Disaster management

Prof. A.K. Sood

MD, PhD, DNB ( Health & Hosp. Mgt), DNB (MCH) , MBA

Head, Department of Education & Training

Acting Head Department of Medical Care & Hospital Administration

National Institute of Health & Family Welfare

New Delhi

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“Any occurrence that causes
damage
ecological disruption
loss of human life
or deterioration of health
and health services

on a scale sufficient to warrant an extra ordinary

response from outside the affected community or area
(WHO)”.

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 Natural Disasters

Earthquake
Volcanic Eruptions
Landslides
Avalanches
Windstorms (Cyclone, Typhooon, Hurricane)
Tornadoes
Hailstorms and Snowstorms
Seasurges/Tsunami
Floods
Droughts
Locust Swarms
Epidemics of diseases

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 Manmade Disasters

Conventional warfare
Nuclear, Biological, Physical and Chemical
Warfare
Vehicular (Plane, Train, Ship and Car etc.)
Drowning
Collapse of building
Explosions
Fires
Biological
Chemicals including poisoning.

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 Health related issues

Food and Nutrition

Mental Health

Communicable Diseases

Injuries Following Disasters

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 General principles

The following principles should be considered before

preparing plan and writing disaster manual:

a. The plan should be ‘simple’ to be understood by

everyone, so that it can be put into action
immediately.

b. The plan should be ‘flexible’ to fit in different

types of disasters.

c. It should be ‘clear and concise’, so that even in

panic and confusion, staff should be able to act
upon it instantaneously.

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d. It should be adaptable for all hours i.e., day and
night including holidays

e. It should be an ‘extension of normal hospital

and public health working’, so that people can
act on it immediately in a routine manner.

f. It should be rehearsed before implementation

and updated according to experience gained.

g. The concept of triage, basic life support and

advance life support should be understood well
and followed to determine priority in order to
manage emergency and mass casualties.
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 Preplanning activities by the DHO

i. Assessment of Problem

The disaster profile of the district and talukas

should be made by the review of disasters that
have occurred during the last 10-15 years.

The analysis of data can reveal type of disaster

the district is prone to.

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ii. Advance Warning

The forecast of disasters like cyclone, flood,

earthquake etc. is made by meteorological
department.

The information should be shared by CMO

along with various departments concerned with
disaster planning and advanced action has to be
taken according to district disaster plan.

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iii. Coordination

The interdepartmental coordination has to be

assured at all levels in the district.

It is done between Collector, Municipal

Commissioner, Chief Executive Officer of Zila
Parishad, Superintendent of Police, Fire Control
Officer, Home Guards, Executive Engineer,
Superintendents of various hospitals, State transport
department and Public Relations Officer.

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iv. Preparedness

The preparation at all the times to face disaster,

chaos, disruption will save undue loss of life.

Much of damage resulting from disaster can be

lessened and human suffering reduced if there
is an organised and planned effort to meet the
problems.

It is therefore essential to evolve a suitable

medical and public health plan for each district
which will be useful to deal with any disaster that
may arise.

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 The Disaster Manual

Introduction

Distribution of responsibilities

Disaster containment

Chronological action plan

Checklist of personnel and

Rehearsal and conclusion

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I. Disaster preparedness- measures taken to prepare for
and reduce effects of disasters.

NDMA given guidelines for medical preparedness and

mass casualty management. States are required to
develop state guidelines

Hazard, risk and vulnerability assessment-types

of hazards, nature of vulnerable people

Response mechanisms and strategies-

evacuation , search and rescue teams, assessment
team, mechanisms for activation of facilities, relief
measures

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 Disaster preparedness plans- for various
agencies and sectors

Coordination-civil defense, police, defense,

NGOs, health , media, red cross,

Information management- collection,

compilation, timely action, decision making,
public information

Early warning signs-to detect, predict disaster,

from health dept, met, agriculture dept, media,
local sources etc

Resource mobilization
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Public education training and rehearsals- of the
preparedness plan

Community based disaster preparedness-local

volunteers, citizens organizations, business
organizations, NGOs

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 II. Disaster mitigation

Taking measures to reduce the effects of a

hazards before it occurs

Minimize the effect on Buildings, community

services, infrastructure water, electricity,
telephone, communication roads, health food,
trade, economies, social harmony, looting , law and
order, political set up etc

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 III. Triage

This should be done at site and at each

department and each point like, at reception,
resuscitation and evacuation of patients since the
priority may have to be changed from time to time.

Triage means allotment of priority for treatment

and evacuation of casualties.

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Priority I (Critical and Severely ill)

It is allotted to the critically ill patients who need

immediate resuscitation and life and limb saving
surgery within six hours.

Priority II (Moderately ill)

These patients require possible resuscitation

and/or early surgery within the next 24 hours.

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Priority III (Minor illness)

These are patients who have minor illness.

The moribund patients under irreversible shock

are also allotted ‘priority III’ since chances of
survival of these patients are very little

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 IV. Principles of Treatment of Casualties

Basic Life Support

Maintenance of airway
Ventilation factor e.g. in pneumothorax
Control of haemorrhage.
Preparation for transportation e.g. use of splints
and stretchers etc.

Advanced Life Support

The various clinical procedures done and life

support provided by various equipments at the
hospital is called ‘Advanced Life Support’.
This is provided in the hospital at wards, ICU
and OT. Dr.A.K. Sood NIHFW 20
 V. Administrative issues

Documentation
The proper documentation in previously
structured forms should be done to save time.
There may be problems to do documentation in
unconscious patients and those brought dead.

Police Documentation Team

This should be assisted by hospital P.R.O.,

however, investigation by police may be delayed, if
hospital is very busy in treating the casualties.

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 Administrative issues

Communication

The telephone line and inter-communications will be

busy or may be faulty, hence messengers should be
earmarked to carry the message.

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Friends and Relatives

The anxious friends and relatives want to know

the welfare of their kith and kin and hospital
administrator or matron should calm them down
and give them all the possible latest details
about their elatives.

Crowd Control

There is ‘convergence effect’ that means crowd

converge at hospital as they are curious to
know as to what has happened and how it has
happened.

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Other issues

 Involvement of Voluntary Workers

 Patient's Property

 Press and Broadcasting Services

 Ambulance Service

 Emergency -To operate X-ray machines,

functioning of operation theatre and carry out
work even in night enough standby arrangements
for light should be procured.

 Disposal of Dead
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 \

Guidelines for hospital emergency

preparedness

GOI UNDP DRM programme (2002-2008)

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