Prepare for Disasters with Effective Plans

It wasn’t raining when Noah built the arc”
Howard Ruff
INTRODUCTION
“Despair is most often the offspring of ill-preparedness.”

“We cannot stop natural disasters but we can arm ourselves with knowledge: so many
lives
Wouldn’t have to be lost if there was enough disaster preparedness.”
“Preparedness, when properly pursued, is a way of life, not a sudden, spectacular
program.”
A disaster is an event or series of events, which give rise to casualties and damage or loss
of property, infrastructure, environment, essential services or means of livelihood on a scale that is
beyond the normal coping capacity of the affected community. Disasters disrupt progress and destroy
the developmental efforts, often pushing nations, in their quest for progress, back by several decades.
Thus, efficient management of disasters, rather than mere response to their occurrence, has received
increased attention both within India and abroad 1. India is one of the most disaster prone
countries in the world. This is largely due to its geo-climatic conditions combined with high
population density and other socio economic factors. India is vulnerable, in varying degrees,
to a large number of natural as well as man-made disasters . Floods, droughts, cyclones,
earthquakes and landslides have been recurrent phenomena 2.
Definition of disaster
“A disaster can be defined as any occurrence that causes damage, ecological disruption, loss of human
life, deterioration of health and health services on a scale, sufficient to warrant an extraordinary
response from outside the affected community or area” 3. (W.H.O)
Causes for Occurrence of Disaster
 Environmental degradation: Removal of trees and forest cover from a watershed area have
caused, soil erosion, expansion of flood plain area in upper and middle course of rivers and
groundwater depletion.
 Developmental process: Exploitation of land use, development of infrastructure, rapid

urbanization and technological development have caused increasing pressure over the natural
resources.
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 Political issues: War, nuclear power aspirations, fight between countries to become super
power and conquering land, sea and skies. These have resulted into wide range of disaster events
such as Hiroshima nuclear explosion, Syrian civil war, growing militarization of oceans and outer
space.
 Industrialization: This has resulted into warming of earth and frequency of extreme weather
events has also increased4.
Disasters are classified as per origin, into natural and man-made disasters. As per
severity, disasters are classified as minor or major (in impact).
 Natural disasters are sudden ecological disruptions or threats that exceed the adjustment
capacity of the affected community and require external assistance.
Natural disasters can be broadly classified into categories including geophysical such as earthquakes
and volcanic eruptions; hydrological such as floods; meteorological such as
hurricanes; climatologically such as heat and cold waves and droughts; and biological such as
epidemics.
 Man-made disasters can include hazardous material spills, fires, groundwater contamination,
transportation accidents, structure failures, mining accidents, explosions and acts of terrorism 4.

Impacts of Disaster
 Disaster impacts individuals physically (through loss of life, injury, health, disability) as

well as psychologically.
 Disaster results in huge economic loss due to destruction of property, human settlements and
infrastructure etc.
 Disaster can alter the natural environment, loss of habitat to many plants and animals and
cause ecological stress that can result in biodiversity loss.
 After natural disasters, food and other natural resources like water often becomes scarce
resulting into food and water scarcity.
 The disaster results in displacement of people, and displaced population often face several
challenges in new settlements, in this process poorer becomes more poor.
 Disasters increase the level of vulnerability and hence multiply the effects of disaster4.

Stages in Disaster Management
Disaster Management efforts are geared towards disaster risk management.
 Disaster Risk Management implies the systematic process of using administrative

decisions, organisation, operational skills, and capacities to implement policies, strategies and
coping capacities of the society and communities to lessen the impact of natural hazards and
related environmental and technological disasters.
 These comprise all forms all activities including structural and non- structural measures to
avoid (prevention) or to limit (mitigation and preparedness) adverse effects of hazards.
 There are three key stages of activities in disaster management:
1. Before a disaster: to reduce the potential for human, material, or environmental losses
caused by hazards and to ensure that these losses are minimized when disaster strikes;
2. During a disaster: to ensure that the needs and provisions of victims are met to alleviate and
minimize suffering; and
3. After a disaster: to achieve rapid and durable recovery which does not reproduce the original
vulnerable conditions.
 The different phases of disaster management are represented in the disaster cycle diagram.

Disaster Risk Reduction (DRR)
 Disaster risk reduction is the concept and practice of reducing disaster risks through
systematic efforts to analyze and reduce the causal factors of disasters.
Pre-Disaster risk reduction includes-
1. Prevention/Mitigation
Prevention/Mitigation is defined as “sustained actions that decrease the risk of a hazard (probability of
occurrence) of a hazard, or to reduce the potential negative consequences suffered by people and/or
property.”
It can involve such actions as:
 Laws and regulations restricting deforestation to prevent mudslides

 Relocating or elevating structures to minimize the effects of floods
 Securing shelves and hot water heaters to walls in earthquake zones
 Developing, adopting and enforcing building codes and standards
 Engineering roads and bridges to withstand earthquakes
 Using fire-retardant materials in new construction to reduce the risk of fire 4
2. Disaster Preparedness

Definition
Disaster preparedness refers to measures taken to prepare for and reduce the effect
of disasters. This is to predict and where possible prevent them, mitigate their impact on vulnerable
population, and respond to and effectively cope with their consequences. 5
The United Nations Disaster Relief Office (UNDRO) uses the following definition of
Disaster Preparedness:
“It may be described as (a series of) measures designed to organize and facilitate timely and effective
rescue, relief and rehabilitation operations in cases of disaster…. Measures of preparedness include
among others, setting up disaster relief machinery, formulation of emergency relief plans, training of
specific groups (and vulnerable communities) to undertake rescue and relief, stockpiling supplies and
earmarking funds for relief operations”.5
Aims and objectives of disaster preparedness
1. Increasing the efficiency, effectiveness and impact of disaster emergency response

mechanisms at the community, national, and Federation level. This includes :
2. Strengthening community-based disaster preparedness through National Society Programmes
for the community or through direct support of the community’s own activity. This could
include educating, preparing and supporting local population and communities in their
everyday efforts to reduce the risk and prepare their own local response mechanisms to
address disaster emergency situations.
3. Developing activities that are useful for both addressing everyday risks that communities face
and for responding to disaster situations- for example, health, first-aid, or social welfare
programmes that have components useful for disaster reduction and response.
4. Ensuring that the appropriate systems, procedures and resources are in right place and right
time to provide prompt, effective assistance to disaster victims, thus facilitating relief
measures and rehabilitation of services.
5. Decreasing community vulnerability to disaster. 5
Principles of disaster preparedness
1. Participation and local ownership : It is important that arrange of people participate in the
process of preparedness planning for a number of reasons:

1) It helps to increase awareness of the plan, imbed it in the organization and build commitment
for its use.
2) Decisions are based on arrange of experience and knowledge, increasing the validity of the
plan produced.
3) Skills and knowledge of staff and volunteers are built through taking part , increasing the
capacity of the organization as a whole.
4) Valuable relationships between staff, volunteers’ community members and external actors
are built through working together.
2. Ongoing learning: Learning through doing Disaster preparedness planning is first and foremost
an exercise in capacity building for the organization and individuals involved.
3. Commitment to good practice: All disaster response work should adhere to Humanitarian
principles of good practice. It is essential therefore that these are taken into account when preparing
plans for response. Adhering to these principles increases accountability to beneficiaries and donors
and has less chance of causing unintentional harm
4. Collaboration not isolation: When disasters occur people are affected in multiple ways and
require a wide range of help and support. It’s unlikely that one organization alone can provide
everything needed, so any organizations provide responses. These organizations need to work in
coordination with each other to ensure an effective and efficient response. In order to coordinate
effectively, relationships between organisations, communities and governing bodies must be built.
5. Prevention before response: The final principle recognizes that preparedness is about reducing the
impact before the event as well as after it. Planning response activities helps reduce impacts in the
event o f a disaster by increasing the speed and quality of response work. 6
Other principles are:

1. Comprehensive: consider and take into account all hazards, all phases, all stakeholders and
all impacts relevant to disasters.
2. Progressive: anticipate future disasters and take preventive and preparatory measures to build
disaster- resistant and disaster -resilient communities.
3. Risk-driven: use sound risk management principles in assigning priorities and resources
4. Integrated: ensure unity of effort among all levels of government and all elements of a
community.
5. Collaborative: create and sustain smooth relationship among individuals and organizations.
6. Coordinated: synchronize the activities all relevant stakeholders to achieve a common
purpose.
7. Flexible: use creative and innovative approaches in solving disaster challenges.
8. Professional: science and knowledge based approach.7

Types of preparedness
1) Target-Oriented Preparedness: Preparedness plans are also target specific, for instance, we
may require different types of planning for the vulnerable groups of women, children, elderly
and disabled. Livestock would need a specific preparedness plan. Then there could be health
preparedness plans, risk reduction preparedness plans, and awareness generation plans.
2) Task-Oriented Preparedness: the various tasks to do as preparedness are;
 Mapping
 Planning
 Forming Disaster Task Forces
 Training of Members of Task Force and other Volunteers
 Creating Structures for Coordination
 Promoting Awareness Campaigns
 Operationalizing Disaster Management
 Recruiting Personnel for Relief and Distribution Tasks
3) Disaster-Oriented Preparedness: Disaster Preparedness, thus, takes place at two different levels,
structural and non-structural:
Non-structural preparedness measures include:
 Administrative and Regulatory Legislation
 Insurance Schemes
 Information, Education and Training
 Community Participation
 Community Action Groups
 Responding to Warning Systems
 Institution Building
 Provision of Incentives
 Creation of Public Awareness
Structural Preparedness measures are proactive and reactive measures. These are used to
arrest the adverse impact of disasters. These measures would vary from disaster to disaster. 6
.
Post-Disaster risk reduction includes
Response

Response is defined as the actions taken to decrease mortality and morbidity, and to prevent further
property damage when the hazard occurs. Response is putting preparedness plans into action.
Response activities may include
 search and rescue

 triage
 acute medical care
 fire fighting
 sheltering victims
 relocating medical records
Recovery
Recovery is defined as the actions taken to return to normal following an event.
Repairing buildings
Replacing homes.5

MODELS OF DISASTER MANAGEMENT
1. Traditional model (cycle of disaster management): The different disaster management

phases, rather than in a sequential manner, run parallel to each other.
2. The four phases model of disaster management (Kimberly model): This model emphasises
emergency management. The most important phase of this model is the response phase.
3. Circular model of disaster(Kelly model) : The main feature of this model is its ability to learn
from real disasters.
4. Lechat model: This model starts with anticipation of disaster and ends at the rehabilitation
stage.
5. Gupta model: This model does not pay much attention to pre-disaster phases.
6. PDCA model: The PDCA cycle with the continuous improvement cycle of plan, do, check
and act was advocated after the Second World War.
7. Monitoring and evaluating model of disaster risk management: This model is a unique
framework for monitoring and assessment of disaster risk management plans for use by disaster risk
management programmes to track the outcomes of their interventions and ultimately raise standards in
this area.
8. Mc Conkey model : Mc Conkey model pays special attention to pre-disaster management in
four stages.
9. Crunch model: This model is a causal model that provides a framework for understanding the
causes of the disaster; its structure is formed by the following equation:
Disaster Risk = Hazard *Vulnerability.
10. PAR model: Unlike the Crunch model and using preventive measures, try to reduce the
disaster risk.
11. Wheel-shape model : One of the comprehensive disaster management models is the wheel-
shape model that is based on the life cycle of disaster and crisis, as well as its various stages. Also, it
is formed by combination of logical and integrated models. 8
THEORIES OF DISASTER MANAGEMENT

1. Sustainable Development Theory: Development that meets the needs of the present without
compromising the ability of future generations to meet their own needs. There are five theories
under sustainable development:
1. Development perspectives
2. Sustainability Perspectives
3. Technology
4. Economic theory

5. Marxist Interpretation of Disasters
2. Emergency Management Theory: Under the emergency management theory there are four
theories.
1. Risk perception and communication
2. Preparedness and improvisation
3. Emergent behavior
4. Organizational behavior
3. System Theory: Four theories are categories under the system theory
1. Social constructionist views

2. Weberian perspectives of emergency management
3. System theory
4. Compliance model of evacuation
4. Policy Making Theory : National Disaster Management Policy in our country turn over a
new leaf and Enhancing professional skills and knowledge of key personnel on risk
reduction, preparedness, warning and forecasting system, and post-disaster activities.
5. Networking and Management Theory: Under the Networking and Management theory
there are three theories
1. Networking and collaboration
2. Integration
3. Management theory
Disaster management is a part of good governance which includes active interactions among various
stake holders like administrative machinery, citizen groups, formal and informal institutions. Disasters
are episodic but are recurrent. Preparedness is the key to the success of Disaster Management Plan
and without citizens’ involvement and participation any effective plan is rendered ineffective. It is
becoming increasingly evident now that a relatively smaller investment in disaster preparedness can
save thousands of lives and vital economic assets, as well as reduce the cost of overall relief
assistance. 8
NEED OF DISASTER PREPAREDNESS

Disasters strike in every corner of the world, during every season,
and on different scales throughout the year. Indeed, hospitals, food banks, human and animal shelters,
and other nonprofits are integrated into most response and recovery efforts during emergencies. These

events are often unexpected by their very nature, leaving little time, if any, to prepare. That is why it is
so important to put time into planning and preparation long before the disaster strikes.
Current status in India
 Due to location and climate, India itself is one of the most disaster-prone areas of the world.
The country is exposed to many natural hazards including floods, cyclones, droughts, and earthquakes
and these disasters often cause significant damage to property and loss of life.
 Disaster risks in India are compounded by increasing vulnerabilities related to changing

demographics and socio-economic conditions, unplanned urbanization, development within high-
risk zones, environmental degradation, climate change, geological hazards, epidemics and
pandemics. Clearly, all these contribute to a situation where disasters seriously threaten India’s
economy, its population and sustainable development.
 The Government of India recognizes the need to shift from a post disaster reactive approach
to a pre-disaster pro-active approach which includes preparedness, mitigation, and prevention.
 In May 2019, more than 20 young people died due to a deadly fire at a coaching centre in
Surat. According to National Crime Records Bureau data, India’s record is appalling on fire safety.
More than 17,000 people nationwide died in fire related incidences in 2015. These tragedies highlight
the gaps in Disaster Management framework of India. In this context, there is a need to understand the
various facets of Disaster Management and what should be done for fixing accountability and
updating of disaster management protocol countrywide. 9
The gaps in disaster preparedness in Kerala flood 2019
 Floods are becoming a common phenomenon in India. Over the past few decades, areas
facing recurring calamities have become relatively better prepared, with an increased understanding of
the risks. This does not hold true for areas that have not experienced a major calamity in the recent
past. Ignoring all the safety guidelines, dwellings, factories and infrastructure facilities have been
constructed in areas that are potentially vulnerable to natural hazards like floods.
 This year, Kerala received unprecedented rainfall, forcing the authorities to open the gates of
all major dams, resulting in the worst flooding in 100 years, with 86% of the territory (12 out of 14
districts) affected. The floods in Kerala highlighted an emerging threat in the country: the danger from
dams. A report published in 2017 by the Comptroller and Auditor General (CAG) about India’s
performance audit on flood control and management schemes categorically stated that only 7% of

dams (349 out of 4,862) have Emergency Action Plans. Kerala has 44 rivers and 61 dams, but as per
the CAG report none of these dams have Emergency Action Plans and Operation and Maintenance
manuals. The audit also draws attention to the absence of flood forecasting systems in 15 states and
Union Territories.
 Until August 2016, only 5% dams (231 out of 4,862) had an operational maintenance manual.
Various committees have been formed for flood management, such as the Rashtriya Barh Ayog. But
their recommendations, with regards to identification of flood prone areas, have not yet been put into
action.
 After every disaster, its aftermath and adverse impacts raise a lot of questions about the status
of preparedness. It is important to acknowledge that we are still not completely ready. This is because
disaster management agencies continue to be reactive in their actions. Following the Uttarakhand
floods in 2013 and Kashmir floods in 2014, it was only after a lot of questions were raised and
criticism directed at preparedness practices that flood forecast stations were set-up in these two states.
The same should have been done for all the flood prone states, but it seems that we did not learn from
our mistakes. We continue to be reactive rather than focusing on preparedness.
 The non-structural measures for flood forecasting — provide early warning in flood prone
areas — have proved to be successful for flood management. However, for the early warning systems
to be effective, continuous and collaborative efforts are required, rather than a one-time action. For
instance, high-tech warning systems on the ground will not be useful until the authorities, key
stakeholders and communities are trained to act upon the information obtained from these facilities.
People affected by the Kerala floods reported that they had heard a faint announcement on the
loudspeakers, but the message could not be heard clearly, so they were unsure about what it meant till
the water entered their houses. Different stakeholders need to come together for mapping risks,
vulnerabilities, and resources; engage in regular preparedness actions like drills and capacity building;
develop and update emergency plans; check the availability of resources at the local level; and act
upon early warning intimations. While the government works towards strengthening systems and
mechanisms for preparedness and response, civil society has a major role to play, at the community
level, for disaster preparedness.
Disaster management plans exist on paper, but implementation remains a challenge. Despite the
emphasis on a paradigm shift to a preparedness approach by the government, most parts of the
country continue to follow a relief-centric approach in disaster management, rather than a proactive
prevention, mitigation and preparedness path. There is a need for investing in disaster preparedness
and mitigation across the country, irrespective of whether any state has been hit by a disaster or not.
India needs to adopt a collaborative approach, where the roles of the government, corporations,

academia, civil societies and communities are recognized, and all actors work hand-in-hand towards
achieving disaster resilience.10
There are some very important reasons why you should prepare for a disaster:
 Saves Lives – Different disasters require different responses. Being prepared for various
disaster emergencies can make a huge difference in saving lives as well as money.
 Reduces Danger – Knowing the steps to take during a disaster – whether flooding,
tornadoes, earthquakes or another crisis – can greatly reduce the danger and distress your
family may face.
 Reduces Uncertainty – Not having a complete understanding of a hazard threat can leave
you frightened and uncertain of what to do to protect yourself and your loved ones. Being
prepared by knowing what to do reduce uncertainty.
 Helps Cope with Stress – Disasters are stressful events over which we have little or no
control. The sudden disruption of everyday life, the experience of fear, feelings of
uncertainty and a lost sense of safety are the common factors that make all disasters very
stressful.
 Speeds Recovery – How quickly you can recover from a disaster depends on how well
you have planned and prepared for one.
 Establishes Sense of Safety and Security – Children take their emotional cues from the
significant adults in their lives. Adults can help children cope first and foremost by
establishing a sense of safety and security. 11
Need of Hospital Preparedness and Emergency Health Management
Hospital preparedness is crucial to any disaster response system. Each

hospital need to have an emergency preparedness plan to deal with mass casualty incidents and the
hospital administration/ doctor/ nurses trained for this emergency. The curriculum for medical and
nursing students does not at present provide due importance for Hospital Preparedness for
emergencies. Therefore capacity building through in-service training of the current health managers
and medical personnel in Hospital Preparedness for emergencies or mass casualty incident
management is essential. At the same time in order that the future health managers acquire these skills
it is proposed to include health emergency management in the undergraduate and post graduate
medical curricula. In consultation with Medical Council of India (MCI), two committees have been
constituted for preparation of curriculum for introduction of emergency health management in MBBS
curriculum and preparation of in-service training of Hospital Managers and Professionals. Rajiv
Gandhi University of Health Sciences Karnataka has been identified as the lead national resource
institution for the purpose.12

Need of Disaster preparedness among nurses
The increasing frequency of disasters worldwide necessitates nurses to adequately prepare to respond
to disasters to mitigate the negative consequences of the event on the affected population. Despite
growing initiatives to prepare nurses for any disasters, evidence suggests they are under prepared for
disaster response12. Nurses being largest group in the healthcare team, play a vital role in disaster
preparedness and response. Nurses practice in a variety of settings, from acute care hospitals to long-
term care facilities and community clinics. Regardless of their practice setting, all nurses need to be
educated in potential disasters and emergency response .Nurses must be equipped with proper
knowledge and skills in order to prepare them for their effective role during large-scale disasters and
mass casualty events. But many studies reveal that nurses lack knowledge, skill and attitude towards
disaster preparedness.
Hammad K, Gloe D S (2018) conducted a systematic review of literature on Disaster

preparedness among nurses: a systematic review of scientiﬁc articles conducted from 2006 to 2016 on
nurses’ preparedness for disasters. SCOPUS, MEDLINE, Pub Med, CINAHL and Psych INFO were
the primary databases utilized for search of literature. Seventeen (17) articles were selected for this
review. The Findings were, factors that increase preparedness for disaster response include previous
disaster response experience and disaster-related training. However, it is widely reported that nurses
are insufficiently prepared and do not feel conﬁdent responding effectively to disasters 12.
A Cross-sectional descriptive study was conducted to examine nurses' knowledge, attitudes, practices
and familiarity regarding disaster and emergency preparedness-using five tools to obtain data from
252 two registered batches of bridging nurses students. Based on the present study results; lacking of
knowledge and practices with acceptable level of attitude regarding disaster preparedness and neutral
familiarity with emergency preparedness were concluded.
Baack S and Alfred D conducted a descriptive analysis on 620 Rural Nurses’ Preparedness and
Perceived Competence in Managing Disasters with a 58‐item Disaster Readiness Questionnaire
through survey method. Findings revealed that most nurses are not confident in their abilities to
respond to major disaster events. The nurses who were confident were more likely to have had actual
prior experience in disasters or shelters. Self‐regulation of behavior (motivation) was a significant
predictor of perceived nurse competence to manage disasters only in regard to the nurse's willingness
to assume the risk of involvement in a disaster situation . 13

REVIEW OF LITERATURE
Common disasters and Vulnerability Profile of India

 India is vulnerable, in varying degrees, to a large number of disasters. Around 59% of the
landmass is prone to earthquakes of moderate to very high intensity.
 About 12% (over 40 million hectares) of its land is prone to floods and river erosion.
 Close to 5,700 kms, out of the 7,516 kms long coastline is prone to cyclones and tsunamis.
 68% of its cultivable area is vulnerable to droughts; and, the hilly areas are at risk from
landslides and avalanches.
 Moreover, India is also vulnerable to chemical, biological, radiological and nuclear

(CBRN) emergencies and other man-made disasters.1
Worst Disasters in India
 Kerala floods (2018), the worst flooding in 100 years, with 86% of the territory (12 out of 14
districts) affected.
 Kashmir Floods (2014) affected Srinagar, Bandipur, Rajouri etc. areas of J&K have resulted
into death of more than 500 people.
 Uttarakhand Flash Floods (2013) affected Govindghat, Kedar Dome, Rudraprayag district

of Uttarakhand and resulted into death of more than 5,000 people.
 The Indian Ocean Tsunami (2004) affected parts of southern India and Andaman Nicobar
Islands, Sri Lanka, Indonesia etc., and resulted in the death of more than 2 lakh people.
 Gujarat Earthquake (2001) affected Bhuj, Ahmedabad, Gandhinagar, Kutch, Surat,

Surendranagar, Rajkot district, Jamnagar and Jodia districts of Gujarat and resulted in death of
more than 20,000 people.
 Odisha Super Cyclone or Paradip cyclone (1999) affected the coastal districts of Bhadrak,
Kendrapara, Balasore, Jagatsinghpur, Puri, Ganjam etc., and resulted into death of more than
10,000 people.
 The Great Famine (1876-1878) affected Madras, Mysore, Hyderabad, and Bombay and
resulted into death of around 3 crore people. Even today, it is considered as one of the worst natural
calamities in India of all time.
 Coringa Cyclone (1839) that affected Coringa district of Andhra Pradesh and Calcutta

Cyclone (1737) are some other instances of natural calamities faced by the country in the past.

 The Bengal Famine in the years 1770 and 1943 affected Bengal, Odisha, Bihar very badly
and resulted into death of nearly 1 crore people.
 Bhopal Gas tragedy (December, 1984) is one of the worst chemical disasters globally that
resulted in over 10,000 losing their lives (the actual number remains disputed) and over 5.5 lakh
persons affected and suffering from agonizing injuries. 1
In recent times, there have been
o cases of railway accidents (Dussehra gathering on the railway tracks crushed by the

trains in 2018),
o fire accidents in hospitals due to negligence and non implementation of existing

mandatory fire safety norms,
o collapse of various infrastructure constructs like flyovers, metro tracks and

residential buildings due to poor quality of construction, illegal addition of floors and recurring
floods.
o Stampede at large public gathering like Kumbha Mela caused by poor people

management and lack of adequate infrastructure to monitor and manage large crowd gathering. 1
Common disasters and Vulnerability Profile of Kerala
 Kerala state is frequently ravaged by the disastrous consequences of numerous hazards and hence
it is a multi-hazard prone State. A study conducted on migration suggested that in the past 80
years the coastal plains recorded a population growth of 306%, whereas the highlands, foot hills
and uplands together experienced a growth of 1342% (Nair et al., 1997). This population with a
density of 819 people/km2 (Census of India, 2001) is more or less widely distributed across all
geomorphic units of the state, exposing them to multiple hazards.
 5642.68 km2 of area which is 14.52% of the total area of the state is prone to floods.
 Kerala is prone to high incidence of lightning, especially during the months of April, May,
October and November.
 Apart from floods the mountain regions of the state experience several landslides during the
monsoon season. It is known that a total of 65 fatal landslides occurred between 1961 and 2009
causing the death of 257 individuals. The west facing Western Ghats scarps that runs the entire
extent of the mountain system is the most prone physiographic unit for landslides
 Between 1871 and 2000, the state experienced 12 moderate drought years.
 The 570 km long coast line of Kerala is prone to erosion, monsoon storm surges and sea level
rise. Land subsidence due to tunnel erosion or soil piping which is a slow hazard, is recently
noticed to be affecting the hilly areas in the state. This often goes unnoticed and is a hazard with

potential of causing landslides, infrastructural damages and crop loss covering vast areas in the
high land regions of the state.
 The high density of population of 860 people/km 2 (2011 Census), narrow roads, high density of
road network, density of coastal population and the general higher standard of living of the public
as compared to the rest of the country are factors that increase the vulnerability of the population
to disasters.
 Natural forest fires are reported in Kerala. It is usually the dry and moist deciduous forests of the
state which experience forest fire. From 2009 to 2014, 18,170 hectares of forest land were
destroyed by recurring forest fires in the state.
 The 590 km coast of Kerala is one of the most densely populated land areas in the country. This
coastline is exposed to high waves, storm surges, ‘Kalla kadal’ and Tsunami.
 Stampedes : Most of the temples, churches and few mosques in Kerala organize annual prayers as
festivals. These festivals attract huge crowds even at village level and thus have potential for
occurrence of stampedes.
 Fire cracker explosions : the recent example is at Puttingal Devi Temple(2016), Kollam.109
people were died.
 Accidental drowning : Drowning is the second biggest accident killer in Kerala, next to road
accidents. According to National Crime Records Bureau about 15.2% of unnatural deaths in
Kerala are due to drowning. More than 1,500 people die per year in drowning, which is the
highest in India.
FEW NOTABLE EVENTS ARE:
 August 2018: Kerala flood

 2017 : “ Okhi ”
 28th May 2016: Five children of a family drown in Chamthachal River, Kannur
 18th July 2016: Five college students hailing from Thiruvananthapuram drowned in the sea off
Kovalam beach
 31st October 2015: Two died in sea off the Mararikkulam beach while two others died at a temple
pond at Thuravoor
 1 st May 2015: Three persons of a family from Karnataka drowned at the Kappad beach in
Kozhikode
 13th April 2014: Two girl students drowned in Cherupuzha, a tributary of Chaliyar, Kozhikode
 26th December 2012: Five NCC cadets drowned in Periyar River at Malayatoor in Ernakulam
district
 14th May 2006: Four youths drowned at Meenmutty waterfalls, Thiruvananthapuram.

 13th October 1991: Nine students from the Dental College, Thiruvananthapuram downed at
Kallar, Thiruvananthapuram.10
Current practices of disaster preparedness among health professionals in India
Disaster preparedness is achieved partially through readiness measures that expedite emergency
response, rehabilitation, and recovery and result in rapid, timely and targeted assistance. It is also
achieved through community based approaches and activities that build the capacity of people and
communities to cope with and minimize the effects of a disaster on their lives.
1. Hazard, risk and vulnerability assessments
2. Response mechanisms and strategies
3. Preparedness plans
4. Coordination
5. Information management
6. Early warning systems
7. Resource mobilization
8. Public education, training and rehearsals
9. Community based disaster preparedness

1. Hazard, risk and vulnerability assessments
All planning and implementation of disaster preparedness measures should be based on
an assessment and prioritization of the hazards and risks that people face, as well as their
ability or inability to cope up with and withstand the effect of those hazards..this assessment
should:
 Identify the characteristics, frequency and potential severity of the hazards a
community face
 Identify the particular geographical areas and communities that are most susceptible
and vulnerable to those hazards.
 Identify the main sectors of a community (population, infrastructure, housing,
services etc.) that would be affected by a specific type of hazard and anticipate how
they might be affected.
 Assess the ability of those sectors to withstand and cope with the effects of
hazardous phenomena.
2. Response mechanisms and strategies
There are many preparedness mechanisms and strategies that will strengthen and
increase the effectiveness of emergency response. These include development formation of:
 Evacuation procedures

 Search and rescue teams
 Assessment teams
 An assessment process and information priorities for an emergency response
 Measures to activate special installation such as emergency or mobile hospital facilities.
 Procedures for activating distribution systems.
 Preparations for emergency reception centres and shelters.
 Procedures for activating emergency programs for airports, harbors and land transport.
3. Preparedness planning
The concept of preparedness planning is very important for those involved in disaster
management. During an actual emergency, quick and effective action is required.
This action often depends on having made and implemented preparedness plan. If appropriate
action is not taken or if the response is delayed, lives may be needlessly lost.
Disaster preparedness planning involves identifying organizational resources, determining
roles and responsibilities, developing policies and procedures and planning preparedness
activities aimed at ensuring timely disaster preparation and effective emergency response.
The aim of preparedness planning is to identify the assignments and specific activities
covering organizational and technical issues to ensure that response systems function
successfully in the event of a disaster.
4. Coordination
National society plans ideally should be coordinated with the plans and intentions of other
agencies and organizations. Effective disaster response requires mutual trust and coordination
of efforts and resources among the many agencies and people involved in emergency
response including the affected local population and local community based organizations.
Working on disaster preparedness planning prior to the disaster helps involved agencies better
understand each other’s aims, objectives and capacities. Such understanding and
communication results in more coordinated efforts, and help avoid duplication and identify
gaps and weakness in necessary services during an actual emergency response.
5. Information management
Disaster preparedness and response depends on gathering, analyzing and
acting on timely and accurate information before, during and after disasters. This requires that
the National Societies predetermine what information they need, how it will be collected, who
will collect it, who will analyze it, and how it will be integrated into a timely decision making
process. If National Societies are to respond to disasters in a timely fashion, they will need to
develop procedures and mechanisms, for obtaining, analyzing and responding to early
warning information regarding hazard detection, forecasting and alerts.

6. Early warning systems
The purpose of early warning systems is to detect, forecast and when
necessary, issue alerts related to impending hazards events. Early warning information need
to be communicated in such a way that facilitates decision making and timely action of
response organizations and vulnerable groups. Early warning information comes from a
number of sources: eg. Meteorological offices, ministries of health and agriculture, local and
indigenous sources, media sources and increasingly from internet warning services.
7. Resource mobilization
National Societies should develop strategies, agreements and procedures for
mobilizing and acquiring emergency funds., supplies and equipments in the disaster event. A
preparedness plan should spell out the policies for acquisition and disbursement of funds, use
of outside equipment and services, and emergency funding strategies.
8. Public education, training and rehearsals
Disaster preparedness must be supported by public education campaign,
training of response teams, and rehearsals of emergency response scenarios. The aim of
public awareness and education program is to promote an informed, alert and self reliant
community, capable of playing its full part in support of and in co-operation with government
officials and others responsible for disaster management activities.
As the preparedness plan is being developed, and upon completion, it is
important to rehearse its major elements. Rehearsals invariably expose gaps that otherwise
remain overlooked. Rehearsals also keep the plans fresh, during extended periods of time
when no disaster strikes.
9. Community based disaster preparedness
Disaster preparedness and response are not solely the work of experts and
emergency responders from National Societies and government disaster organizations. Local
volunteers, citizens, organizations and business have an active and important role to play
before, during, and after the major emergencies and disasters. Therefore community based
disaster preparedness is process that seeks to develop and implement a locally appropriate and
locally “owned” strategy for disaster preparedness and risk reduction. 2
EXISTING KNOWLWDGE, ATTITUDE AND SKILL OF NURSES IN DISASTER

PREEPAREDNESS
A cross sectional descriptive study was conducted on disaster preparedness among members
of staff at kenyatta national hospital, nairobi county, Kenya to find out whether members of
staff at Kenyatta National Hospital are prepared for disasters. Data was collected using self

-administered questionnaire containing both closed and open ended questions. The study
involved 361 respondents sampled from 4646 being the total population of members of staff at
Kenyatta National Hospital. Most members of staff of KNH were aware of the existence of a
disaster management committee and the existence of a disaster plan in the hospital. Majority
of the respondents felt that firefighting equipments and evacuation plans are inadequate. The
study found out that 58% of the respondents had no training on disaster management. Majority
of the respondents indicated that there was no adequate infrastructure to manage disaster with
62.3 % indicating there was inadequate fire fighting equipments. The study will assist KNH
and other health facilities in formulating policies on disaster preparedness. The study
recommends that Kenyatta national Hospital improves on the training of staff on disaster
management in order to respond to emergencies effectively and efficiently.15
An explanatory study (mixed methodology) was conducted on disaster

preparedness of rural hospitals in the U.S. and explores the relationships between risk
perception, funding from the Health Resources and Services Administration (HRSA), and
preparedness. The results indicated that rural hospitals were moderately prepared overall (78%
prepared on average), with high preparedness in education/training (89%) and
isolation/decontamination (91%); moderate preparedness in administration/planning (80%),
communication/notification (83%), staffing/support (66%), and supplies/
pharmaceuticals/laboratory support (70%); and low preparedness in surge capacity (64%).The
respondents reported greater risk perception from natural disasters (79% reported moderate to
high risk) and vehicular accidents (77%) than from manmade. 15
A study was conducted on nurses knowledge, attitudes, practices and
familiarity regarding disaster and emergency preparedness – Saudi Arabia. Cross-sectional
descriptive study was conducted using five tools to obtain data from 252 two registered
batches of bridging nurses students. Five tools were demonstrated to collect data about
demographic data, questionnaire for knowledge, attitude and practice to measure disaster
preparedness and emergency preparedness information questionnaire to measure nurses'
familiarity. A highly significant difference was found for attitude and practice regarding
disaster preparedness as well familiarity concerned emergency preparedness P≤.000. Based on
the present study results; lacking of knowledge and practices with acceptable level of attitude
regarding disaster preparedness and neutral familiarity with emergency preparedness were
concluded. Thus an integration of clearly titled theory and practice teaching courses about

disaster and emergency preparedness into nursing curricula are crucial needed and provided in
respect to their learning/training preferences. Further, follow up research are necessary for
maximizing nursing education and nursing quality in these critical areas applied to healthcare
and community settings.16
EXISTING PROBLEMS IN DISASTER PREPAREDNESS
 There are significant gaps in preparedness on various aspects of risk management,

particularly for catastrophic disasters like major earthquakes and floods.
 Though all of India’s states have departments of disaster management or relief and

rehabilitation, they are still poorly prepared to lend support in times of disasters, according
to the UN Development Programme (UNDP).
 In a number of recent disasters, 2010 mudslides in Leh, Sikkim earthquake in 2011 and

the Uttarakhand floods of 2013, the level of preparedness was inadequate, leading to high
levels of mortality and displacement of people.
 Facilities such as emergency operations centres, emergency communications, and search and
rescue teams are being made available but these systems and facilities need to be
strengthened.
 In India Disaster management is yet to be seen as an essential part of good governance and
integral to development planning.
 The preparedness at various levels are not people-oriented.
 India’s capacity to manage disaster risk is challenged by its size and huge population. The
country is likely to have the greatest exposure of any nation in the world to extreme weather and
natural disasters by 2030.
 The northeast region is most at risk from earthquakes and lacks seismically secure
infrastructure and buildings. It is also vulnerable to landslides, floods and erosion.
 Flooding on the country’s plains is a regular occurrence, and although communities are
resilient, the intensity of floods has reduced their capacity to adapt.
 The local adaptation efforts driven solely by communities are no longer sufficient
and additional, scientifically planned adaptation is needed, which will require
government support.

 The division of responsibilities under the Disaster Management Act is not very clear,
resulting in its poor implementation. There also exists an overlap between the
implementing agencies
 Intense public and media scrutiny after disasters automatically leads to a higher priority
being given to response, rather than risk reduction.
 Furthermore, where risk-reduction activities are described, State Disaster Management

Plans (SDMPs) does not institutionalise accountability mechanisms to ensure that
departments follow these considerations in their own planning.
 As a result, risk-reduction activities are driven by schemes and external projects, rather
than by guidelines in SDMPs.
 Because risk-reduction needs are locations specific, this gap is an opportunity for
stronger, locally led risk-reduction planning by Strengthening disaster risk management
in India.
 There are insufficient levels of implementation for each monitored activity. For

example, Disaster risk management plans or a risk sensitive building codes exist but they
are not enforced because of a lack of government capacity or public awareness.
 There is lack of local capacities to implement disaster risk management. Weak capacity
at the local levels undermines the implementation Disaster preparedness plans.
 Absence of integration of climate change into Disaster risk management plans.
 There is divergence of obtaining political and economic commitments due to other

competing needs and priorities such as poverty reduction, social welfare, education etc.
require greater attention and funding.
 Due to poor coordination between stakeholders, there is inadequate access with respect

to risk assessment, monitoring, early warning, disaster response and other Disaster related
activities.
 Insufficient investment in building disaster resilient strategies, also private sector are

least contributors in the share of investment. 17
STRATEGIES TO IMPROVE THE DISASTER PREPAREDNESS

I. Planning: Most of the assessment and planning is done in the pre-disaster phase, the hospital plans
are formulated and then discussed in a suitable forum for approval.
II. Preparation of written disaster manual: The hospital disaster plan should be written down in a
document form and copies of the same should be available in all the areas of the hospital.
III. Staff education and training: It is very important for the staff to know about and get trained in
using the hospital disaster/emergency manual. Regular staff training by suitable drills should be
undertaken in this phase.
I. Planning
• Formation of hospital Disaster Management Committee
• Initiation of central Command structure (Incident command system)
• Preparation of Job Cards
• Plan activation of different areas of hospital
• Increase bed capacity in emergencies
• Planning of public information and liaison
• Planning for security of hospitals in emergency situation
• Logistics planning: It include
a) Planning for communications (within and outside the hospital)
 Communication from the state level to lower level & back As a member of the State Level
Disaster /Crisis management Committee, Principal Secretary Health will co-ordinate the
overall Disaster /Crisis management for the Health Department.
 Updated information on the details of the hospitals coming under various Govt. departments,
private sector, Co Operative Sector etc. with the telephone numbers of the RMO and Supt will
be compiled at the District level and updated periodically.
 In order to meet the higher demand in disaster situations, a pooling of resources from various
sources, including private, and co-operative sectors is advised.
 Prompt reports of available beds, personnel, emergency and specialty services, patient
transportation facilities, patient support facilities like ventilators, supplies, and mortuary
capacities of major public, private, and co-operative sector institutions in the district and
neighbouring districts should be made available at the hospital, district, and state level
command centres.
b) Transportation (To and from the site/ other hospitals)

Details of Ambulances available in Govt Hospitals/ Private Hospitals/ Other Agencies /
Special Schemes, with the telephone numbers of the Hospitals and drivers will be compiled at the
district level and made available to the nearby district, state level and other stakeholders.

c) Stores planning
 It is recommended that adequate stores of linen, medical items, surgical items should be kept
separately in the Emergency/Casualty and should be marked the “Disaster Store”.
 The activation of this store is done only after the Disaster has been notified by the appropriate
authorities.
 As immediate measures, the buffer stocks earmarked for the Casualty/Emergency Services
should be utilized till the fresh stocks are replenished from main Hospital stores/ disaster
stores.
d) Personnel Planning – Medical and Non-Medical
 Medical and Non-Medical and Medical Staff: In addition to the members of clinical staff,
Para and preclinical disciplines (if present in the facility) should render their services in
managing the casualties.
 Duty roster for standby staffs should be available in the control room/Command center
 Nursing Staffs: The Nursing Superintendent should be able to prepare a list of nursing staffs
who may be made available at a short notice.
 The nursing personnel officer should be also able to mobilize additional nursing staffs from
non-critical areas.
 Other Staff: Duty roster (including those on standby duty) of all ancillary medical services
(e.g. Radiology, Laboratory, Blood Bank) and also other hospital services (e.g. house-
keeping, sanitation, stores, pharmacy, kitchen etc.) should be available with the duty officer/
hospital administrator.
e) Financial Planning
An important aspect of any management plan is the financial management. It is recommended that
the disaster plans are made in close association with the financial advisors of the hospital/institution.
This will make them more cost effective and avoid unnecessary and repeated expenditure.
II. Preparation of written disaster manual
Principles of a Hospital Disaster Plan

• Predictable: The hospital disaster plan should have a predictable chain of
management.
• Simple: The plan should be simple and operationally functional.

• Flexible: (Plan should have organizational charts). The plan should be executable
for various forms and dimensions of different disasters.
• Concise: (Clear definition of authority)
• Comprehensive: (Compatible with various hospitals). It should be comprehensive
enough to look at the network of various other health care facilities along with
formulation of an inter-hospital transfer policy in the event of a disaster.
• Adaptable: Although the disaster plan is intended to provide standard procedures
which may be followed with little thought, it is not complete if there is no space for
adaptability.
• Anticipatory: All hospital plans should be made considering the worst-case
scenarios.
• Make provisions for vulnerable groups
III. Staff education and training: Most of the existing categories of Health Staff are expected to
play a major role in the disaster management. All of them need to be equipped with the necessary
managerial and technical skills for the effective and systematic management of the disasters.
It can be included as a component of the NHM Training, Public Health training etc. State level,
district level and block level trainings will be required. Periodic review trainings are also advised to
ensure staff readiness.
Major training programmes are
- Disaster Drills
- Partial evacuation/Non-evacuation Drills
- Revision of Hospitals Disaster/Emergency Plan
- Continuing Staff Education.18
TRAINING AT STATE LEVEL
1. State level inter-sectoral co-ordination meeting involving the line departments NGOs etc.
by the fifth month of every year.
2. Convening of the state level Rapid Response team shall be done in conjunction with the
state level inter-sectoral co-ordination meeting.
3. Senior Medical Officers Conference: As usual all the district Medical officers of the health
and other senior medical officers and Programme officers will be attending the above
meeting. Brief presentation of the disaster Preparedness plan of every district will be done
and activities to be done at state level, district level and other area specific activities will be

specifically identified.19
TRAINING AT THE DISTRICT/ BLOCK/ GRAMA PANCHAYAT / URBAN LEVEL
1. Institution level and LSGI level disaster preparedness plan finalization/ updating: This will be
done every year from January to March, and will be a part of the annual LSGI plan.
2. PHC Level full day zonal meeting of the last working day of April of every year the finalized
disaster preparedness and epidemic preparedness plan of the Panchayat will be presented.
Following specific tasks will be addressed in these meetings.

• Role and responsibility of each department and individuals of each department in
case of a disaster / epidemic prevention.
• The timely communication of the disaster, /warning.
• Updating the telephone number address etc.
• Vehicle arrangement with the telephone number, including the govt/ private/ NGO
vehicles.
• Ensuring the availability of the consumables including the drugs, reagents,
insecticides, bleaching powder etc.
• Arrangements for the temporary sheds/ shelters/ relief camps etc. (preferably the
nearby schools/Kalayanamandapam / halls etc.)
• Finance including the mechanism for meeting the contingency expenditures
in case of emergency situations.
3. CHC (Block Level) Conferences of May, June: In the CHC (Block level) conferences convened
on the block level disaster preparedness plan and the disaster preparedness plan of every panchayath
of the locality will be presented. The above meeting will be planned such a manner that adequate time
would be allotted for the review of disaster preparedness. Similar to the work planning done at the
Panchayat levels every component of the disaster preparedness with the specific earmarking of the
roles and responsibilities of the departments / individuals would be done.
4. DMO (H) Conference: District level planning and block level and panchayath level review and
the activity plan will be similarly done in special session as part of the district Medical officers
conference convened on the 5 the working day of May. The district level meeting will also be
attended by the district collector. Representatives of all the line departments and NGOs and private
sectors will also be participants of the meeting. 20
NURSING IMPLICATIONS

1. DISASTER PREPAREDNESS AND NURSING PRACICE
Disaster nursing requires the application of basic nursing knowledge and skills in difficult
environments with scarce resources and changing conditions. Nurses must be able to adapt nursing
practices to the specific disaster situation while working to minimize health hazards and life-
threatening damage caused by the disaster .Nurses must work collaboratively with other health
professionals, disaster responders, nongovernmental organizations and governments. Nurses must be
capable of shifting focus of care from one patient to large numbers of patients.
In the response phase of a disaster, nurses provide care in a variety of areas, including trauma, triage,
emergency care, acute care, first aid, infection control, supportive and palliative care, and public
health. Hospitals, emergency aid stations, shelters, homes, mass immunization sites, mortuaries and
makeshift clinics are examples of where nurses may be required to practice.
Nursing comprises the largest healthcare workforce, and yet there is very little research examining
nurses’ readiness for disaster.13
Competencies in disaster nursing:
 facilitate deployment of nurses globally;

 create consistency in the care given;
 facilitate communication;
 build confidence;
 facilitate a more professional approach;
 promote shared aims;
 allow for a unified approach;
 enhance the ability of nurses to work effectively within the organizational structure; and |
assist nurses to function successfully as members of the multidisciplinary team.
Care of Individuals and Families
Assessment
(1) Performs a rapid assessment of the disaster situation and nursing care needs.
(2) Conducts a health history and age appropriate assessment that includes physical and
psychological responses to the disaster.

(3) Recognizes symptoms of communicable disease and takes measures to reduce exposure to
survivors.
(4) Describes the signs and symptoms of exposure to chemical, biological, radiological, nuclear and
explosive agents.
(5) Identifies unusual patterns or clustering of illnesses and injuries that may indicate exposure to
biological or other substances related to the disaster.
(6) Determines need for decontamination, isolation or quarantine and takes appropriate action.
(7) Recognizes health and mental health needs of responders and makes appropriate referrals.
Implementation
(1) Implements appropriate nursing interventions including emergency and trauma care in accordance
with accepted scientific principles.
(2) Applies critical, flexible and creative thinking to create solutions in providing nursing care to
meet the identified and anticipated patient care needs resulting from the disaster.
(3) Applies accepted triage principles when establishing care based on the disaster situation and
available resources.
(4) Adapts standards of nursing practice, as required, based on resources available and patient care
needs.
(5) Creates a safe patient care environment.
(6) Prepares patients for transport and provides for patient safety during transport.
(7) Demonstrates safe administration of medication, vaccines and immunizations.
(8) Implements principles of infection control to prevent the spread of disease.
(9) Evaluates outcomes of nursing actions and revises care as required.
(10) Provides care in a non-judgmental manner.
(11) Maintains personal safety and the safety of others at the scene of a disaster.
(12) Documents care in accordance with disaster procedures.

(13) Provides care in a manner that reflects cultural, social, spiritual and diverse background of the
individual.
(14) Manages the care of the deceased in a manner that respects the cultural, social and spiritual
beliefs of the population as situation permits.
(15) Manages health care activities provided by others.
(16) Works with appropriate individuals and agencies to assist survivors in reconnecting with family
members and loved ones.
(17) Advocates for survivors and responders to assure access to care.
(18) Refers survivors to other groups or agencies as needed
Psychological Care
(1) Describes the phases of psychological response to disaster and expected behavioural responses.
(2) Understands the psychological impact of disasters on adults, children, families, vulnerable
populations and communities.
(3) Provides appropriate psychological support for survivors and responders.
(4) Uses therapeutic relationships effectively in a disaster situation.
(5) Identifies an individual’s behavioural responses to the disaster and provides appropriate
interventions as required (e.g. psychological first aid).
(6) Differentiates between adaptive responses to the disaster and maladaptive responses.
(7) Applies appropriate mental health interventions and initiates referrals as required.
(8) Identifies appropriate coping strategies for survivors, families and responders.
(9) Identifies survivors and responders requiring additional mental health nursing support and refers
to appropriate resources.
Care of Vulnerable Populations (Special Needs Populations)
(1) Describes vulnerable populations at risk as a result of a disaster (e.g. older persons, pregnant
women, children, and individuals with a disability or chronic conditions requiring continued care)

(2) Creates living environments that allow vulnerable populations to function as independently as
possible.
(3) Advocates for the needs of the vulnerable populations.
(4) Identifies available resources, makes appropriate referrals and collaborates with organizations
serving vulnerable populations in meeting resource needs.
(5) Implements nursing care that reflects the needs of vulnerable populations impacted by a disaster.
(6) Consults with members of the health care team to assure continued care in meeting special care
needs.
10. Long-term Care Needs
Individual and Family Recovery
(1) Develops plans to meet short- and long-term physical and psychological nursing needs of
survivors.
(2) Identifies the changing needs of survivors and revises plan of care as required.
(3) Refers survivors with additional needs to appropriate organizations or specialists.
(4) Teaches survivors strategies for prevention of disease and injury.
(5) Assists local health care facilities in recovery.
(6) Collaborates with the existing health care community for health maintenance and health care.
(7) Serves as an advocate for survivors in meeting long-term needs.
Community Recovery
(1) Collects data related to the disaster response for evaluation.
(2) Evaluates nursing response and practices during the disaster and collaborates with nursing
organizations to resolve issues and improve response.
(3) Participates in analysis of data focusing on improvement of response.
(4) Identifies areas of needed improvement and communicates those areas to appropriate personnel.

(5) Assists the community in transitioning from the response phase of the disaster/emergency through
recovery and rehabilitation to normal functions.
(6) Shares information about referral sources and resources used in the disaster.
(7) Assists in developing recovery strategies that improve the quality of life for the community.
(8) Collaborates with appropriate groups and agencies to re-establish health care services within the
community.21
2. DISASTER PREPAREDNESS AND NURSING EDUCATION
The complexity of disasters seen today requires an educated health care workforce capable of working
in all areas of the disaster continuum. At the 2006 American Public Health Association Meeting, Dr
Frederick Slone (2006) emphasized the importance of having a health workforce prepared to respond
quickly in the time of a catastrophic event, making disaster education a national priority. Recent
disasters have demonstrated that the lack of knowledge in disaster response and management creates
confusion among the responders and delays effective humanitarian response.
The sporadic nature of disaster nursing education has resulted in a

workforce with limited capability to respond in the event of a disaster, develop policy, educate or
accept leadership roles. As the largest sector of the health care workforce, nursing’s inability to
actively participate in a knowledgeable manner throughout the disaster continuum would place the
population at risk. Few programmes are preparing new nurses for disaster situations. Disaster nursing
education has not been a priority. There is also a lack of confidence among faculty who feel prepared
to teach disaster nursing. The lack of formal education has created a workforce with little or no
competency in disaster nursing. As a result, many nurses do not view disaster response as a priority or
lack the confidence to respond when needed.
The disaster education in nursing curriculum:
(1) Maintains knowledge in areas relevant to disaster and disaster nursing.
(2) Participates in drills in the workplace and community.
(3) Seeks to acquire new knowledge and maintain expertise in disaster nursing.
(4) Facilitates research in disaster.
(5) Evaluates the need for additional training and obtains required training.

(6) Develops and maintains a personal and family preparedness plan.
(7) Describes the nurse’s role in various disaster assignments (e.g. shelters, emergency care sites,
temporary health care settings disaster coordination and management units).
(8) Maintains a personal disaster/emergency kit (e.g. identification card, appropriate clothing, insect
repellent, water bottle) in the event of deployment to a disaster.
(9) Implements preparedness activities as part of a multidisciplinary team.
(10) Assists in developing systems to address nursing and health care personnel capacity-building for
disaster response.
(11) Takes on a leadership role in the development and implementation of training programmes for
nurses and other health care providers.
(12) Evaluates community readiness and takes actions to increase readiness where needed. 22
DISASTER PREPAREDNESS AND NURSING ADMINISTRATION
Nurses who have an understanding of health issues in the community play a major role in disaster
planning, programme development, mitigation, training and education at the community, state,
national and international level. Their knowledge of community resources, populations at risk,
vulnerable individuals, workforce issues, supply needs and nursing roles and practices are crucial
contributions to disaster planning.
Nurses play an important role in disaster preparedness by: educating the community on disasters;
working to reduce hazards in the workplace, homes and communities; contributing to the
development, implementation and evaluation of community readiness; participating in and evaluating
disaster drills; and coordinating and working with community organizations. In the workplace, where
disaster planning is absent or fragmented, nurses have a leadership and advocacy role in developing
disaster plans and exercises.
Nurses can also be found assuming responsibility for management of the other aspects of the disaster
response, such as sheltering and health centres. As the disaster situation transitions to the long-term
recovery phase, nurses take on the role of managing the ongoing health threats to individuals, families
and the community, as well as the continuing care needs of those with injuries, illnesses, chronic
disease and disability.
Policy Development and Planning
(1) Demonstrates an understanding of relevant disaster terminology.

(2) Describes the phases of disaster management continuum: prevention/mitigation, preparedness,
response and recovery/rehabilitation.
(3) Describes the role of government and organizations in disaster planning and response.
(4) Understands the community disaster plan and how it relates to the national and international
response plans.
(5) Recognizes the disaster plan in the workplace and one’s role in the workplace at the time of a
disaster.
(6) Participates in disaster planning and policy development.
(7) Contributes to the development, evaluation and modification of the community disaster plan.
(8) Ensures that the needs of vulnerable populations are included in the community disaster plan
(including children, women, pregnant women, individuals with mental or physical disabilities, older
people and other vulnerable persons/households).
(9) Interprets role(s) of nurses in relation to other members of the team.
(10) Participates politically and legislatively in the development of policies related to disaster
preparedness and response.
(11) Describes the role of public health in disaster and how it relates to the nurse’s role.
Accountability
(1) Accepts accountability and responsibility for one’s own actions.
(2) Delegates to others in accordance with professional practice, applicable laws and regulations and
the disaster situation.
(3) Identifies the limits of one’s own knowledge, skills and abilities in disaster and practices in
accordance with them.
(4) Practices in accordance with the laws and regulations governing nurses and nursing practice.
(5) Advocates for the provision of safe and appropriate care.

Communication and Information Sharing
(1) Describes the chain of command and the nurse’s role within the system.
(2) Communicates in a manner that reflects sensitivity to the diversity of the population.
(3) Describes the principles of crisis communication in crisis intervention and risk management.
(4) Identifies and communicates important information immediately to appropriate authorities.
5) Utilizes a variety of communication tools to reduce language barriers.
(6) Coordinates information with other members of the disaster response team.
(7) Provides up-to-date information to the disaster response team regarding the health care issues and
resource needs.
(8) Works with the disaster response team to determine the nurse’s role in working with the media
and others interested in the disaster.
(9) Understands the process of health information management in a disaster.
(10) Demonstrates an ability to use specialized communication equipment.
(11) Maintains records and documentation and provides reports as required.
(12) Communicates identified or suspected health and/or environment risks to appropriate

authorities.18
Global increases in natural and human‐induced disasters have called attention to the part that health
providers play in mitigation and recovery. Since nurses are involved in planning, mitigation, response,
and recovery aspects of disasters, they should actively seek opportunities to participate in actual
disaster events, mock drills, and further educational opportunities specific to disaster preparedness.
Administrators must support and encourage disaster preparedness education of nurses to promote
hospital readiness to provide community care delivery in the event of a disaster situation .22
DISASTER PREPAREDNESS AND NURSING RESEARCH
The integration of clearly titled theory and practice teaching courses about disaster and emergency
preparedness into nursing curricula are crucial needed and provided in respect to their
learning/training preferences. Further, follow up research are necessary for maximizing nursing
education and nursing quality in these critical areas applied to healthcare and community setting. 12
But the Research and therefore the evidence base for disaster nursing are critically sparse.

PRIORITY ISSUES FOR RESEARCH ON DISASTER PREPAREDNESS
Protecting vulnerable populations in emergencies (improving the identification of health
vulnerability and evaluating interventions to lessen the risk of poor health outcomes),
Strengthening response systems (developing and evaluating integrated systems of emergency
public health services and incident management),
Preparing the public health workforce (developing and evaluating strategies and tools to train
and exercise the public health workforce to meet responsibilities for detection, mitigation,
and recovery in varied settings and populations),
Improving timely emergency communications (evaluating characteristics of effective risk
communication in emergency settings and system enhancements to improve effective
information exchange across diverse partners and populations under emergency conditions),
and
Improving information management to increase use (scenario modeling and forecasting;
information and knowledge management tools to improve the availability and usefulness
during crisis decision-making).22
ORGANISATIONS RELATED TO DISASTER MANAGEMENT FRAMEWORK AT
GLOBAL LEVEL
There are three international agreements within the context of the post- 2015 development agenda.
These are:
 The Sendai Framework.

 Sustainable Development Goals 2015-2030
 The Paris agreement (COP 21) on Climate Change.20
 WHO
ORGANISATIONS AND POLICIES RELATED TO DISASTER MANAGEMENT

FRAMEWORK AT NATIONAL LEVEL
The Disaster Management Act, 2005
Salient Features of the Act

 The Central Government can issue directions to any authority (union or state) to assist in
disaster management.
 Any officer or authority shall have to make available such manpower as requested by NEC,
SEC or DDMA.

 If it appears to the NEC, SEC or DDMA that provisions of any rule regulation etc. need to be
made or amended for purposes of prevention and mitigation of disasters, it may require to do
so.
 The NDMA, the SDMA or a DDMA may recommend to the Government to give direction to
any person in control of any media or means of communication to carry out any warnings or
advisories regarding disasters.
 The NDMA shall prepare an annual report to the Central Government which shall cause it to
be laid before Parliament.
 Actions taken under this law will be immune from court challenges.
Agencies involved in Disaster Management
 National Disaster Management Authority (NDMA)
 National Executive Committee (NEC)
 National Institute of Disaster Management (NIDM):- The NIDM’s primary responsibility is

capacity development, along with training, research, documentation and development of a
National level information base. The NIDM runs the training of trainers, DM officials and
other shareholders.
 National Disaster Response Force (NDRF):- The command and supervision of the NDRF
would be under the Director General of Civil Defense and National Disaster Response Force
selected by the Central Government. Currently, the NDRF comprises eight battalions and
these battalions will be positioned at different locations as per the varying requirements.
 Mitigation Reserves:-. These reserves are needed for prepositioning of some essential
reserves at crucial locations, including some for the high altitude areas intended to augment
the resources at the State level. Mitigation reserves will be placed at the disposal of the NDRF
on the wake of a disaster.21
The National Disaster Management Authority (PM Level Body)
 It was established in 2005, under the Disaster Management Act 2005.
 The objective of NDMA is, to build a safer and disaster resilient India by a holistic,
proactive, technology driven and sustainable development strategy.
 The NDMA is chaired by the Prime Minister of India and has a vice chairman with the
status of Cabinet Minister and eight members with the status of Ministers of State.

 The NDMA Secretariat is headed by a Secretary and deals with mitigation, preparedness,
plans, reconstruction, community awareness and financial and administrative aspects.
1. To lay down policies on disaster management.

2. Lay down guidelines to be followed by the states in drawing up the State Plan and the union
ministries to draw up their plans.
3. Approve the National Plan and plans prepared by various union ministries.
4. Coordinate the implementation of the plans for disaster management.
5. Recommend provision of funds for the purpose of mitigation.
6. Provide support to other countries.
7. Lay down broad policies and guidelines for the functioning of the National Institute of
Disaster Management.
The National Executive Committee (Secretary Level Body)
 The NEC consists of members like Union Home Secretary as Chairperson, and the Secretaries
to the Government of India (GoI)like Ministries/Departments of Agriculture, Atomic Energy,
Defence, Drinking Water Supply, Environment and Forests and so on. The NEC prepares the
National Plan for Disaster Management as per the National Policy on Disaster Management.
1. Act as the national level coordinating and monitoring body for disaster management.
2. Prepare the National Plan to be approved by the NDMA.
3. Monitor and evaluate the preparedness level, the implementation of the national policy,
guidelines laid down by NDMA, national plan, plans of various union ministries.
4. Provide necessary technical assistance to the states for preparing their disaster management
plans and carry out other functions under this Act.
5. Promote general education and organize special training programmes in relation to disaster
management.
6. Coordinate response in the event of any disaster. Require any department or agency to make
available men or material resources for emergency response.
7. Lay down guidelines for, or give directions to union ministries and states regarding measures
to be taken by them in response to any threatening disaster situation or disaster. 23
National Disaster Management Plan (NDMP)
 It was released in 2016, it is the first ever national plan prepared in the country for disaster
management.

 With National Disaster Management Plan (2016) India has aligned its National plan with the
Sendai Framework for Disaster Risk Reduction 2015-2030, to which India is a signatory.
 The objective of the plan is to make India disaster resilient, achieve substantial disaster risk
reduction. It aims to significantly decrease the losses of life, livelihoods, and assets in terms of
economic, physical, social, cultural, and environmental. To maximize the ability to cope with
disasters at all levels of administration as well as among communities.
 Measures to be taken for the prevention and mitigation.

 Measures to be taken for integration of mitigation measures in the development plans.
 Measures to be taken for preparedness and capacity building to effectively respond.
 Roles and responsibilities of different ministries.
The National Institute of Disaster Management (NIDM)

1. It will function within the broad policies and guidelines laid down by the NDMA.
2. It will be responsible for promoting research in the area of disaster management.
3. It will be responsible for documentation of the disasters and their management cases.
4. It will be responsible for the development of a national level information base.
The National Disaster Response Fund & The National Disaster Mitigation Fund
1. The response fund will be made available to the NEC and the mitigation fund to the NDMA.
2. Besides, every ministry shall make provisions in its annual budget, for funds for actions set
out in its disaster management plans.
Role of Union Government

 It plays a key supportive role with resources and providing complementary measures such as
early warning and co-ordination of efforts of all Union ministries, departments
and organizations.
 At the apex level, a Cabinet Committee on Natural Calamities reviews the crisis situations.
 A High Level Committee of Ministers under the chairmanship of Minister of Agriculture
deals with the issue of financial support to be provided to the State Governments.
 Matters relating to nuclear, biological and chemical emergencies are looked after by the
Cabinet Committee on Security.
 The Cabinet Secretary heads the National Crisis Management Committee. Secretaries of
ministries and departments concerned and heads of other organizations are members, which
reviews and monitors crisis situations on a regular basis and gives directions to the Crisis
Management Group.

 The Central Relief Commissioner in the Ministry of Home Affairs is the Chairman of the
Crisis Management Group (CMG) consisting of nodal officers from various concerned ministries.
The CMG’s functions are to review annual contingency plans formulated by various ministries,
measures required for dealing with a natural disaster, coordinate the activities of the Union
Ministries and State Governments. In the event of a disaster, the CMG meets frequently to review
relief operations and extends assistance required by the affected states.23

FRAMEWORK AT STATE LEVEL
State Disaster Management Authority (SDMA)
 At State level, State Disaster Management Authorities are established under Disaster
Management Act 2005.
 SDMA is chaired by the Chief Minister of the State and has not more than eight members
who are appointed by the Chief Minister.
The SDMA prepares the state disaster management plan and implements the National Disaster
Management Plan.
1. Lay down the State disaster management policy.

2. Lay down guidelines to be followed by the state ministries.
3. Approve the State Plan and plans prepared by various state ministries.
4. Coordinate the implementation of the state plan and other state ministries’ plans.
5. Recommend provision of funds for mitigation and preparedness measures.
The State Disaster Management Plan (Prepared by SEC and approved by SDMA)
includes
1. The vulnerability of different parts of the State to different forms of disasters.
2. The measures to be adopted for prevention and mitigation of disasters.
3. Measures to be taken for integration of mitigation measures in the development plans.
4. Measures to be taken for preparedness and capacity building to effectively respond.
6. The roles and responsibilities of different state ministries
The State Executive Committee (Chief Secretary Level Body)
1. Lay down guidelines for preparation of plans by the various state ministries and the DDMAs.

2. Monitor the implementation of the national policy, the national plan, the state plan and the
plans prepared by various state ministries and the DDMAs. Also monitor the implementation of
guidelines laid down by the SDMA and evaluate the level of preparedness.
3. Provide necessary technical assistance or give advice to DDMAs and state ministries.
4. Coordinate response in the event of any disaster. Give directions to any Department or
agency regarding response actions to be taken.
5. Promote general education and community training.
6. Advise the State Government regarding all financial matters in relation to
disaster management.
7. Examine the vulnerability of different parts of the state and specify measures to be taken.
8. Examine the construction in any area and if it is of the opinion that the standards for the
prevention of disaster have not been followed, may direct the DDMA to take needed action.
9. Ensure that communication systems are in order and the disaster management drills are
carried out periodically.
Role of state government

1. The basic responsibility to undertake response measures rests with the State Governments.
2. The entire structure of crisis administration in the State Governments has been oriented
towards post disaster relief and rehabilitation.
3. Most of the states have Relief Commissioners. The Relief Commissionerate is usually an
adjunct of the Revenue Department. In some states, the Revenue Secretary is also the ex-officio
Relief Commissioner.
4. This has the advantage of providing a direct chain of command to the district Collectors and
the Tehsildars, but the focus on crisis prevention and mitigation or even of preparedness
is missing.
5. Every state has a Crisis Management Committee under the Chief Secretary, consisting of
secretaries of concerned departments, which reviews crisis situations on a day-to-day basis,
coordinates the activities of all departments and provides support to the district administration.
6. At the ministers’ level, a Cabinet Committee on Natural Calamities under the Chief Minister
takes stock of situations and is responsible for all important policy decisions. 21

FRAMEWORK AT DISTRICT LEVEL
District Disaster Management Authority (DDMA)

 Under Disaster Management Act 2005, every State government shall establish a DDMA for
every district in the State.
 The DDM Authority shall consist of:
o Chairperson - the Collector or District Magistrate or Deputy Commissioner act as

Chairperson of DDMA.
o Co-Chairperson - is the elected representative of the local authority. In the Tribal
Areas, the Chief Executive Member of the district council of autonomous district is the co-
chairperson.
 There are not more than seven other members in DDMA.
 The Disaster Management Committee governed under District Magistrate will formulate

village level disaster management plans for concern villages.
 The DDMA makes District Disaster Management Plan and implements the state Disaster
Management Plan.
1. Collector as ex officio Chairperson, elected representative of the local authority as the ex

officio co-Chairperson, the Superintendent of Police, Chief Medical Officer and maximum two
other district level officers to be appointed by the State Government, as members.
2. It acts as the district planning, coordinating and implementing body for disaster management
and takes all measures according to the guidelines laid down by the NDMA and the SDMA.
The District Disaster Management Plan (Prepared by DDMA) includes

1. Every office of the government having office at district level shall prepare a disaster
management plan in accordance with the district plan and submit a copy of the plan to the
DDMA.
2. The areas in the district vulnerable to different forms of disasters.
3. The measures to be taken, for prevention and mitigation of disaster.
4. The capacity-building and preparedness measures to effectively respond.
5. The response plans and procedures, in the event of a disaster, providing for-
1. Allocation of responsibilities to the departments and the local authorities in the
district.
2. Prompt response to disaster and relief.
3. Procurement of essential resources.

4. Establishment of communication links.
5. Dissemination of information to the public.24
LOCAL AUTHORITIES:- Local authorities would include Panchayati Raj Institutions (PRI),
Municipalities, District and Institutional and Legal Arrangements Boards, and Town Planning
Authorities which control and manage civic services.
Field level response

1. The community is the first responder in a disaster. Field level response in rural areas is by the
nearest police station and the revenue functionary; in urban areas the response is by agencies
like the civic authorities, the fire brigade and the local police station.
2. At present, panchayats do not have the capacity to react in any effective manner and it is the
district administration with the Collector playing a pivotal role. He has the authority to mobilize
the response machinery and has been given financial powers to draw money.
3. All departments including the police, fire services, public works, irrigation etc. work under
the leadership of the Collector during a disaster, except in metropolitan areas where the
municipal body plays a major role.
4. The District Collector also enjoys the authority to request for assistance from the Armed
Forces if circumstances so demand.21
CONCLUSION
Natural disasters are very much part of the natural cycles. But accelerated
changes in demographic and economic trends disturb the balance between the ecosystem and leading
to increased frequency and the negative impact of disaster. As the 21st century approaches, we face a
challenging mix of demographic, ecological and technological condition which make population more
vulnerable to the impact of natural calamities. However, the number of natural disasters are not more
than they were in the past, but what has increased is the magnitude of the effect of each disaster. The
important and related factor is the population-pressure in almost all the countries, for people to live on
and use marginal land which by its very nature may put inhabitants and property at great risk. Disaster
preparedness should be a collective effort and it should be built up with self-reliance and confidence

at the village level. A well preparedness approach requires the development of better institution
mechanism for community participation in planning and their involvement in implementation process;
strengthening of existing mechanism; creating better atmosphere for dissemination of know-how;
training thereby helping institutions, community groups, NGO's Governmental agencies and people to
take preparedness measures against earthquake disaster; and also establishing or building up a reliable
information system
Our vision 2020 is to build a safer and secure India through sustained collective
effort, synergy of national capacities and people’s participation. What looks a dream today will be
transformed into reality in the next two decades. This is our goal and we shall strive to achieve this
goal with a missionary zeal. The path ahead, which looks difficult today, will become a lot easier as
we move along together.2

Prepare for Disasters with Effective Plans

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Prepare for Disasters with Effective Plans

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It wasn’t raining when Noah built the arc”

“Despair is most often the offspring of ill-preparedness.”

Causes for Occurrence of Disaster

 Developmental process: Exploitation of land use, development of infrastructure, rapid

Disaster preparedness Page 1

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 Disaster impacts individuals physically (through loss of life, injury, health, disability) as

 Disasters increase the level of vulnerability and hence multiply the effects of disaster4.

Disaster preparedness Page 3

Disaster Management efforts are geared towards disaster risk management.

 Disaster Risk Management implies the systematic process of using administrative

 There are three key stages of activities in disaster management:

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Pre-Disaster risk reduction includes-

It can involve such actions as:

 Laws and regulations restricting deforestation to prevent mudslides

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Aims and objectives of disaster preparedness

1. Increasing the efficiency, effectiveness and impact of disaster emergency response

5. Decreasing community vulnerability to disaster. 5

Principles of disaster preparedness

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Other principles are:

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 search and rescue

Recovery is defined as the actions taken to return to normal following an event.

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1. Traditional model (cycle of disaster management): The different disaster management

THEORIES OF DISASTER MANAGEMENT

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1. Social constructionist views

NEED OF DISASTER PREPAREDNESS

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Current status in India

 Disaster risks in India are compounded by increasing vulnerabilities related to changing

The gaps in disaster preparedness in Kerala flood 2019

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Need of Hospital Preparedness and Emergency Health Management

Hospital preparedness is crucial to any disaster response system. Each

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Hammad K, Gloe D S (2018) conducted a systematic review of literature on Disaster

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 Moreover, India is also vulnerable to chemical, biological, radiological and nuclear

Worst Disasters in India

 Uttarakhand Flash Floods (2013) affected Govindghat, Kedar Dome, Rudraprayag district

 Gujarat Earthquake (2001) affected Bhuj, Ahmedabad, Gandhinagar, Kutch, Surat,

 Coringa Cyclone (1839) that affected Coringa district of Andhra Pradesh and Calcutta

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In recent times, there have been

o cases of railway accidents (Dussehra gathering on the railway tracks crushed by the

o fire accidents in hospitals due to negligence and non implementation of existing

o collapse of various infrastructure constructs like flyovers, metro tracks and

o Stampede at large public gathering like Kumbha Mela caused by poor people

Common disasters and Vulnerability Profile of Kerala

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FEW NOTABLE EVENTS ARE:

 August 2018: Kerala flood

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Current practices of disaster preparedness among health professionals in India

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