Medical management when mother nature is unkind

 Earthquakes
 Floods
 Tsunamis
 Hurricanes
 Cyclones
 Landslides
 Draughts
 Wildfires
 Sea erosions
 The mythical Goddess of retributive justice
 Japanese word meaning “High harbor- wave” means
disaster the world over
 1998 in Papua, New Guinea
 Rocky planet
 Diameter 12,756 kms
 Core 6,900 kms across
 Surrounding mantle 2,900 kms thick
 Protective Lithosphere 80 kms thick and has moving
plates
 Origin a few kilometers below seabed
 Continental plates slipped abruptly
 Stretching over a thousand kilometers
 Sudden formation of 10 meters high cliff
 Tsunami at the speed of 800 kms/hr
 Giant waves originate in deep sea
 Follows submarine earthquakes
 No warning
 No preparedness possible
 Wave speed @ 300 to 600 miles/hr
 No energy lost with distance
 Reach areas remote to epicenter
 Takes 2 to 3 hours after quake for a wave to hit a coast
 Wave height increases as speed decreases near coast
 Shallower the seabed the higher the wave
 Maximum height of wave is 30 Metres
 Coasts close to epicenter affected by speed of wave
 Coasts far from epicenter affected by height of wave
 Waves at maximum height of 30 meters at interval of
10 to 45 minutes
 May last several hours
 Less than 50 feet above sea level
 Within 1 mile of sea shore
 Devastating effect on coastal communities
 Human life, livestock, properties, roads and
landscapes are literally washed away
 Those recovering from first wave have to face
onslaught from successive waves
 Monitoring
 Forecasting
 Warning
 The sea moves back and stays deceitfully calm before
the cataclysmic tsunami waves.

 “Heed this warning and flee for dear life”

 “NONE”, when under an attack of Tsunami waves
 Possible action would have to be a split-second
decision then and there as the situation demands
 Help thyself and others as in an “all for one and one for
all situation”
 Run, to be carried away?
 Hold on to floating objects, to float away?
 Hold on to tall trees, will it stay?
 Run up tall buildings, will it hold?
 Run to hospital, is it there?
 Call anybody, no phone lines?
 “Hit and run” type situation
 Mob hysteria & panic
 Irrational behaviour
 Herd instincts prevail
 Inadequate everything
 High expectations from medical personnel who are
themselves in danger of being affected
 All for one & one for all
 Rescue
 Recovery
 Relief
 Rehabilitation
 Reconstruction
 Repair renewal
 Retrofitting
 First aid to injured and trauma cases
 Remove road blockades
 Re-establish communications, power & water supply
 Maintain morale
 Law and order
 Emergency shelters
 Disposal of human and animal dead bodies
 Control of spread of infectious diseases
 Family separation needs reunion
 Rehabilitation of destitute persons
 Without placing yourself at risk, remove the casualty
from the water
 Make sure that his/her head is kept low, this will
discourage the threat of inhaling one's vomit
 Once on land/boat/floating objects perform mouth -
to- mouth resuscitation
 Wrap them as quickly as possible with a blanket
 Look/Listen or Feel for signs of breathing
 CPR
 Combination of mouth to mouth rescue breathing and
chest compression

 Chest compression to move blood to vital organ like

brain, lungs and heart

 Rescue breathing to oxygenate the blood

 Check signs of life
 Position person on back on hard surface
 Lift chin forward to open airway
 Watch for spontaneous breathing, if nil
 Pinch his nostrils
 Breath into his mouth @ 12 breaths/min
 Completely refill your lung after each breath
 What if still there are no signs of life?
 Begin chest compressions
 Place heel of both hands on lower end of chest bone
 Keep elbows straight
 Lean forward and press making use of your weight
 Push down 1.5 to 2 inches @ 80 –100 times/min
 Between 15 each compressions breath into him twice
 Check for signs of life after every four cycles of 15
compressions and 2 breaths: namely neck pulse,
spontaneous breathing movement and/or cough.
  This is the point where medical aid comes in.

 OK

 From where?

 The available medical aid might have been washed

away in the Tsunami!
 From neighbouring unaffected area

 Accessibility is a problem since roads might have been

washed away
 Peculiar situation & appraisal is difficult
 Mob hysteria interferes with work
 Infrastructure if any remaining is grossly inadequate
 High expectations from medical staff
 All specialists have to assume role of family physician
 All countries : 2, 95, 000
 In India : 10, 749 (3.64% of total)
 In Kerala : 172 (0.06% of total)

 Loss of properties worth Rs:1358.62crores

 First peak:
 seconds to minutes after

 Second peak:
 minutes to hours after

 Third peak:
 days to weeks after
 Drowning
 Injuries incompatible with life
 Post-traumatic complications
 Dehydration
 Starvation
 Fluid electrolyte imbalance
 Complications
 Sepsis
 Multi-organ Failure
 Shortage of drinking water
 Overcrowding in rescue camps
 Unclean physical environment
 Confusions
 Loss of initiative
 Poverty
 Psychiatry problems
 Anger & Apprehension
 Anxiety & Depression
 Insomnia & Exhaustion
 Bereavement & Separation
 ASD & PTSD
 Perceived danger of death
 Disproportionate anticipation of undesirable events
 Substance use disorder
 Women, children, aged & the poor
 Rescue workers and body retrievers
 Media personnel
 Bereaved parents
 Heroes & helpers
 Supervisors & community leaders
 Public relations officers
 News audience – local & global
 Habitual rumor & panic generators
 (Acute Stress Syndrome & Post Traumatic Stress
Syndrome)

 Persistent re-experience of trauma

 Avoidance of reminders of trauma
 Symptoms of dissociation
 Feelings of distress
 Feeling of impairment
 Faecal contamination of drinking water
 Accumulation of garbage
 Breeding of houseflies
 Outbreak & spread of water & vector borne diseases
 Scant regard to personal hygiene
 Debris
 Sewage
 Dead bodies
 Sea organisms
 Flushing of wells
 Allow water to recuperate
 Ground water from aquifer fills the wells
 Test for pH, total dissolved solvents, E.Coli & total
bacterial count
 Chlorinate & allow to remain for 12 hours
 Repeat the methods till repeated retests showed
micro-organisms below permissible limits
 Physical
 Mental
 Social
 Occupational
 Relief camps
 Free food ration
 Temporary shelters
 Medical aid & public health activities
 Maintenance of law & order
 Ensure safety, respite & physiological recovery
 Relieve stress
 Medications
 Provide reality orientation
 Encourage ventilation of feelings
 Educate medical personnel & social workers on
normal responses
 Care of orphaned people
 to minimize loss of life/property in the next tsunami

 Prediction
 Preparedness
 Prevention
 Planning
 Protection
 Promotion
 Publicity
 Participating
 Partnership
 Coastal protection from tidal wave intrusions
 Shelter forestry as cushion buffer
 Safe building construction
 Promote public awareness
 Monitoring
 Forecasting
 Warning
 “NONE” - The fury of nature can never be prevented,
yet the number of casualties can be reduced by

 Vigil
 Early warning
 Timely evacuation
 Train people in risk areas on survival techniques
 Eco-Education should be given priority
 Enforcing Coastal Regulation Zone 1991
 Restrict dwellings in area within 500M from high tide
border
 Interferes with nature at sea shore as well as at
resource areas
 Not cost effective, rocks go under the seabed with
passage of time
 Cannot be constructed high enough to block high tide
 Will prevent drainage of water on land with low tide
 Beware and be Aware

 Mother nature can be kind yet unkind at times!