the team to site
• Assess the situation in the site.
• Render first aid at the site and during transport
• Stabilize the serious cases.
• Transport serious cases to the hospital under direct supervision.
27. 2.INTERNAL DISASTER PLAN
It is activated when the hospital buildings are effected in
disaster. Action plan should clearly mention:
• Alternate site (dharmashala,Temple,Schools,Playground
nearby)
• Folding tents, cots, trolleys for temporary shelters
• Identify a nearby tent house to provide beds,blankets
• TPT for transportation of cases to alternate sites or hospital
• First aid and drug kits, potable lights.
• Portable communication system.
• Identify local voluntary organization, who can provide
services of care,food and water.
28. 3.EXTERNAL DISASTER PLAN
(TEN STEPS)
• 3.1.DISASTER RESPONSE • 3.7. PUBLIC RELATION
• 3.2. AUTHENTICATE • 3.8. TRAFFIC CONTROL
SOURCE • 3.9.PERSONAL
• 3.3. ACTIVATION OF PROTECTION
DISASTER PLAN • 3.10.CHEMICAL
• 3.4. CREATION OF DECONTAMINATION
ADDITIONAL SPACE
• 3.5. AUGMENTATION OF
SERVICES
• 3.6. MAINTENANCE OF
RECORD
29. 3.EXTERNAL DISASTER PLAN
3.1.DISASTER RESPONSE:
STEP 1 ONE CASUALTY - Approach using normal
procedures
STEP 2 TWO CASUALTIES - Approach with caution,
consider all options
i).Report on arrival, update control.
STEP 3 THREE CASUALTIES or MORE Do NOT wait
i).Evoke Disaster action plan
ii).Call for specialist help.
Disaster response depends on:
• Time available between the first information and arrival of
casualties.
• Type of preparedness and training of staff.
• Accessibility to disaster manual.
• Role played by different category of staff.
30. 3.EXTERNAL DISASTER PLAN
3.1.DISASTER RESPONSE:
STEP 1 ONE CASUALTY - Approach using normal
procedures
STEP 2 TWO CASUALTIES - Approach with caution,
consider all options
i).Report on arrival, update control.
STEP 3 THREE CASUALTIES or MORE Do NOT wait
i).Evoke Disaster action plan
ii).Call for specialist help.
Disaster response depends on:
• Time available between the first information and arrival of
casualties.
• Type of preparedness and training of staff.
• Accessibility to disaster manual.
• Role played by different category of staff.
31. 3.2. AUTHENTICATE SOURCE OF INFORMATION:
•Media, Telephone, Police, CATS on arrival of
casualties.
• Authenticate the information received.
• Try to know the type of disaster, time of
occurrence.
• Estimate number or type of casualty expected.
32. DISASTER MANAGEMENT
NOTIFY KEY PERSONS INITIATE PREPARATION
o All the dept & designated staff get into
INITIAL ALERT o
readiness to attend casualties
Crisis expansion of hospital beds.
(POLICE, TV, o Preparation for decontamination area
TELEPHONE ,PATIENT)
RESUSCITATION COLLECT MOBILIZATION OF RESOURCES
o Manpower: Disaster Management
INFORMATION Team medical , nursing and other
INVESTIGATION Personnel
o Material and supply eg: antidotes
o Transportation means
ICU
TRIAGE
TREATMENT DUCUMENTATION
OT
IN DOOR DECONTAMINATION
OPD DEATH
ARRIVAL
OF
DISCHARGE PATIENT
MORTURY
33. 3.3. ACTIVATION OF DISASTER PLAN:
On confirming about the information the MS
should be informed and others to be informed
through hospital exchange.
The CMO on duty is responsible for
activation of the disaster plan.
All the available doctors and staff to be
alerted about the incidence.
34. 3.4. CREATION OF ADDITIONAL SPACE:
A. Triage/shorting area:
This is the area where the specialists will be there to
categorize the patients as per priority.
• Primary treatment area Resuscitation
• Secondary treatment area Stabilization &
treatment (Disaster ward)
• Evacuation area First aid To wards & discharge
/death
• Control room and information center
• Volunteer reception area (porter services)
• Relatives waiting area
• Media and communication area
• Traffic control
35. TRIAGE/SHORTING
Priority I: Serious cases Red band Resus. ICU.
Priority II: operation Yellow band Resus. OT Ward
O
U
T
Priority III: Requiring admission Blue band First aid Ward
Priority IV: Minor injuries Green band First aid
Priority V: Dead Black band Identification Morgue
36. 3.5. AUGMENTATION OF SERVICES:
•All supporting and utility services to be augmented.
• Staff strength in different areas to be increased.
• OTs to run round the clock.
• CSSD, Laundry, Kitchen time to be extended to
compensate
• Sanitation & Security services to be augmented
• Continuous supply of electricity and water.
• Communication service to run round the clock(Tel.
Exchange)
• Medical record section to be augmented.
• Investigation services to run round the clock.
•Medical store to be opened round the clok
37. 3.6. MAINTENANCE OF RECORD:
Proper record of all cases to be made for identification.
MLC to be made in all cases with name, address, injuries
and treatment given.
All records to be preserved for future compensation and
Legal evidence
A copy of the list to be handed over to police and inquiry
counter.
Documentation, follow up and research programs should
be used as feedback for future improvement and lessons
learnt.
38. 3.7. PUBLIC RELATION:
An inquiry counter be opened round the clock for
information of public and relatives.
Media briefing to be made by Med. Supdt. Only
Public announcement be made for voluntary blood
donation.
Information centre displaying information to public, to
relatives of victims and media with warning guidelines,
“DOs and DON’Ts” and condition of patients in the
hospital.
Adequate place for waiting relatives, toilet and drinking
facilities.
39. 3.8. TRAFFIC CONTROL:
This is very essential in a disaster situation
Adequate measures to be made to control the traffic
There should be clear area for off loading patients
from Ambulances
Necessary arrangement should be made for VIP visits
Assistance of local police and volunteers may be short.
40. PERSONAL PROTECTION
3.9A. PPE:
PPE, when decontamination, of specific agents, diagnosis
& immediate management of chemical incidents, radiation
facts, emergency contacts.
PPE will protect you, the patient, and other patients and
colleagues from infection and from other hazards, but only if
selected, worn, and discarded correctly.
Remove PPE as you have been instructed in training.
For advice on choosing and using PPE contact your
infection control team (infection hazards) or for chemical/
radiation, Health Protection Team
41. 3.9B.HAND HYGIENE:
If your hands are visibly dirty, or contaminated with blood or body fluids, use
soap and water to clean your hands
If your hands are not visibly dirty, use an alcohol-based hand rub, or soap and
water
Always clean your hands:
– Before any patient contact (even if you are ‘only’ going to examine them)
– Before any clinical procedure
– Before you eat
– After any patient contact
– After completing a clinical procedure
– After handling or touching any contaminated item or equipment (eg bed pan,
suction apparatus, toilet flush-button)
– After removing your gloves
– After leaving an isolation room
– After using the lavatory
Never try to clean visibly soiled disposable gloves by cleaning your gloved
hands: it doesn’t work. Remove gloves, clean your hands, and reglove
42. 3.10.CHEMICAL DECONTAMINATION:
Decontaminate according to protocols for clinical, emergency or
mass decontamination.
Decontamination of the injured and emergency decontamination is
led and managed by the Ambulance Service
Removing the casualty from the source and prompt
decontamination may be life-saving; as may prompt administration
of the specific antidotes that are available for some chemicals (eg
cyanide, organophosphates)
Decontamination to be done by shower jet with plenty of water.
Record any treatment given on the triage tag attached to the
casualty
Feedback relevant information regularly to MIO/Ambulance Control
Ensure that you and your equipment remain in the contaminated
area until decontaminated.
Collect samples and send for Lab test for confirmation of the
45. RESCUE
Emergency Management at the incident Site:
•Personal Protective Equipment will be made available
• Temporary decontamination facility
• On-Site Triage, Resuscitation.
Safe transportation of the casualties in ALS ambulances
Evacuation Plans for nearby affected communities.
Earmarking of health care facilities able to cater different
types of casualties like chemical burns, respiratory problems
etc.
Hospital to be informed to initiate disaster management
plans to deal with mass casualty events caused due to CBRN
disasters.
Preparation of Trained Medical First Responders.
Identification of Casualty Profile & their classification for
transfer.
Risk and Resource Inventories and supplies augmentation.
46. DISASTER ZONES
PUBLIC PASSAGE
MEDIA
COMAND CENTRE
AMBULANCE
WIND DIRECTION
TRIAGE
FIRST-AID
DECONTAMINATIO
N
EVACUATION
TEAM
DANGE
R ZONE
NO ENTRY
47. RELIEF
1. Prime responsibility of Public Health authorities.
2. They must ensure safe water supply, clean food
availability.
3. Maintenance of hygiene and sanitation by proper bio-
waste disposal.
4. Water testing and food inspection must be carried
out.
5. Decontamination of the area, equipment, vehicles
and disposal of left over contaminants.
6. Removal of dead bodies from site has to be carried
out in the Post-disaster Scenario and their disposal.
7. It also involves restoring life of victims to normalcy
in resettlement colonies.
48. 3. REHABILITATION
It involves providing temporary shelters with minimal hygiene
sanitation to the affected, restoring “normalcy” through ensuring
resumption of family’s daily living patterns.
Psychological impact of chemical disaster manifested as post
traumatic stress disorders (PTSD) in displaced people due lo disaster,
needs care by a psychologist and psychiatrist.
In post-disaster scenario some of the casualties will develop
sequel due to chemical/Radiation injuries.
These cases may need regular follow-up, medical care,
reconstructive surgery and rehabilitation.
Close monitoring is required to see any long term health effects like
blindness, interstitial lung fibrosis and neurological deficiencies etc.,
and need to be treated as well.
49. EFFECTS OF IMPACT
Psychological vulnerability and
Neuropsychological Sequel
Fear of unknown calamities.
Fleeing of affected community.
Exponential spread of disaster victims.
Over crowding of hospitals by people believing
themselves to be affected.
Hoarding of food, water and essential items.
Decreased efficiency of system.
Collapse of civil management and lack of
essential services.
50. POST DISASTER DOCUMENTATION AND
ANALYSIS
Information will be prepared by a medical administrator.
During response in hospital an information centre will
provide information to public, to relatives of victims and
media
Warning guidelines, “DOs and DON’Ts” and condition of
patients in the hospital.
Dissemination of information to electronics and prints
media will also be carried out by medical team.
Documentation, follow up and research programs should
be used as feedback for future improvement and lessons
learnt.
51. MEDICAL RESPONSE TO LONG TERM
EFFECTS
1. In post-disaster scenario some of the casualties will
develop sequel due to chemical/Radiation injuries.
2. These cases may need regular follow-up, medical
care, reconstructive surgery and rehabilitation.
3. Close monitoring is required to see any long term
health effects like blindness, interstitial lung fibrosis
and neurological deficiencies etc., and need to be
treated as well.
52. hospiad
Hospital Administration Made Easy
http//hospiad.blogspot.com
An effort solely to help students and aspirants
in their attempt to become a successful
Hospital Administrator.
DR. N. C. DAS