Presented by

Dr. Ulfat Ara

Senior Lecturer,
Department of Public
Health, NUB

A disaster is a sudden, great misfortune. It is the situation

arising from the event where disruption of great
magnitude occurs in:

a. Life (Human, animal and plant); and

b. Life supporting systems (water, air, food).

• A sudden event, such as an accident or a natural

catastrophe, that causes great damage or loss of life.

• “A disaster is a situation or event which overwhelms

local capacity, necessitating a request to a national or
international level for external assistance.”

So: The Center for Research on the Epidemiology of Disasters (CRED)

‘Natural’
‘Man made’.
Droughts
a. Riots
b. Violence
c. Terrorism
d. Accidents (chemical, nuclear, transport),
e. Dam collapse,
f. food poisoning,
g. Fires
h. Building collapse etc.)
 1. Human failures and accidents
2. Violence
3. In some cases clear distinction between these
two can’t be understood — e.g.
a. Poor construction of building in an earthquake
prone area

b. Failure of the authority in time to react

A good action plan to be made in anticipation of a

disaster. Absence of a plan will create confusion
and ineffective management of the crisis. This is
likely to paralyze the whole service system and
affect the reputation of the institution. All staffs
may be frustrated for unwanted failure of providing
the proper patient care.
The Hospital Management System (Administrator)
must be ready within the available resources at all
times to manage the crisis when ever it happens.

Types of Crisis
• Natural disaster--Earthquakes, volcanic
eruptions, tornadoes and hurricanes, floods, landslid
es, tsunamis, storms, and droughts.
• Technological crisis--Software failures, industrial.
accidents, and oil spills.
• Confrontation--Boycotts, and other types are
picketing, sit-ins, ultimatums to those in authority,
blockade or occupation of buildings, and resisting or
disobeying police.
Affected People due to Confrontation
 Effects of Disaster

• Malevolence: When opponents or miscreant

individuals use criminal means or other extreme
tactics for the purpose of expressing hostility or
anger or seeking gain from, a company, country, or
economic system with the aim of destabilizing or
destroying it. e.g. product tampering, kidnapping,
malicious rumors(hateful rumors or gossip),
terrorism, and espionage.
• Organizational Misdeeds: Crises of skewed
management values (when managers favor short-term
economic gain and neglect broader social values and
stakeholders other than investors. , crises of deception,
and crises of management misconduct.

• Workplace Violence: violence against other

employees on organizational grounds.

• Rumors: False information about an

organization or its products creates crises
hurting the organization’s reputation
 Effects on Health
1. Direct health effects:
a. People killed, wounded or traumatized by
weaponry, intentional attacks or the mechanical
force of nature in disasters.
b. In earthquake, there may be crush injury from
falling buildings.
In a civil conflict, this may be gunshot injuries,
wounds from shrapnel, or the psychiatric effects of
witnessing or experiencing traumatic events.

Effects on Health-contd
d. In a post-war situation, this may be the
trauma resulting from accidental
triggering of landmine or unexploded
ordnance.

2. Indirect health effects:

Increased risk of disease and death due to---
a. Starvation because food sources have been
destroyed or are unavailable;
b. Occurrence of vaccine-preventable diseases
because vaccination services are no longer
offered because health facilities have been
destroyed or health workers have fled;
c. Worsening of existing chronic diseases which go
untreated because medications are unavailable.
 How to Handle?
1. Crisis Team: A crisis team should be developed
in the hospital by the administrator. The staffs
like doctors, nurses, paramedics should be
carefully selected and trained. This team should
be capable to be assembled with a short notice
quickly either day or night.
This team should be conversant with topography
and should be helped by other like teams in the
area.

How to Handle?-contd
2. Linkages: If the crisis is beyond the control of
the local health institutions--- it should have
prior link with other specialized teams and
hospitals for timely referral or reinforcement of
men and material whenever necessary.
3. Training: The members of crisis team need
training extensively to keep them up to date with
latest knowledge and know how.

How to Handle?-contd
4. Leadership: To avoid conflicts and confusion there
should be unified leadership who will provide decision
for actions. It should be also decided beforehand who
will be the leader in absence of the designated leader.
The leader must ensure proper communication ------
a. Among the team members.
b.With the anxious relatives and friends of the
victims.
c. With the public.
d. With the authorities &
f. With the media
1. Information received at the health care institution.
2. The team leader and members of the team are
informed.
3. The team get ready with necessary facilities.
4. Victims are received.
5. Preliminary examination and sorting.
6. Brief documentation.
7. First aid given to all, attending to those seriously
injured first. The observation—diagnosis &
treatment.
8. Referral, where necessary.
The emotional Reactions may be:
1.Immediate, during and after the disaster.
Immediate reactions are----
a. Physical injury
b. Exposure to extreme danger
c. Witnessing death of close ones
d. Traumatic experiences of helplessness and
hopelessness
e. Need to choose between helping others and
fighting for own survival.
 Psychological Consequences-
contd
The Adaptation reaction may not function properly-----
a. Paralyzing anxiety
b. Uncontrolled flight behavior (

c. Group panic
The immediate post-disaster reaction which is
called ‘Disaster syndrome’ may be present in 25-
75% of the victims.

“panic”
“Panic”

“Panic”
Reactions after the events-------
a. People feel numb or relieved, often with strong
positive feelings about having survived; later
stress effects may surface.
b. Intense feeling of anxiety (frightening memories
of anxieties)
c. Nightmares
d. Post-traumatic stress disorder

Post-traumatic Stress Disorder

1. If hospital is over flooded with patients; hospital

authority should have contingency plan to place
more beds. It may be 1:1.
2. If more skilled manpower is required, prior plan to
be made to get reinforcement from nearby hospital.
3. Whenever necessary patients to be referred to other
hospitals for better management. Adequate
resources to be arranged to that effect.
4. Adequate reserve of medicines and relevant stores
are to be kept ready in stock.
 Patients’

Environmental Health for

Disaster Management
 Emergency response

Recovery

Preparedness and prevention