TRANSPORTATION AND HOSPITAL EMERGENCY CARE, EFFECTS OF DISASTERS CONSEQUENCES OF DISASTERS ON HEALTH SERVICES DISASTERS AND HEALTH SECTOR RISK OF A DISASTER Role of Hospitals in Disasters/ Mass Casualty Incident (MCI) MENTAL HEALTH WAYS MANAGE YOUR STRESS FRAMEWORK FOR HEALTH PROFESSIONALS DISASTER MANAGEMENT PLAN HOSPITAL NETWORKING INCIDENT COMMAND SYSTEM

1. TRANSPORTATION AND HOSPITAL
EMERGENCY CARE
S T A T E L E V E L C O N F E R E N C E O N D I S A S T E R
M A N A G E M E N T
P.S E LVA R A J.M .S C (N U R S IN G )
A S S O C IAT E
P R O F E S S O R IN P S Y C H IAT R IC
N U R S IN G
S C O N
S A L E M

2. Definition
A serious disruption of the
functioning of the society, causing wide
spread human, material, or
environmental losses which exceed the
ability of the affected society to cope
using its own resources

3. VULNERABILITY
Definition
“The extent to which a
community, structure, service, or
geographical area is likely to be
damaged or disrupted by the
impact of a particular hazard

4. HAZARD
A naturally occurring or
man-made condition or
phenomenon that
presents a risk or is a
potential danger to life or
property

5. EFFECTS OF DISASTERS
Health Problems Might Be Related To
1. Food and Nutrition,
2. Water and Sanitation,
3. Mental Health,
4. Climatic Exposure
5. Shelter,
6. Communicable Diseases,
7. Health Infrastructure and
8. Population Displacement.

6. CONSEQUENCES OF DISASTERS ON
HEALTH SERVICES
1. DAMAGE TO HEALTH INFRASTRUCTURE
• water supplies and sewage systems
• Provision of medical care to the population
• Structural damage
• The supply chain (medical equipment and
pharmaceutical supplies)
• Limited road access
• Pre-hospital coordination and communication

7. 2. INCREASED DEMANDS FOR MEDICAL
ATTENTION
• Climatic exposure because of rain or cold
weather
• Inadequacy of food and nutrition exposes
the population
• If there is a mass casualty incident, health
systems can be quickly overwhelmed and
left unable to cope with the excessive
demands.
• Additional stress and demand

8. DISASTERS AND HEALTH SECTOR
 In major disasters, the health sector has a
vital role particularly in the first seventy-
two hours.
 The organization of health services in a
country is a key element in facilitating
preparedness planning and effective
response.

9. THE HEALTH SECTOR DISASTER
MANAGEMENT PLAN
•Organization structure,
• Relationships and
•referral network of existing
health services

10. HEALTH TEAM MEMBERS
• DOCTORS
• NURSES
• OPERATION THEATRE STAFF
• PHARMACIST
• PHYSIOTHERAPISTS
• MEDICAL SOCIAL SERVICE
• LAB TECHNICIANS
• AMBULANCE DRIVERS
• SANITATION ATTENDERS

11. KEY ELEMENTS OF DISASTER MANAGEMENT:
1. PREVENTION
2. MITIGATION.
3. PREPAREDNESS.
4. RESPONSE AND RELIEF.
5. REHABILITATION.

12. COMPONENTS OF DISASTER HEALTH
SYSTEM
1. Medical response to a disaster area in the
form of teams, supplies and equipment
2. Patient movement from a disaster area to
unaffected areas
3.Definitive medical care at participating
hospitals

13. RISK OF A DISASTER
RISK =HAZARD X
VULNERABILITY -RESOURCES

14. RISK REDUCTION
A. Preparedness:
• Minimizing loss of life,
• Disruption of critical services and
• Damage
• .Preparedness includes
• Development of emergency response plans,
• Effective warning systems,
• Maintenance of inventories,
• Training of manpower etc.

15. • B. Mitigation:
• Mitigation encompasses all measures
taken to reduce both the effect of
hazards itself and the vulnerable
conditions in order to reduce the
losses in a future disaster.

16. EMERGENCY MEDICAL RESPONSE
"TRIAGE"
sorting has been developed called "Special
Triage and Rapid Transport" or START.
The first arriving team at the site
of disaster by ambulance will have the
trained health team who are responsible for
the scene triage. The triage team should
ideally be identified by vests or badges.

17. START
• SIMPLE TRIAGE AND
RAPID ASSESSMENT

18. MASS TRIAGE
M – MOVE
A – ASSESS
S – SORT
S - SEND

19. COLOUR CODES IN TRIAGE
• PRIORITY 1 : (Red)
Critically ill or injured who needs immediate
treatment
• Head injuries,
• Severe burns,
• Severe bleeding,
• Heart-attack,
• Breathing-impaired,
• Internal injuries) are assigned a priority 1 or "red" triage tag
code

20. PRIORITY 2 (YELLOW)
No currently life threatening illness or
injury, but potentially life threatening if care
is delayed.
Not immediately life-threatening) injuries
(such as fractures) are assigned a priority 2 in
the Triage tag code.

21. PRIORITY 3 (GREEN)
Non urgent condition that will require
medical attention but not immediate treatment
• "Walking-wounded“ Victims
• Meaning Delayed treatment/Transportation.
• To Await Delayed Evaluation And Transportation.

22. PRIORITY 4 (BLUE)
• Those victims with critical and
potentially fatal injuries or illness
are coded priority 4 or "Blue"
indicating no treatment or
transportation.

23. PRIORITY 5 (BLACK)
• Dead or no chance of surving before
reaching hospital
• Victims who are found to be clearly
deceased at the scene with no vital signs
and/or obviously fatal injuries are classified
as deceased or priority 5 (Black) in the
triage coding system.

24. ROLE OF HOSPITALS IN DISASTERS/
MASS CASUALTY INCIDENT (MCI)
• Provide 24x7 emergency care service
• Diagnosis,
• Treatment and
• Follow-up for both physical and psychological
care.
• Hospitals are central to provide emergency
care and hence when a disaster strike.

25. MASS CASUALTY INCIDENT (MCI)
• Resources, transportation, access and physical
environments are often disrupted during a
disaster.
• Emergency medical care that should be given
immediately to the affected population. An MCI’s
efficient management requires the pre-
establishment of basic guidelines and principles
of an Incident Command System (ICS), triage
and patient flows according to the hospital’s
plan.

26. INCIDENT COMMAND SYSTEM
Major components
• Incident command;
• Operations;
• Planning;
• Logistics; and
• Finance

27. INCIDENT COMMAND
• Set objectives and priorities
• Maintain overall
Command
Center
Defines the
mission and
ensures its
completion

28. OPERATIONS
• Carries out the medical objective
to the best of the hospital’s
ability.
• Direct resources
• Oversee
decontamination
and waste control

29. PLANNING
• Determines and provides for the continuance
of each medical objective. Prompts and drives
all HEICS officers to develop short- and long-
range action plans
• Develop action plan
• Collect information
• Maintain resource status

30. LOGISTICS
• Provides for a working environment and
adequate materials to meet the overall
medical objective
• Provide resources
and support to
meet incident
needs

31. FINANCE
• Provides funding for present medical objective
and stresses facility-wide documentation to
maximize financial recovery and reduction of
liability
• Monitor costs
• Track accounting
figures

32. Hospital EmergencyIncident CommandSystem
HEICS
PublicInformationOfficer LiaisonOfficer
SafetyandSecurityOfficer
DamageAssessment and
Control Officer
SanitationSystems
Officer
Facilities
Unit Leader
CommunicationsUnit
Leader
TransportationUnit
Leader
MaterialsSupplyUnit
Leader
Nutritional Supply
Unit Leader
LogisticsChief
Situation-Status
Unit Leader
Labor Pool
Unit Leader
Medical Staff
Unit Leader
Patient Tracking
Officer
Patient Information
Officer
Nursing
Unit Leader
PlanningChief
Time
Unit Leader
Procurement
Unit Leader
Claims
Unit Leader
Cost
Unit Leader
FinanceChief
Medical Staff
Director
Surgical Services
Unit Leader
Maternal Child
Unit Leader
Critical Care
Unit Leader
General Nursing
CareUnit Leader
Out Patient Services
Unit Leader
In-Patient Areas
Supervisor
Triage
Unit Leader
Immediate Treatment
Unit Leader
DelayedTreatment
Unit Leader
MinorTreatment
Unit Leader
Discharge
Unit Leader
Morgue
Unit Leader
Treatment Areas
Supervisor
Medical Care
Director
Laboratory
Unit Leader
Radiology
Unit Leader
Pharmacy
Unit Leader
Cardiopulomonary
Unit Leader
AncillaryServices
Director
Staff Support
Unit Leader
Psychological Support
Unit Leader
Dependent Care
Unit Leader
HumanServices
Director
OperationsChief
Incident Commander

33. HEICS
• A dependable chain of command
• Improved communication through
common language
• Flexibility
• Prioritization of tasks
• Organized documentation system
• Effective mutual aid planning

34. HEICS TOOLS
• Organization chart
• Job Action Sheets
• Forms

35. JOB ACTION SHEETS
• Your disaster response job
descriptions
• Tell you
• What you are going to do
• When you are going to do it
• To whom you are going to report it
after you have done it.

36. TRANSPORTATION OF VICTIMS
• Transportation Officer
• Emergency Medical Officer
CATEGORIZE
level I and II Trauma Centers
within a "golden hour"

37. VEHICLES
Ambulances for lying cases
• Trucks,
• Lorries And
• Buses With Adequate stretcher fitments.
Vehicles for First Aid Parties and sitting
casualties
• Private cars, vans, taxies,
• Tempos and other similar light vehicles

38. CASUALTY PREDICTOR
DISASTER PARADIGAM
D - DETECT
I – INCIDENT COMMAND
S – SCENE SECURITY AND SAFETY
A – ASSESS HAZARDS
S – SUPPORT
T – TRIAGE
E – EVACUATION
R - RECOVERY

39. CATEGORIZATION
• Number of casualties coming to a hospital the
ability of the hospital to cope
• The number of doctors and nurses available and
the availability of supplies and support services.
• Hospital Treatment Capacity (HTC),
• Hospital Surgical Capacity (HSC

40. A)Hospital Treatment Capacity (HTC)
The one hour window begins the first
casualty arrives at the hospital.
Total expected casualties = (Number of
casualties arriving in one hour window) x 2
B)Hospital Surgical Capacity (HSC)
it is the number of seriously injured patients that
can be operated upon within a 12-hour period

41. CATEGORY A: PATIENTS IN CRITICAL
CONDITION
• Include cases of poly trauma
with head injuries, thoracic injuries,
abdominal injuries, fractures of
major bones with profuse bleeding
etc.

42. CATEGORY B
Patients in serious but not life threatening
condition
• Include polytrauma cases of a less serious
nature,
for example, fractures and crush injuries
of limbs with out major blood loss, facial injuries,
spinal injuries, etc.

43. CATEGORY C: WALKING
WOUNDED
• These patients may have minor
injuries requiring dressing or limb
fractures requiring closed reduction
and immobilization.

44. CLASS
• Class A:without any disruption to the normal and
routine work of the institution.
• Class B:with minor disruption to the day to day
functioning of the hospital and with some
readjustments. The plan may be upgraded to C if
the numbers of casualties increase.
• Class C:definite disruption of routine work: Major
readjustments would be required in hospital
functioning

45. HOSPITAL NETWORKING
1. Information
2. Materials
3. Manpower
4. Training

46. DISASTER EXPECTED INJURY
PATTERN
• Drought heat exhaustion,
• Stroke,
• Dehydration,
• Renal failure,
• Malnutrition and starvation
• Earthquake fractures,
• Blunt trauma,
• Wounds, crush syndrome
• Epidemic specific to type of infectious disease

47. • Temperature extremes hypothermia,
• Hyperthermia,
• Frostbite,
• Heat stroke slide blunt and penetrating trauma,
• Crush syndrome,
• Fractures,
• Severe burns,
• Crush injuries,
• Respiratory infections/complications

48. • Waterborne communicable diseases
• Windstorm blunt/penetrating trauma to
head/chest (caused by flying debris),
• Blast injury,
• Chemical burns,
• Illness from biological warfare,
• Amputations

49. FRAMEWORK FOR HEALTH PROFESSIONALS
DISASTER MANAGEMENT PLAN
The disaster management plan could be
developed within the comprehensive phases
of disaster management.
• General preparedness
• Warning
• Response
• Recovery

50. PREPAREDNESS PHASE
• Development of plans and procedures to manage in
the event of a disaster
• Procurement and storage of essential supplies
equipment and material
• Inventory of recourses and maintenance of
equipment.
• Mutual aid agreement to ensure assistance at local
and national level.
• Simulation exercise and drills

51. WARNING
• Dissemination of information the disaster situation
and remind community of safety measures
• Review of emergency procedures and action plan.
• Ensuring the system is in place and working.
• Supervision of evacuation of high risk and
individuals and groups to shelters.
• Security of health facilities to reduce vulnerability

52. RESPONSE
• Immediate damage/ needs assessment
• Management of casualties
• Evacuation / referrals
• Coordination of health status and volunteers
• Health care in shelters
• management of maternal pediatric and medical
surgical emergencies.
• Collecting and dissemination of information
• Monitoring of environmental health and safety

53. RESPONSE
• Collection and dissemination of information
• Monitoring of environmental health and
safety
• Epidemiological surveillance
• Public health information/ education
• Emotional/ psychological support to health
staff and community members

54. RECOVERY
• Continued damage/ needs
assessment
• Restoration of normal health services
• Rehabilitation of health
• Documentation of health sector
response and experiences

55. MENTAL HEALTH
1. Distress and depression
2. Intrusive memories of the disaster
3. Flashbacks of upset felling
4. Intense distress at reminders
5. Irritability, blunting of feelings
6. Lack of interest in pleasurable activities
7. Troubling dreams, insomnia and poor
concentration

56. FUNCTIONS OF EMERGENCY CASUALTY
1. To attend to all patients brought to the department and
appropriate management, which includes
• Immediate resuscitation
• First aid
• Emergency investigations
• Hospitalization
• Referral to specific speciality
• Observation of patient to decide
• Reassurance and short counselling

57. 2.To carry out medicolegal formalities
3. To maintain up to date list of critically ill patients
for the purpose of
• Issuing one visit pass to relatives
• Replaying to telephone calls
• Deciding on acceptance or rejection of transfer
of patient from other hospitals
• Assisting in intra hospital transfer

58. 4. To carry out services of nonemergency nature
as per the policy of the organization
5. To maintain list of doctors on emergency duty,
their availability and alternative arrangements if
they are busy
6. To be prepared for mass causalties

59. DISASTER CONTROL ROOM
• In the eventuality of a disaster the
existing casualty would be refereed
as the disaster control room.it
would be manned round the clock
by CMO’s.

60. RAPID RESPONSE TEAM
• The medical superintendent would identify
various specialists, nurses and
paramedical staff to respond within a short
• The list of names of doctors, nurses,
paramedical staffs with their address and
telephone numbers should be displayed in
DCR

61. INFORMATION AND
COMMUNICATION
• To collect
• Coordinate
• Disseminate
Information would be shout
• On time
• Place
• Nature of disaster
• Approximate number of causalities

62. DISASTER BEDS
• Utilization of vacant beds, day care beds,
preoperative beds.
• Elective surgical cases and patents with domiciliary
care or OPD management should be discharged.
• Utility areas to be converted into temporary wards
such as side rooms, corridors, seminar rooms etc.
• Creating additional beds using trolling, folding beds
and floor beds.

63. LOGISTICS SUPPORT SYSTEM
• Resuscitation equipment
• I/V sets, ventflon and i/v fluids.
• Disposable syringes, needles, gloves.
• Dressing materials, suturing materials, splints.
• Oxygen mask, nasal catheters, suction machine
and catheters.
• E.C.G. monitors, defibrillators, ventilators.

64. • Cut down sets, tracheotomy set ,lumbar
puncture tray
• Linen and blankets
• Stretchers , wheel chairs.
• Projective personal kit(HIV Kit)
BLOOD BANK
TRAINING AND DRILLS

65. DOCUMENTATION
• Documentation will be done at the casualty
by CMO and attending health care
professional.
• All the MLC will be recorded as per
institutional police.
• The treatment of patients will get priority
over the paper work.

66. PUBLIC RELATIONS
The medical superitentdent or the
person authorized by him should brief the
Media(Press, Radio, TV)
• List of causality
• Status
• Both in English and local language

67. •Essential services
•Crowd management
/security arrangements
•Disposal of Dead

68. DESIGN OF CASUALTY
• Reception or enquiry counter
• Waiting areas for the relatives
• Space for trolleys and wheel chair
• Space for trolley/stretcher boys and ambulance
driver
• Space for security staff and constable
• Space for administrative medical officer or
administrator and night supervisor
• Space for patient brought dead

69. PERSONNEL INVOLVED IN
EMERGENCY CARE
Staff required:
• Senior physician/surgeon/orthopaedic
surgeon
• Casualty officers
• Specialist doctors
• Nursing staff
• Labour staff

70. PROBLEMS FACED IN CASUALTY
• Poor upkeep of premises
• Poor level of cleanliness
• Shortage of doctors on duty due to rapid turnover
• Delays, long waiting hours
• Conflicts due to poor public relations and stress due to nature
of work
• Sudden shortage of certain items during heavy attendance
• Pressure for hospitalizations in public hospitals for nonmedical
reasons
• Incomplete/poor documentation in medico legal cases
• Non affording critically ill patients brought to private hospital

71. BE PREPARED---- PLAN FOR EMERGENCIES
• Disasters can happen anywhere and at anty
time
• If you are unprepared for disaster, it can shatter
your life
• Expect the unexpected and plan for
• In a disaster, local officials and relief workers
cannot reach every one immediately
• Health may not arrive for hour or days.

72. • You need to be prepared ahead of time
because you won’t have time to shop or search
for the supplies you will need when a disaster
strikes
• By taking the time to create a family disaster
supplies kit, your family will be prepared in the
event of a disaster
• The kit also help children fell more secure
knowing it is there in cause of any emergency

73. DISASTER KIT
- First aid kit and firstaid manual
• Flash light and extra batteries
• Battery operated radio
• Supply of prescription medications
• Credit card and cash
• Identification for each family member
• Matches in a water proof container
• Phone number and a map identifying safe place to go
• Special needs items such as diapers,formula, hearing
aids, spare eye glases are items for other physical needs

74. • Three gallons water per person
• Three days supplies of non perishable food
• Kitchen tools[mechanical can opener, utensils]
• complete change of clothes for each family
member
• Tools and other accessories
• Sanitation and other personel hygiene products
such as toilet paper soap, toothpaste and tooth
brush
• Entertainment such as games, books, compact
discs and tapes with battery operate players

75. NORMAL REACTION TO A DISASTER EVENT
• No one who response to a mass casualty event is a
untouched by it
• Profound sadness, grief, and anger are normal
reaction to and abnormal events
• You may not want to leave the screne until the work
is finished
• You will likely try to override stress and fatigue with
the dedication and commitment
• You may deny the need for rest and recovery time

76. PROTECT YOURSELF
Be aware of
• Personal injury
• Violence
• Abuse/sexual abuse
• Preventable disease

77. WAYS MANAGE YOUR STRESS
• Limit on duty work hours to no more than 12 hours per day
• Make work rotations from high stress to lower stress functions
• Make your work rotation from the scene to routine
assignments as practicable
• Use counseling assistance programs available through your
agency
• Drink plenty of water and eat healthy snacks
• Take frequent, brief breaks from the scene as practicable
• Talk about your emotions to process have seen and done
• Stay in touch with your family and friends

78. CONCLUSION
• Disaster is an emergency situation
therefore coordination of actions
and various departments is an
essential requisite for efficient
management of mass casualties.

79. The lives of millions of civilians are
at risk each time an earthquake, hurricane or
other natural disaster occurs particularly in poor
countries with less developed infrastructures,
high population densities and inadequate
emergency preparedness.
Take care-----------

80. Thanking
you…