Seminar ON

Disaster management

Moderator
Mrs. Meena Aggarwal Lecturer College of Nursing All India Institute of Medical Sciences New Delhi.

Presenter
Ms. Manju M.Sc. 1st Nursing student (Nephrology) All India Institute of Medical Sciences New Delhi.

Introduction
Disasters have existed since ever the history of mankind and have shaped the destiny and its people. The term disaster originated from the French word, (des-bad or evil and aster means star). Disasters occur when hazards strike in vulnerable areas. Disasters are generally more limited in scale than doomsday events, the global impact of which would threaten a large proportion of life on earth. The word disaster's root is from astrology: this implies that when the stars are in a bad position a bad event will happen.

Definition of Disaster
According to WHO Any occurrence that causes damage, ecological disruption, loss of human life or deterioration of health services on a scale sufficient to warrant an extraordinary responses from outside the affected community area. A disaster is any human made or natural event that causes destruction and devastation that cant be relieved without assistance. A disaster is a result of a vast ecological breakdown in the relation between humans and their environment, a serious or sudden event on such a scale that the stricken community needs extraordinary efforts to cope with it, often with outside help or international aid EK Noji, The Public Health Consequences of Disaster.

Indian scenario
The country is very vulnerable to natural disasters. Earthquake: 54% of the landmass is prone to earthquake. Flood: 40 million hectares of landmass prone to floods. Cyclone: 8000 Km long coastline with two cyclone seasons. Drought: low and medium rainfall regions which constitute 68% of the total areas, are vulnerable to periodical drought. India is also vulnerable to other natural calamities like avalanches/landslides etc.

Major disasters in India

Type of disaster
Earth quake Super cyclone Earth quake Drought Heavy rains Earth quake Heavy rains Heavy rains /flood Tsunami Heavy rains /flood

State
Bihar Nepal Boarder Orissa Uttar Pradesh Karnataka A.P A.P Gujarat U.P West Bengal Tamilnadu/Kerala Mumbai

Year
1998 1999 1999 19992001 2000 2001 2001 2001 2004 2005

Major disasters in the world

Calamity Country Year
Earth quake China Earth quake Japan Earth quake China Cyclone Bangladesh 1920 1923 1927 1970 1976 1931 1984 1991 2004

Deaths
2,00,000 1,42,000 2,00,000 2,00,000 2,42,000 37,00,000 3,000 1,38,000 11,60,00

Earth quake China Flood Methyl isocyanate gas leak Cyclone Tsunami China Bhopal Bangladesh South Asia

Type of disasters
1. Natural disaster 2. Man- made disaster Natural disaster: It is defined as a sudden major upheaval of nature, causing extensive destruction, death and sufferings among the stricken community and which is due to mans action. It has 2 subcategories: Sudden impact or acute onset Slow or chronic onset

Sudden impact or acute onset

Geological or climatic hazards

Hurricanes/typhoons Tornadoes: A tornado is a natural disaster resulting from a

thunderstorm of severe conditions, and is a large funnel of extremely high pressure winds cycling and twisting at random. Tornadoes are measured in power according to the Fujita scale: an F1 being the least powerful and an F5 being the most powerful. The most powerful tornado ever recorded in terms of wind speed was the monster which swept through Moore, Oklahoma in 1999 and reached wind speeds of up to 318 mph. one mile below the maximum F5 speed ever considered.

Earthquakes: An earthquake is a sudden shift or movement in the tectonic plate in

the Earths crust. On the surface, this is manifested by shaking of the ground, and can be massively damaging to poorly built structures. Earthquakes occur along geologic fault lines, and are unpredictable. e.g., the 2004 Indian Ocean earthquake.

Volcanoes: A volcanic eruption is the point in which a volcano is active and releases
its power, and the eruptions come in many forms. Recent large volcanic eruptions include that of Mount St. Helens in Washington and Krakatoa in Indonesia, occurring in 1980 and 1883, respectively

Floods: A flood is caused by excess water in a location, usually due to rain from a
storm or thunderstorm, or the rapid melting of snow. Other causes can include flooding from water displacement, such as in a landslide, the failure of a dam, an earthquakeinduced tsunami a hurricane's storm surge, or melt water from volcanic activity. The 1991 Bangladesh cyclone caused massive floods that covered almost three quarters of the nation and left behind a situation of disease and famine. An example of a man-made flood is the one caused by the building of the Vajont Dam in northern Italy in the 1960s; a landslide into the reservoir sent a wave over the dam's crest and into the densely populated valley

Tsunamis: A tsunami is a giant wave of water which rolls into the shore of an area
with heights that can be anywhere from 15 feet to even 50 feet in height. It comes from Japanese language meaning "harbor wave". Tsunamis are caused by undersea earthquakes or landslides, and are not noticed until reaching the shore, where the wave lifts form the rising sea floor. The tsunami generated by the 2004 Indian Ocean Earthquake currently ranks as the deadliest tsunami in recorded history.

Wildfires Landslides: A landslide is caused when soil, rocks, trees, structures and other items on slope comes into motion. Landslides can be initiated by earthquakes, volcanic eruptions, or by general instability in the surrounding land caused by deforestation or lack of porous soil. Mudslide, rockslides, and lahars are particular types of landslides. The deadliest recorded landslide occurred in 1985 in Armero, Colombia, when a volcanic eruption caused snow melt to pile up and destroy the town below, killing over 25,000 people.

Avalanches: An avalanche is a slippage of built-up snow down an incline, possibly

mixed with ice, rock, soil or plant life in what is called a debris avalanche. Avalanches are categorized as either slab or powder avalanches. Avalanches are a major danger in mountainous areas during winter. The Himalayas are well known for the occurrence of snow avalanches particularly Western Himalayas I .e. the snowy regions of Jammu and Kashmir, Himachal Pradesh and Western Uttar Pradesh. Epidemics Food, water, vector-borne diseases Person-to-person transmission diseases

Slow or chronic onset

Drought: A drought is a long-lasting weather pattern consisting of dry conditions with very little or no precipitation. During this period, food and water supplies can run low, and other conditions, such as famine, can result Famine: Famine, or food insecurity, is characterized by a widespread lack of food in a region, and can be characterized as a lack of agriculture foodstuffs, a lack of livestock, or a general lack of all foodstuffs required for basic nutrition. Famine is almost always caused by pre-existing conditions, such as drought, but its effects may be exacerbated by social factors, such as conflicts. Particularly devastating examples include the Ethiopian famine, which lasted for many years, and the Irish Potato Famine. Environmental degradation: it is related to the deterioration of the environment both in terms of quantity and extinction of some wildlife species and quality like air, water or land pollution. World Resources 1998-99 report describes how preventable illnesses and premature deaths are still occurring in shockingly large numbers. If they have a chance to make vast improvements in human health, millions of people are living longer, healthier lives than ever before. In these poorest regions of the world an estimated one in five children will not live to see their fifth birthday, primarily because of environment-related diseases. 11 million childhoods have been dying every year worldwide - equal to the combined populations of Norway and Switzerland - mostly due to malaria, acute respiratory infections or diarrhea, all illnesses that are largely preventable.

Chronic exposure to toxic substances Desertification: is the degradation of land in arid, semi arid and dry sub-humid areas resulting from various factors including climatic variations, but primarily human activities. major impact of desertification is biodiversity loss, and loss of productive capacity. In the Madagascar central highland plateau, virtually ten percent of the entire country has been lost to desertification due to slash and burn agriculture by indigenous peoples Pest infestation: Food losses due to pests, disease, wild animals, insects and weeds are considerable. It is estimated that 35% of word crop production is lost in spite of pesticide and other control programs. The primary pests are insects, disease and weeds

2.Man- made disaster

Industrial/technological Transportation (vehicular): Disasters have afflicted travelers by train, bus, and ship. One of the largest transportation disasters in history, not involving an act of War, is the sinking of the Titanic, due to the collision with an iceberg in the North Atlantic Ocean Deforestation: is the conversion of forested areas to non-forest land use such as arable land, pasture, urban use, logged area or wasteland. Generally the removal or destruction of significant areas of forest cover has resulted in a degraded environment with reduced biodiversity. In many countries, massive deforestation is ongoing and is shaping climate and geography Material shortages Wars and civil strife: War is conflict, between relatively large groups of people, which involves physical force inflicted by the use of weapons. Warfare has destroyed entire cultures, countries, economies and inflicted great suffering on humanity. Other terms for war can include armed conflict, hostilities, and police action. Acts of war are normally excluded from insurance contracts and disaster planning.Armed aggression Insurgency: or insurrection, is an armed uprising, or revolt against an established civil or political authority. Persons engaging in insurgency are called insurgents, and typically engage in regular or guerrilla combat against the armed forces of the established regime, or conduct sabotage and harassment in the land in order to undermine the government's position as leader; the government established by an invading force counts as "collaborators", not "established authority

Causes of disasters
Urban areas Ecological imbalance Inappropriate construction Inadequate planning Rapid growth Unmanaged urbanization Rural areas

Others

Poor land use management Erosion Deforestation

Lack of employment development Physical factor: intense rain falls over short period of time. Social & economic: poverty, population. Transitions in cultural practices. Civil strife Lack of awareness & information Misuse and abuse of modern technology

Characteristics of disaster
Casualty: a human being who is injured or killed during or as a direct result of

an accident. Multiple casualty incident (2-100) Mass casualty incident (>100) Scope: range of effect of disaster either geographically or in terms of number of victims. Intensity: level of destruction and devastation caused by a disaster.
Direct victims: are people who experience the event whether a fire,

Victims of disaster
volcanic eruption, war or bomb. They are the dead or survivors, ands even if they are without physical injuries; they are likely to get affected from their experience. Displaced persons: have to lave their homes to escape the affect of disaster. Usually displacement is a temporary condition and involves movement within the persons own country. E.g., relocation of residents of flooded areas to schools, churches and other shelter on higher ground. Refugee: are those who are forced to leave their homeland because of war ort persecution. Indirect victims: are the friends and relatives of direct victims. Although these people dont experience the stress of the event itself, they often undergo the extreme anguish when trying to locate their loved ones or accommodate their emergency needs.

Phases of a disaster
Pre disaster preparation Warning Impact Emergency Recovery

Pre disaster preparation

Geological hazard surveys, risk assessment survey. Adopt laws & codes to prevent and mitigate disaster. Effective disaster plan is developed, distributed, tested in mock disaster exercises, revised & kept up to date.

Warning
This is the period of time from the first possible danger signal to the moment of impact. Disaster prediction is done using satellites & networks. Activation of disaster plan & establishment of emergency operation is made.

Impact
Phase at which disaster actually strikes and essentially a period of enduring the disasters effects and holding on.

Emergency
It starts at the end of impact & continues until the immediate threat of additional destruction has passed & the community is organized for recovery and rehabilitation

Recovery
Begins during the emergency phase and ends gradually with the resumption of normal community order and function.

Disasters: The Public Health Impact

Mortality & Morbidity
Disasters cause deaths, injuries, and illnesses .Disasters may overwhelm medical resources and health services.

Health Care Infrastructure

Disaster destroy hospitals, disrupt routine health services with a Consequence: long-term increases in morbidity and mortality.

Environment & Population

It Increase potential for communicable disease, exacerbate environmental hazards with the consequences of increases in morbidity and premature death, and decreased quality of life.

Psychological and Social Behavior

Disaster may cause generalized panic or paralyzing trauma, Provoke increase in anxiety, depression and neuroses. Disasters may lead to post-traumatic stress disorder (PTSD).

Food Supply
Disasters may disrupt the food supply, causing Specific micronutrient deficiencies. May provoke severe nutritional consequences including famine and starvation.

Population Displacement
There is large spontaneous or organized population movements resulting increase morbidity and mortality. Epidemics of communicable diseases in both displaced and host communities occur. Crowding of populations and overlay of refugee and host populations and may lead to injuries and violence.

Vulnerable groups
o o o o o o Single parent families Pregnant and lactating woman Neonates and pediatric group. Geriatric group Relief workers Mentally and physically handicapped Infectious diseases Overcrowding Disruption in water and waste management system Disruption in other public health programs and infrastructure Direct disaster injuries Malnutrition Mass migration Disruption in medication supply The Disaster Syndrome victims response generally involve

Public health issues

1. 2. 3. 4. 5. 6. 7.

Common reactions to disasters Adults

Extreme sense of urgency, Panic and fear, Disbelief, Disorientation and numbing, Reluctance to abandon property, Difficulty in making decisions, Anger and blaming, Delayed reactions, Insomnia, Headache, Apathy and depression, Sense of powerlessness, Guilt, Moody and irritable, Jealousy and resentment, Domestic violence.

Children
Regressive behaviors, Fantasies that disaster never occurred, Nightmares School related problems including and inability to concentrate and refusal to go back to school.

Common psychiatric response

Organic mental disorder secondary to head injury, toxic exposure, illness and dehydration. Acute stress disorder Adjustment disorder Substance use disorder Post Traumatic Stress Disorder(PTSD) Generalized anxiety disorder Psychological / Behavioral response: Grief reaction, Family violence

Victim reaction seven categories

Category
1.Grief: denial, anger, depression 2.Guilt : why the loss is small 3.Isolation nonvictims :alienation

Selected interventions
Attending farewell rituals Counseling fromVictim support groups Psychotherapy Psychotherapy Stress reduction techniques Couples therapy focusing communication skills. on

4.Anger : blaming others 5.Depression 6.Anxiety and vulnerability 7.Relationship problems

Research inputs
Bride BE et al, done a study to investigate the prevalence of secondary traumatic stress (STS) in a sample of social workers and found that social workers engaged in direct practice were highly likely to be secondarily exposed to traumatic events and many were likely to experience at least some symptoms of STS, and a significant minority may meet the diagnostic criteria for PTSD

Disaster management

Principles of disaster management

Preventing the occurrence Minimizing the number of casualties Preventing further causalities Rescuing the injured Providing the first aid Evacuating the injured Providing definitive care

 Facilitating reconstruction/recovery

Phase 1-Preparedness
It is a programme of long term development activities to strengthen capacity and capability of a country to manage efficiently all emergencies. It Strengthen the technological and managerial capacity of Govt., Organizations and communications. It ensures strategic reserves of food, equipments, water, medicine and other essential elements. Develop Disaster plan, warning system, communication system, evaluation of plan and training, resource inventories. Public education is given.

Phase 1-Preparedness -role of nurse

A) Personal Preparedness It is very important fro a nurse to be healthy both physically and mentally. B) Professional Preparedness Take time to read and understand community disaster plans Be aware of disaster plans and participate in disaster drills. Be knowledgeable, creative and possess competent skills in providing care. Have ability to improvise services in delivering care. C) Community preparedness Prepare by having written disaster plans. Participate in yearly mock disaster drills. Review the disaster history of the community. Adequate warning systems and back-up evacuation facility. After several hours of disaster training, nurses may wish to take the following steps to get actively involved. Join a local Disaster Action Trams (DAT) Act as a liaison with local hospitals. Determine health related appropriateness for shelter site, plan with pharmacies, opticians, and other health personnel to facilitate service for disaster victims. Plan for and retain needed supplies. Teach disaster nursing in the community.

Phase 2-Disaster response

According to Federal Emergency Management Committee (FEMA) 3 levels of disasters are there. Level 1 disaster (massive): This involves a massive level of damage with severe impact on multistage scope. Level 2 disasters: Result in major presidential declaration with moderate federal assistance.

Level 3 disasters: Considered as a minor disaster. It involves a minimal level of damage but could result in presidential declaration of an emergency or a disaster. It provide immediate assistance to maintain life, improve health, support morale of affected area. The focus is to meet basic needs. Action is taken by of humanitarian agency.

Organization of site 1. Disaster zone: This is the actual location of the incident. The first triage decisions
are made at this zone. 2. Treatment zone: Here patients are shifted to receive treatment .This is situated 50 feet off the disaster zone. Triage of patients Assessment Treatment of injuries Preparation for transportation 3. Transportation zone: This is next to the treatment zone and should have the clear passage for emergency vehicle to enter and exit. The management of mass casualties can be divided into 1. Search and rescue 2. First aid 3. Triage & stabilization of victims 4. Hospital treatment 5. Redistribution of patients to other hospitals

Search, rescue and first aid

It is able to meet only a fraction of demands. Majority of help comes from the uninjured survivors.

Primary survey: The primary survey deals with life threatening or evolving life threatening illness or injuries. Airway Breathing Circulation (pulse, skin, hemorrhages?) Disability ( consciousness) Exposure ( undress ) Secondary survey: It includes the head to toe assessment.

Triage
Principles of Triage Every patient should be received and triaged by appropriate skilled health professionals. Triage is clinico-managerial decision and must involve collaborative planning. The triage process should not cause a delay in the delivery of effective clinical care.

Objectives of Triage Ensure immediate medical intervention in life threatening situations. Expedite the care of patients through a systemic initial assessment. Ensure that patients are prioritized for treatment in accordance with the severity of their medical condition. Reduce morbidity associated with medical conditions through early intervention. Assist patients requiring treatment in another department or health care institution. Triage consists of rapidly classifying the injured on the basis of the severity of their injuries and the likelihood of their survival with prompt medical intervention. Higher priority is granted to victims whose immediate or long term prognosis can be dramatically affected by simple intensive care. Red indicates high priority treatment or transfer, yellow signals medium priority; green indicates ambulatory patients and black for death and moribund patients. Triage should be carried out at the site of disaster, in order to determine transportation priority, and admission to the hospital or treatment centers, where the patients needs and priority of medical care will be reassessed.

Simple Triage and Rapid Treatment (START)

This system takes into account the respiratory status, the perfusion and the mental status of the patient. The patients who can walk are asked to move away from the incident area and are categorized under GREEN. After assessment of respiratory rate, pulse and ability to follow command the victims are categorized under RED, YELLOW and BLACK.

Hospital networking
Emergency Nearest hospital Triage

Disaster response: Role of nurse

The initial assessment reports should include

Geographical extent of disasters impact. Population at risk or affected. Presence of continuing hazards, Injuries and deaths, Availability of shelter, Current level of evaluation, Status of health care infra structure, Assurance of medical needs First aid, Meal serving , Keep patient records Ensure emergency communications , Transportation Provide safe environment

Stable

D/C

Facilit

First aid among victims? How to relieve stress &CPR

Listen to the victims; help to express their feelings about the disaster and current situation. Encourage to share feelings with one another. Help victims make decisions. Provide basic necessities. Attempt to recover or gain needed items ( medicines) Provide basic compassion and dignity. Refer to mental health counselor if needed.

Refer

Networked hospital

How to relieve stress while working?

Get enough sleep. Take time away from disaster. Avoid alcohol. Eat frequently in small amounts. Use positive talk. Take time to defuse or debrief. Stay in touch with people at home. Provide mutual support. Use humor to relieve tension and provide relief

Relief phase
Humanitarian relief supplies are started and include Acquisition of supplies Transportation Storage Distribution Disease control is achieved by Implementing the public health measures as soon as possible. Identify outbreaks and start control programmes. Investigate all reports of disease outbreaks rapidly. Nutrition Water supply Food supply Basic sanitation and personal hygiene Vector control rehabilitation.

Phase 3-Recovery phase

The last stage in disaster take place when involved agencies join together to restore the economic and civic life of community. Govt. may start rebuilding efforts. Housing and Urban development Department provides grant for temporary housing CDC provides continuing surveillance and epidemiological services. Role of nurse in recovery phase Community clean-up efforts can bring upon physical and psychological problems. Nurses need to be alert for environmental health hazards during the recovery phase of a disaster. Nurses should be vigilant in teaching proper hygiene and making sure immunization records are up to date. Referrals to mental health professionals should continue as long as the need exists. Nurses should assess to the dangers of live or dead animals and rodents that are harmful to a persons health.

Phase 4-Mitigation
This is minimizing the effect of disaster. Reduce the probability of disaster occurrence , unavoidable disasters Building codes Vulnerability analyses update Zoning and land use management decrease the effect of

 Building use regulation & safety codes Preventive health care Public education

Management of Biologic warfare /Bio-terrorism

Personal protection: cover head, wear scarf and cover nose .Use ultra high efficient filter mask. Collective protection: All windows of buildings must be closed. Immmunoprophylaxis: vaccines should be used if available. Chemo prophylaxis General measures of protection Only cooked food should be used. Boiled, chlorinated and filtered water should be used. Insect and rodent control measures must be initiated at the earliest. Isolation of confirmed /suspected cases preferably in negative pressure isolation.

Ethical concerns

Disaster represents a disparity between the resources of the health care agency and the needs of the victim. Rationing care Futile therapy Consent Confidentiality Resuscitation Assisted suicide

Disaster plan at AIIMS Hospital

Hospital disaster manual is the written statement of disaster plan which need to be activated at the time of disaster.

Aim
To provide prompt and effective medical care to the Maximum possible in order to minimize morbidity and Mortality.

Objectives
To optimally prepare the staff and institutional resources For effective performance in disaster situations. To make the community aware of the sequential steps to be taken at individual and organizational levels

Disaster committee
1. Medical Superintendent

2. Chief medical officer 3. Head of Departments 4. The chief Nursing Superintendent 5. Blood Bank- In Charge 6. Officer in charge stores 7. Engineering department 8. Security officers 9. Dietician 10.Transport officer 11.Sanitary Superintendent Head quarter for disaster Control room: Room no. 12 M.S. Office Reception center Moderate load Heavy load Casualty. MOPD, POPD, Ground floor of RAK OPD with additional beds at AB-7, corridor of A, B & D wing.

First Aid and sorting ( Triage ) Priority level 1 2 3 4 Mx Imm. Rescusc. Color of ribbon Red Action needed MOT, Em OT/ICU/ICCU Em. Ward D/C after F.A Mortuary

Urgent surgery Yellow First aid only Brought dead Green Black

Tagging An integral part of the Triage, Pre- requisite for effective mass management Priority 1: Red, Priority 2: Yellow, Priority 3: Amber, Priority 4: Green Priority 5: Black

Disaster plan
Vaccination After biologic warfare typhoid A-F toxoid vaccines are given. Logistic support system Disaster cupboards

 Stores Drugs and equipments Air way devices Shock management Drugs, Blood Medical equipments Linen & blankets Stretchers & wheel chairs, O.T. tables Protective personal kit The key should be available with the S/ in charge on duty and also with DNS & ANS of casualty. As an immediate measure buffer stock should be used. Medical & surgical stores should be opened immediately. Essential drugs, crystalloids etc should be issued. Medical supplies, basic equipments should be kept prepared, and properly labeled and updated. Operation theaters Emergency blood bank Clinical services ( lab, radiology ) Linen stores Documentation center : special record for each victim Information services ( PRO,MS) General section ( CSSD, Ambulance) Maintenance service (Water, electricity)

Disaster plan-duties of staff

Chief Nursing Officer -CNO In a major disaster she will do the Administrative functions. Responsible for notifying all Dept. heads and alternates. Responsible to see that families of victims are notified as soon as possible. She can take help from Medical Social Worker. Nursing supervisor Attempt to find out adequate number of nursing personnel. Organization of medical and surgical items required for the treatment. Quick Response Medical Team (QRMT) Will be formed to be deployed in case of crisis situation ranging from natural disaster to complex humanitarian emergencies , anywhere in South Delhi. Functions: Primary first aid at the site Stabilization of the casualties Triage Casualty evacuation

Disaster plan mitigation

Physical aspect Sanitation officer and the administrators ensure proper sanitation and waste management. Psychological aspect Psychiatrist and psychiatric nurses work to reduce the effect of PTSD.

Internal Hospital disaster plan

Evacuation plan
The evacuation of patients, visitors & staffs should be made safely. All the fire escape routes & emergency exit doors should be clearly marked with illuminated paints, electrical sign posts with clear direction in Hindi & English. Keys of all emergency exit doors should be kept in the box near the door & frequently checked and the entire ward sister should be informed about this key. One key will be with sister on duty. Large display boards will be placed at prominent places showing display roots in case of fire. The locks of the emergency doors should open by one master key which will be kept in the central fire control room. Evacuation can have either vertical or horizontal flow to move the patient to a safer area. Blankets can be used as improvised stretcher. Details of evacuation plan need to be discussed with fire people. Activation of disaster plan as for external disaster.

Mental health support to victims..

Education Crisis intervention Ventilation Active listening Empathy Rebuilding support systems. Spirituality externalizing interests Relaxation and recreation. Critical Incident Stress Debriefing (CISD): intervention ideally held between 24 hours and 72 hours (normal working hours) after the incident, with a group of people (10 to 30 people). The goal is to mitigate the effects of exposure to a traumatic event and accelerate the recovery process. CISD is a discussion of the involvement, thoughts, reactions and feelings resulting from the incident, and does not constitute an evaluation of the incident or of the quality of employee's participation to this incident. The session allows for the sharing of information and reactions about the incident, and the provision of information and educational material on stress management and the establishment of a support network within the work environment. The session also serves to establish the need for any other subsequent stress management interventions. Support and follow-up are provided, and referrals to appropriate resources are made available, as required. The CISD intervention is led by a CISM mental health professional. The CISD session may

be conducted by a peer-support person with appropriate training, but always in the presence of the CISM mental health professional.

Role of nurse in D.M

Planning Preparation of area for patient triage, morgue, relatives and media. Provide current information regarding the number of available beds, nursing staffs and locations & type and quantities of supplies available. Assess the state of patients for potential discharge and transfer. Arrangements for extra staffing and period of duty ( 12 hrs) Accurate inventories and supplies to be established. Activate a telephone cascade system.

Guidelines for hospital nursing personnel

Remain calm. Inform patients and family of disaster situation & request co operation. Notify on duty staff & call off duty staff as needed. Obtain initial account of available beds. Reallocate the resources to the treatment areas. Conserve supplies and resources left on the unit. Avoid use of lifts and telephone except for disaster activities.

Rehabilitation
Physical Rehabilitation A disaster can leave many people handicapped amidst the panic and fear, many of the victims either loose any of their limbs or sight or may go for severe forms of handicaps. The nurse can teach such people to return to their normal life style by using prosthesis and cope with it for the rest of the life. The victims should be encouraged to go on with life. Social rehabilitation Explain them that all others are in the same situation. Encourage the victim to do necessary chores &participate in decision making Help the individual to identify his roles in the society and indulge in him a spirit of well being by encouraging him often of the potentials he has. Discuss with the victim, how he can create a normal life again, how to use his potential and help others who are in need much more than him. Educate about the community sources which are available. Vocational rehabilitation Assure the activities that the client is best at. Assess the physical strength attention, and concentration. Make them to perform various activities like weaving, basket making, stitching, and gardening and sell these products to earn their living.

Management of Disaster in India

Every year 2nd October has been designed as world Disaster Reduction Day as part of International Decade for Natural Disaster Reduction activities.(19801990) Indian Meteorological Department (IMD) plays a key role in forewarning the disaster. Insat Disaster warning System receivers have been installed primarily in the coastal areas of Tamil Nadu and A.P. The Snow and Avalanche Study Establishment (SASE) in Manali have been issued warning to people about avalanches 24 to 48 hours in advance.

Disaster
Central Government

Paradigm shift: from disaster Response towards Disaster Reduction

Government appointed HPC on Disaster Management (1999) which submitted one of the most comprehensive reports ever produced. Tenth Five Year Plan (2002-07) outlined a multi-pronged strategy for total risk management for sustainable development The WCDR organized by the International Strategy for Disaster Reduction was opportunity for Development of Disaster Management Framework that India presented in January 2005 India actively participated in drafting the Hyogo Framework for Action: building Resilience of Nations and Communities to Disasters

MHA

State Government

NIDM

National D

Politica
State Crisis Management Group:

Development chaired by the state relief This is

commissioner or chief secretary. The committee develops various contingency plan to deal with various types of disasters.

District administration: Revenue department and the Relief department are

responsible. District collector, SDO, Tehsildar and village officers are involved.

Disaster Risk Assessm , ent

Disaster management bill -2005 Prevention, Preparedness

Natural Disaster Response- Government of India

Disaster management bill 2005 under the article 51( A) of the constitution has been put up for implementation. In this, mandatory training for all youth above 18 years to be implemented by training institutes like Panchayats, Municipal bodies . All organizations and hospitals should have Disaster Management plan for Non -structural managing all type of casualties. Structural m easures

m e

Environm ental shield Capacity Build High Powered Committee on Disaster Management Plans Retrofitting Risk transfer, insu HPC constituted in August,1999
To prepare comprehensive

National Crisis Management Committee(NCMC) under Cabinet Secretary Poverty allevia Crisis Management Group(CMG) under Central Relief Commissioner Infrastructure Em powerm ent Group of Ministers, Group of Secretaries and High Level Committees-Need base of w

model plans for management of disasters at the National, State and District levels Ambit of the Committee enlarged to include manmade disasters also Two Interim reports submitted. Final report awaited by September, 2001

Role of various agencies in D.M

Sustai

The central Government plays a supportive role in terms of provision of financial and other resources.

 The Ministry of Home affairs is the nodal agency for disaster management. The Central Relief Commissioner in the DAC coordinates the relief operations.

Various agencies in D.M

National Disaster Management Authority All India Disaster Mitigation Institute National system for D.M National Centre for D.M Ministry of Agriculture. Disaster Risk Management Programme National Disaster Management Framework Calamity Relief Fund National Calamity Contingency Fund(NCCF) Every country is a potential source of health humanitarian assistance for some other disaster stricken country. United Nations Office for the Co ordination of Humanitarian Affairs(OCHA) World Health Organization (WHO) World Food programme Food and Agricultural Organization International Committee of Red Cross International Council of Voluntary Agencies.

International agencies

Recommendations
Enactment of Disaster Management policy and Act Enactment of D.M authority Undertake large scale awareness measures/campaigns Review and amendment of existing building codes and byelaws Inclusion of DM elements in school curriculum Safe housing atlas (earth quake resistant reconstruction in J&K). Seismic zoning map National core group for disaster mitigation Decentralization of the disaster management process Development of warning manual Faculty members of civil engineering to undergo 6 week course in earth quake engineering Special training in IPS, IAS.. Special training for women in first aid, shelter, management, water sanitation, rescue and evacuation. Constitution of committees at all levels with adequate women participation.

Recent advances

 Thermal imaging: This is a sophisticated sensor with wires are pushed into the rubble. Body temperature of humans provides thermal images of survivors caught under the rubble. Sniffer dogs: Trained to bark when they detect any living person. Multiple sensors: These sense very low sound waves from the rubble and hence spot trapped people. Electronic resources of information: Internet connectivity and web utilization enhance resource availability. Healthy people 2010 and disasters Assure that state health departments establish training plans and protocols and conduct multi- institutional exercise to prepare for response to natural and technological disasters. Promoting Global and Regional Cooperation in disaster Reduction

India worked closely with International Strategy for Disaster Reduction in developing the Asian Strategy for Disaster Reduction at the Beijing Conference. India took proactive role in developing SAARC Regional Framework for Disaster Risk Reduction in South Asia India plans to host the next Ministers- level Conference to review the implementation of the Asian Strategy for of Disaster Reduction India is maintaining WMO regional early warning network. India is hosting SAARC Disaster Management Centre at New Delhi.
Disaster Management in Education-Government of India initiatives

Inclusion of disaster management in school curriculum

The process was initiated with a set of recommendations to be put in place by the state govt. from Home Secretary to the Chief Secretaries of the states- one of them being DM in EDUCATION. Introduction of DM in Class VIII, IX and X as part of the frontline curriculum by CBSE. Many of the state Boards have already introduced DM in school syllabi. NCERT initiatives Development of training modules for the teachers and teacher educators. Safety in Schools, Midday meals, Health, well being and safety of students

Challenges ahead
Recent disasters like Tsunami and Mumbai floods have demonstrated that much needs to be done. Growing economy and urbanization have exposed more areas, assets and people to risks. Enforcement of building codes and zonal regulations in rural and urban areas still a huge task.

 Communicating early warning to the last mile. Diversifying livelihood opportunities in disaster prone areas. Promoting effective regional cooperation under HFA.

Research inputs
Aucamp Coordinator PJ et al, (2007) found that Computer models predicted a

disaster if no action was taken to protect the ozone layer. Based on this research and monitoring, the nations of the world took action in 1985 with the Vienna Convention for the Protection of the Ozone Layer followed by the Montreal Protocol on Substances that Deplete the Ozone Layer in 1987. The Convention and Protocol were amended and adjusted several times as new knowledge was obtained. Disaster medicine education in Canadian medical schools before and after September 11, 2001.Cummings GEet al (2005), Six schools reported no DM teaching before 9/11; 7 reported no DM instruction after that date. Respondents from 12 schools felt that DM should be taught at the undergraduate level, and 9 of the 12 felt it should be included as core content CONCLUSION: Despite support for DM instruction and increases in terrorism and global disasters, 46% of the responding medical schools do not teach this topic and there has been a downward trend in this regard since 9/11 EXPLORING DISPARITIES BETWEEN GLOBAL HIV/AIDS FUNDING AND RECENT TSUNAMI RELIEF EFFORTS: AN ETHICAL ANALYSIS, Christie Tet al (2007) First, what is it that motivates a more empathic response to the victims of the tsunami than to those affected by HIV/AIDS? Second, is there a morally relevant difference between the two tragedies that justifies the difference in the international response?

References
P.K .Dave et al .Emergency Medical services & Disaster Management - A holistic approach, Jaypee, 2001 S.Seliger et al .Emergency Preparedness -Disaster planning for health facilities, Aspen, 1986 Peter Basket et al Medicine for disasters.Wright, 1988 David E et al Disaster Medicine, LWW, 2002 Stanthope et al Foundations of community health Nursing, Mosby, 2002 Suzane C Smelter et al Medical surgical Nursing K. Park. Preventive and social medicine, 2004 Disaster management plan AIIMS, 2006