1. Global Disaster
Preparedness and
Response
Carlos Primero D. Gundran, EMDM
EMS and Disaster Management Coordinator,
Philippine College of Emergency Medicine

2. Objectives
• Define “Disaster” • Show the occurrence of
• Define the aspects of disaster on the following
Disaster setting: Global, US,
• Define the characteristics Philippines.
of a Disaster • Define a Mass Casualty
• Define Hazards Incident.
• Enumerate the different • Who are involved in an
types of Hazard. MCI?

3. 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.

4. 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

5. 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.

6. Characteristics of a Disaster
• 1. Mismatch
– Needs>capacity
• 2. Chaos
– Everybody does his
and her own thing

7. Hazards
• a situation that poses a level of threat to life, health
property or environment.

8. Increased frequency of disasters
in the world today
• One disaster
everyday
somewhere in the
world.

9. 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.

10. 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.

11. 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 ).
Category
Year 1/ 2/ 3/
TD TS TY 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

12. 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).

13. 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).
Highest Wind
Name Period of Occurrence Speed Place Observed
Recorded
November 26-December
1. REMING (Durian) 320 kph Virac, Catanduanes
1, 2006
2. SENING (Joan) October 11-15, 1970 275 kph Virac, Catanduanes
October 30-November 4,
3. ROSING (Angela) 260 kph Virac, Catanduanes
1995
Daet, Camarines
4. ANDING (Irma) November 21-27, 1981 260 kph
Norte
5. LOLENG (Babs) October 15-24, 1998 250 kph Virac, Catanduanes

14. Typhoon in the Philippines
• 1.4 Total damages brought about by typhoons increased
by 408% from 2003 to 2006 (Table 3).
2006 2003
Damages Damages
Month Typhoon Month Typhoon
(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

15. 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

16. • 22 Typhoons every year
• 5 will be destructive

17. Typhoon Sendong/ “Washi”
Sendong/ “Washi”
Iligan City and Cagayan De Oro
December 16, 2011
1268– dead
1268–
100,000 evacuated
P2.068 B - damage

18. Geologic Hazards
• 5 quakes/day
• 1,825 quakes/year
July 16, 1990; Intensity 8
1,666 dead – 3,500 injured
P11B cost of damage in
property P1.2B in agriculture

19. Negros Earthquake
Magnitude 6.7
February 6, 2012
48– dead
48–
92- missing
92-
P266million - damage

20. Pantukan, CompostelaValley,
Pantukan, CompostelaValley,
January 5, 2012
25 dead – 16 injured – 150 missing

21. MASS CASUALTY INCIDENTS

22. 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.

23. 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.

24. Based on experience:
• The name of the game in MCI is OCCCC:
– Organization
– Command
– Control
– Coordination between emergency agencies
– Communication

25. • 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.

26. 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

27. Conventional Mass Casualty in
Urban Areas
• Short duration
• Short distance = ambulance availability
• Scoop and Run= (AW and Bleeding)

28. Mass Casualty in Rural Areas
• Extended period of arrival
• Treatment according to PHTLS
• Evacuation according to medical priorities
• Helicopters- best means of transportation

29. 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

30. 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

31. Tip
• Dispatch and Control Centers and Teams should have:
• Easy to forget specific tasks when working under stress
or pressure.

32. 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

33. Immediate Phase
Only urgent and life-saving procedures
are performed.

34. Medical Treatment at the Scene
• Airway Management
• Ventilation or Oxygen Supplementation
• Relief of Tension Pneumothorax
• Treatment massive bleeding wounds from
extremities

35. 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

36. Manager’s Actions
• Remove from danger
• Utilize forces and provide first aid to
victims
• Report to level in charge
• Join medical care providers

37. Second Phase
Medical treatment will be provided to the severely
injured based on medically defined priorities

38. 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

39. Manager’s Action
• Gather casualties
• Maintain continuous
contact with medical
care providers

40. 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)

41. Ambulance Evacuation Helicopter Evacuation
Third Phase
Casualties prepared for evacuation
and evacuated

42. Manager’s Action
• Call Evacuation
• Land helicopter

43. • In all events, COORDINATION between acting agencies
is the most important factor.
• Without it, there is NO CHANCE of providing OPTIMAL
CARE

44. Practice makes Perfect
• Planning and practicing at calm times,
greatly increases the chance that forces
will collaborate and function well under
emergency conditions.

45. 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?

46. 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.

47. 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

48. 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

49. 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.

50. Action Priorities
• Governance
• Risk Identification
• Knowledge
• Reduce the underlying risk factors
• Strengthen Disaster Preparedness
for Effective Response

51. Disaster
Problem Solution
• 1. Mismatch • 1. Maximize your capacity
• 2. Chaos by teamwork
• 2. Bringing order by
working together as a
TEAM.

52. Mismatch?

53. carlosprimerogundran@yahoo.com