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:
disruption occurr ing on a scale
suff i c i ent to require outside assistance; A disaste r is an event located in of t ime and space which produces structure and process of socia l
condi t i ons
It
is
an event or ser i es
dis rupts
normal
act i v i t i e s ; Calamitous, distressing, or ruinous effects of a disastrous event (such as drought, flood, fire, hurricane,
war) of such scale that they disrupt (or threaten to disrupt) critical functions of an organization, society
or system, for a period long enough to significantly harm it or cause its failure. It is the consequences of a disastrous event and the inability of its victims to cope with them that constitute a disaster, not the event itself. Although there is no universally accepted definition of a disaster, the following observation by the US disaster relief specialist Frederick C. Cuny (1944-1995) comes close, "A situation resulting from an environmental phenomenon or armed conflict that produced stress, personal injury, physical damage, and economic disruption of great magnitude." The definition adopted by the World Health Organization (WHO) terms a disaster as "The result of a vast ecological breakdown in the relations between man and his environment, a serious and sudden (or slow, as in drought) disruption on such a scale that the stricken community needs extraordinary efforts to cope with it, often with outside help or international aid." The US Federal Emergency Management Agency (FEMA) describes it as "An occurrence of a natural catastrophe, technological accident, or human caused event that has resulted in severe property damage, deaths, and/or multiple injuries." Dr. Kathleen J. Tierney (Director, Disaster Research Center, University of Delaware) puts the matter in a different perspective: "Many people trying to do quickly what they do not ordinarily do, in an environment with which they are not familiar."
The magnitude of the effects of the event will be viewed differently. DISASTERS ARE CLASSIFIED IN VARIOUS WAYS
Natural disaste r s and Man made disas ters Sudden disas ter s and Slow onset disaste rs
l i ne
disasters
is ACTIVITIES imprecise .
RELATED TO MAN MAY EXACERBATE NATURAL DISASTERS DISASTER MEANS SUDDEN OR GREAT MISFORTUNE
Although experts may differ in their definitions of disaster, many public health practitioners would characterize a disaster as a "sudden, extraord inary calamity or catast rophe, which affects or threatens. heal th" DISASTERS INCLUDE
FIRES EARTHQUAKES SEVERE AIR POLLUTION (SMOG) HEAT WAVES EPIDEMICS BUILDING COLLAPSE TOXICOLOGICAL ACCIDENTS, (E.G. RELEASE OF HAZARDOUS SUBSTANCES NUCLEAR ACCIDENTS EXPLOSIONS CIVIL DISTURBANCES WATER CONTAMINATION FOOD SHORTAGES TORNADOES/HURRICANES/FLOODS/SEA SURGES/TSUNAMIS SNOW STORMS/LANDSLIDES )
EFFECTS OF MAJOR DISASTERS DISASTERS throughout history have had significant impact on the numbers, health status and life style of populations.
Deaths Severe in j u r i e s , requi r i ng extens ive treatments
Increased r i sk of communicable diseases Damage to the heal th fac i l i t i e s Damage to the water systems; Food shortage Populat i on disp lacements
Communicable diseases Cl imat i c exposure Mental heal th Damage to heal th in f ras t r uc ture
Appropr i a te
in j ury ,
and
Morbid i t y
and mortal i t y
according to the
type and locat i on of the event requi res specia l i z ed response. In any disas ter , prevent i on should be di rected towards reducing
1) 2)
THEREFORE,
Losses due to the disaste r event i t se l f Losses resul t i ng f rom Mismanagement of disaster rel ief . the
THE
PUBLIC
HEALTH
OBJECTIVES :
OF
DISASTER
Prevent unnecessary morbidity, mortality, and economic loss resulting directly from the disaster.
2.
Eliminate morbidity, mortality, and economic loss directly attributable to Mismanagement of disaster relief efforts.
NATURE AND EXTENT OF THE PROBLEM Morbidity and mortality, which result from a disaster situation, can be classified into four types:
1. 2. 3. 4. Injuries, Emotional stress, Epidemics of diseases, Increase in indigenous diseases.
THE RELATIVE NUMBERS OF DEATHS AND INJURIES DIFFER ON THE TYPE OF DISASTER : -
INJURIES usual l y
exceed deaths
in
explos ions ,
typhoons,
hurr i canes,
fi re
famines, tornadoes, and epidemics. DEATHS f requent ly exceed in ju r i e s in lands l i des , avalanches,
volca
erupt ions , t ida l waves, f l oods , and earthquakes. DISASTER VICTIMS often exhib i t SYNDROME. The syndrome emotional stress or the " DISASTER SHOCK" of successive stages of shock,
consists
suggestibility, euphoria and frustration. Each of these stages may vary in extent and duration depending on other factors. EPIDEMICS are included in the definition of disaster; however, they can also be the result of other disaster situations. DISEASES, which may be associated with disasters, include
flu H1N1).
speci f i c
and cholera), vector borne illnesses (e.g. plague and malaria), diseases spread by person-to-person contact (e.g., hepatitis A, shigellosis) Diseases spread by the respiratory route (e.g., measles & influenza, Swine
medicine can lead to a significant reduction in the threat of epidemics following disaster. Immunization programs are rarely indicated as a specific post disaster
measure.
diseases indigenous to the area if there is disruption of medical and other health facilities and programs.
Ideally, attempts to mitigate the results of a disaster would not add to the negative consequences; However, there have been many instances in which inappropriate and/or incomplete mortal i ty , and a waste of resources .
Many of the Causalities and much more of the Destruction occurring to natural disaster are due to ignorance and neglect the part of the individuals and on public authorities. MANY OF THE MISMANAGE NT PROBLEMS TEND TO RECUR ME
Physi c i ans and nurses have been sent into disas ter
.
areas in numbers
far in excess of actual need. Medical and paramedical personnel have often been hampered by the to the disaste r si tuat i on
resul t i ng
the importat i on
In a study of past disaster mismanagement problems and their causes, these problems were categorized as follows:
1. Inadequate apprai sa l of damages
2
2. 3.
4. 5.
6.
DISASTER RELIEF
The Petroleum Depot Fire has not been identified by any of the Districts in Rajasthan in their Disaster Management Plan.
The lack of Fire Fighting Resources with Indian Oil, Hindustan Petroleum, Bharat Petroleum, Airport Authority, Nagar Nigam and JDA were noticeable. As per Mr. Gopal Prasad Gupta, President, Rajasthan Builders & Promoters Association, they have contributed over Rs. 15 Crore to the kitty of Nagar Nigam towards fire safety of Multi Storied Buildings; however, the funds are misappropriated towards salary and allowances of the staffs.
Indian Oil Corporation Limited failed to use the fire fighting resources.
An effective plan for public health and other personnel during a disaster would outline activities designed to minimize the effects of the catastrophe. These efforts can be summarized as closely situation analysis
and response; the two types of activities are interrelated. Although many relief workers may be needed to obtain surveillance information, analyze the data, provide relief services, evaluate results, and provide information to the public , it is essential that a single person with managerial experience be placed in absolute charge of the entire disaster relief operation. Following a disaster, the desire to provide immediate relief may lead to hasty decisions which are not based on the actual needs of the affected population. The disaster relief managers can determine the actual needs of the population and make responsible relief decisions. Reliable information must be obtained on problems occurring in the disaster stricken area, relief resources available and relief activities already in progress. For this, a surveillance system must be set up immediately . The object i ve of Survei l l ance in a disaster is to obtain information si tuat i on
7 6 5
required for making relief decisions. The specific information required would vary from disaster to disaster, but a basic, three -step processes includes: 1) 2) 3) Collect data, Analyze data, Respond to data.
What problems are occurr i ng? Why are they occurr i ng?
There was no regular bulletin disseminating information on disaster on any of the local TV channels.
As all kinds of disasters require immediate rescue and Medical Relief, thus Vice-Chancellor Rajasthan University of Health Sciences, Jaipur should be in-charge of Disaster Relief Management. All major Hospitals should be nodal centre for Disaster Relief Management.
The CGM BSNL and MOBILE SERVICE PROVIDERS must be part of Disaster Relief Management team to establish communication facilities or help lines, if required.
Where are problems occurr i ng? Who i s af fec ted? What problems are causing the greates t morbidi ty
What problems are increas ing or decreas ing? What problems wi l l What problems wi l l What re l i e f subs ide on thei r own? increase i f unattended?
act i v i t i e s act i v i t i e s
in fo rmat ion
needed for
After answering such questions one can carry out the third part, i.e., planning an appropriate Response to the situation described in the surveil lance data. In developing this plan one will decide what types of relief responses are appropriate and what the relative priorities are among the relief activities. This 3-step process of Data Collect ion, and their effects. SURVEILLANCE FOLLOWING A DISASTER EVOLVES IN PHASES: 1. 2. 3. IMMEDIATE ASSESSMENT The object of this phase of surveillance is to obtain as much general information as possible and as quickly as possible. THE MOST BASIC FOLLO WING : INFORMATION NEEDED AT THIS POINT IS THE Immediate Assessment Short term assessment Ongoing Surveillance Analysis and Response can be
1) 2) 3)
The geographical extent of the disaster-stricken area, The major problems occurring in the area, The number of people effected.
This information can be obtained by whatever means seems most efficient. Listening carefully and asking questions is the best way to begin. An Arial survey may be useful in defining the geographical extent of the disasterstricken area and in observing major damage and destruction. Census data can be examined to determine how many people previously lived in the disaster-stricken area and thus were at risk. HOSPITALS , CLINICS, AND MORGUES, which were in operation, may be able to obtain numbers of known deaths and injuries. It is useful to determine the most frequent causes of deaths and types of injuries in order to predict whether demands for medical care will be increasing or decreasing. Some problems likely to occur after a disaster can be predicted according to past experience with that particular type of disaster. For example, experience has shown that disruption of water supplies
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earthquakes. New types of disasters, such as chemical emergencies and nuclear accidents10, still present many unknown problems. SHORT-TERM ASSESSMENT The short-term assessment involves more systematic methods of collecting data and is likely to result in more detailed reliable information on problems, relief resources, and relief information on problems, relief resources and relief activities in progress. One way to organize data collection during this phase of assessment is to divide the disaster-stricken area into smaller areas or "blocks" to be surveyed simultaneously by different workers or teams of workers. Simple reporting
One of the most atrocious Disaster Management Decision taken by the district administration was to close down all Petrol Pumps in five kilometer area without making alternative arrangement for supply of Diesel to the Hospitals which were running on DG sets in the absence of electricity supply.
The Public Health Engineering Department must have a Disaster Management Plan. One of the actions could be to have under ground/above ground storage tanks in addition to overhead tanks. There must be parallel arrangement for supplying water directly from tube well into the domestic water supply line.
10
KOTA, RAWAT BHATA must have disaster management plan to deal with such situations.
mechanisms (formats) can be developed and workers sent out to survey the different areas and report at a specified time. The following is a list of Information, which may be needed in order to make relief decisions
The geographica l
other clear boundaries. The number of persons known to be dead. The estimated number of
persons severely injured requiring medical care, possibly according to age group, sex, and type of injury or medical problem. Location and condition of health facilities, estimates of medical personnel, equipment's and supplies available.
which are still habitable. Condition and extent of water and food supply. Condition of schools, churches, temples and other public buildings etc. and
also condition of roads, bridges, communication facilities and public utilities. Description of relief activities already in progress (E.g. search and
ONGOING SURVEILLANCE Depending on the factors above, Short-Term Assessment12 may take 5-6 hours or up to 2-3 days. ASAP relief priorities should be determined; and full scale relief activities initiated. Once appropriate relief is in progress, surveillance becomes an ongoing system. When ongoing surveillance information is analyzed new problems may require attention, coordination with different agencies to prevent duplication of relief efforts. A rel ief plan developed during any of the surveil lance cycle may
11
Either we should do away with naming the streets with names of persons living or dead, or alternatively should have a parallel system of streets and avenues so that even a first timer to the city in a rescue team can find his way.
12
The assessment should be immediately put in public domain to (a) avoid panic and (b) sourcing help like rare blood group donors and services of specialists.
El iminat i on of physica l
Evacuat i on of the populat inuclear and chemical emergencies ) on ( Provision of off- site preventive and routine medical care Provision of water, food, clothing, shelter Disposal of human waste Control of vector born diseases
MASS CASUALTY MANAGEMENT MANAGEMENT OF MASS CASUALTIES IS DIVIDED INTO THREE MAIN AREAS 1. PRE-HOSPITAL EMERGENCY CARE
Search and Rescue First Aid Field Care Stabilization of the victims Triage13 Tagging
14
Triage (pronounced /tri/) is a process of prioritizing patients based on the severity of their condition. This rations patient treatment efficiently when resources are insufficient for all to be treated immediately. The term comes from the French verb trier, meaning to separate, sort, sift or select. There are two types of triage: simple and advanced. The outcome may result in determining the order and priority of emergency treatment, the order and priority of emergency transport, or the transport destination for the patient, based upon the special needs of the patient or the balancing of patient distribution in a mass-casualty setting.
14
The Disaster Management Act, 2005 envisages that every State Government, in turn, is
to establish a District Disaster Management Authority for every district in the State with the
10
The objectives of the disaster preparedness is to ensure that appropriate systems, procedures and resources are in place to provide prompt, effective assistance to disaster victims, thus facilitating relief measures and rehabilitation services. Disaster preparedness is an ongoing, multi-sectoral activity to carry out the following activities;
Adopt standards and regulations Organize communication, information and warning systems Ensure coordination and response mechanisms Adopt measures to ensure that financial and other resources are available for increased readiness and can be mobilized in disaster situations.
Develop public education programs Coordinate information sessions with news media Organize disaster simulation exercises that test response mechanisms
For the Health Sectors Disaster Preparedness plan to be successful , clear mechanisms for coordinat ing with other sectors Health Disaster The and Coordinator is in charge of preparedness activities and coordinating plans with:
Govt. Agencies Foreign Relations- UN, UNICEF, WHO & other international agencies NGOs- Red Cross etc. Those responsible for power, communication, Housing, water services etc. Civil Protection agencies-Police, Armed Forces
EMERGENCY PREPAREDNESS
District Collector as the Chairperson and such number of other members, not exceeding seven. The District Authority is to act as the district planning, coordinating and implementing body for disaster management and take all measures for the purposes of disaster management in the district in accordance with the guidelines laid down by the National Authority and the State Authority. However, the information on JAIPUR District Disaster Management Authority is missing from the state website. http://www.rajrelief.nic.in/ddmplan/ddmp.htm
15
SHOCKINGLY FIRE FROM AN OIL DEPOT WAS NOT IDENTIFIED AS POTENTIAL DISASTER.
11
1.
Typhoons, Tsunamis;
Natural
Disasters :
Earthquakes,
Floods ,
Cyclones,
2. 3.
Sarin19;
Bio- Terrorism Agents: Anthrax, Plague, Smal lpox; Chemical Emergencies: Ricin16, Phosgene 17, Bromine18,
4. 5. 6.
Radioactive Emergencies: Mass Trauma: Explosions, Blasts, Burns, Injuries Recent Outbreaks and Incidents: Bird flu, SARS, West
is possib le minimize or mitigatetheir damage effects. Mitigation measures to aim to reduce the Vulnerability of the System [e.g. by improving & enforcing
building codes etc.]
damages from a hazard, but it is not realistic in most hazards. [e.g. Relocating a
population from a flood plain or from beach front]
16
Ricin (pronounced /ra sn/) is a protein that is extracted from the castor bean (Ricinus
communis). It can be either a white powder or a liquid in crystalline form. Ricin may cause allergic reactions, and is toxic, though the severity depends on the route of exposure. The U.S. Centers for Disease Control (CDC) gives a possible minimum figure of 500 micrograms (about half a grain of sand) for the lethal dose of Ricin in humans if exposure is from injection or inhalation.
17
Phosgene is the chemical compound with the formula COCl2. This colorless gas gained infamy as a chemical weapon during World War I, and is also a valued industrial reagent and building block inorganic synthesis. In low concentrations, its odor resembles freshly cut hay or grass. Some soldiers during the First World War stated that it smelled faintly of May Blossom. In addition to its industrial production, small amounts occur naturally from the breakdown of chlorinated compounds and the combustion of chlorine-containing organic compounds. Bromine (pronounced /bromin/ BROH-meen or /bromn/ BROH-min, from Greek: , brmos, meaning "stench (of he-goats)"), is a chemical element with the symbol Brand atomic number 35. A halogen element, bromine is a reddish-brown volatile liquid at standard room temperature that is intermediate in reactivity between chlorine and iodine. Bromine vapors are corrosive and toxic. Approximately 556,000 metric tonnes were produced in 2007. The main applications for bromine are in fire retardants and fine chemicals.
18 19
Sarin, also known by its NATO designation of GB, is an extremely toxic substance whose sole application is as a nerve agent. As a chemical weapon, it is classified as a weapon of mass destruction by the United Nations in UN Resolution 687. Production and stockpiling of Sarin was outlawed by the Chemical Weapons Convention of 1993.
12
reduced by improving the Structura or Pr ivate System bui ld ingsOF SAFETY , etc. Mitigation
and Publ i c
FACILITIES,
Sewerage
complements the Disaster Preparedness and Disaster Response activities. A SPECIALISED UNIT WITHIN THE NATIONAL COORDINATE HEALTH THE DISASTER OF
MANAGEMENT
PROGRAM
SHOULD
WORKS
Heal th , Publ i c Heal th & Hospi ta l Publ i c Pol i cy Water Systems Engineer ing & Archi tec ture Planning, Educat i on etc . Civi l Defense
Adminis t ra t i on
1. 2.
Ident i f y areas exposed to Natural /Man- made Hazards and determine of key heal th fac i l i t i e s the work of codes Disaster Mult i and water systems teams in in the designing f rom and &
developing damages.
bui ld i ng
dis t r i but i on
planning
3.
vict ims.
Identify priority hospitals and critical health facilities that comply with current building codes and standards.
4. 5.
facilitys maintenance plans. Inform, sensitize and train21 those personnels who are involved in
planning, administration, operation, maintenance and use of facilities about disaster mitigation. Promote the inclusion of Disaster Mitigation in the curricula of
20
All hospitals must necessarily b equipped with Diesel Generating sets and keep stock of diesel for minimum seven days.
21
HCM (RIPA) should not only train Government Servants but also citizens about disaster mitigation
13
Professional training institutes, such as MNIT, SMS Medical College, and Nursing Colleges.
Treatment of in j ured Ident i f i c a t i on and disposal of dead bodies Epidemiolog i ca l surve i l l ance and disease contro l
Basic sani ta t i on and sani ta ry engineer ing Heal th management in shel te r s or temporary sett l ements Train i ng heal th personnel and the publ i c Logis t i ca l resources and support
i.
ii. iii .
Simulat i on exerc i ses /Mock Exerc i ses Desktop simulat i on exerc i ses [war games] Fie l d exerc i ses Dri l l s designed to impart ski l l s
EPIDEMIOLOGIC
SURVEILLANCE
AND DISEASE
CONTROL:
Natural
disasters may increase the risk of preventable diseases due to adverse changes in the following areas
Populat i on densi ty Populat i on disp lacement Disrupt i on and contaminat i on of water supply and sani ta t i on serv i ces Disrupt i on of publ i c heal th programs Ecologi ca l changes that favor breeding of vectors
Displacement of domestic and wi ld animals Provi s i on of emergency food, water and shel te r in disaste r si tuat i on
THE PRINCIPLES OF PREVENTING AND CONTROLLING COMMUNICABLE DISEASES AFTER A DISASTER ARE TO2 2 ;
al l
publ i c
heal th
measures to
reduce the r i sk
22
Looking at important role of health services in post disaster management, all Government Hospitals and Dispensaries should be the nodal point for Disaster Management Activities.
14
si tuat i on may prevent unnecessary dispers i on of scarce resources and disrupt i on of normal progress .
ENVIRONMENTAL HEALTH MANAGEMENT Post disaster environmental health measures can be divided into two priorities
1.
water ,
Ensur ing
that
there
are
adequate
amounts
of
safe
dr ink ing
disposal
of excreta ,
2.
vector contro l Water Supply
measures,
establ i sh i ng
or cont inui ng
Food Safety Basic Sani tat i on and Personal Hygiene Sol i d Waste Management Vector Contro l Bur ia l of the Dead
EVALUATION In the case of disaster management, the Evaluator wil l be look ing at
actual" verses the "desired" on two levels, i.e. the overall outcome of disaster management efforts and the impact of each discrete category of relief efforts. (Provis ion of food, shelter, management of communications etc) A critical step in the management of any disaster relief is the setting of objectives, which specify the intended outcome of the relief. The general objectives of the disaster mortal i t y management will be the
15
of
the
"actua l "
with
"desi red"
is
the
first
cr i t i c a l
the object i ves were met, those who have part i c i pa ted in the re
have demonstrated that they have accomplished what they set out to do. On the other hand, if the objectives were not met, it is desirable for those conducting the evaluation to continue with the evaluation process, identify the reasons for the discrepancy and suggest corrective action. SIMULATED DISASTER PREPAREDNESS OPERATIONS should be
undertaken to test the var ious components before actual need ar ise . EVALUATION OF THE HEALTH DISASTER MANAGEMENT PROGRAM
Evaluat i on of the preparedness program Evaluat i on of the mitigat i on measures Evaluat i on of the tra i n i ng
PREVENTION OF DISASTERS EXISTING KNO WLED GE THAT MIGHT REDUCE THE . UNDESIRABLE
Requirement of protect i ve cel lars / she l te rs in disaster prone areas. A Seismic housing code for earthquake- prone area. Str i c t procedural code fol l owed to prevent Nuclear , Toxicologica l and
Chemic
disasters . Early warning systems and Disaster preparedness which wil l help to
minimize
morbidi ty ,
CONCLUSION Disasters loss .Public have resul ted is in signi f i c ant with morbid i ty , two mortal i t y in and
econ
health
concerned
objectives
disaster
management;
23
Despite experiencing Disaster in 1981 floods and periodic noises by people, media, courts; the civil administration controlled by land mafia has allowed construction of houses and Multi Storied flats in Amani Shah Nala.
16
the el iminat i on of the preventable consequences of the disas ter The prevent ion of losses due to disaste r mismanagement.
Through study of the past disasters, their effects and their relief efforts [what
has been effect ive and what have been mismanaged]
better
plans as for
are
now
avai lab le
for
effect i ve
disaster
management as wel l
the reduct io
preventable losses .
The country wi l l
Any Disaster is an emergency situation and the health sector alone cannot
tackle it in isolation.
It must have Coordination with the local community, civil defense, army,
police, FIRE BRIGADE and with various governmental and non-governmental bodies including voluntary organizations like Red Cross.
1.
17
2. 3. 4.
Wikipedia Disaster Management & Relief Department, Government of Rajasthan http://www.rajrelief.nic.in/ The Disaster Management Act, 2005
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