1. Professor Syed Amin Tabish
FRCP(London), FRCP(Edin.), FAMS, FACP, MHA (AIIMS)

2. Disasters: the scenario
 A global problem: a major disaster
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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)

3. 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

4. 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.

5. 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

6. 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

7. 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.

8. 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

9. Natural Events
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Avalanches
Cyclones
Droughts
Earthquakes
Dust
Sand Storm
Epidemic Diseases

10. Natural Disaster
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Famines
Floods
Heat waves
Hail Storms
Hurricanes (Katrina, Rita)

11. Natural Disasters
 Land Slides
 Severe Storms
 Tornados
 Tsunamis
 Volcanic Eruptions

12. Man-made Disasters
 Air Safety
 Fire Emergencies
 Nuclear Accidents & Radiation
(blast, heat)
 Hazardous material (chemical &
biological)
 Bioterrorism
 Conflict / Terrorism

13. BCW: possible weapons
against humans
Bacteria
 Bacillus Anthracis
 Brucella Species
 Bartonella QuintanaVibrio Cholerare
 Plague
Fungi
- Coccidiodes immitis
Viruses
- Hanta virus
- Ebola virus
- Smallpox
Protozoa
- Naeglaeria fowleri

14. BCW
Routes 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

15. Recent Outbreaks &
Incidents
 Hurricane (the USA)
 Avian Flu (Hong Kong)
 Earthquakes (Pakistan)
 Floods (Bangladesh)
 Mad Cow Disease (the UK)
 Marburg Virus Hemorrhagic Fever
 Anthrax (the USA)
 Tsunamis (Indonesia, Sri Lanka)
 SARS (30 countries)

16. Earthquakes
 Surviving 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.

17. 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

18. 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.

19. Impact of Disasters
 Disasters 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

20. 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 programs

21. Impact
 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 largescale economic and social harm
 the deterioration in the social
well-being of the population

22. Disaster Management
EMERGENCY
PREPAREDNESS

23. Goal of Emergency Preparedness
To reduce:
 loss of lives
 damage to property
 impact on environment
 impact on community

24. Activation of External
Disaster Plan
 Information from the Red
Crescent Ambulance authorities
 Arrival of casualties without prior
warning
 Doctor on Duty to inform ED Chief
 ED Chief to contact the Disaster
Executive Committee (Hospital
Director, Executive Director,
Medical Director, Nursing
Director)

25. 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

26. Activation of DM Plan
 Beep to Transport Department for
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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 Supdt to arrange
nurses

27. 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

28. Main Disaster
Teams
RESPONSIBILITIES

29. Disaster Executive Committee
 Coordination all Disaster
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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

30. 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

31. 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

32. Hospital Triage Team
 Receiving the Disaster
Patients
 Screening (Triaging)
 Transferring all incoming
disaster patients to
different treatment areas

33. Red Area Team
 To resuscitate,
stabilize patients on
red area and shifting
them to definitive care
areas

34. Yellow Area Team
 To resuscitate and stabilize
patients with serious non lifethreatening injuries
 Provide care to those patients
who are seriously injured and
likely to die
 Transferring resuscitated
patients to definitive care areas

35. Green Area Team
 Care of patients with
minimal injuries

36. ED Patients Team
 Treating of the
normal ED patients

37. Evacuation Team
 Making beds available
for casualties from the
disaster by bed
expansion and
discharging current cold
patients

38. Evaluation Team
 Monitoring the
management of the
disaster and forward a
final report to the Chief
of the Disaster
Management Committee.

39. Triage Team
 Hospital triage is team
responsible for:
 receiving the disaster
patients
 screening the disaster
patients
 transferring all incoming
disaster patients to different
treatment areas

40. Responsibility of the Yellow area
team
 to resuscitate patients with serious
non-life threatening injuries
 stabilize patients with serious nonlife threatening injuries
 to provide care to those patients
who are seriously injured and
likely to die
 transferring resuscitated patients
to definitive care areas

41. National Policy-making
 Risk and vulnerability
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assessment
Development of training
programmes
Public health in disasters
The management of programs
involving refugees and internally
displaced people
Shelter needs in disasters

42. National Policy-making
 The development of disaster management
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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

43. National Policy-making
 Leadership and decision making
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in disaster management
Managing incidents involving
terrorism or civil unrest
Crowd management
The development context of
disaster management
Disaster relief logistics

44. Biochemical Weapons
 Identify the hazard
 Evaluate the hazard
 Introduce risk reduction strategies
(control contamination)
 Chemical detection & identification
(lab dx. By DNA based & other
molecular methods)
 Risk communication & dissemination
of information
 Contamination control (entry & exit
control)

45. BCW
 Decontaminate both materials &
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persons
Triage
Medical care & evaluation of
casualties
Definitive decontamination (a
final decontamination of the site)
Command, control &
communication

46. Pak Earthquake
 The death toll from the
7.6-magnitude earthquake
that was centered near
Muzaffarabad, on October
8 stands at over 86,000 in
Pck and in NWFP.
 Over 79,000 people
injured and estimated 3
million displaced or

47. 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.

48. SouthAsia Earthquake Jan
2005

49. South India earthquake

53. Asian Earthquake 2005

54. Asian Earthquake 2005

56. Asian Earthquake 2005

57. Asian Earthquake 2005

58. Asian Earthquake 2005

59. Asian Earthquake 2005

60. Asian Earthquake 2005

61. Pakistan: Villages wiped out

62. Bodies recovered

63. Asian Earthquake: Grim
situation

64. Tsunami Catastrophe
2004-05

65. 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.