Overview Of Disaster

Medicine & Mass Casualty

Incidents

Nik Ahmad Shaiffudin Bin Nik Him

MD, MMed(Emerg.Medicine, USM), AM(Mal)

Faculty Of Medicine & Health Sciences

University Sultan Zainal Abidin (UniSZA)

Objective
Objectives :
Develop the understanding of disaster medicine and mass casualty
incident management
Subject contents :
1. Overview of disaster medicine and mass casualty incident
2. MKN Directive No. 20
Performance criteria :
Establish command on the implementation of incident
management system based on MKN Directive No. 20.

Learning
Learning Outcome
Outcome
1. Able to deliver an efficient health response according to
MKN Directive 20.
2. Understand the response and able to assist local and state
authorities in dealing with the medical and health effects
disaster/MCI following the national disaster response
framework
3. To develop a trained group of health personnel for disaster
response who would be readily deployed to site to render
both direct patient treatment and technical advice.

Presentation Outlines
1. The overview
Introduction
Types & Epidemiology
Disaster Hx
Disaster cost
Concept of disaster management
Lesson identified..... Lesson learnt

2. NSC Directive No. 20

3. Summary

Introduction
Disaster.....
When the destructive effects of natural or man-made forces
overwhelm the ability of a given area or community to meet the
demand for health care.
~American College of Emergency Physicians~

A sudden ecologic phenomenon of sufficient magnitude to require

external assistance.
~World Health Organization~

An Interface between an extreme physical event & vulnerable

human population
~ Susman et al ~

Generally defined by the effect on people and infrastructure resulting in the loss of the
ability to respond independently

Introduction cont.
MCI:
Large
number
of
victims.....enough
to
overextend/disrupt the normal course of emergency and
health care services not overwhelm your facilitys
capabilities.
Mass Casualty Event The number of casualties overwhelms
hospital capabilities (usually >20 patients).
MCM: management of victims of a mass casualty event,
aimed at minimizing loss of life and disabilities.
The magnitude

1 - 99 casualties:
100 - 999 casualties:
=>1000 casualties:

Mild
Moderate
Major

~American College of Emergency Physicians~

Introduction
Introduction
Disasters follow no rules!!!!
Time, location or complexity of
a
disaster....unpredictable!!
The occurrence of a disaster creates varying
degrees of chaos and disruption of the normal
functioning of society combined with a
mismatch
between
resources
and
needs .......................... the numbers of sick and
injured overwhelm the resources available for
rescue and treatment.

Introduction
Introduction
Disasters differ in the degree to which these consequences occur
and the degree to which they disrupt the medical and public
health infrastructure of the disaster scene.
However, all disasters, regardless of the etiology, have similar
medical and public health consequences during which treatment
is needed irrespective of whether or not there are a hundred or a
thousand of individuals who are dead, trapped or injured.
The key principle of disaster care is to do the greatest good for
the greatest number of patients, while the objective of medical
care is to do the greatest good for the individual patient.

Types & Epidemiology

TYPES OF DISASTER/MCI
1. NATURAL DISASTERS
2. TECHNOLOGY & HUMAN CAUSED
(MAN-MADE)
3. HYBRID OR MIXED

Types - Natural

Types - Human caused

(Man-Made)

Types - Hybrid (Mixed)

Disaster - Epidemiology

Disaster History

Disaster History

Disaster History

Summary of Natural Disasters

(1975-2002)

Source: ADRC, Japan based on CRED EM-DAT database, 2003

Disaster Cost

Concept of Disaster
Management
Management of the Event itself is as important as the
management of the individual patient

Concept of Disaster Management

BASED ON NORMAL ACTIVITIES

The response to major events should be consistent
with normal arrangements wherever possible to
avoid confusion and lack of knowledge.

This is not the time to learn

something different

Concept of Disaster Management

DISASTERS ARE DIFFERENT

It is not just an increase in medical effort that is needed but a
different medical approach also.

Number and variety of casualties.

Initial disorder.
Initial lack of resources.
Effects on health system / community.
Loss of infrastructure
Need for multidisciplinary teams.
Multiplicity of tasks.

Concept of Disaster Management

A PARADIGM SHIFT

Concept of Disaster Management

DUAL WAVE

Concept of Disaster Management

Comprehensive Approach Disaster

Management

Response Management
Framework

Command, Control &

Coordination

Communication

Problems in Communication

Failures

Clinical Mx - Principles

Containment

Continuity of Buisness

Capability

Lesson Identified....
Lesson Learnt

Lesson Identified Malaysian Experience

Date

Disaster/Major Incident/MCI

Dead

Injured

19 Oct 1968

Collapse of 4 storey building, KL

11

Jan 1971

Monsoon flood spilled over to West

Coast of W. Malaysia

24

National
Emergency
Declared

31 July 1988

Collapse of Sultan Abdul Halim

Jetty, Butterworth, Penang

32

1674

22 Sept 1989

Fire at Sek. Agama Rakyat

27
Taufiqiah Khairiah Al Halimiah, Yan,
Kedah

7 May 1991

Fire & Explosion of Bright Sparkles

Fireworks Factory, Sg Buluh
Selangor

103

22

Malaysian Experience
Date
5 April 1992

Disaster/Major Incident/MCI
Fire at SAAS International Airport,
Subang, Selangor

20 Jun 1992 Choon Hong III Ship, Explosion and

Fire, Port Klang, Selangor

Dead

Injured

3
10

11 Dec 1993 Collapse of Highland Tower

48
Condominium Hulu Klang, Selangor.
4 7 Dec
1994

Landslides In Cameron Highlands

30 Jun 1995 Landslides off Genting Highlands

Road, Pahang

7
20

22

Malaysian Experience
Date

Disaster/Major Incident/MCI

Dea
d

Injured

15 July 1996

Tourist Bus Accident,

Landslides at KM 15, Genting
Highlands, Pahang

20

23 injured

29 Aug 1996

Mudslides at the Aborigines;

Village in Pos Dipang,
Kampar, Perak.

50

12 injured
250 homeless

26 Dec 1996

Tropical Storm GREG

(Typhoon) Keningau West
Coast Of Sabah.

270

26 injured
3,000 homeless
1,150 affected

1 30 Apr
1997

Enteroviral Outbreak Sibu

Sarawak

25

Many affected

Malaysian Experience
Date

Disaster/Major Incident/MCI

Dead

Injured

July Oct
1997

Country wide haze in Malaysia

and haza emergency in
Sarawak

Enviroment Damage,
Health Problems &
Economic Losses.

24 Dec 1997

Fire and Explosion Shell SMDS

Bintulu Sarawak.

12

Feb May
1998

Forest and peat fires

throughtout the country

Mac Sept
1998

Water supply crisis in Klang

Valley

4 Feb 1999

Kg Gelam Landslides

3000 hectares of
forest burnt
1.8 Million residents
affected
17

Malaysian Experience
Date
Oct 98
June 99

Disaster/Major Incident/MCI
Japanese Encephalitis (JE) Outbreak
In Perak, Negeri Sembilan and
Melaka.

28 Jan 2002 Ruan Changkul Simunjan, Sarawak

Landslide
2003

SARS
Anthrax Scare

2004

Avian Flu

Dead
101

16

26 Dis 2004 Tsunami

64

28 Mac
2005

Nil

Earthquake

Injured

69

POS DIPANG 30 AUGUST 1996

HIGHLAND TOWERS 11 December 1993

GREG TYPHOON 26 DECEMBER 1996

PENANG FERRY BRIDGE

31 DECEMBER 1988

Powders, Powders Everywhere

Anthrax Scare Threatens Malaysia

Yearly monsoon reminder in the

East Coast of Malaysia

Pictures from KEDAH & LANGKAWI

Kuala Chenang, Langkawi

Chenang Beach, Langkawi

Kg. Sungai Muda, Kedah

Kuala Muda Kedah

Pictures from Penang..

Bagan Jermal, Penang

Gurney Drive, Penang

Pictures from Perak & Penang

Tg. Bungah, Penang

Tg. Piandang, Pt. Buntar, Perak

Jalan Tg. Tokong, Penang

Terengganu Experience ???

Flood at Setiu, Terengganu on 18 December 2005.

Source: NST

Terengganu Experience
1.Motor vehicle accident
Date

Disaster/Major Incident/MCI

Dead

Injured

2002

5 kereta MVA Sg Ular

15

2003

Bas sekolah Vs Lori , Sg Ular

2003

Bas sekolah terbalik di Jln Air Putih

20

2003

MVA 4 wheel Vs Car Vs Van Pekerja,

Kemaman

11

2007

Bas sekolah MVA

33

2008

Car VS Van Pelancong, Cherating

9/7/08

MVA Trak tentera Vs Van, Cherating

20

15/7/09

Fire Engine slide, Manir

16

Terengganu Experience
2.Industrial Accidents/Poisoning/Building Collapse
Date

Disaster/Major Incident/MCI

Dead

Injured

2000

Lack of O2 di Perwaja Steel Sdn Bhd

2001/2

Keracunan gas di Kaw Perindustrian Telok

Kalong ( See Sen)

10/15

2002

Letupan Gas Petronas GPP 01

2003

Kebakaran dan letupan di KSB

2000

Pembakaran sampah di asrama SMKSI

20

2002

Keracunan UiTM Dungun

20

2009

Roof of Stadium SMZA collapsed

Community Expectation

The need to have an

integrated disaster
management system to deal
with any kind of disaster
The need to
formulate a policy
and mechanism of
Disaster
Management in
an integrated,
coordinated and
systematic
manner to
manage and
handle disasters
on land.

LESSON
LEARNE
D
The need to have a
specialised and
highly skilled search
and rescue team.

The need to
have a sound
system of
coordination
among
agencies in
search and
rescue
operations as
well as relief
and
rehabilitation.

The Guidance
Directive No. 20 NSC......11 May 1997

What is inside - MKN Arahan 20 ?

Semakan 30 Mac 2012
BAHAGIAN I : Permulaan
BAHAGIAN II : Tanggungjawab MKN
BAHAGIAN III : Mekanisme Pengurusan Bencana
BAHAGIAN IV : Pencegahan & Peredaan
BAHAGIAN V : Kesiapsiagaan
BAHAGIAN VI : Mekanisme tindakbalas bencana
BAHAGIAN VII : Pemulihan
BAHAGIAN VIII : Perisytiharan Darurat Bencana
BAHAGIAN IX : Pengurusan Kewangan
BAHAGIAN X : Peruntukan Am

NSC DIRECTIVES NO. 20

EXECUTIVE ORDERS BY PRIME MINISTER
Thereduce
reduce
The
casualtiesand
and
casualties
minimisedamage
damage
minimise
toproperties.
properties.
to
Toprevent
prevent
To
disastersfrom
from
disasters
spreading.
spreading.
Tocoordinate
coordinaterelief
relief
To
andrehabilitation
rehabilitation
and
tovictims.
victims.
to
Tocoordinate
coordinaterelief
relief
To
andrehabilitation
rehabilitation
and

Tooutline
outlineaaPolicy
Policyon
on
To
Disaster
Disaster
Managementand
and
Management
Reliefon
onLAND
LAND
Relief
accordingto
tothe
the
according
levelof
ofdisaster.
disaster.
level
Topreserve
preservethe
the
To
environment.
environment.
Toimmediately
immediatelybring
bring
To
backthe
thesituation
situationto
to
back
normalcy.
normalcy.

Toestablish
establishaa
To
Management
Management
Mechanismwith
with
Mechanism
thepurpose
purposeof
of
the
determiningthe
the
determining
rolesand
and
roles
responsibilitiesof
of
responsibilities
thevarious
various
the
agencies
agencies
involvedin
in
involved
handlingdisaster.
disaster.
handling

Accidents involving
the transportation,
channeling
and transferring
of hazardous
materials.
Industrial
disasters : fire,
explosion
andemission of
hazardous
materials,
channeling and
transferring of
hazardous
materials.
Natural disasters :
floods, storm,
draughts, beach
erosion, landslides or
disaster resulting
from storm and
heavy rain.

Nuclear and
radiological mishaps.

The burst of hydro

dam or reservoir.
Trains collisions
or derailments.

TYPES OF
DISASTERS

Collapse of
high-rise buildings.
The emission of
poisonous gas in public places.
.

Fire outbreak in
large areas forest fires/ open
burnings

Air accidents
that occur in
populated areas.

Haze, which causes

environmental disaste

DIRECTIVE 20 NATIONAL SECURITY

COUNCIL
LEVEL 1
Localized major incident
under control
not complex
small no. of casualties and property loss
minor disruption of daily community activities
manageable by the local authorities not
requiring multi sectoral involvement.
e.g. bus accident, train derailment, landslide.

LEVEL 2

Widespread over a large area but under control

Complicated and complex
Large no. of casualties and property loss.
Affecting daily community activities
Not manageable by the local authorities
requiring assistance from other states or
National Authorities
Support required, Regional or National Support

e.g. Highland Towers Collapse, Greg Storm

Sabah, Bright Sparklers.

LEVEL 3
Involves a very large area.
Loss of many lives.
Total Destruction of infrastructure and public facility.
Complicated and complex.
High risk to rescue workers.
Complete disruption of daily community activities.
Major destruction of resources.
All local resources destroyed and assistance from
external resources required.
e.g. Earthquake, typhoons, volcanoes, war

BAHAGIAN II

INFORMATION FLOW: PRESENT MALAYSIAN SCENARIO

INCIDENT SITE

999
Red Crescent

Police

Informer/Caller : Provide the following Info:

Identification of Caller
Time of Incident
Type of Incident
999
Location
Civil Defence

999

Hospital

Fire & Rescue

Analysis of Information
Stand Down
on Yellow
Alert

Yellow Alert
Standby

Red Alert
Declaration of
Disaster

Deployment of
Rescue Team

Deployment of
Rescue Team
Activate
Hospital
Alert
System

INCIDENT SITE

Deployment of Search &

Rescue Team

YELLOW ZONE

RED ZONE
Access Road
Guard Post

Guard Post

Operating zone for Specialised

Search And Rescue Units

PKTK

YELLOW ZONE
Pertahanan
Awam

Emergency
Medical Services

RED ZONE
Access Road

INCIDENT SITE

JBPM

Operating zone for Specialised

Search And Rescue Units

Guard Post

SMART

PDRM

ATM
PKTK

GREEN ZONE
YELLOW ZONE
Media
Centre

Temporary
Mortuary
Pertahanan
Awam

Emergency
Medical Services

RED ZONE
Access Road
Guard Post

JBPM

Operating zone for Specialised

Search And Rescue Units

Guard Post

PDRM

Rest Area
Food Store

SMART

ATM
PKTK

Counseling
Centre
Aid Agencies and NGOs

Family
Bereavement
Centre

Peranan Agensi

Summary
1.
2.
3.
4.
5.
6.

Understand the various causes of disaster...

Anticipate the effect on US...
Adhere to comprehensive disaster mx
Mangement of the risk.....
Contingency Planning
Know your Hospital disaster preparedness plan !!!....
Workout your plan

Conclussions
1. Understand the concepts and principles
2. Take a practical strategic approach
3. Familiarization
4. Abide the NSC , Directive 20, PM Dept.

Arts of War Sun Tzu

The Art of War teaches us to rely not on the

likelihood of the enemys not coming, but on
our readiness to receive him; not on the
chances of his not attacking, but rather on
the fact we have made our position steadfast

Thank you.. 1Malaysia Boleh

Refferences
1. MKN Arahan 20 Semakan 2012
2. Disaster /MCI Management - ACEP
3. EMA Australian Emergency Manuals Series