Distance learning in health and family welfare management, Module 9, disaster management
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- Distance learning in health and family welfare management, Module 9, disaster management
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NATIONAL INSTITUTE OF HEALTH AND FAMILY WELFARE
NEW MEHRAULI ROAD, MUNIRKA,NEW DELHI-110 067
Module 9 Disaster Management
Introduction
Natural calamities and industrialisation have increased the incidence of disaster. It is obvious
that disaster can occur at anytime, anywhere and in any weather. These situations contribute to
the sufferings of mankind and present a formidable challenge to health managers to cope with
the health problems of the victims and the community. Therefore in fitness WHO in 1990 gave
the call to member nations "Should Disaster Strike - Be Prepared."
Avalanches, droughts, floods, cyclones and earthquakes are well known phenomena causing
havoc in various parts of the country. Gas leaks, air crashes, boat capsizes, train accidents are
also* adding to the miseries. These events happen and we are caught unaware. It is, therefore,
essential to know about the nature of the disaster and to be prepared for it in order to lessen the
human miseries and losses. Il involves evolving a suitable medical and public health relief plan
for each district which would prove useful to deal with any disaster that may arise.
Objectives
After going through the module the students are able to:
1.
2.
3.
Describe the types of disaster and its managerial dimensions in health.
Develop a disaster plan for the district to cope with the health problems during disaster.
Organise public health and medical relief measures for disaster.
Units
In order to achieve the above objectives, the following units are presented as part of the
module. These are:
Unit 9.1 Disasters and Dimensions for Management in Health
Unit 9.2 Health Management in Disaster
Unit 9.1
Disasters and Dimensions for Management in Health
9.1.1 Objectives
At the end of the unit, the student is able to:
Define disaster, its various types and subsequent injuries,
Prepare the community about disasters before they strike them, and
Define the role of district health administration in disaster preparedness and managing its
after math.
i.
ii.
iii.
9.13
Key Terms and Concepts
Disasters - natural and manmade, slow and sudden, secondary disasters, disaster
preparedness, sequalae to disasters, district health administration and disaster management.
9.13 Introduction
WHO in 1990 has given the call to member nations to meet disasters. It focussed on "Should
disaster strike - Be prepared" which is very relevant in the present context. The MIC leak in
Bhopal had hit the headline of the newspapers all over the world in 1984,... perhaps the greatest
manmade disaster in history. The cyclones in Andhra Pradesh had created havoc in coastal
regions in 1977. The Bangalore air crash in 1990 has happened just yesterday. How tragic and
devastating to human life?
All these situations, have caused large scale disruptions of human ecology. They are to be
regarded as disasters. All these situations present major health problem in the deaths, injuries
and human sufferings which they cause. Disasters of magnitude involve emergency relief from
international and national sources consuming approximately $.1 billion each year. Therefore,
understanding about disaster and being prepared before it strikes requires to be looked into
from its managerial dimensions.
9.1.4 Definition of Disaster
The term disaster is generally used to cover such desperate events as wars, industrial
accidents, blizzards, avalanches, volcanic erruptions, earthquakes, fires, floods, famines,
windstorms and train or air accidents - events which have little in common except for their
destructiveness: Defining a disaster is a difficult proposition. The definitions known are either
too broad or too narrow.
A few attempts, made to define a disaster, arc as follows:
i.
ii.
iii.
The relatively sudden and widespread disturbance of a social system and life of a
community or a large part of a community by some agent or event over which those
involved have little or no control.
An event or series of events which seriously disrupt normal activities.
More sociologically, a disaster is an event, located in lime and space which produces the
conditions whereby the continuity of the structure and processes of social units become
problematic.
The Pan American Health Oiganisation has summed the definition of disaster in perhaps the
simplest and the most precise manner. According to them disaster is an overwhelming
ecological disruption occurring on a scale sufficient to require outside assistance.
Type of Disasters
Disaster may be classified into two groups, ‘natural’ and ‘manmade’ and may sometime be
subdivided again into those of‘slow* and ‘sudden’ onset. To illustrate certain disasters caused by
"fires" may be both ‘natural’ or ‘manmade’ according to the circumstances. Natural disaster may
also be because of the direct result of human action, for example, establishing settlements in
areas prone to the risk of frequent floods, or the use of construction material and methods
known to be of high risk in. earthquake prone areas. Under certain conditions such
sudden-onset disasters like floods, and earthquakes may also occur slowly, otherwise those are
instant enous.
Disasters have different type of effects and therefore involve multiple dimensions of
management. First of all we should know the types of calamities or injuries following the
disasters. Measures to contain disaster and provision of first aid and medical and public health
relief management are discussed in unit 9.2. Their interrelation with epidemic management has
been described in unit 10.1
Classification of Disasters
Disaster affects health services due to events affecting community, causing calamities, injuries
and casualties. The classification of disaster as given by Western is as follows:
1.
Natural Disasters
a.
Natural Phenomena Beneath Earth’s Surface
i.
ii.
iii.
b.
Natural Phenomena at Earth’s Surface
i.
ii.
c.
Earthquake
Tsunamis
Volcanic Eruptions
Landslides
Avalanches
Meteorological/Hydrological Phenomena
i.
Windstorms (Cyclone, Typhooon, Hurricane)
.ii.
Tornadoes
iii.
iv.
v.
vi.
’ Hailstorms and Snowstorms
Seasurges
Floods
Droughts
3
d.
Biological Phenomena
i.
ii.
2.
Locust Swarms
Epidemics of diseases
Manmade Disasters
a.
Caused by Warfare
i.
ii.
Conventional warfare
Nuclear, Biological and Chemical Warfare
b.
Caused by Accident
i.
ii.
iii.
iv.
Vehicular (Plane, Train, Ship and Car etc.)
Drowning
Collapse of building
Explosions
v.
Fires
vi. Biological
vii. Chemicals including poisoning.
The general belief that, disasters cause only surgical problems is not true. The example of
chemical poisoning due to leakage of MIC in Bhopal and subsequent epidemics of diseases are
both medical and public health problems.
In India different States are prone to the following types of disasters:
A-
Natural: Earthquake, Floods, Avalanches, Drought, Cyclone etc.
B.
Manmade: Gas leakage, Accident, Mass Casualties due to fire etc.
A.
Natural Disaster
i. Earthquakes
Those generally occur in well defined belts and are due to interactions at the edge of great
plates which make up the surface of the world. However, no country is immune to the risk of
earthquakes (1960 Agadin earthquake in Morocco and 1967 Koyna in India, have occurred well
away from zones of high seismic activity. The overwhelming majority of people who die in
earthquakes are killed by the collapse of manmade structures, particularly domestic dwellings.
ii Tornadoes
A tornado is like a cyclone, a vortex of air, but on a much smaller scale. The velocity of air
rising in the centre of a tornado vortex may be very high and is responsible for much of the
damage. Objects like cars, even railway stock - are vacummed from the ground. The sharp
pressure differences across a tornado may cause houses to ‘explode’. A tornado may cause
destruction 500 - 1000 mts wide and while crossing an urban area it may totally destroy houses
and buildings.
4
In the tornado in Lebanon in 1965, many people got injured, about 17 people were killed of
these ten had been at home and seven were riding on motorbikes. Of the 24 patients admitted
to the hospital, 20 had been al home.
iii.
Floods
'Floods are the commonest of ail natural disasters and cause greater deaths than any other
type of disaster. Most of the States in the country are prone to floods and they may occur for a
variety of reasons like (i) over-topping of rivers, (ii) rainfall and melting of snow, (iii) the
rupture of dams and glacial lakes, and (iv) cyclonic storm surge and tsunami. In the first two
categories escape is generally possible and mortality generally low. In the last two categories, in
densely populated areas many thousands die. Floods generally account for approximately 50
per cent of the disasters and a similar proportion of deaths.
iv.
Cyclones
Cyclones begin as low pressure areas in equatorial"latitude. Severe winds occur in a circular
band. Wind speeds diminish from the centre to the periphery, surface winds upto 64 kms/hr.
may occur upto 60 kms from the centre. The threat of cyclone is only in coastal regions like
Andhra Pradesh where it causes heavy damage. The deaths are generally due to crush asphyxia.
The injuries are generally lacerations caused by missiles or falls.
v.
The Cyclonic Storm Surge
The countries bordering the Indian Ocean and particularly those bordering the Bay of Bengal
have suffered most from cyclones and sea surges in the world. 13 out of 19 ‘noteworthy* tropical
cyclone disasters over a period of 250 years occurred in India and Bangladesh. In the same
period the Western hemisphere has suffered only three comparable events.
The cyclonic storm surge is caused partly by the pressure differential within cyclonic storm
and partly by high winds acting directly on the water. This results in a mass of water above the
general sea level moving at the same speed as the cylone. After striking the coast a storm surge
will move in land and will only be stopped by high inland. The water then begins to retreat.
On the night of November 19/20,1977 a cyclone, heavy rainfall and a storm surge struck part
of coastal Andhra Pradesh. The delta of Krishna river caught the worst of the wave. Along the
front of the river delta, the wave was 15 ft. high, reducing to 3 ft. further inland. The wave
moved at about 10 mph and penetrated inland for 10 miles. Together the cyclone and storm
surge affected an area of approximately 7,500 sq. miles. There occurred approximately 400 mm
of rainfall in a 6-7 hour period. Total of 8,504 people were killed. 6,892 were killed by the storm
surge in Krishna district while most of the 1,519 people reported killed in Guntur were reported
to have died as a result of building collapse due to high winds and torrential rain.
vi.
Tsunami
Tsunami results from sudden movements of sea bed caused by under sea earthquakes. These
movements displace large volumes of water, causing a wave of low amplitude but long wave
length. Damage and loss of life may occur at great distances from the point of origin of the
5
wave. The tsunami set up by Lisbon earthquake of 1755 caused great tides as far as in Barbados
and floods in Norway and Germany.
vii.
Avalanches
An avalanche is a mass of snow which is set in motion by its own weight through a violent
disturbance of its equilibrium. Avalanches occur in all mountaineous areas where slopes are
sufficiently steep and where a large proportion of the precipitation is in the form of snow. There
are two kinds of avalanches, the surface avalanche in which only the lop covering of the snow
slips, and the ground avalanche, in which the whole mass is carried away.
Principal Types of Avalanches
a.
Powder-snow Avalanche
It is generally a winter phenomena occurring on steep slopes after a fresh fall of snow. There
has to be some violent stock for it to become detached, such as a very strong wind or the blast of
another avalanche. An avalanche of powder snow is capable of flattening quite a large tract of
forest because of its blast.
b. Avalanche of Fresh Wet Snow
This is after a surface avalanche, but its weight may make it a ground avalanche. Il moves a
little slower than a powder snow avalanche. Its consequences arc the same as those of the
powder snow variety but has, in addition a crushing effect because of its weight. On coming to a
halt it hardens immediately like plaster.
c.
Wet Snow Avalanches
This is predominantly a spring time avalanche and nearly always is a ground avalanche. It
may also occur in winter when there is rain. It flows slowly but .its force is considerable, it
flattens and destroys everything. One cubic metre of powder snow weighs about a kilogram
while the same volume of wet snow might weigh several hundred times more.
d.
Snow Slab Avalanche
This is a dangerous avalanche because it is often unforsecabJe. A snow slab is made of snow
which is superficially compressed but has not adhered to the underlying layer from which it
remains separated by a layer of air, snow slabs are particularly to be feared after a fresh fall of
snow, for then they are not longer visible. They are in any case difficult to recognise.
e.
Sea/River Avalanches
They are caused by the movement of the glacier and may occur al any time. Avalanches are
of increasing importance because of the population growth in the mountain ranges of Himalayas
and growing popularity of winter sports, mountaineering and tourists coming to hill resorts.
f.
Volcanoes
The mortality from volcanic activity is low. During the last 500 years only 200,000 people
(400/yr) have died from this cause. However because of the fertility of volcanic soils, the areas
6
around many volcanoes arc densely populated, and within these areas the risks arc substantial.
For example, more than a million people live in the area around Merapi volcano in central Java,
and every few decades eruptions lake a few hundred to a few thousand lives.
Secondary Disasters
It is said certain natural phenomena causing disaster like earthquakes and Tsunami are
followed in quick succession by secondary disasters like Tire storm, breach of dams or tidal
waves etc. but the popular notion that it often occurs in quick succession is not very tenable and
seems to be rarely happening in reality. After a natural disaster has struck, there arc two main
risks to survivors. First from the secondary disaster e.g. breach of a dam which is triggered off
by the primary event like earthquake. Second, it is much more regular, but generally causes
minor risks alone leading to loss of property and physical injuries to survivors in the post
disaster environment.
b.
Manmade Disasters
Manmade disasters generally occur in the following forms which cause damage to mankind
and bring calamity. These arc:
J.
2.
3.
4.
War and civil strifes
Accidents - Air and Rail
Fires
Gas leak
The magnitude of different types of disaster events that occurred in India from 1960-1989
(compiled by WHO) are presented below:
Table 1
Disaster Events in India from 1960-1989
Type
Frequency
Total Affected
Injured
Killed
Accident
Avalanche
Civil strife
Cold wave
Cyclone
Drought
Epidemic
Earthquake
Fires (major)
Floods
Heatwave
Storm
44)
1
2
7
26
9
19
8
7
38
7
27
5512
250
5660
1555
31730
0
16150
595
60857
24988
1235
2647
101359
0
0
0
1700
0
0
2424
103059
HXX)
0
(1
1993
9672267
Total
191
151179
211535
1742872687
7
351010
0
10400000
0
33474172
70666000
35723
51KXX)
754926905
223296610
The abo\e table clearh brings out that cyclones, floods. Iircs. storm and accidents have
caused maximum loss of human life.
Check Points
Enumerate the disasters that occurred in your district in the last ten years.
How many of those disasters were predicted in advance?
Which type of disasters cause:
1.
2.
3.
i.
ii.
iii.
iv.
9.1.5
High mortality and high morbidity?
High mortality and low morbidity?
Low mortality and high morbidity?
Low mortality and low morbidity?
Health Problems Common to All the Disasters
After a major disaster initially the only behaviour exhibited is either generalised panic or
stunned waiting. Spontaneous yet highly organised individual actions occur as survivors rapidly
recover from their initial shock which may be just minutes after an earthquake. Often rumours
particularly about epidemics abound. The following table presents the short-term effects of
major natural disasters:
Table 2
Short-term Effects of Disasters
Earthquakes
High winds
(without
floodings)
Tidal
waves flash
floods
Floods
1. Deaths
Many
Few
Many
Few
2. Severe
injuries
requiring
extensive care
Overwhelming
Moderate
Few
Few'
3. Increased
communicable
diseases
Potential risk following all major disasters
(Probability rising with over crowding and
deteriorating sanitation)
4. Food
scarcity
Rare
Rare
Common
Common
5. Population
displacement
movements
Rare
Rare
Common
Common
Effect
' i. Climatic Exposures
The health hazards of exposure to the climatic hazards reported are small, even after
disasters in cold countries. As long as the population is reasonably well clothed death from
exposure does not appear to be a major risk. The need to provide emergency shelter therefore
varies greatly with local conditions.
ii.
Food and Nutrition
Flooding and sea surges often damage household food stocks and crops, disrupt distribution
and cause major local shortages. Food distribution, even for the short-term, is often a major
and urgent need, but large scale distribution is not always necessary.
iii.
Mental Health
Anxiety, neuroses, and depressions are not major acute public health problems following
disasters, and family and neighbours can deal with them temporarily. Wherever possible, efforts
should be made to preserve'family and community social structures. The indiscriminate use of
sedatives and tranquilizers during the emergency relief phase is strongly discouraged.
jy. Communicable Diseases
Disaster does not usually result in outbreaks of infectious diseases, although in certain
circumstances it does increase the potential for disease transmission. The most frequently
observed increases in disease are caused by fecal contamination of water and food. The risk of
communicable diseases is proportional to population density and displacement, which increases
the load on water and food and its risk of contamination as seen in refugee camps.
In the longer run an increase in vector borne diseases may occur in some areas as insecticides
may be washed away and the breeding sites of mosquitoes may increase.
The epidemics of communicable diseases following disasters have been discussed in the
Module 10 on Epidemics Management.
Injuries Following Disasters
The injury patem following a particular disaster is quite constant and it varies from one to
another type of disaster. Its knowledge, therefore, could be of utmost help in the planning and
monitoring processes of health aspects of disaster management.
i.
Earthquake
The mortality in an earthquake is primarily due to the collapse of the manmade structures.
The risk of dying is high inside or near dwellings but is very small in the open. The earthquakes
at night, are more deadly as most of the people are indoors. Fractures of pelvis, thorax and
spine are common as the people are lying in bed. Crush injuries constitute a vast majority of
cases. The common internal injuries are rupture of bladder and the urinary tract as the bladders
are full.
The earthquakes occurring during the day time cause injuries to arms, legs, collarbone and
skull. Cases of burns may occur in areas close to where electricity and gas are installed.
t-
The mortality rates are found to be high for the very young and the very old, but relatively low
for those aged 15-44 years. The risk of death of the infants is low as he/she is normally with the
mother.
ii.
Cyclones and Storm Surges
The mortality is generally not high unless tidal waves and storm surges occur. The combined
effects of wind and torrential rain may cause the houses to.collapse. Crush asphyxia, takes a
heavy toll. Objects are lifted in the air and carried along by the wind. The common injuries are
lacerations, fractures, cuts and bruises caused by missiles, flying objects, crushings or falls.
iii.
Tornado
Severe crushing injuries of the skull are the commonest cause of death in a tornado. Cases of
empty cranium with cranial contents perhaps being sucked out and crushing injuries of the chest
and trunk are seen. The common injuries are of skull and fractures, of other parts, lacerations,
abrasions and severe and extensive soft tissue injuries. Foreign materials such as splinters, tar,
dirt, and manure are deeply embedded into soft tissue injuries.
iv.
Floods
In floods the mortality is high only in the case of sudden floods i.e. flash floods or the collapse
of breaches in dams. In normal cases there is sufficient time to warn the public. Fracture,
injuries and bruises may also occur. Floods in winters may also cause hypothermia.
v.
Volcanic Eruptions
In volcanic eruptions, the mortality is high in case of mudslides and glowing clouds. There
may be injuries, bums and suffocations. The WHO has identified the following diseases which
are consequent to disasters and need to be monitored so that they may not take the epidemic
form:
Diseases to be Monitored when People are Housed in
Temporary Shelters after Onslaught of a Disaster Event
Disease1
Main Causes
Diarrhoeal diseases
Overcrowding, contaminated water and food.
Measles
Respiratory complaints
Overcrowding
Poor housing conditions, shortage o(f blankets and clothing.
Malaria
A new environment with a type of malaria against which the refugees
have no protection. Stagnant water becoming a mosquito breeding
ground.
1.
People suffering from malnutrition are particularly al risk of serious attacks of all these
diseases. Good nutrition therefore constitutes an effective preventive measure.
o
Meningococcal
meningitis
Overcrowding in a region where the disease is endemic (it is often
seasonal in certain places).
Tuberculosis
Overcrowding.
Helminths, particularly
hookworm
Overcrowding, poor sanitation.
Scabies (a skin disease
caused by mites)
Overcrowding, poor body hygiene.
Xerophthalmia
(night blindness)
Vitamin A deficiency (Xerophthalmia is often provoked
by measles or some other aclue infections).
Anaemia
Malaria, hookworm, shortage or poor assimilation of iron and folate.
Tetanus
Injuries in an unvaccinated population. Poor obstetrical practice may
cause tetanus of the newborn.
Check Points
1.
2.
Why do various disasters have differrenl types of injuries pattern and health problems?
Is it possible to make a common plan to deal with all the disasters? If yes why? If no why
not?
9.1.6 Multiple Dimensions of Health Care Managements During Disaster
No major disaster can be managed without assistance from the State, the Centre and maybe
even International agencies. The strange thing however is that even with the best possible help
provided the relief operations shall be far from satisfactory if the district administration is
inefficient and poorly co-ordinated.
. First of all a good state of preparedness before the striking of a disaster may reduce its impact
and the greatest number of lives may also be saved during the first few hours after the disaster
has occurred. Howsoever developed a country may be no outside help beyond district can arrive
during this initial brief period. Thus, if the lives have to be saved the District Health Officer has
to be prepared for a disaster. If the community is properly educated, well organised and actively
involved the numerous problems of survival and health are dealt with more efficiently.
The people who are to take early action in the event of a disaster are:
a.
b.
c.
the local health personnel,
the community, and
the local authorities and individuals or groups who concern themselves in the localitie
with rescue work, communications, transport, shelter and food supply.
The local population stricken by a disaster should be enabled to be raking action for itself, nc
as action being taken for it. This presupposes a fundamental shift compared with the usua
notion that the responsibility of caring for disaster stricken community should be entirely take
over by outside agency or official authorities. Experience of disasters have shown that case5 (
panic arc generally localised and shortlived. The majority of people continue to slay in lhe
threatened area and generally lake steps to protect their families and together with their friends
and groups participate in rescue operations. Conflicts and class differences often die down and
a sense of community solidarity not ordinarily present develops. Local communities react
quickly and effectively, particularly if they arc supported by assistance from outside.
The action of the local community is of utmost importance but by no means can it be self
sufficient in case of a disaster. Most of the problems can be solved only through outside
assistance al various levels:
The intermediate level : The nearest and best equipped urban hospital other than the
district/local hospitals.
The national level : The government and national bodies, including non-govenmcnlal
organisations.
The international level: The international organisations and may be even other countries.
a.
b.
c.
A District Health Officer has to co-ordinate with all the above mentioned levels. However,
an efficient disaster preparedness plan laying special emphasis on the commonly occurring
disasters in the district should be prepared in advance.
('heck Points
What is the importance of co-ordination in the.management of disasters?
What role can the local agencies play in the management of disasters?
Make a list of people and institutions in your district you would co-ordinate within ihu
event of a disaster?
I.
2.
3.
9.1.7
Dimensions of Health Management
Prior lo managing the health aspects of disaster the following stages need to be considered:
i.
Warning Stage
This is the period of lime when meteorological, seismological and olher forecast related
departments can predict the occurrence of a disaster before it really strikes a few hours lo foriy
eight hours before in case of a cyclone and a week before in case of Hoods.
ii.
Stage of Impact
This is the lime period during which the disaster actually strikes. Il may be jusl a few minulcs
in case of earthquakes, hours in cyclones and days in floods.
iii.
'Stage of Rescue Operations
Il is lhe lime when lhe actual rescue of the victims and lheir evacuation is being done. This
requires active work and should be completed al lhe earliest in lhe mosl efficient possible
manner. Il should nol lake more lhan iwo lo ihree days even for worst of lhe disasters provided
there is good disaster preparedness.
i
Stage of Health and Medical Relief
iv.
This is the most crucial phase of the disaster management. The mortality, jnorbdity and the
loss of property is inevitable when the disaster strikes. It shall however be a further disaster if
survivors of the disaster succumb and suffer due to relief work being not upto the mark. It
requires a lot of foresight, planning, co-ordination and management. An efficient relief phase is
infact the hallmark of a competent District Health Officer.
Rehabilitation Stage
v.
»
The displaced persons are then to be rehabilitated in their original settings. This depends on
the resources of the state and its commitment. Healthy rehabilitation is possible only if there is
good political support. A poor rehabilitation phase results in an exodus as large number of
refugees and the people migrating to nearby urban areas resulting in slums, unemployment and
deprivation like what happened in the East Pakistan cyclone (now Bangladesh) in 1970.
Check Points
1.
2.
What can you as a District Health Officer do before the disaster has occurred?
What shall be your role in the various stages of the disaster?.
9.1.8
Planning to Management a Diss ster
In order to manage disaster the following preparation and advance actions need to be
undertaken by a DHO in consultation and close collaboration with district administration in
various phases:
Planning Phase
A thorough and feasible planning in advance is mandatory for a smooth and efficient
management of a disaster. It is something like the mock exercises so frequently done by the
commandoes and soldiers.
I.
Review
Pre-planning requires detailed review, of all the disasters that have struck the district in past
years and the neighbouring districts. The information may be collected on an open ended
proforma based on a checklist something like described below for action diagnosis:
i.
ii.
iii.
iv.
v.
vi.
vii.
Would it have been possible to forsee the disaster?
What preparedness would have limited the number of victims and the damage?
What caused the victims and the damage?
What were the problems in the subsequuent hours and days?
What errors were made which must not be repeated?
What actions did the most good?
What were the main difficulties in the relief work?
The checklist for the local health personnel may be as follows:
a.
b.
What types of emergency cases occurred and what was possible to do for them?
What problems were encountered in the reception of the injured?
/ ?
What supplies were lacking?
What difficulties arose in sending the injured to properly equipped hospitals?
Would it have been possible to obtain better co-operation from the volunteers?
What were the difficulties of co-ordination with the authorities and the other community
groups?
How would it have been possible to obtain more effective outside assistance?
What health problems arose after the disaster and what were the difficulties in coping with
them?
c.
d.
e.
f.
g.
h.
Based on the analysis of the previous disasters and their management in the past we shall
learn from our mistakes and try not to repeat them in the future.
II.
Pre-determining the Community Needs
Pre-determining the needs in the event of a disaster not only avoids be wilderment and
confusion but also serves to:
i.
ii.
iii.
define priorities for direct action by local staff in the emergency relief work and later in the
management of health problems.
determine the real and accessible resources available in the way of personnel, premises,
medicaments, equipments and materials.
ascertain what is missing and what must be obtained as a priority from outside assistance.
The need pre-determination must seek to establish in every instance what must be done, who
should do it, in what way and by what means.
The community is expected to co-operate and show solidarity. In order to get the best out of
them, the knowledge of several aspects of life and moving forces in the community should be
assessed like: (i) the composition of the population by age, sex and household; (ii) social
structure; (iii) its economic and productive activities; (iv) the community institutions, services
and administration; (v) the forms of local political management, influential groups and persons,
current conflicts; and (vi) traditions, eating habits, the various aspects of local culture.
III.
Co-ordination with Olher Departments
The health department can never manage a disaster by itself. The District Health Officer
should thus in his plan for preparedness scheme develop proper co-ordination with the
following departments:
i. District Administration
ii. Public Utilities Departments (water, electricity etc.)
iii Post and Telegraphs Department
iv. Transport Services
v. The Department of Social Welfare
vi. Voluntary Organisations
vii. Redcross and the other International Organisations
viii. Outside Assistance Agents/Agcncies.
14
IV.
Training Health Personnel
The training of (he health personnel is an important component of the disaster preparedness.
The training component can be divided into two components:
a.
b.
First aid in the various types of emergencies.
The development of working methods to deal with various aspect of public health.
(a) Various types of emergencies for first aid:
i.
haemorrhages
ii. cardiovascular failure
iii. respiratory distress
iv. stales of shock
v. skull injuries
vi. burns
vii. fractures, dislocations,
viii. wounds
ix. exposure to cold
x. drownings
xi. electrocutions
xii. poisoning
Development of working methods to deal with various aspects of public health:
health information network, use of record cards, notebooks and registers, drafting reports,
disease monitoring system,
action to promote mental health and how to deal with psychological difficulties,
psychological and physical rehabilitation,
education for health, hygience and a clean environment,
control of endemic diseases (diarrhoea, tuberculosis, malaria, parasite diseases, vaccinable
diseases), and
vii. monitoring of nutritional status, remedial diet, education on nutrition in famine areas.
i.
ii.
iii.
iv.
v.
vi.
V.
Preparation of the Health Centre or Hospital
The preparation of the hospitals and health centres to deal with the emergency must be
made. The following provision must be made in the hospitals or health centres:
premises for receiving and sorting the injured,
a reserve stock of emergency medicaments,
a stock of medical supplies for use in emergencies,
essential medical equipment, bearing in mind the level of professional skill of the local
health personnel (sterilisation, minor surgery, resuscitation etc.),
v. ensuring the availability of water, electricity, fuel and supplies needed for the health facility
to function,
vi. means of transport (ambulances, other vehicles), and
vii. means of communication (telephone radio etc.)
i.
ii.
iii.
iv.
15
When the local health personnel include several professionals. a plan for emergencies must
be prepared which assign to each of them precise tasks such as:
i.
ii.
iii.
iv.
v
vi.
co-ordination of reception of cases.
screening and emergency care,
organisation of the voluntary health workers in (he health facility.
organisation of the voluntary health workers in the community,
supplies, and
communications.
Even the local hospital may get damaged in a disaster. To deal with that possibility, a plan
must be drafted to make provisions for:
iv.
v.
the tasks and responsibilities of staff,
instructions for using the disaster warning systems,
explanation of fire fighting equipment and the points at which extinguishing equipment is
kept,
ways and means of evacuating hospitalised patients, and
periodic excerise.
VI.
The Training ofVoluntary Health Workers
i.
ii.
iii.
The voluntary health workers should be trained in specific areas so that their services are
properly utilised for example:
i.
ii.
iii.
iv.
v.
collaboration in first aid,
reception of cases at the health facility,
liaison with the family groupings,
operation of the health information system, and
collaboration in carrying out programmes of vaccination, health education, environmental
sanitation, nutrition, menial health.
VII.
Preparedness Activities for Population
Disaster preparedness activities should be included in programmes focussed on certain
population groups:
i.
ii.
iii.
iv.
schools, occupational training centres,
work places,
neighbourhood groups, and
associations, groups of volunteers etc.
They should be trained in:
i.
ii.
First aid,
Activities to ascertain health risks,
16
iii.
iv.
Exercises in sanitation ana hygiene, ana
Activities concerned with the health education of groups at risk.
Check Points
What is the significance of investigating the details of the disasters that have occurred in
your district?
You are informed that the level of water in the river in your district is above the danger
mark. After 48 hours the water would flood 200 sq. kms’. of the area. Outline the steps you
wall plan to take to fare the calamity.
1.
2.
9.1.9
Implementation Phase
The immediate reaction of the people after a disaster is that of FEAR. Surprisingly people
rise to the occasion and give support to each other and take the injured to the health centre or
the hospital. Yet fear must be countered immediately by issuing certain items of information or
instructions (by using loudspeakers and mobilizing volunteers).
i.
ii.
iii.
iv.
What to do to be safe?
Information on the evolution and consequences of the disaster.
Where to obtain information about the scattered members of the family?
Information on essential matters like water, shelter and food.
Panic is not a common reaction and occurs when the disaster finds people crowded in sky
high buildings, towers, or theatres. Readers would recall that about a decade back quite a few
children died in the stampede in the Qutub Minar because of the panic caused by power failure.
Instructions over the loudspeakers to be calm and indicating where the exits are is to be
broadcasted.
I. Rescue Operations
A disaster may result in people being:
trapped under the ruins of buildings that have collapsed,
buried under mud or landslides, and
cut off by floods or the blockage of communication routes.
The rescue work will mostly be carried out spontaneously by relatives, friends and local
volunteers. When it is difficult to reach a victim or when there is a risk of further caving in, it is
advisible to leave the work of extrication to experts (fire fighters, army, trained volunteers,
building workers etc.). As soon as the rescuers reach on injured person they should help to:
maintain and ease respiration,
clear the victims airways by using fingers to clean the mouth and throat, taking out
dentures and loosening collars, belts and clothing, and
use blankets to prevent the victim catching cold.
The stretcher must be put down near the injured person. If no stretcher is available, one can
be made with blankets, pieces of cloth, ladder, door planks etc.
17
| When lifting the injured person certain rules must be followed:
movements must be calm and coordinated and carried out in accordance with the
instructions of a rescue worker,
the injured person must be moved as little as possible, and
the victims head, neck and trunk must be kept in the same axis.
(
B Conveyance by stretcher to the local health establishment must follow simple, common sense
Bules of patient transport.
I. Reception at the Health Centre or Hospital
(
The volunteers assisting the local health personnel should ensure the queries of the people
and guide them and help scattered families to re-unite or communicate and identify the injured.
Triage
When a large number of injured people are brought at the same lime to the health
stablishment, the more expert among the local health workers, taking into account the
quipment and professional skills available, must sort the cases into the following categories:
E
A. Those who must be sent urgently to the nearest properly equipped hospital. Among those
|two orders of priority may be distinguished.
A.l. Emergency cases that must be operated on within the hour:
i.
acute cardio-respiralory insufficiency
ii. severe haemorrhages
iii. internal bleeding
iv. rupture of the spleen
v.
injuries of the liver
vi. severe chest injury
vii. severe cervico-maxillary lesions
viii. states of shock
ix. severe burns (over 20%)
x.
skull injuries with coma
I
I
I
I
A.2 Emergency cases in which it is possible to wait a few hours before operating:
I
B.
i.
ii.
iii.
iv.
v.
vi.
vii.
ligatured vascular injury
intestinal lesions, severe haemorrhage or shock
open joint and bone injuries
multiple injuries with shock
injuries to the eyes
extensive closed fractures and dislocations
less severe burns
viii.
skull injuries without coma
Those given attention on the spot. Priority is given to the most serious cases among those
18
with a chance of surviving. There arc those who are attended to while waiting to be sent to a
specialised centre and (hose who do not need major medical care and can be treated oil the spot
The early group also includes very serious cases with no chance of survival who would be
pointless to be moved.
This shall be discussed in detail in the units 9.2 of this module.
Check Points
1.
2.
3.
When docs panic occur in a disaster? What can be done to prevent it?
What role can the people struck by the disaster perform in the rescue work?
How important is the role of the local people in reducing the mortality in the event of a
disaster?
9.1.10
Planning for Post Disaster Action
The District Health Officer now bears the responsibility of co-ordination with all the
departments and organisations already described and gear up action. The action will include
the assessment of the magnitude of the disaster and concommilment needs and extent of
delegation of responsibilities. Th'* help sought will cover general problems and activities for
health.
1.
Assessing the Quantum of Services and Resources
A. General Information
i.
ii.
iii.
iv.
v.
vi.
estimate the number of victims
assessment of the number of homeless
evaluation of the type, extent and seriousness of the material damage
information on isolated villages
information on people cut off from their families
forecasts as to how the natural phenomena responsible for the disaster will develop.
B. Inventory of Support Material Required for Assistance
i.
ii.
iii.
iv.
v.
vi.
vii.
viii.
ix.
x.
xi.
xii.
machines for clearing trouble
means of transport, fuel
shelters (tents, materials for constructing shelters, caravans, others)
blankets, clothings
food
tools, batteries, containers, materials
persons specialising in rescue work
health equipment and material
medicaments
any health personnel required
suitably equipped hospitals to which patients may be sent who cannot be looked after on
the spot.
means and organisation for evacuating the injured and the risk.
19
II.
Other Relevant Aspects
A. Family Groupings
The community should be sub-divided into groups consisting of neighbouring families and
someone should put in charge of each group. This person delegates special tasks to the
members of the group and keeps in daily touch with (he person delegated by the District Health
Officer. This helps:
i.
ii.
iii.
iv.
to collect information or requirements.
to pass on instructions and information,
to distribute where necessary the means of survival (clothing, blankets, food etc.), and
the health personnel using the system for health activities.
B. Temporary Shelter and Sanitation
Temporary shelter is a very important component of management. 11 the temporary shelter
and sanitation are well taken care for the ensuring epidemics that follow disaster (discussed in
detail in the units on management of epidemics) are greatly reduced. The site chosen for
erecting shelters should be:
Hood proof, above high waler level,
preferably on a gentle slope to facilitate rainwater and waste waler drainage,
not loo close lo the waler table otherwise (he ground could become marshy in the rainy
season,
iv. protected against landslides,
v.
easily accessible, not far from the centre of population,
vi. al a higher level than waste lips, and
vii. down stream from sources of drinking waler.
i.
ii.
iii.
The group looking after lhe organisation of relief camps should give priorly to the following:
i.
silc location
ii.
camp layout
iii. food requirements
iv. waler needs
v.
sanitation
vi. security
vii. information
viii. children’s problems
ix. lost and found senace
x.
equipment store
xi. volunteer’s residence
xii. camp director and administration
*
The camp director should erisurc that:
i.
ii.
volunteers are not rushed from one (ask lo another without proper resl,
there is no confusion in assigning responsibilities lo individuals or groups,
20
a pressing problem is not shelved but is tackled with faith and determination,
no one is reprimanded in presence of others. Call the defaulter separately and explain the
way it should be handled,
v.
all victims and volunteers are treated alike and no favouritism is shown to anyone,
vi. officials on duty arc not absent from camps for long hours,
vii. all preparations arc there to face adverse weather, rain or storm,
viii. campers (victims) are treated with sympathy and courteously,
ix. a sense of humour can save many a critical situations, and
x.
gradually involve the victims in relief administration.
iii.
rv.
Disposal of the Dead
C.
An early disposal while giving the dead due respect should be done. It is necessary to:
i.
vi.
remove the bodies from the disaster area as rapidly and discreetly as possible. As soon as
this has been done, attempts should be made to gather and note down information
necessary for identifying them like (place where one is found, information from relatives
and neighbours).
identify the bodies and attach tags to them giving the identification particulars.
draw up an official register of the deaths, containing identification particulars.
transport the bodies, which should be covered, to the place where they are to await
cremalion/burial and where personal belongings are also deposited.
cremate/bury the dead as late as is compatible with the laws, customs and weather of the
country so as to enable identification.
handover personal effects to the nearest relatives.
D.
Dealing with Animals
ii.
iii.
iv.
v.
In a disaster animals may be killed (in large numbers in floods for instance) or dispersed.
They may lose their shelter. Endemic zoonosis may spread. Dogs may revert to the wild and go
about in packs. The community, possibly using groups of volunteers (who will be more effective
if they have been trained in advance), should take steps to carry out the essential tasks:
i.
ii.
Destruction of animal carcasses: this is not easy because they are difficult to burn and
burying them involves a great deal of labour.
Housing of shelterless animals; treatment of stray animals. The animals must be brought
together in specially prepared premises, fed, milked and looked after.
The veterinary services in the area should:
i.
ii.
iii.
organise the monitoring of communicable animal diseases and of slaughter houses.
carry out'mass vaccination, depending on the local hazards such as rabies, fool and mouth
disease; swine fever, anthrax etc.
eliminate any sick animal and isolate the farms affected.
Measures to save slock may be very important in the rural areas and have a great impact on
the morale, health and economic recovery of the community.
III.
Health Problems in the Posl-disaster Phase
After the emergency treatment phase, in addition to the need to resume routine health
activities, problems arise that are specific to the post-disaster period:
possible complications and sequlae of injuries, fractures, cuts and burns,
the possibility that poor sanitary' and living conditions may favour the recrudescence and
spread of diseases already present in the area, and
the psychological suffering and disquiet that affect individuals and diminishes the
community’s power to recuperate.
i.
ii.
iii.
The District Health Officer must organise his staff to take on these new problems as part of
their activities which include:
iv.
the twenty four hour running of the health centre or local hospital and provision of routine
care,
the disease-monitoring system,
the resumption of the health programmes in progress before the disaster (vaccinations,
maternal and child health, control of tuberculosis, malaria, diarrhoeal diseases,
malnutrition and other health problems depending on the circumstances), and
activities to alleviate psychological sufferings.
IV.
Monitoring the Community’s Health
i.
ii.
iii.
Monitoring of the community’s health is based on a few essential elements:
i.
ii.
iii.
iv.
the basic network made up of voluntary workers with the charge of the family groupings,
the instructions issued at national or international level on the diseases that must be kept
under special scrutiny,
the possibility for the local health personnel to send specimens to an intermediate level
laboratory for examination to confirm diagnoses, and
the drafting of regular reports.
Disease monitoring must be particularly meticulous when one or more of the following
conditions exist:
i.
ii.
iii.
iv.
v.
vi.
vii.
presence of endemic foci,
people living in shelters,
concentrations of displaced persons in camps or on sites without services,
precarious or unsatisfactory nutritional status,
difficulties in supply of safe drinking water,
difficulties in disposal of refuse and waste waler, and
unfavourable climatic conditions.
V.
Health Education
When a concentration of displaced persons are living in temporary shelter, health education
is very important. It should include informational and educational activities on:
utilisation of water, cleanliness and protection of drinking water containers, making water
fit to drink (boiling, filtration), disposal of waste water.
ii. the utilisation and cleaning of laterines.
ui waste disposal, education on keeping public areas clean.
iv. cleanliness of the temporary dwellings.
v. control of lice and other parasites.
vi. control of flies, insect disease vectors and rodents.
vii. keeping everywhere dean, protection of food, minor deaning work.
i.
VI.
Reporting by the Local Health Personnel
The health personnel should submit periodic reports( weekly at the outset, then monthly) to
the intermediate levels and then to the District Health Officer. He should periodically study
them and advise accordingly.
Check Points
1.
2.
3.
List the broad managerial actions that you would take in case disaster occurred in your
district
Where do you think the management could be improved and how?
How can the mortality and morbidity be reduced during disaster?
9.1 JL1 Unit Review Questions
1.
Which of the two disasters - natural or manmade are worse and why?
2.
Are the injuries similar in all types of disaster? If not why?
3.
Name the disasters which are preventable.
4.
What are the problems faced in the relief operations in disasters?
5.
Your district is a flood prone one. You have been informed that the river has crossed the
danger mark and may flood the district within 24-36 hours. How will you proceed?
6.
Make a mock plan of the rescue and search operations in a district after a major
earthquake.
7.
What is the significance of the restoration of the public utility services?
8.
Why should assessment of needs be done before finishing the relief operations?
9.1JL2 Test Items
Select the most suitable or correct answer from the following and tick against that:
1.
After a major disaster the mature behaviour exhibited is of:
a.
b.
^c.
d.
being in panic.
stunned waiting for outside help.
spontaneous yet organised action by suffers after recovery from shock.
inaction due to shock for few days to a few weeks.
23
|2.
The injury among (his group is highest after an earthquake:
j
■
,a.
b.
c.
d.
[3.
The aftermath of winter floods is:
a.
b.
c.
xd.
I
4.
'
high mortality,
high mortality in flash floods,
high mortality in collapse of dams, and
floods in winters may cause deaths due to hypothermia.
Following a disaster all the following actions take place except:
a.
b.
c.
<d.
5.
persons who are indoors,
infants,
old aged persons, and
young children.
local people busy themselves in rescue operations,
caste and class differences die out and people work together,
the majority of the people prefer to stay in the threatened area, and
the responsibility of caring for a disaster stricken community should be entirely is
taken over by outside assistance and State authorities.
In (he preplanning for disaster management it is important to:
a.
b.
c.
✓d.
collect information about the diseases that occurred in the past in the district, •
know the type of disasters and flaws in the management in the past,
determine the problems being faced in co-ordinating within health sector and other .
organisations, and
all of the above.
9.1.13 Further Readings
1.
Arnold C, Eisner R, Durkin M, Whitaker D: Occupant Behaviour in a Six Storey Office
Building Following Severe Earthquake Damage, Disaster 6: 207-214 (1982).
2.
Bres P. Public Health Action in Emergencies Caused by Epidemics, WHO, Geneva.
3.
Cohen S,P.; Raghavulu C.V. The Andhra Cyclone of 1977, Vikas Publishing House, New
Delhi 1979.
4.
Davis I. Disaster and Small Dwellings, Pergamon Press, Oxford 1981.
5.
Gaur S.D.; Marwah S.M. Public Health Aspect of Floods with Illustrations for 1967
Varanasi Floods, Indian J Public Health, Varanasi Vol. 12, (1968).
6.
Green S; International Disaster Relief; Towards A Responsive System, McGraw Hill, New
York 1977.
7.
Quarentelli E L; The Community General Hospital: Ils Immediate Problems in Disasters,
Am. Behav. Seienl. Vol 13.
8.
Seaman J; Epidemiology of Natural Disasters 1984, S.Korgen, Base! (Switzerland).
9.
Semmer A, Moseley \y.H.; East Bengal Cyclone of Nov 1970, Epidemiological Approach
to Disaster Assessment, Lancet ii, London, 1972’.
10.
Western K.D. : Epidemiologic Surveillance After Natural Disaster, Scient. Publ. No.420;
Pan American Health Organisation, Washington, 1982.
11.
WHO, Coping with Natural Disasters : The Role of Local Health Personnel and the
Community, Geneva, 1989.
12.
Aqueil Ahmad - Disaster Management Preparedness and Response, Workshop
Proceedings ASCI 7 ARTIC, 1981.
13.
PAHO, Emergency Health Management after Natural Disaster. Pan American Health
■Organisation, New York, 1981.
14.
Natural Disasters - A Guide for Relief Workers, Joint Assistance Centre, 1988.
25
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