DISASTER hIANAGEMENT

Structure
2.0 Objectives'

2.2 Basic Conccpls

2.2.1 General
2.2.2 Disaster Classtficntion
2.2.3 Dihastcr~P~.~ccss
2.2.4 Spccttuln ol' Disaster Mani~gc~ncnt
2.2.5 Special Charactel~istics
2.3 Disaster Mauagemenl in India
2.3.1 Nntionnl Level
2.3.2 Stnte T,evel
2.4 Principles uC Disasler Pliulniny
2.4.1 l'rincjplcs
2.4.2 1)ih:~sterilnci I-Iealtl~IJrc~hlcms
2.4.3 I)rganisntio~il'or Medlc;ll Rclicf
2.4.4 IJrinciplcs of Mass C:ls~~alty
h/I;~nogcment
2.5 Objectives ot' IJospital Disaster I1:111
2.5.1. Ncerl for Hospi1:ll Disaslcr lllan
2.5.2 Objective and Prlrposc
2.5,3 Plant~iugIJrocess anil 1)cvclopmenl of Plan
2.6 Disaster Co~illnittce
2.7 Org2ulisatio11, Rolc tuld Rcsponsibi lilics
2.7.1 Orgnnisation
2.7.2 Rolc ;~nrlResponsibili~ies
2.8 Organising 1)isnster l~~lcilities

2.9.2 i1lcr.L :~ndKccall

.2.9.3' DcploymenL
2.9.4 Dis;~sterAdrn~~~ibh.aL~vl!
2.10 Disaster Manual
2.11 Disnstcr ]$rill
2.12 Lcl Us Suiil TJp
2.13 Answers 10 Check Your Progress

After going tllrough this w i t , you should be able to:

o unilcrsland Ule concrpls of disnstcrs iuld its m~m:~gcmcl~t;
describc tlie principles of disaster platlni~~g
i u ~ dthe oh,jeclives tuid purpose ol'tlis:~sler
pl:u1;
o describc llic cnmposition, li~llctioilsi ~ l d~ ~ : s p o ~ ~ s i bof
i l iDisaster
t ~ ~ s Commillee:
 -.- .--------- 4

2.1 INTRODUCTION --
In this unit you will le<mlbasic co~lccptsof disasles managelnent :iliij pri~~ciples 01'
disaster planning. You will Icam about tile ohjectivcs md purpose ol'tli!;;tslcr pl;*l, role
and respo~isibilitiesof stair ;uld the basic fii~ilitic?rcquired lo lncct rhc c:h;~llengeof
disasters and elnergency response.
bisasters have existed ever since the existence of ~nankindiuitl no c o r n m u ~ ~ i t i~nnlune
~-ii
to the emergencies caused by natural iu~dm;ulmatle disasie1.s. Tlie disiister cvcnts result'
in number of deaths, injuries amongst tlie commnunity, wide spreatl destruclion of
property, economic losses etc, ant1 colilrnunity requircs immedi:lle ;assislaalce to overcome
its effects. Globally tlie toll 01 death and damages in nalunul tlisnslcrs is inc.reasiiig. Tile
cost to the global ecoilorny is es?imaled to be 50,000 million US tlollars pcr year, of
which a third represents the cost of predicting, preventing uid ~niliguliu~g cIis:istcrsxnd
other two-third represents tlic direct cost of darnages. Dcalh toll uzay vsuy liom year to
year ivith global meal of 2,50,000 deatlis of which i~lajordisaslcr Iiills on ;maverage of
1,40,000 people per yettr. -rile slutly of IJnircd Nations Enviroilment.1)rogl.amme(IJNEP)
indicates Mat India is one oftlie [nost disasccr pronc ccrm~l.riesas fin. ::IS oattaral disasters
are concenled. In this unit you will lean1 their i~n~ortlu~cc'of sci$neitjc m;milgelncnt of
disaster events and emergency response for medical care. 11i/rliistwit ycw will illso l e m
to relate the disaster ~narlagemcntat riationnl, state and district 1evc:l. You1 will 1cw1ilbout
the disaster characteristics, need for disaster plimning, key issues invc.)lvesland bilsic
principles of disaster matiagenzealt. You will lean tl~eprocess oT tletrclopment of disaster
p m ~its
, components and purpose. Tlie basic purpose of this unit is focussed on leanling
developnlent of plans, response actions aid issucs in disaster preparedness.
$

2.2 BASIC CONCEPTS

The frrst important aspects of disaster management are to understrmd the. disasters. The
disasters are a phenomenon in themselves and have various chi~dcterisl'rcswhidi are
crucial for disaster management. A clear understanding of thcsc basic conccpts is
necessm for scientific planning, preparedness atld emergency response.

The concept and definition of s disaster has altered over timcs, in accordance with
changing concepts concerning cause and effect. The infectious discases were considered
inevitable disasters prior to 1700 AD. In 1950s the concept of natural disasters cii,wged
&om characteristics of physical forms and resultcult darnages to social issues. The
definition of the disaster has reflecled U~isch~mgewith ilicreasi~lgat tenltion being given to
the social aspects of disaster situation and collective ability to meet thc requirements of
these situations. How the word "Disaster" is defined gives meani~igto such descriptive
terms as Disaster Prevention, Disaster Preparedness and Disaster Rcsponse etc. The
disasters have been defined in various ways on the basis of degree of j111ysical impact of
the-event, magnitude, disruptions of public safety, disproportion of resources in terms of
special efforts required and controllability of event.
WHO defrned disaster as any occurrence that causes damage, ecologicd disruption, loss
of human life and deterioration of health and health services on a scale sufficient to
warrant an extraordinary response from outside the aiTccted cornmunily. Pan American
Health Organisation (pPJ.10) defined disaster as m overwheln~ingecological disruption,
which exceeds the capacity of a community to adjust and consequently requires
assistance from the outside.
..
W, Nick Carter defined it as an event, natural or manmade, sudden or progressive, which
impacts with such severity Ulat the affected community has to rcspond by t ' h g
exceptional deasures.
2.2.2 Disaster Classiflcatiow Disuatcr Manugcllrc~~l

Disasters 1i:lvc bcl.11 cl;~ssifivtlin various ways but the most convenienl ~petliodused is the
divis~o~iol' clisaslcrs into two dls1111ctcatc~oricsaccnr ding lo Llicir causes:

s Disasters c:nlsctl by the ~ialuralplienoinorioo

Natural Dis;asters

NIetcorologic:~IUisiistcrs: Sterols (Cyclones, Iiailstonns, Iiurriciuics, Lor~iadocs,typhoons

a i d s11nw slotms), Cold spells. I [cat W;ivcs ;uid Drougl~ls
Typological I1isnsfea.s: Av;~li~~iclics,
I.,i~ndslitlcsarid I~loods
'Felluric arrd 'fiotolnic Il1is:tsters: Iiii~~ll(luakc~,
'I'sun;unis ;uid Volcanic E~uptions
Biologic:hl il)isasters: 111scclS\v:lr.n~s,(c.y. locust) ; u ~I?l>idclnics
l of Co~n~~lunicilhlc
Diseases.

Civil I)istarI,;r~accs:12iols a ~ i dI ~ ) c m o n s l ~ ~ ; ~ t i n ~ ~ s

Warfare: (lonvcncion;~lW:~rSi~rc(l>o~rn~l,ard~nc~it,
blocl<i~gciind siege)
Non Convcnation:rl W:~rf:~a.e: Nuclci~r,1~iolngii:iiliu~dClicniical wi~rfiirc,Guerrilla
Wxfiirc inclucling 'I'cn'oris~rl
Refugees: 1:orcud Inovenleal of I ; q c uumbcr of people usnally across Sronticrs
Accidents: 'l'ransportntion cala~nilies(I:ind, ilir and sea), ('ollapsc ol'buildi~ig,dtmis and .
other slniclurcs, mine disaslcrs.
'Itchnologicill fili1un.e~(c.:!. :l mishap i1t.a nuclc:~rpower slalion, a leak ;it ti Chemical
pliuit c a u s i ~ ~pollution
p of a1llnosp11c1.cor llic brc:d; ilowli ol' a pddic s:uiit;i~io~~
systcm)
\

'l'liis rclativcly si~rlplec1;issiliaition liiis h c e ~overlaid

~ by liiore co~'nplicalcdcliissilicalio~i
scheme of vtlrious r c ~ c a r ~ l i c r s'I'lic
. classiliciilions ilrc by tio mc;ms li~llyconlprcliensivc
iu Ihcse tncrely intlic;~lc[hc nun1e180uscauses or porailial c:iuscs ol' so~iicof the lliorc
serious dis;uters. 'I'lic tlivisiolr hciwcel~niituriil i n d manrnarlc is 10 some extelil an
oversini1)lificntion as tuiuiy tlisaslcrs uui hc ci~usctlby either. Some or the worst
ca1:uilnities auc oticn caused I)y Llic cu~iiulalivccl'fcct of several of tlle ;il)ove mentioned
factors both nalurill and ~ilntunnadc.

2.2.3 Disaster Psoccss

b

Disaster situation has been co~icepluulized;IS ;I proccss will1 differing phases, hi each
differcirt phase, the information, the action r c q ~ ~ i rtlle
~ d prc~blems
, encou~itcredand
pcoplc jnvolved may bc quire different. 'The inlcn.clstionshi o i tliese diffcrcnl pllascs
a i d activities is import:l111 for its mauiagemcnt. Various researchers like Powel and
Rayner, Garb arid Gng, Skeet, I1y11cs:md liussell have tlividcd dis:ister into V ~ X ~ O Ustages
S
or phases. This artilicinl timc divisio~iof tlisnslor stuclics is an important base for
pl~ining.
Each type of pllasc will vary iiccordi~igLO llle type of dis'~slcrevcnt wit11 difScrwi1 time
element likc in tui a~rcraftcrash llicrc 111ily hc no warliiuy or very litlIc warning as against
lloods. wliicli Illnay give suflicicnt wanii~lgfor prcp;ucdncss.
'rlie disaslcr and its ni;ut;i:!cment has b c a ~considered as a conlinuum or inlcrliuked
'
aclivlues in wliicli 1l1c cyclicill nature 01 varlous componcnls of' rlisasler in>uli~gemenl
bas
been roilnccl)rualiscd ils a &sastcr cycle b y W. Nick Clartcr.
 Disaster Process

L F --I
~ Long Tern1 Rehabilitation 1 ,-
Disaster Inlpact
I

DISASTER )

2.2.4 Spectrum of Disaster Management

'I'hc spectrutn of disasier management involves disaster prevention, mitigation,
prcparednesb, response ant1 recovery. It is esse~!tial10 clearly understand these terms and
the vcope of 21c1ivitie.sin each nl' them.

Disaster Prevention: It covers those measures which are aimed at impeding 1he
cxcut-rcr~ce01' o disasler even1 andlor preventing such an occurrencc having harmful
cl'l'ccls on co~lil~unities.Prevention concerns the fo~.tnulationsand implementation of
long range policies and programmes. ,.
Disaster Mitigation: Measures aimed at reducing the impact of a natural or manmade
disaster on a nation or community.
Disaster Preparedness: Meas~trcs,which enable governments, organisations,
communities and individuills 10 respond rapidly and effectively b disaster situntioos.
IneiLsures incluclc ihe forlnulation of viable disaster plans, the mai~tenance
Prep~~redness
of resources and the training 01. personnel. Organising, planning, coordinc*~g, ~.esobrce
planning and training are its nli!jor concerns.
Disaster Response: Response measures are those, which are taken immediately prior to,
and following disaswrs, Such measures are dirccied towards saving life and protecting
property and to dealing with 1ht: i~nilledialedamage caused by the disaster. Its success
depends vitally on good prepiuedness.
Disastcr Recovery: Recnva-y is the process by which co~nmunitiesand the nations are
assistcd in relumjng to thcir' proper level of functioning following a disaster,
 2.2.5 Speci'al Characteristics
Disasters are considered phe~lomenoni11 tllemselves with some colnmoil characteristics.
There me several facts and pllenomenon associated with disaster events which requires
clear understanding as these have many plcvlilingand response in~plications

Geography of Diasters '

The geographic divisions of the total area concerned with a disaster were coilceived in
order to classify the arising problems arid help manage the~n.Solonlon Garb and Eveling
Eng divided the area in the three major divisions:
Impact Area: Area in which Ule impact agent works out its full capacity foz destruction.
The area will vary with the lype ~f disaster like in aircraft or train accident the area will
berelatively small. But in floods, dun burst, lyphoon and storins the ;uea will he very
large.
Filter Area: It is virtually the ~11d;~nilgcd
zo~lcfiaomwhich tl~ereserves enter the area :md
through which evacuees iuld rescue workers ~llustpass. Serious Wal'lic confusion often
occurs in this area.
Community Aid Area: Thc area outside Ihe liltcr area ii-oln wllerc tlle cornmu~~ily,
special institutions and org:ulised lcains opcnitc ror pcri'orming rescue auld rehabi1it;ltion
roles.

Disaster Behaviour
Analysis of various disaster situations of dii'l'ering ~nagnitudeand consequences cluried
out over a period of more tllat~30 yeius in differc~llcouiltrics coniirrn that here are mimy
common pattens of human and orgiulialtional behaviour in einegency situations. The
psychology of disaster involves several tlisli~lctl"lcets like psychology of victims before,
during and after disaster, of the volutiteer iiclper, trailled prolkssio~lalsiu11d the onlooker.
, Each-must be understood in order to cope with tllc problcins. Pre disaster plarlilii~gis
dependent in large parts on what is assmnetl about 11um:m behaviour in clnergency
situations. Valid assumptioils are essential for tt~eplanning and iinpleincntation of
effective emergency measures zuld post dis:lster responses.
Tlte Victim: Most people bclieve (.hat a disaster is some tlling that happens Lo someoile
else not to ll~emselvesor heir families. 'This is called Ll~e'dclusion of personal
invulnerability'. As a result they are likely to ignore or miniinise wm1ing ant1 refrain
from taking preventive measures. It can be countered by vigorous trailling or by
imaginative action or both. These persons who have ignored all warnings before the
disaster impacts often over react to wart~ings,rurnors iu~dwild speculations after tlle
impact, Prornpt setting up of an el'licient colnmunications system will lninimise Llle harm
from this sort of psycl~ologicalpattern.
Disaster Syndrome: A form of stress or shock reaction, called a 'Disaster Syndrhme' has
s h e times been observed in the afternlalh ofrclatively sudden arld extensive disasters
withicute disorientation and apparel11loss of irldividdal purpose or direction. It does not
occur in a great number of people and is geilcrally of short duration, A stress situatioils
called 'Counter Disaster Syndrome' has been described where some uninjured or slightly
injured survivors of the impact and volunteers Inily sMfer this short duration syi~drotlle
which is marked by vigorous rescuc activity.
EL Quarantilli disproved the inytl~about panic flights, helplessness, paralyziug trauma,
anti social behaviour zuld low cominuility Inorale during disaster situations. Recognition
of the ability of people to cope suggests tl~atas a basic premise, tlle actions and resources
of survivors must be considered in planning for w d providing assistance i n emergency
situation.

Convergence in Disaster

Convergence is observed to be a common problem in most disaster eveills iuld it has

important bearing on disaster inanage~netlt.Convergence, cl~aracterisedby tl~e
spontaneous movement of large number ofpeuple and large 'mounts of materials towards .
S:~l'etyP I I Risk
~ hfa~tuge~t~e~~t the zone of impact, is a common pl~cnomenonin all cmergencics. :l'his convergence is
motivated by a concern for victims, a desire to help, smlple curiosity i u ~ dllie search for
information. This movemelit usually outweighs Lhc outw;ud f'low of those wishing to
I leave. The convergence is described to he of three types:
Personal convergence: The physical ~nove~nent
of people.
Material convergence: T l ~ physical
e Inovclnellt of su1)plics and equipment.
Information convergence: Ti~cquest for infonnatic?n Ihrough the lriu~slnissionof
messages by word 01' mouth, tele pliones, wireless eLc.
[n past disasters unofficial co~~vergence.
has been one of Lhe greatest obst;lclcs lo giving
2fkicient help to the victims. The extent to which convergencr: 11;unpcrs cll'cclive rescue,
first aid and evacuation is usru~llymuch greater tlliul lllurc people realise.
It is important therefore, to untlcrstimd the convergence plienomcnon, its origins m d
possible ways of dealing with it. Convergence causes 1ogi:;tic aultl admi~~isLr;itive
problems, Studies havc concluded that convergcncc rcm:lil~slargely il crlllterttual problelrl
which c'm not be avoided. Convergence cannot be cornpleteiy blocked out bul il can be
channeled. Convergence of telcplionc calls is known to iaun llic co~nmmnicillionsch;~nncl
of hospitals ilnd the conveyance ol' pcol~lcin liosp~lalc;~uscsconl'vsio~~.IJnco~~trollcd
convergence of relief material is likely lo crc:llc Iogislic piohlcms as wcll as may Icatl to
traffic jams. As convergence is likely to occur al'tcr evcry cl~s;~stcr.
it requircs cmcful
considcralion in order to enhance the uscli1111cssof clon;llicms :uld oii~limiscrhc
adminislrative and logistic dillicu I1IPS.

Leadership in Disaster
Ill a ~ ntternllt
~ y to bring order and efficiency oul of disorder and conlilsion, !;oulld
leadership is necessary. This is particularly tsuc in tlisasCcrs which arc the cpilome of
disorder ;uld confiision. Past experience has shown how 11clpful sound leadaship ciui be
a ~ how
d it can save lives :uld prevent suffering. By conbast, ] ~ o oor r absent lcatlership
has solnetiines resulted in needlcss cxtra casuallics. Disaslcr lnunagcmcut involves
lnany agenses a i d orgiulisations at various s l a p . h r a rotill inreg~nlionauld
optiinisation of resources of lk~ultiplccIi;u~ncls,multiple sources 1i;lvc got lo be
systc~naticallyled by someone. 'I'he lcade~sllipprinc~plcscommonly found useful in
disaster situation are: ,

#
e lde;ldersl1ip ill disaster must be shaucd.
e OrgLanisationof lcadershil~l'raineworlc must be cleiu :uld wcll clcfined..
0 ide:~lly,hc held by persons who
The higher lev.:ls of leadership in a disaster sho~~lcl,
already have recognised authority under existing law.
0 Leadership must understand Lhe pri~~cip!esuf organisation and of delegation of
authority.
0 Leadership s1ioul.d be 1 open-ended
a miu~agc~nent.

Key Issues
Disaster management implicates dii'fere~ilsectors at different times :uid the need for
cooperalion atld coordination iunong local, state and national agencies is never more
apparent than iri the case of disasters, hence disaster ina~lagema~t necessitates a
multidisciplinary approach. It is not possible for any organis:uion to c:lrry the l~urdeiiof
the disaster plan. Disasters cannot be m:uiaged in a vacuum 'knd miuly agellcies have to
be integrated and coordinated into the plan to preverit dul~lica~tions and confusion. It is
necessary to promote maximum coordination of all the commu~lityresources for tlic time
whei~disaster may strike, Coordination is a key issue in disaster m:ui:~gement.
Disaster is no respecter nf circu~nstx~ces :u~dit is known to strike with suddelilicss and
fury of its own wid1 a curious l'aculty for choosing tui inopportune moment to hit. The
inotto "preplanning prevents poor perfonnmce" is most applicable to disasters. A
realistic, well-rehearsed and coordinated disaster pl;ul executed by a well-trained system
is essential to inect Che cl~allengeof disasters. The key issues in disaster m~iiageinentare:
 Disnster Management

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2) Ucscribe llic ilis;rs(cr proccss ;uid its inzportuocc.
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..a
2.3 DISASTER MANAGEMENT IN INDIA

l11e disasler management systcm of varlous countries iridicales a need of'a clcar National
Disaster Miu~agemenl~ o l i for c ~eslablisliing :mtl rnainlai~iulfadequilte :~rr;ulgerncntsto
deal will1 all aspects oSa disaster tllrenl. Tllis policy tia~ncworltdiould bc a1 all levels of
the n;~tionalstructure and orgu~isaliollsat lli1li011a1,state i ~ l ddistrict ICVC~S,Adecluille
(1is:lsler legislation is 1lecess;u-y lo provide autliorily iuld assume cooperation ;lilt1
assistalce among often competing govemmclit jurisdiction. Thc policy md lcgislalioil is
to be wlppotted by iippropriale orgaulisation ant1 disasldr plails. 'l'lle n:ltional level
org:misaLio~~s and pluls l~eeclsto bc supported by regional1st;llc level plans.
India is a vast country, thc main land area corisists of 32,37,782 scluarc kilomctcrs. India
with 2.4 per cent of worlds land mass, seventh 1:trgesl couiltry in tile world, wiLh 15% of
worlds population is llle second most populous country in llle world. l'lic currenl
estimaled population of a billion has a population density of 273 persons par sq kilometer,
which makes the effects oS disasters very scrious, India maulnifcsts many natural disasters
like floods, earthquakes, cyclones and drought elc. iuid also the iniu~marlcdisasters like
c1lemic:il disasters in Bhopal, collapse of buildings, train iuld aircraft accidents etc. The
vulnerability to National Disasters can be see11 lion1 Ihe I'ollowing:
Floods: India is one of thc most flood prone countries in the world. On average about
9 millioil lieclares are allected by flood every year. India accounted for 115 of global
deaths due to floods horn 1960 to 1380's.
Earthquake: The couillry !las about 56.3 % of total area :unounting to 3.3 ~nillioilsq
kilometers vulnerable to seismic activities of varying intensity. The eartllclualce prone
areas have witnessed over 33 major earthqualces wiUlin Ule couiltry. Durl~glast 80 years
India llas lost about 70000 lives due to earthquakes.
Cyclo~les:India has a very long coastline oC 5700 kilometers, which is vulnerable to
tropical cyclones arising in the Bay of Bengal atld Arabian Sea. Cyclonic storms have
been causing considerable damage to life aid property in the coastal :uea of India. The
cyclo~iein Paradip on 30 ~cto'bcr1979 c1:~imed10,000 fives. Orissa cyclone in 1982
distressed 7 millio~ipeople a~dA.~idl~ra Cycloile in 1997 killed 10,000 people and 23,000
ciiule.
Manmade llisasters: India suffered the largest mdlrn:lde disaster in Bhopal on 3rd
1.lecember 1984 when chemical gases leaked killing 2500 people. 17500 were
hospitalisctl besides incapacitating thousalds.
, .
The vuh~embilityof the comitry requircs a~ppropriatcdisasler plans at llle national, state,
district level and in each hospital. Each and every response orgalisation must be prepaed
lo play a rc!e in disaster situations,
1 2.3.1 National Level
In the federal set up of India both the central government and state government share the
responsibility for disaster management. l11e basic role of central government is
supportive in providing mfomation, financial, technical and material support.
Contingency Action Plan for Natural Calamitio,~issued by Ministry of Agriculture,
Government of India is the basic document guiding disaster management in India. Tliis
brief documen1 provides a policy statemcnl and response mechanism. The focus of this
documall is lnostly rclicf oriented. It is reported thal h e natural disaster policy is under
preparations. The organisalional component at the national level is:

o Cabinet commitlee headed by Prime Minister

Naliollal Crisis M;u~ageinenlCommittee under the chairmanship of Cabinet
Secrelary
0 . Crisis Mmageinent Group under the Chairmauship of the Central Relief
Commissioner
I

/ Financial xra~~gements
are basically tllrough the 'Cal,irnity.Iielief ufn'!
I

B.3.2 State Level

The policies, orgilllisalion structure tuld ful~clionsat cenlral governmeill level art:
reflected in the stale govenlment. There is no standard orgCmisation,policies, or
functional arriulgemenls, as each stale govenllneilt has its own organisation patterns,
policies and p1;uls to tackle disasters. The primary responsibilily of disaster ~nanagemenf
'
/is of the stale governmciit for relief operalions, preparedness and rehabilitation. Each
'
slate llas a Stale Crisis Management Group headed by the Chief Secretruy. The senior
officers from various dep:~tmenlsfirin part of this group. *
The state is divided in various dislricts, which form thc basic slructure of Ihe slate
iichninistration and focal functional unil with represenlation of all thc elelneilts of
administration smclurc. 'I'he tlislrict is the basic unit for emergency plruls, response,
coordination, supervisioll iuld inoniloring of relief operations. The dislricl ildininistralion
preparcs conti~lgcncyplans with specific resporisibililies for implementation. The districts
l~avcDislricl Relief Commitlees for rclief lneasures and District Conlrol Rooin for dny to
day monitoring of rclief lu~drescue operations.

2.4 PRINCIPLES OF DISASTER PLANNIFG

2.4.1 Principles
Disastcr Ma~:igemcnlu ~ c w tis pliulned zuld sysleinatic approach lowards understimding
smd solving problems in tile w;ke of d~saslers,Tl~eeffects of disaslers could bc
miniinised, if here is prc-disasler preparedness and properly drawn up disaster pltuls,
Some gcneral principles of disaster planning are as under:

I1 sllould be a conlinuous process.

It should reducc the uiiknown in a proble~nalicsituation by foresceing what is likely
to happen.
Plan inust evoke appropriate response.
e Plsul lnusl be based on valid lalowledge.
Plan must Li~cus011 general principles.
e PIXI should serve as UI eeducalio~lillactivily.
Plan must be tested.
@ Adjust plrulning to people ralhcr than expecting people to change. their bcl~avimrin
order lo collfvrln will1 the plm~i~ipg.
 Slrcty n ~ ~Risk
c l Rlanngcl~~c~~t e Greater the prep;uedncss for probable or l'oseseeable events, rnore effective the relief
operators will be.
e No two disasters are alilce, but the l~roblemstl~ata certain kind of disaster is likely to
I
# \ create are quite foreseeable.
I
t

I
e There cxn be 110 tailor made plan ]'or all situal~ons,but as rnost clc~ilentsof response
1
I are comnloll to all disasters, a general preparedness plan will help in a more rational
I response in various emergency situations.
I i: e Plans lnust be realistic c ~ adaptable.
d
e Plmis must use existing suvcturc rather than create ncw ones.
e Pliu~smust be clearly written.
e Plalls at each level should be lianllonised with those ol' tile levels above.

2.4.2 Disasters and Health Problems

Disasters iiivaria1,ly have healll~conscquences, The health probler~isin disaster could be
due to cither or any cotnbil~ationor factors enumerated below:

0 Di~ecllydue to impact of drowlah7g during flo;ods, irijuries during earthquake

e Due to delay in evacuation
e Due to non-availability or inadequate immediate medical care

I 0

0
Due to disorganisation or non-availability of ceiltrcs I'or advanced iiiedical care
Due to delay in transportation to medical centres.

!
The health hazards resulting from the disaster events depend upon a large number of
. .factors as given below:

e Population density
e Population displaccinent
e Disruption of pre-existing facilities
e Disruption of normal health proynrn~nes
lilcreaskd vector breeding
e Cliinatic exposure
e Iiladecluacy of food and nutrition

There is probably no evait that so severely tests tile adequacy of heallh infrastructure as
the occurrence of i L sudden disaster such as XI earthc~u~ake and cyclone elc. To a large
extent, wdl-plulned health delivery systems is the tnost iinpnrtcvit preparation for a
catastropl~e. Planning, ogu~isingiuid coordillati~lghealth care in advance needs the
utmost priority in order h a t a disaster stricken population may be attcnded in a more
. rational way.

2'4.3 Organisation for Medical Relief

~ the location and magnitude of the disastcr, iirst level of care is generally
~ e p e n d i nupon
organised at the disaster site to provide relief and first aid to the victims. The ,.
organisation of mehical rdicf involves two distinct facts:

e Pre-hospital care
e I-Tospltal care
Tllc prc-hospital pllase involve desp;ltcll of firs1 aid Lc;uns auld ~nobilcmedicill serviccs l o
the disaslcr site, A1 sitc the prelimi~iaryphase involves orgiulising 011 site ;uiillysis, on site
Lrcnunent, stnbilisation :uld tramsporli~igLo seleclivc care facility. The tletinilive care
pliilse at the receiving hospital i~ivolvcspatient trmsfer, triage, continu;llion ol' treaunenl,
second stage diagnosis, emergency room weat~nenl,intensive care, deiinite diilgnosis,;uld
treauncnt. The recuperntioll 2uid re11;lbilitation pl?:lsc conlinues for a long period auld may
even last for years as in case of nuclex and chemical disastcr like in Bhopal gas Lragcdy
victims. Medical care, which can be effectively organiscd at disaster sites, illvolves some
impor1;uil aspeas of org;ulisntion iuld stal'fing:

o Command ;uld Co~ltrol

e Coordinalion
s 'Triagc Tcaurl
e First Aid Te;un
ea Mobile Hospital
s Evaluation and Castia1t.y Clearing Team

2.4.4 Principles of Mass Casualliy Management

llisaster inediciue is :I mass auld multiple trauma inedicine iuld it is not diPiierent from
ordi~iarymedicine, Llic tlistinguishing fcilturc, is its lncthod of applicatioil auld prirnay
concern for yield iuld efiiciency.
Sornc typcs of disastcrs usuiilly result in i1 l~ugcilu~nbcrof casualties, wllicll are bcyand
Ihe routine hultlling capacity of llle Ilcal UI carc system. Applicatiail of principles of mass
casualty management 11elps111cct llle demand of a large number of peoplc. The prirlciplcs
of mass casualty mu~llageincntarc universal a i d can bc applicd ill :my mnss ca$uallty
situatioll nalural or mimmade,

m ~ o i n gthe besl for the most wilhin Llle available resources

9 Triagc is inescapable U~roughout the cliaiil of treatment
Graded care of casl~i~ltics,lirst ;lit1 lilk saving measures, preparalion for cv:lcuaLion,
primary surgery ~ i tleliililivc
d keahncnt
e First aid lneasureg c;u~icdout at the carlicst assumes l i b saving signilica~lcc
o First aid a1 thc sccnc of disnslcr must be liinited to rnollitoril~g:uld restoring vital
functions
o Simplc imd standard Ilier:ipcutic principles
m The casualty must be collditioned or treated so Illat Ule degree of urgency is lessened

Mau~agementof mass casualties c2u1 he divided inlo four phases, sescue, first aid,
trwsporlalion ;uld deiiilitivo treaullelent. Rescue ill large-scale disasters in inost insuu~ces
nus st be of necessity arid is perl'onned by the survivors themselves. Tlic rescue team
supports Ihe conllna~lityrescue eflorls witli special equipment. A reductioli in mortality
in llie severely iiljurcd can be ilchicved by early firs1 aid. The tirst aid is usually Iiiliitcd
Lo prinlary life support lneasurcs - che mait) l'unctions of which are maintaining Airway,
-
Rrealliiulg and Circulation. 'Tho routine practice in medical care lirst come iirst treated
-is inadequate in Inass cmcrgencies. Whenever time, personilel and resources arc
grossly insui'licici~tto meet all the needs surti~lgor triage is the only appropriate way to
provide a maximum bellelit Lo most of the u~,jurcd.Tlie process involves sortiilg out tllose
of llie wouncled whose progress is most i>ivourable.
The mass casually mamagcincnl iiivolves cqtegorizing the casualty for priority of
treaunent auld evilcuation based on Uthe cliances of survival w d most benefit from
measures. There are various types of classificalion of casualties available worldwide but
the most comInon categories are as under:
Category I: Immediate Reatrnent: Severely irljurcd victims who can be saved if they
receive appropriate stabilisation, transportation and treatment immediately.
Category 11: Delayed Treatment: Urgent but less serious injuries who can be transported
and treated alter the most seriois have bee11attended to. These victims will require
surgery i n 8 to 12 hours,
Category 111: Minimal Treatment: Wallting woulldcd who can often be attended in
small group and if ambulances are in short supply cam be transported by other means.
Category IV: Injuries: hjufies, whicll are not serious, will generally be. treated and sent
back to their homes. In a disaster event causing very lauge number of casualties this
category may include moribund cases or so severely wou~ldcdLllan eve11 immediate care
would be inadequate to prevent death. ..
Tagging is a co~nmonlyused inelhod to indicate priority of evacuation. Various types of
tags :uc in vogue. Each patient must be identified will1 lags stating Uleir name, age, sex,
place of origin, triage category, diagnosis and initid treatment given. Usually red tzlgs
indicate first priority, yellow priority two and green priorily three.

Clleck Your Progress 2 '

1) Dekine the principles of disaster plannil~g.

2) Discuss t l ~ 1ie;ilLh
e consccluences of tlie disasters iuid principles of Inass casualty .
iniu~lagemenl .

2.5.1 Need for Hospital Disaster Plan

The hospitals play a vital rola in Ule medical care of the co~nmunityduring disaster
sitwtion. Disasters pose 101s n l challenges to Ihe hcaltll care system and only tilose
hospitals thal arc prepared can meet the danand of sucl~silualion.
P.E.A. Savage defined disaster in Lenns of medical relief tuid hospitals as '1Arriva.l with
little or no wanling of marly more casualties of all types of degree and severity t l ~ mtile
hospi~91is staffed or equipped to h;lndle at tl~alparticular lime." This definition focuses
on organisalional ability and required services, which cxplai~lsLIle response needed.
I-Iospitals should be prepared for two kind of disaslers:
0 Intenial Ilospital disaster: such as an explosion or il major lire -
o Extenlal disaster such as floods, eartllquakes, lecl~nologicaldisasters elc.

2.5.2 Objective and Purpose

The purpose oP a disasler pliu1 is to make it possible to attend, proinptly and elfedively, to
the largest possible number of people recluiring medical care, in order Lo rccluce tlle
lumber of deaths and disabilities. Tlle principal objectives are:
S:~ti.iy :~nc!Itirii ~r;lllag~ll,cklt B '[b prep;ue h e stall' iuld institutional rcsourccs li)r optimal pert'onnancc in ;UI
emergency situation of certain magnitude
To mill..^ llle conl~nunityaw;lrc Llle i~npost;lnccof Lllc Oisilslcr plan, llow it is
cxccured :uld the benclits it pl.ovidcs
s ?b train the staff as :L
part of eclucatioll;~lactivily
e To carry out periodic drills and its evaluation to update plans.

2.5.3 Planning Process and Developrlae~rtof Plan

Disilstcr a u e is, of necessity, purcly cmcrgcllcy care and bccausc hospital disaster
operations csselitially an expulsion ol' (lay to d:ly clnerseucy sc~viccsol' !he hospitals
11 prcrcquisite to good disaster ~n;uiagementis that clnergcncy systclns rllust be
Iunctioning well on a routine basis. Tlie respolisc cilp;~bilityof Lhc Ilospital will vary
liom liospiti~lto 11ospit:il b ~ s e don its size, Lype of hospital, loci~tio~l
of tllc liospitill
rcsourccs available and role ;ilIotted.to the hospital in ewer all co~nlnnuitypliul.

'i'lie cfevelopment oC disaster plan slioultl lake inlo account Ulc p l i ~ n i ~ process:
lg
e hialyse Ll~erisk and hazards in llle gc,ogriy)hiclocatioll cu~~cerncd
will1 h e hospital

a Ciirry out ~~~lncrability

;malysis of the community exposed to Uie risk :u~dh n ~ i ~ d s

a. The probable deiniuid ;uld ilaturc of work cxpcctcd during disaslcrs

e Assess the resaurces available

r Dermtine response capabililies
s DeLennine the turn Uie disaster plan based on I'actors cnumeratccl above

@ Jletennine arg~ulisationslruchlre for disaster

o Devclapment of organisation, allocalion of role arid responsibilities. Authority
structure sl~olrldbe clear
e Training of'orgru~isation

e Testi~lgofrtlle organisacion

a Testing of the plan

0 Periodic revision of b o b llle plai a ~ the
d organisiltion.

'l'lie hospital disaster plan pro~dsionsshould hiclude the I'ollowing:

e Eficient system of alert and staff assignment
Co~iversionof a usable space into clearly defined areas for triage, paticnt observation
ru~dimmediate care

Reinoval of casualties to Illore appropriate :md dciiiii~ivemedical care facilities

e Sl~ecialmedical services for disaster cases
e Procedure for prompt umsfer of patienu within the hospital
o Security atrmgernents
' e Establiihment of a public iaforlnation centre
8 Evaludon of hospital services and its sources of electricity, gas, water, rood aid
lnrdicnl supplies
o Method of identifying patients kho are immediately dischargable or tt;uislerable

, Special disaster.~neclicalrecord imd ~xedicaltag

0 Planning use of OT, X-ray, blood blank and laboratory.
 2.6 DISASTER COMMITTEE

The hospital disastcr m:uiagemc~itcommiltee operates at the decision making level wd

dte action decided upon are executed by the lliedical slaf'r supported by the institution's
logistical and general servlce units. Tlie composition of tile committee sllould ivclude
doctors and nurses as well 21s aclminislralive staff. 'l'lle number, sl)ecialisation and
seniority of committee mcinbers Lo be drclded according to the need. Tlie membersllip of
tile comlniltce generally includes, the following:

'I'he Director of' I-Iospilal

In charge ol'hccident and Elncrgcncy Scrviccs
e Depi~rtlncntI-Icncls
o The Nursing Supcrizitcndent

B A stall' reprcscntalive

'The fu~uncrtonsof tllc liospilnl disaster collllnitlce are:

e To (levclop thc hospilal disas(er pl:u~
'To develop deparlinental plans in suppor.1of ~ h hospital
c plan
e To illlocate dulics to the 11ospit;ll staK

s To est;lblisl~stantlards of eincrgcncy caw

e To conduct :uld supervise trilining ptograunrncs
e 'Ih suq~crviscdrills to lest llle hospiti~lpl:ul
s To reilew and revtse the clisastcr plan at rcgul* iiitervals.

2.7 ORCANPSATION, ROLE AND RESPONSIBILITIES

The hospitals needs a proper org:misillion h r disaster mnn;lgcmall. Idcillly, the

organisation chart in efkct durilig a clisastcr pcriod should bc Ihe llospitals regular one,
possibly strengtbcned ;md improved. 'I'he organisatioil chut should specify fie levels of
command in supervision and adlninistracion,so that duplication of effort may be :ivoided.
The organisalio~ishould provide a delinite line ol~~~rulliosity establisl~edin each iueas in
, advance and there should be no clueslion over who is in charge. 'l'lle organisation sllould

include medical staff, nursing st:lSf, ildmi~lislrativestaff :uld dcpartl~lcl~theads.

2.7.2 Role and Responsibilities

llle effective iinpleincutation of the disaster plan would necessarily require clear
ill all tllc fuunclioiial areas essential to supporl the
assignlne~ltof the role i ~ ~~espo~isibilities
~ d
plarls. Clearly laid down role ruldresponsibilities of me tbllowing would be essential:
Disastdr .Coordinator: 0rg:uiising. cotnmnunicating, assigning duties, deploying staff auld
taking key decisic)~is..
Administrator: Tlle responsibilities ilre extensive and most of Ute authority is executed
through deptt heads,
Department Heads: Developxnent of deparlmental plans to meet the requirement of tile
over all plzm 01' tlie hqspital.

Nursing Superintendent: Deployment of nursing starf and augmenting key meas of

!.pspital.
Su1i.t~and RlskM~nagc~i~q!t Me(lica] Staff: Specific authority and respoasibilily during initial responsc ~und
reiilforce~nentoi'i~nporlantm a s .
Nursing Staff: Rolc ;uld responsibilities to support crilical areas.

The following importault depauullents play a crucial role in tlisalsler miulagcment and
therefore the role auld respo~lsibililiesbe clcauly delineated.
Accident m d Emergency DeptlrtInnen't
Operating Dcpaut~nei~t
Laboratory
Radiology :md Imaging
Critical Care Units

Tlle logislic support becomes crucial (luring the i~nplemcnlalionof a (lisas~erplan. 'I'he
role auldresponsibilities of the Ibllowing dcpiutInent needs lo bc clearly laid down Lo
support the disaster plan:

1,incn :ultl laundry

CSSD
CaLebng deparuncnl
1

. FIouse keeping

. .
Medical Records
Porler staff
Engineering department
Medico-social worker

p Communicalion
I'

e Media co1lUo1
e Morgue

Check Your Progress 3

I) What is the objectives of the hospital disaster plau~:uld how will you develbp a plan
for the hospiti~l?
2.8 ORGANISING DISASTER FACILITIES

'li, ~ucclthe medical care dcm:niJs ~L'disaslcrviclims, spcc~all'u~~ulioniil

:,u.casslioul~lhc s c ~
up wilhin tlic hospilal, whicli includes:
I l ldrgeor
'3..
sol.tiilg area: L o a ~ ~ will1
c d Accidc111and Emergency services wlicre Iriagc 1c:ull
consisling ol'c~ncrgc~icy physiciiu~,surgeon, nursing pcrsonncl b~undlethc incoming
casuallics. I-Iere rapid assessmait oC Lhe injury :uid exlent oI sevcrily of the ca~ui~lty's
illjuries ilre carried oul by a doc~orliiursczuld assigns tlial c;isuiilty lo Im approprialc
trcalinellt area.
Priil~uryrli-cati~~ei~t Areas: Immcdia~clyirSlcr triage casualtics :re sclil to ilppropriiue
Vcilllnclil areas. 'rllesc LrcrLullleil iucas tvould illelude imlnecliate, urgclil luld non-urgcot
tare iEc:ls, Those in lieed of iin~neditltclire saving mcasurcs ire sell1 to rcsuscitalion
rooln wllcrc l'acililies arc availiible Lor esti~hlishingriilvay, cOllb'Olliflg Iiacinorrliagc
supporling fractures a i d ~rcaiiligshock. C;~sualticsslioultl remtdn in llie rcsusciliilion
rooin lbr tile shorlesl possible Lilnc, I'urllicr investigations :uid LrcaMcnl being cruricd out
in atlodler Lreahnent area. IJrgcnt cases needing diagnosis, illvesl~giltion:uid inilial .
Suf'Fty il~lclRisk M n r n g e ~ ~ ~ c l ~ t ,treatme.ntof their ilijul-iesreceive attention in arn urgelit tt.cat.sr1cntarea. Non-urgent
cilsualtics may be investigated, diagnosed :u~dtreated in non-urgent Lrc;lunent area.
Special treatment areas may be needed for the iiianagement of' bu~-lls,fractures i ~ i din case
'of chemical or nuclear disaster victi~ns.
Secondary Treatment Areas: Tlie secontlnry treauntxlt areas include all Lllc wounds,
critical care uiiits and operating and diagnostic depu elc 'I'hc casualties requirir~g
imnportant care will be take11 from pri111;u.y[real~ncntarc;, to the Ilitc~isiveCare Unit,
Operating 'rlieatres or to special rccciving wards which have llcell evalcuated to house tile
disaster victims.
In-patient Evacuation Holding Area 7'11~ scrling up of olic 01'lnore wards to receive all
the admitted victims of dis:~steris esse~~ti;ll 11 mccl~c:~l :urtl ~ l u l ~ sstaSS
i ~ ~ arc
g 11ot to be
scattered aroulld thc liospitnl. Clcarinp ol' thccc designated wautls clioul\l bc carried out at
;ul early stage in preparing tlle hospital ti1 cope witti a liisastcr, and personnel iuld
equipment c;ui be diverted to tllc receiving w;lrd. A d t l ~ t h ~bctls
a l arc madc :~vtl~lable in
ouier wards by arrangi~lgfor suit:~blcp:ltiellts lo l ~ dischagcd
c 11omeor L ~ ~ U I S ~ C I ' I ' to
C ~ other
hospitals.
Additional Facilities: Tlie addido~lilI'acilitics wclulcl be sequircd to be created like:

o Voluotcer reception
0 Relatives wailing area

e Media room

The staff' alert, recall and deploy~nent,immediately on rcccipt o f i inibr~nalioiiaid also to

sustain the activity till all tllc need lasts is :1 m;ljor issue ill orgauiising. 'I'lic initial efforts
sllould be to e~nploythe tri:~getewn, reinforce the accident aid emcsycncy tlepastnlent and
critical care areas. Initial minimum deployincnt o f stafi'in e:dl iIrc:l must bc given priority.
Tlie deployment as initial response lias to he ~ ~ l l o w ebyi l tlic: assessment ol'cxpccled
number of casualties of various types iuid degree bascd 011 rlic disilstcr event to determine
tile staffing need in all areas to sustain tlze ilctivitics to lncct tlie requirement. 'lhc stalling
require~nelilrnayco~iti~lue tbr few days if dis;~stcris of severe type lie~iceUic stal'l'rest,
reception ~uldredeployment lms to be planned. 'I'lie ~ ~ c oi' e dthe portc~ingstaff,
documentation clerks etc, lias to be co~lsidercd.
The secondary ~reatn~ent ireas would co~iti~lue to functiwl cverl when ttic ficsh cases of
casualties stop arriving. I-Ience t!ic staff ~iectlof rhc scco11d;lt-y care arca Il:ts to bc plmined.
It may require redeploymelit of stali'&om c~lhcr;was. The relieving o C t11c surgical team,
intensivist etc, would require attention ;IS no surgic:ll te:url c a i c:~rryon witl~outrelief l'or
more tlian 12 hrs. Very oflcn tlle largest auluber of casualtics I'all illlo non-urgent category
hence appropriate staff will bc required to a u c for Uic~n.
Support facilities play a vital role in managing ll~edisaster victim. ' h c s c support facilities
like, CSSD Pliarmacy, Dietary service, security services, 1r:ulsport etc. would require staff
support.

2.9 DISASTER RESPONSE

2.9.1 Response *

The disaster response is lleavily clcpencient on tlic disaster p l i ~preparedness,

, training
'and periodic rehearsals. Tlic disilster res~olisemust he in clira~ioIogicalorder to facilitate
execution. The designaled hospital stai'i'should bc responsible to :~ctiv;iteLhe 11ospiWl
disaster plan. Tlle Casualty Medical Ofticel; I-losplttdAdministratur on duty o r Senior
Coiisultant on call can be designiltcd ibr puttill}; 11l;utinto action. iIospjtal plan oftal
fails to start whe11 disaster strikcs bccwse llley aue tlestgned oil iw all or none response.
Graded response or pliased response has been suggested to ovcrcome these problems.
'rlie graded response system in vogue am ;ls undel.:

Green Alert: Should there be :I sntidcti inllux of casualtics it mobiliscs on duty medical,
nursing and other p~umnedicnlstafl' Lo support Ll~eaccident and emergency department. It
is used at frequent intervals with minimal inlcrfcrence wilh hospital :~ctivity.
Amber Alert: l'rcpares tile hospital to admit a l q e number of casualties. It is 8 1
extension of green alerl, which inusl be cornplcted first. Receiving wards :re cleared,
stalled 2u1d prepiucd together will1 ICTJ tlnd OT.
Red Aiert: 11 prepares hospitals for a lnajor colnmunily disaster, An extcnsio~lof the
gccn w d amber alert maunly in time scale involved.
In slnallcr llospital only two categories of Plan - a minor plan for small case load and
major plan which involves stoppage ol'norinal work of the hospital to cope with rush of
disaster victims.

2.9.2 Alert and Recall

The hospital may rcccivc tlle disaster alwt on telephone or tl~rougl~ casualty staff w11en
casuallies arrives. 'I'lle dctails ~-cgilrdingUlc ilisaslcr event, estimated number mrd type of
casualties be :~sccrtainedas fa]-as possible, by the person receivi~lgIhc alert. The
designaletl stnit'should then ttdw action for ;ilcrting and rcc:dl ol' tlie staff.
Staff alert and rec:lll is lirsl slcp in inlplcmentation ol'plml. A number of llospital plals
have failed in tile past bcc:lusc tlle alerting procedure has been too"defi~se,Tllercfore the
alerting procedure need to bc iicilucnlly tested as fililme at this level will inevitably mean
failure of the rest of the l~lilr~.
Metllod of alerting Ilospital stafl' will vary from hospital to l~ospitaldepending on type, size,
communiallion facilities 2nd localion of the hospitnl. Public address system, coded light
system, personal paging syslcln iuid lclrpl~onesystem are usually used. 111smaller places
messenger lnay 11;lvcto bc used. Some Iiospitals use a siren system. Tllere rue mamy
methods used to s : timc ~ in r~lcrlingUkc alerting Ilcad of tile Department who in run]
infor~nother ineil~bcrsof th~dcpmtmentI1ospiL:il switch hoard operators aul play a key
role in alerting the slal'concc the disiister plaui acliviltion is announced.
A hospilal's ability to respond rapidly lo a disaster depends on the lirnc of the day ;md thc
day ot'the week, Duriiig worlcing (lays llospilals :uc fully stafled but conclilion will be very
#'*

different durirlg lllc nigh1 holiclays :uld weclccnds. A separate slaTLillert :ind recall pltm will
be rccyiircd by tllc hospilals.

Expcricncc has shown that in tile circrnnst:u~ccsoi'disostcr there is liltlc or no tune to start
thinking libout how besl lo dcploy hospitd star; A sysleln oTaclion cards dr~wnup in
advance will enable tlie 1iospit:ll plaul to put in cffcct with the lninimuin confusio~land
tlelay, An action c:ud melhotl incorpt)rales written info~~nation, advim cmduistruclion for
hospilill slal'f. Some aclion card 1n:iy be kcpt on permanent display in Accidcn~m d
Eincrgency Departmcnl wliile ollier are iin~nediatelyavililablc in casily idenlifial~leracks .
and can be hru~dedover to staff as rcyuired. Cards ol' different colonrs c:ul be used to
indicate different stages of alerl procctlwcs. The cards should be of slal~dardformat and
instructions should bc siinple tuld clear.

2.9.4 Disaster Administration

Control Centre
The aunospherc of cliaos and confusion auld ovcrload ol' work is expected in disaster
silualion, An efficient execution of the disigtcr plan nceds effeciive conlr lo tncet the
goal. A comn~niv~d %
nucleus in thc I'ornl of Control Centre is esscnlial.from wilere the key
functiont~iesorgiluise, co~ninui~icale and control l l ~ implemenL~tion
e of disaster plan.
Staff Report Isonrd
Thcre is a requircmeill 01' a stafl'reporl board. Whenevcr key meinbers of the staff arrive in
the hospital they rcporl by tcleplione lo Ule inl'onnation centre and whereabouts of eilc11
jndividutll is plotted on stnfircport board to facilitate easy contact in case required,
'I
Safety wtd Rlsk M n a n g c ~ ~ i e ~ ~ t Information Centre
Combillillg Ule I~lformntionand Control Centre in conveniently sited rooms helps the
senior rnembers ol' the hospital to control the Inmy facets of the hospital during a disaster,
,&Iinfonnation centre appropriately staffed has a vital role. A hospital administrator acts
as a I-Iospital Informatioil Officer, supervising the casualty and general status board, liaison
with vlvious authorities, medical qnd nursillg staff report centres, relatives, reception area
and other departments. It also help in drawing attention to bottlenecks or the need to make
additional beds available.
'I

1
i Communication
Witl!out colninunication Infonnation Control Centre cilll control nothing. A
cominunication cenue with dedicated facilitics within Ihe hospital and outside, based on
intercom, telephone, wireless, and other system would be needed.

I\ 2.10 DISASTER MANUAL

A writtell disaster inanual is an essential requirement for ex11 hospital. It serves to provide
information, educate staff, helps in orienting the staffjoining the hospital and serves as a
reference when needed. The'tlisaster inanual sboulcl be a working manual, actioil oriented
hill1 apractical and direct review of disaster response. It is important that disaster manual
be in the fonn of multiple custom made manuals so that a persoil c'm easily tind pertinent
inforpation to the specific job.
All items in the plan should be presented in order of application and importance. The
expression must be concise and clear. It would be ideal to have a inanual easily identifiable
by a distinctive cover ;uld its contents so that information may be obtained as.
rapidly as possible. It will have many app$ndices :uld iumexures on various aspects. Many
authors have provided details of tlie infopnation to be included in the m a ~ u abut
l generally
the inanual should cover the followin&,importantaspects:
e General Hospital Policies and Procedures: It iilcludes disaster organisation roles and
responsibilities, the Hospital policies and procedures for alerting, phased response,
general instructi6ns, various facilities and procedure for staid down.
e Disaster Notilication: It lists plan on working day and silent hour plan.
e Accident and Emergency ~ e ~ a r t m e nItt :covers the casualty management,
deployment of staff, emergency medial care, discl~argeprocedure and documentation
etc.
I
I

e Special Duties and ~c's~onsibililies: This section deals with roles and
responsibilities of vatious administrative staff, medical staff, nursing staff, supportive
services staff etc.
Nursing Services: The nursiug services, in various areas and the role of the nursing
staff in specific areas is provided in this section,
0 Departmental Dutics and Responsibilities: In this sectioil various departmental
duties.andresponsibilities of deparment like dietary service, linen stores, CSSD,
house keeping, medical-recordsetc, is given.
. 3

0 In case of specific risk of a particular type of disaster like nuclem or chemical

disaster the specilic facilities, staff responsibili&s etc. could be given.

2.11 DISASTER DRILL

\

The disaster drill is to test the llospital preparedness imd response to delermine wlleqer
response was effectiveand efficient. The disaster &ill presents an opportunity for the
I hospital to reach out to the cold community and to coordinate and cooperate with local and ,

state authorities in meeting community ileeds. 'There is little doubt tllat in the absence of a
real disaster, the only way to ascertain the level ol'preparedness and success of response
plan is lo test it, The system must be rehearseduntil participants are as familiar as rjossible
s
42 .
' '
with their role. Drill inust be well organised whelher annou~~ced or uniu~nounced.In the Dlauster
siinple exercises the specific procedures drill alerting, staff recall mangemeilts are tested.
Eventually a full scale disastar'exercise can be planned wilh realistic siinulation or mock
casualties, The aiin of the drill sliould be to train, test performance and to demorlslrate
weakness that requifes revision.
Evaluation of the drill is a11 essciltial requirement and inust be built in to disaster pl<m.
Evaluation will be necessary both in training and following any disaster with the
continubus turn over of hospilal stafl'. It is essential tllat Ihe knowledge of ;my pl;m is tested
and that Ihe individual must demonstrate lulowledge ol'his role. Evalutltio~~ method could
be internal corninittee or extenlal agency evaluation. Evaluation validates and
compleinents p1,uming and helps 'arrive at a critical assessment of the peri'onnance as
under:
0 Whether file ~ r ~ ~ ~ i s a t i o n a l . nprovided
~ e ~ ~ o in
d stllc plan were carried out in a tiinely
and proper manney.
0 Whether medical care in h e disastcr area was adequate and efficieilt.
o Whether the evacuation to hospital proccddcd according to plan.

e Whefller inua hospital care was adequate, tiinely ;mdspeedy.

Clieck Your Progress 4

1 Describe the dikster facilities required in a 1~ospil;ll.

S:~fotyand Risk Mn~mgeo~el~t 2) Describe h e disaster response ~necl~alism
~ u essallial
~d aspect of tlisahtcr
administration.

2.12 LET US SUM UP ..

111this unil you have learned aboul Ule basic concepts ol'disaster including the disnstcr
process and special chilracterislicsof disasler evcnts which have sigl~iiioiu~tman:igancnt
imperatives. The key issues involved in disaster nuulilgement focussed on the effcct for
coordination of multiple agal'ciesor multi-disciplines involved in t l ~ rcspolisc
c opwalions.
You also le'amed about the disaster mi~llage~nenlsystem at National, Statc and Dislrict
levels. The principles of disaster pluming described the rcquirelilent of ti suitable plan and
how thc medical relief i~~organised. The medical care duril~gdisasler events whcre the
workload exceeds tl~ecapabilities and resources a\lailable tle~nandtllal the principles of
mass casually ma~agementbe practiced,
The hospital disaster planning process and mehod of devclop~nc~~t ol' plan 1s ;i scie~~tilic
process for arriving at tlle objectives and tlppropriale dis:lstcr p l x ~bawd on the response
capabilities. You would have also learned about the role and respollsibilities of h e staff
and facilities required lo care fur the disastcr victims. You would understood the
response mnechanism and imnportancc of the disaslcr mmual and dis:lslcr tlrill.

2.13 ANSWERS TO CHECK YOUR PROGRESS

Check Your Progress 1

1) WHO has defined disaster as any occurre~~cc that c a ~ ~ sdamage,
cs ecological
44 disruption, loss of human life :md deterioration of health and heallh services on a real

-
 sufficienl to warrant rui cxki~ordi~iatry
response iioln oulside tlie affected community. Dlsnster

Classification of Disasters: Disrisler has bee11 classified ia various ways but tlie Innst
convenient method used is llic divisioli of disastcrs illto two disti~ictcategories
accordi~ig10 llieir cuuscs:
e , Disasters caused by thc nalural phcnc?~nenon
c M;u1111adedisasters
Natural Disasters

o Meteorulogical tlisnstcrs-Stos~l~s (Cyclones, hailstorms, liurricaues, tornadoes,

typlioons and snowstonus), Cold spells, I-lcal waves and Droughts.

c Tclluric arid ?buLonic Uisaslers-E;uLllclu:lkes, Tsunamis and Vo1c;uiic Eruptions.

@ Biologiakl Disasters-Insect Swiu-ms (e 2,locust) iu~dEpidc,inics of
cormnunicahlc diseases.
Manmade Ilisasters
e Civil Disturbsmccs - Riors ;uld Denlonstrations.
e Wnrf~re - C:onvcntion;ll Warfare (bombxclment, blockage and
sicye).
- NOI~-COI~VC Watfare
II~O~ (Nuclear,
; ~ ~ Aiologi~idaid
C'licmical w i ~ i ' lCiucrrilla
~, Watl'are illcludi~~g
Tcrrorism).
o Refugees - 170rccdn~ovanetltof large nu~nberof people usually
:moss 17ro~ltiers.
e Accidents - 'Lin~lsportatic?~~
caliunities (laid, air :uid sea) Collapse
of 13uilding,dims atid other structures, mine disasters.
e Technological f~lilurcs(e.g. a mishap at a nuclear power stiltion, a lei& at a
Chemical pliu~tcausi~lgpollutio~~ of atmosphere or lhc break down of n public
siu~it;ilionsystcnl).

Disaster silualiori tuto 1i:is bcci~conccptuilliscd ils :I process wilh dil'fer?e11Lphilscs. I11
eacllplinse llic ititi,nnalion, die iwtio~ircqniicd, the problems encountered and people
involved may bc quite difl'crctit. 'l'hc inlerrelarionsl~it,of thcse diffcrent phases u~tl
activities is imporlull for its management. 'l'he tirnc diversio~iof disaster phe~~omenon
forms an irnporta~ilb:lsc h r pl;mnin$. Ei~clitype ol' clisaster p11;lasc will vary according
to tlie typc of disaster cvent with different time elernen1like in an air crasli'there may
be little or tlo wavitig :is agiiinst floods, wldcli may give suff~cientwaving for
prepar&dness.

3) The geographical diversiori Fonns the biisis to classitjl tlie arising problems it also
explain the type ol'm~u1;1gcmc111activi1.y required in tl~eparticular gcogrilpliicalarea.
There ;lrl: threc major divisions:

a) ImpactArea
b) Filter Area
C) Community Aid Area

Convergence is a comlnon problem in inosl disaster event and is charecterisedby tl~c

spot'meous movelnent of luge liumher of people and large mount of materials
towirds tlic zone of impart. 'his convergence is rnolivaled by a concern of victims, a
desire to hclp a simple curiosity and search for infonnation,Themovement usually '

outwc~ghsthe ou1w:~dflow of tllose wishing to have,

 Snfcty n11i1 Risk Managenlent Check Your Progress 2
... , 1) Disaster management requires a planned and systematic approach towards
. understanding and solving problem to mii~imizethe effects of disaster. The general
rrinciples of disaster plannii~gare as under:
Principles: Disaster management means aplamed and systematic approach towards
understmlding and solving problems in the wake of disasters. The effeds of disasters
could be minimized, if there is pre-disaster planning are as under:
, e It should be a continupus process.
e It should reduce the w1:;nown in a probleinalic siluation by foreseeing what is
likely to happen.
e Plan inust evoke appropriate response.
. Plat] must be based on valid knowledge.
e Elan must focus on general principles.
Plan should serve as im educational ilctivity.
Plan must be tested.
Adjust planning to people rather tlTm expecting people to change their
behaviour in order to conform with the planning.
Greater tlle preparedness for probable or foreseeable events, more effective the
relief operators will be.
No two disasters are alike, but the problems that a certain kind of disaster is
likely to create are quite foreseeable.
There can be no tailor made plan for all situations, but as most elements of
response are common to all disasters, a general preparedness plan will help in a
more rational response in various emergency situations.
Plans must be realistic and adaptable.
Plans must use existing structure rather then create new ones.
Plans must be clearly wsitlen.
I Plans at each level should be harmonized with those of the levels above.
I

2) Disasters invariably have health consequences. The health problems in disaster could
be due to either or any combination of factors ellmerated below:
Directly due to impact of drowning during floods, injuries during earthquake.
Due to delay in evacuation.
Due to non-availabilhy or inadequate immediate medical cue.
Due to clisorganisation or non-availability of centres for advanced medical care,
1

Due to delay in transportation to medical centres.

Tile health hazards resulting from the disaster events depend upon a large number of
factors as given bclow:
Population density
Populn tion displaceme11t
Disruptioll of pre-exisling facililies
. Disruption of normal healtll programines
Increased vector breeding
 e Climate exposure Disnster Mnangenie~~t,
I

0 Inadequacy of food and nutrition.

'There is probably no event lllat so severcly tests the atlequacy of health infrastructure
as the occurrence of a sudden disaster such as XI autl~quakcand cyclone etc. To a
lxge exteat, well-plulned liealth delivcry systems is thc most irnport;ult preparation
for a catastroplie. Plimning, organising and coordinaling bealtl~care in iidvance needs
fie utmost priority i11 order that iI disastcr slriclccn population may be attended in a
more national way.
l'rinciples of Mass Casualty Rllt~nagement: 1lis:lster ~ncdicirleis a lnass arid multiple
trauma medicine ;md it is not different from ordinary ~nedi(;inc,ll~edistinguishing
feature is its method of application and priln2u.y colicern for yicld 2 u d efficiency.
Some types of disasters usually resull in a latrge numl~erofcasu:llties, which are
beyoild Ihe routine bundling capacity of llle heaildl care system. Application 01'
principles of Inass casualty management helps rilcel Uie dclnarld of a large nulllber of
people. The prillciples of mass casualty management are universal kmd can be i~pplied
in any inass casualty situation natural or manmadc.
0 Doing tlie best for the most within the available resourccs.
Q Triage is inescaipable Ihrough out the chain of treabnent,
e Graded care of casualties, lirst aid lifc saving rne:lsures, preparation for
evacuatioil, primary surgely and detinitive treabnent,
e Rrst aid measures cmied out at the earliest nssutnes life saving significance,
e First aid at the scene of disaster must be li~nitedto monitoring lmd restoring
vital functions.
Q Simple iuld standard theraipcutic principles.
Q The casualty must be conditioned or treated so that the degree of urgency is
lessened.
!. Management of mass casualties cnl be divided hlto four pbilms, rescue, first aid,
transportation and definitive trealment. Rescue in large-scale disalsters in inost
insta~cesmust be of necessity and,is perfo~medby the survivors themselves,The
rescue tearn supporu the 6olnmunity rescue efforts wit11 spe,cialequipment, A
reduction in mortality in the severely injured c:1.11 be nchievtd by e:uly first aid. 'l'he
-
first aid is usually limited to primary life supported lneasurcs the main functions of
which are maintaining Airway, Breathing and Circulation. The routine practice in
medical care -first come tirst treated - is inadequate in inass emergencies.
Whenever
. . time, personnel and resources are grossly insufficient to Ineel all the needs
s.orti11gor triage is the only appropriate way to provide a maximum benefit to most of
h
htk injured. The process ii~volvessorting out Uwse of the wounded whose progress'is
;' most favourable.
The most casualty management involves categorising Ule casualty l'orprioiity of
Weahnent i ~ l evacuation
d based on the chariccs of survivill ~ t most
l bellefit from
measures. There are various types of classification of casualties available worldwide
but the most colninon categorics arc as undcr:
e Category I : Iminediatc Treatment: Scvercly injured victims wlio can be saved if
Ihey receive appropriate ~L~bilisation
truisportatioii and trealmenl immediately.
Category I1 : Delayed li-eabnent: Urgent but less serious injuries who car1 be
transported and trealed after the most serious have been attended to. These
victims will require surgery in X to 12 hours.
Category I11 ; Minimal Trcattnent: Wallking wounded wlio can often be attended
in small group and if~~lnbulances
are in short supply caul be transported by oher
means.
Category I V Il!jurics, which are not serious, will geilcrally be treated iuld sent
back to llleir homes. 111 a disaster cvcn causing very large number of casualties
 this category may ~ncluderuorihuld cases or so scverely wounded then eve11
immediate care ~voultlbe inadequate to provcn~death.
Tagging is a co~ninonlyused rnelhod lo i~idicatcpriorily 01' evacuation. Various types
of tags are in vogue. Eacli patietit must be idctililied with tRgs stating tlicir name, age,
sex, plilce of origin, Iriage category, tliagnosls ~uldinitiill trc:ltlnent given. Usually red
tags indicate first priority, ycllow priority two :md green prbrily three.

I; Check Your Progress 3

1) Ol~jectivesand Purpose: 'rlie purpose of a disasler plrm is lo makc it possible to

attend, promptly and cl'fectivcly. to the largcst possiblc numbcr o l people requiring
lnedical care, 'in ordcs to reduce the nunlber of deaths ;lntl disabililies. Tlic pri~iciple
objectives are:

e To prepiuc the staff :md itis1ilulion;ll resources lor opliinal performance in an

emelagencysitualion ol' certain magnitude.
To ~ n , ~ kthe
c community aware of tlie imporlru~ceof the disaster plan, how it is
executed uid the benefits it provides.
o 'To train tlie slalf as a past of educatiot~ali~clivily.

s 'To carry out periodic drills ;uid its evaluation to uptlale p1:uls.
Development of Plan for a Hospital: Disastcr t1i:lnngemcnt plan sliould be
developed in a manner that Ihc emergency systeln must be liinctioning on a routine
basis. It sliould be take it~loaccount thc plxliiiiig process, as follows:
4

e h ~ a l y s eUie risk iuid hazards in'tlic geogrilpliic location coricerned with the
hospital. r

r Cary vulncrabilily analysis 01' tlie colninutiity exposed lo this risk and hazards.
r The probahle denland aud nilture ol' work cxpcctcd during disasters.
4 Assess the resources :~vail:~blc.
e Determitie response capabililics.
Dctenniiie the aitn of the dislister pl2u1 based on factors enumerated above.
e Detennine org;misation slructure for tiisastcr.

4 Developmen1of orgalisation, allocution of rolc :und responsibilities. Authority

structure sliould be madc clear.
r Training of orgariisntioii,

0 Testing of orgiu~isatioii.
o Testing of tlie plan.
4 Periodic revision of both the plan imd the Oguiisation.
The llospitd disaster plrui provisio~lssliould include the i'ollowing:
o Efficieiit system of alert uld staff assignment.
o Conversion of a usable space into clearly defincd areas for triage, patient
observation and iminediate care.
Removal of casualties to Inore appropriate and cleliiiitive medical care facilities.
Special, medical services for disaster cases. '

Procedure for protn~tLransfer of patients within tlie hospital,

4 Security arskuigemelits.

Establishment of a public infonnalion cellwe.

--
 o Evaluaticm of hospital services :uid its sources of cleclricity, gas, water, rood
iuid medical supplies.
o Mctllc~dof itlcntifying p:llicnts who are immediately dischxgablc or
trmisf'erablc.
o Special disaster ~ncdicalrecord and 1ucdic;ll tag.
o Plmning use of OT, X-r;ly, I3lood R~lntlant1 Laboralory.

2) Disaster Committee: The hospital dis;~stcrm:ul:lgc,menl co~iilnilleeoperates at the

decision m:lking level aiid Ihe ection clccided up011arc executcd by thc 1lledic:ll staff
supported by (lie instilutio~i'slogistical and gener:ll service units. The colnpositioli of
the coln~ilittceshoultl i~icludcdoctors and nurses as well as athninistrative stnff. 'The
numl,er, speciillizatioii :uitl scnioriL.y ol'commit.r.ecmc~nherssltould be clccided
nccording to tlic iulticip:ltetl ~ieerl.'rlie merbcrsl~ipof the commitlee ge~ierally
includcs the following:
s 'Uic Director ol' I-lospit:~I

s 'I'hc Nursing Supcrintendcnt

o A reprcsc~itativefro~nUlc com~nunitylcivil administration.

Tlic functions of the I-1ospit:ll Disastcr ro~ii~nirlec

are:
6 To develop llic hospital disaster pl:u~.
To allocalc duties lo tlic liospital st:11T.
o To es~;lblisl~
st;n~clilrdsof emergency ciue.
0 To conduct mid supervise Ir:~iningprugrammcs.
e To supervisc drills to test tile h~spiti~l
pl;ul.
e To retlcw :und rcvise thc dis;~slerplan at regu1:u i~~tervals.

'ck \'oar Progress 4

To meet Uie n~cilicalcare danaticls ol' dis:lster vic~imsspecial function:ll areas should
be set up withill the hospital, which includes rhc lbllowing racilitics:
o Triage or Sorting Are:): Lncalcd will] Accident a~tdElncrgcncy services where
triage team consislini of clncrgclicy pl~ysici;~~, surgeon, ilursilig p&so~incl
handles thc incoming casuallics. tlcrc rapid assesanent ol'tlle injury :md exlent ol'
:ve carried out by ;1 doctorlnurse :md assigns
scverily of Ille casoalty's i~~.juries
h a t caslinlly to :m nppropriale trcalli~ci~l
areil.
e Pritnary Treatmeilt Areas: Immediately ill'tcr uiage casuilltics are sent to
ilppropriate trcatmeiil :Ireas. 'l'licse treatment arcns would include immediate,
urgelit luid lion-urgent care :lre;ls. 'rbosc in nced of iminedialc life saving
measures are sent to resuscilatinn rooin where l'acilities are available for
cslablisliing airway, controlling hemorrhage supporting Sractures and treating
shock. Casuillties should remain in tile resuscitation room for thc sliorlest,possible
time, furlher invcs1ig;ilions :md trernuncnt being carried oul in cmolliertreahnellt
area, Urgent c:ises needing diagnosis, invesligiltioli and.initia1treatmelit of Lheir
injuries receive allelition in urgent trei~lnentarea. Non-urgent casuallies may
11e investigated, diagnosed ui(1treated in non-urge111treattnent area. Special
trcattnenl areas may be needed lor 111cmanalgemenl of bums, li-actures aid in
case of cl~e~nicals or xlucleslr disaster victitns.
m Secolidary Treattnent Areas: The scconckuy treaunncnt areas include ill1 the
 wounds, critical care units and operating NIU diagnostic deptt etc. The casaalties
requiring important care will be taken fro~nprimary treaunent area to the
Intellsive Care Unit, Operating Tlleatres or to special receiving wards which
have bee11 evacuated to llouse tllc disaster victims.
o In-patient Evacuation Holding Area: The setting up of one or lllore wards ,to
receive all the admitted victim of a disaster is essential if medical and nursing
staff are not to be scattered around tlle hospital, Clearing of these designated
wards sl~ouldbe carried out at a11exly stage in prep;uing tlie hospital to cope
with a disaster, and persol~nel:uld equipment G L Ibc divcrted lo the receiving
ward. Additional beds are made available in other wards by arranging for suitable
patients to be discbarged home or traulsferred to other hospitals.
' e Additional Facilities: The additional facili~icswould be required to be created
like:

- Relatives waiting area

- Mediaroom
Support t'acilities play a vital role in maulaging tlle disaster victim. These support
facilities like, CSSD, Pbannacy, dietary services, security services, transport etc.
would require staff support.
Response: The response to disaster is heavily dependent on t l ~ edisasler pl;u~,
preparedness, training m d periodic rel~earsds.T l ~ disaster
e respollse lnus be in
2
chronological order to facilitate execution. The designated l~ospitalstaff hould be
responsible to sictivale tlle hospital disaster pl'm, The casualty Medical Oflicer,
Hospital Administrator on duty or Senior Consultant on call can be designated for
putting pl-m into action. Hospital plan often fails to s l a t when disaster strikes because
they are designed on an all or none response. Graded response or phased response has
been suggested to overcorn5these problems. The graded response systems in vogue
are as under:
0 Green Alert: I should there be a sudden influx of casualties it mobilize on duty
medical, nursing and other paramedical staff to support the accident and
emergency department, It is used at frequent intervals with minimal intercerence
with hospital activity.
e Amber Alert: Prepares tbe hospital to admit a large number of casualties. It is
a11 extension of green alert, which must be colnpletcd iirsL. Receiving wards are
clearcd, staffed and prepared together will1 ICY and OT.
o Red Alert: It prepares hospitals lor a major coin~nunitydisaster. An extension
of Lhe green and mnber alert ~nail~lyin time scale involved.
Disaster administration: To work in a cohesive and syste~naticnlanner will~our
chaos and co~lfusionit is of paramount impor1;mce that every individual in Ule
hierarchy knows his job m ~ dUle work for each individual is well defined. Control ,
moilitoring centres at different level should be establisl~ed'asfollows:
e Control Centre: The atmosphere of chaos and collfusion and overload of work
is expected in disaster situation. An et'iicie~~t
execution of the disaster plan needs
effective control to meet the goal. A col~imald11u~:leus in the fonn of Control
Centre is essential from where Lhe key ~ U I I C ~ ~ O org;u~ise,
~ ~ U I ~ Scolnrnunicale and
conk01 the il~~ple~nentiltionoS disaster plm.
e Staff'Report Board: There is a1 require~ne~~t of a stabreport board. Whenever
key members of Ule slal'l' arrive in thc hospitill Uley rzport by telephone to tile
infor~llationcentre iu~dwhereabouls of cach indi\~idualis plotted on staffre1)ort
board to facililatc easy contact recluircd.