DISASTERS

What we all need to know

 Introduction
Prof V. Anantharaman
Dr Gene Ong Yong Kwang
Dr Chng Siew Ping
Dr Wong Ting Hway
Dr Lim Jia Hao
Dr Vincent Lum
Dr Pek Jen Heng
Mr Wayan Tsai
Ms Angela Lee

Singapore Health Services

 Programme
1. What are disasters? Anantha

2. Types and Impact of disasters Vincent

3. Community Based Disaster Response. Gene

4. Break-out sessions ALL OF US

5. Community Emergency Response Teams Lim

6. Health Aspects of a Disaster Pek

7. Assessment Chng
 Objectives
1. Provide you with an understanding of need
for community disaster preparedness
2. Understand that disaster preparedness
involves commitment to training and working
with different groups of people
3. Interest you to want to be involved in
community disaster response programs.
What are Disasters?
 Definition of Disasters

A disaster is an incident disrupting the

normal conditions of existence and
causing a level of suffering that
exceeds the capacity of adjustment of
the affected community.
 Hazard
A hazard is a natural or human-made event that
threatens to adversely affect human life, property
or activity to the extent of causing a disaster
NATURAL MAN-MADE
a. Earthquakes g. War, civil strife
b. High winds, storm, typhoons h. Economic crisis
c. Floods, tsunami i. Nuclear, biological or chemical
d. Landslide
j. Riots and demonstrations
e. Volcanic eruption
f. Drought k. Building collapse
  l. Fire and Explosion
m. Airplane crash
n. Sinking of ship
 Why Disasters Occur?
Underlying Causes Dynamic Pressures Unsafe Conditions
Poverty Lack of Fragile physical
Limited access to - Local institutions environment
- power structures - Education - Dangerous locations
- Resources - Training - Dangerous buildings,
Ideologies - Appropriate skills etc.
Economic Systems - Local investments
Age - Local markets Fragile local economy
Sex - Services - Low income levels
Illness - Press freedom - Livelihoods at risk
Disabilities
Macro forces Public actions
- Population expansion
- Urbanization
- Environment degradation

RISK = PROBABILITY OF HAZARD X DEGREE OF VULNERABILITY

 Types
and
Impact
of
Disasters
 Do
Disasters
Occur In
Indonesia?
Drought
Landslide
Type of

Earthquakes
Disaster

War, civil strife

Economic crisis
Floods, tsunami

Volcanic eruption
Impact

chemical incidents
Nuclear, biological or
of
Disaster

High winds, storm, typhoons

Disrupt Normal Life.

-
-

+
+

++
++
++

+++
+++
 
Affects a Large number of People (injured and

-
+
+
+

++
++
++
dead)

+++
+++
Losses to Livelihoods, Property

+
+
+
+
+
+

++
+++
Loss of housing

-
-

+
+
+
+

++
++
+++

Damage to infrastructure

-
-
-
-

+
+
+
+
+++

Disruption of transport and communication

-
-
-
-

+
+
+
+
++

Disruption of marketing systems

-
-
-
-

+
+
+
+
+

Breakdown of social order

-
-
-
-

+
+
+

++
++

Loss of business
-

+
+
+
+
+
+

++
++

Loss of industrial output

-
-

+
+
+

++
++
++
++

Adverse effects on environment

-
-

+
++
++
++
++
++

+++
 True impact of disaster depends on:

1.Cause of disaster
2.Frequency of occurrence
3.Timing
4.Rapidity of onset
5.Whether limited or wide array of people
6.Capacity of event to cause damage
 From a healthcare perspective,

disasters have significant adverse

effect on the health of the population

of the affected community

Immediate effects (first 24 hours)
• Acute trauma resulting in death or injuries,
when immediate care is delayed
• Loss of availability of health services,
especially if healthcare institutions are
directly in the location of the disaster
• Overwhelming of acute healthcare facilities
and resources
• Delay in elective health care programs
Delayed effects (next one week)
• Displacement of the local population with
resulting increase in homeless people
• Interruptions to water and electricity supplies
• Effect on civil authority and disaster response
agencies
• Complications of injury and untreated illnesses
with in ability of families to cope
Long-term effects (next > 1 year)

a.Long-term effects of population

displacement, social unrest, poverty
b.Communicable diseases aggravated by
resulting environmental degradation
c.Food and nutritional issues,
d.Water supply and sanitation
 Impact of Disaster
• Felt not only by the healthcare institutions
in the immediate vicinity of the disaster
site but also in the community in general.
• Therefore, disasters need to be managed
by whole community rather than a couple
of selected healthcare institutions.
 Severity of Impact

1.The local community (the district)

2.The neighbouring communities (the province)

3.The distant communities (the country)

Community-based
Disaster Response
(CBDR)
 Early care and impact of injury
Mortality / Morbidity

Natural progression of
disease / injury
Early
Emergency
care
Truncating natural
course of illness / injury
through early
intervention

Time
 Principle of disaster management
• bring the appropriate resources to the
affected population as early as possible.

• reducing the vulnerability of the affected

population to ongoing diseases and
injury
 Disaster Management
•Most effective at the community level where specific local
needs can be met
•Most communities don’t know where their resources are.
•Therefore casualties are denied use of these resources
•The community suffers as a result of ignorance and ill-
preparedness of local community to ensure that their self-
help mechanisms have not kicked into gear.
 Involve communities in
disaster preparedness and
mitigation activities
 Assumption 1
Communities in disaster affected areas are:
• the real sufferers
• the first responders
Therefore, they should take charge of their
own relief in the initial phase of disasters
They should be trained to carry out that all-
important first response.
 Assumption 2
• Local people should be empowered to take charge and
ownership of the initial actions in their own
communities even before arrival of other response
units.
• This is be better than stripping them of such
responsibilities.
• Not empowering them would tend to leave them more
powerless in case external intervention does not occur.
 Assumption 3
• It is not only the ‘big’ disasters that destroy life and livelihoods.

• Learn from the many ‘little’ disasters

• Accumulated losses from small floods, droughts / landslides exceed

losses from big ones and increase vulnerability at local level.
• “Little” disasters provide experience base to gel together as active,
purposeful teams to better manage major future incidents.
• With appropriate training and guidance, learn to manage and cope
with effects of such incidents.
• Invest in Community Based Disaster Preparedness activities.
 Assumption 4
If you wait for resources ad assistance from central government,
factors will tend to result in a poor outcome for your community:
• Reaction time: time needed for central government to act. In
meantime people with injuries and Illnesses get worse
• Injuries or illnesses in disasters are time-sensitive conditions
– Delay in rescue, the worse is the outcome
– Delay in initial resuscitative care, the worse is clinical outcome
– Delay in evacuation to appropriate and definitive treatment
facility, longer is period of morbidity and higher the mortality.
 Civil authorities responsible for
disaster management
• often ignore perceptions, needs, potential
value, inherent capacities of local resources
• often unsuccessful in interacting closely
with local community in pre-disaster period
• fail to utilize available wealth of social
capital in the community.
Planning for effective CBDR
1. Community should be made well aware
of risks and hazards they live with
2. Such knowledge should be ingrained into
the understanding of local community
3. Disaster prevention and risk mitigation
become an ongoing community effort.
Planning for effective CBDR
4. There must be clear understanding of

• the agencies that exist in the community

• their roles, capabilities and potential to assist in

disaster management

• understanding to be shared intimately with

existing agencies.
 Planning for effective CBDR
5. Agencies to interact with one another to:
• develop closer understanding of capabilities
• to be able to work together if need arises

Need for well laid-down plan of action / list of

activities to guide manage initial events in
disaster.
Planning for effective CBDR
6. Each member of community needs to be
aware of his/her responsibilities in an
emergency situation /disaster
• not only to the community at large
• also to neighbourhood and family
 Planning for effective CBDR
7. No single agency can effectively manage all aspects
of disaster
• No single healthcare institution can adequately cope
with management of all casualties sustained at
disaster site
• Every healthcare institution in community has a
range and variety of specific resources, skills and
expertise
 Planning for effective CBDR
8. Sending all casualties to single health facility will likely:
• overpower resources of that facility
• cause overcrowding of patient care areas and adverse
consequences of this
Early distribution from disaster site to most appropriate
facilities will facilitate appropriate care of the patient
Every health facility in community should have stake and
share in supporting needs of emergencies in that society
Community Emergency
Response Teams
(CERT)
 A Prepared Community
1.Individuals are aware of the hazards
2.They would know how to protect themselves
3.They would know how to protect their families and
homes from common hazards
4.They would know how to perform basic life-saving first-
aid procedures
5.They would be prepared to work together to provide that
initial assistance which is crucial for survival in disaster
situations.
Mobilize community citizens for
1.Basic fire-fighting procedures
2.Simple life-saving procedures
3.Organising the homeless and providing a roof
over their heads
4.Organizing simple meals for those who have
lost their homes
5.Counselling those in distress
 Community Emergency
Response Teams (CERT)
•Communities can develop and maintain these skills
in residents by training them to be part of CERT teams

•CERT members can assist others in neighborhood or

workplace following event when professional
responders not immediately available.

•CERT members can support response by taking more

active role in community emergency preparedness.
Health Aspects
of
Disasters
 Why?
Need for community residents to
understand basic aspects of health
response in disasters so that they
are better at making appropriate
use of the various health facilities
in the community.
 Disasters result in casualties

1.People get injured

because of falling
walls, heavy structures
and debris.
2.They may get burnt,
exposed to blast
waves or may fall and
hurt themselves.
 Illness from Disasters
1.Some disasters result in illnesses due to

Chemicals

Infectious agents
Natural course of progression
If not treated promptly, casualties go through a
period of pain and suffering that may result in
death or Natural progression of
disease / injury
significant
Early
inability to Emergency
care
function as Truncating natural
course of illness / injury
independent through early
intervention
individuals

Time
If rescue carried out early
and injuries
promptly treated,
the casualty would
not need to die.
Early rescue and
crucial life-saving
first-aid can help
many casualties
Early First-Aid
Those with moderate
injuries usually good
chance of survival. If
treatment is
significantly delayed,
some may die over
the next few hours or
days.
Early first-aid is crucial and can be provided
by any trained member of the public.
 Light Casualties
Conscious
Rush to nearest medical
facilities on their own even
before the arrival of rescue
teams
Insist on early care, to the
detriment of more sick
casualties unable to
complain as loudly.
Light casualties need to be managed calmly and promptly
They may be returned quickly to their normal roles in society
 The Stress of Disaster
All casualties in a
disaster may
require counselling
and be kept up-to-
date with
information on
course of the
disaster.
This is a basic component of the psychological
management of populations exposed to disasters.
Evacuate out of disaster site
• and to an appropriate
hospital early
• They need to be
reviewed once again
so as not to miss
potentially life
threatening injuries.
 Distribute the casualties
Severe casualties
can easily overcome
capacity of any
hospital to provide
reasonable standard
of immediate
medical care.

No single hospital can manage all the casualties

from a single disaster site
Good standard of medical care

Deserved by all disaster casualties for optimal

care and early recovery.
Care during Medical Evacuation
From disaster
site to the
hospitals by
ambulances with
trained crew and
appropriate
equipment.

Care should be provided continuously from site

to arrival in hospital
 Receiving casualties in UGD
Hospitals sort them
initially based on injury
severity (triage)

Hospitals must ensure

appropriate manpower
and equipment are
deployed for their care.
Hospitals need to be organized to receive casualties
 Organising the UGD
The UGD to be organized into Staff from other
following types of care areas: areas of the
hospital would
• Reception and Triage usually be required
• Priority 1: serious casualties to come to the
Emergency
• Priority 2: moderate casualties department to help
in the management
• Priority 3: light casualties
of casualties.
Emergency Department als
in Disasters ri v
Reception Ar
& Triage Regular
Priority 2 Patient
(Critical Area
Care) Priority 1
ED
(Resuscitation)
Reporting Point
Emergency
Department Priority 3 24 - hour
Operations (Minor Emergency
Room
Emergencies) Observation Ward
Inhospital Admissions
 Cut elective procedures

During disaster situations hospitals may need to

curtail non-essential and elective procedures so
that available healthcare staff and resources may
be focused on the disaster casualties.
 Key areas of Hospital

Emergency Department
Operating theatres
Intensive Care Units
Disaster wards

Operations centre coordinates response of hospital

Coordinated Community Response
In any disaster it is the coordinated response of
the community and the health services that
together allows the most number of casualties
to be saved.
 Be a First Responder
1.All community members have role to play to
ensure disasters in their area are well managed.
2.Work towards having at least one member of
each household to be a trained first responder.
3.Be a community first responder and do your part
as a responsible member of your community.
Join the Community Emergency
Response Team
Workshop
 Your Community
District : Kabupaten Masyarakat Indah in the
Indonesian province of Sulawesi Selatan.
Total land area of 3,000 sq km
Size: 50 km from N to S, and 60 km from E to W.
Population: 3 million
Cities: 1. Kota Beria-ria (population 1.2 million)
2. Kota Harapan (population 300,000)
3. Kota Cinta (population 100,000).
 Chinta

Harapan
Beria-ria
 Kabupaten Masyarakat Indah
a. Fire and Rescue Department (BaSARNas)
b. KMI Police Force
c. Medical Services – 3 public hosp (500 beds, 300 beds, 200 beds), four
private hosp (400 beds, 300 beds, 300 beds, 200 beds) and 9 PusKesMas
d. Ambulance Services (6 with PMI, 4 /public hosp and 3 / private hosp)
e. Telkom Services Masyarakat Indah (TSMI)
f. Public Utilities (Water, Gas, Electricity) – Tenaga Nasional Indonesia
g. Social Services (Community and Family Services)
h. Environment (Water, Pollution, Air Quality, Sanitation)
i. Military Services: 1 x military hospital, 1 x Bn Indonesian Infantry
j. Meterological Service
k. Education Department which runs 25 schools
 Industries and Hazards
•2 x large petrochemical plants
•Agriculture (rice and coconut)
•Handicraft industry
•Airport 10 km from Kota Beria-ria.
• Major disaster threats facing his district are:
– typhoons, earthquake, cyclones
– aircrash, forest fires
Bupati says: Create Safe Community
• Community Disaster Planning Group (CDPG)
• Must respond well to disaster with 500 casualties
• Planning Guidance:
1. 500 casualties (up to about 50% serious + critical)
2. All casualties occur within 4 hours
3. The casualties need emergency help immediately
4. ? existing health facilities not good
5. Routine plans of work not adequate
6. Consider additional help, if needed.
 Team A

•Identify the planning team

•Determine the roles of response agencies for

Disaster Planning and Execution

•Present your recommendations to Bupati

•Give a 5-minute presentation

 Team B

•Recommend Incident Management System for

the Disaster Site

•Who should be Incident Manager

•Present recommendations to Bupati

•Give 5-minute Presentation on these

 Team C

•Recommend Medical Support Plan at Disaster

Site

•Present recommendations to Bupati

•Give 5-minute presentation

 Team D

•Recommend how to organise health and

related services

•Recommend how to provide appropriate care

of casualties at the hospitals in the Kabupaten

•Present your recommendations to Bupati

•Give a 5-minute presentation

 Team E
•Aeroplane carrying 230 passengers + crew missed
airport runway. Crash-landed into a 5-storey office
building in residential area outside the airport

•List actions required in the first 30 minutes

•Suggest who may carry out these actions.

•Present recommendations to Bupati (5 minutes)

 Team F
•Earthquake just occurred in your district
•5 buildings in Kota Cinta collapsed like stack of
cards. Number of casualties unknown (? hundreds)
•Main road linking Kota Beria-ria to Kota Cinta
badly damaged. Not passable to traffic for next 2 hr
•What can citizens of Kota Cinta do in first 2 hr?
•Present to Bupati (5 minutes)
 Let the Workshop Begin
• 6 teams (A, B, C, D, E, F)
• Team leaders + Reporters
• Flip Charts + marker pens
• Rooms for each team
• Facilitators
• Start now at 2:10 pm
• Back here by 2:40 pm (Group Presentation)
• Refreshments: 3: 15 pm
 Group Presentations
• Team A Format of Presentation
• Team B 1.Scenario and Assigned Tasks
• Team C 2.Summary of Discussions
• Team D 3.Conclusions
• Team E 4.Recommendations
• Team F 5.Questions and Answers
Test
 1
The following are the common hazards we must
plan for in Indonesia
a.Tornado, snow fall, smallpox
b.Earthquake, typhoons, floods
c. Volcanic eruptions, attacks by sharks, building
collapse
d.Nuclear attack, underground explosion, civil riots
 2

The following factors favour occurrence of

disaster in Makassar
a.Political ideology
b.Gender of casualties
c.Lack of training
d.Weak security at border zones
 3
Within the first 24 hours of a disaster
happening the following are likely effects:
a.Food and nutritional diseases
b.Lots of injured people
c.Social unrest because of unhappiness with
government efforts
d.Spread of communicable diseases
 4
The reason for involving community volunteers in disaster
response is:

a. Volunteers are usually not prepared to assist in the initial

phase of disaster response

b. Volunteers would usually be injured casualties and will need

help. They cannot be assisting in disaster relief.

c. Volunteers will have to look after the welfare of their

families first

d. Community volunteers are closest to the scene and best able

to provide initial assistance to the casualties.
 5
The impact of a disaster on local community will
depend on :
a.Capacity to cause damage to lives, property and the
economy
b.Which political party holds power in that district before
and after the present elections in the district
c. Whether the same disaster is also affecting other
countries
d.How many residents in the community have high blood
pressure
 6
After a disaster, assistance from central government:
a.Only arrives after incident verification, discussion at
government level and approval with a likely long reaction time
b.Is the best form of assistance since the resources are usually
provided free of charge
c. Time sensitive medical conditions such as major injuries or
chemical wounds would get better because the quality of
resources provided by government is usually good.
d.The government authorities will always consult with local
community leaders and follow their advice.
 7
The following are true of medical support in a
disaster:
a.Only ambulance crew are needed at a disaster
site
b.The largest public hospital in the community
should receive all casualties from the disaster
site
c.Casualties at the disaster site need to be
distributed to many hospitals in the community
 8
Responsibility for initial care of disasters in a
community belongs to the following:
a.The educational institutions in that community
b.The religious groups in that community
c.The commercial organisations in that
community
d.The individual, the family, the neighbourhood,
the town and all agencies in the community
 9
In a ready community, the following are usually
seen:
a.Most citizens are not aware of the hazards
b.Protection of homes and families from common
hazards is not important
c. Members would be prepared to work together to
provide initial assistance to casualties
d.Only the ambulance paramedics are trained in
basic life-saving first-aid
 10
The role of hospitals in civil disasters would be as follows:
a. Need to have Emergency Departments that can triage casualties
into moderate, light and severe types
b. During civil disasters more elective surgeries must be done so that
people’s chronic medical problems can be easily solved
c. It is best to ask all hospitals to operate their own field hospitals in
the same way that the military runs combat field hospitals in
times of war
d. Next to the Emergency Department, the key facilities in the
hospital during a disaster would be the outpatient clinic and the
pharmacy
Feedback
Thank You