c S
 - (immediate) are used to label those who cannot survive without immediate treatment but who

have a chance of survival.

c {   - (observation) for those who require observation (and possible later re-triage). Their condition
is stable for the moment and, they are not in immediate danger of death. These victims will still need hospital
care and would be treated immediately under normal circumstances.

c î
 - (wait) are reserved for the "walking wounded" who will need medical care at some point, after
more critical injuries have been treated.

c J
  - (dismiss) are given to those with minor injuries for whom a doctor's care is not required.

c x - (expectant) are used for the deceased and for those whose injuries are so extensive that they
will not be able to survive given the care that is available.

½
   


-----------------------------------------------------------------------------------------------
ë
 




Disaster is an occurrence arising with little or no warning, which causes

serious disruption of life and perhaps death or injury to large number of
people. It is any man made or natural event that causes destruction and
devastation which cannot be relieved without assistance. Natural disasters
are catastrophic events with atmospheric, geologic, and hydrologic origins.
Natural disasters can have rapid or slow onset, with serious health, social,
and economic consequences. Developing countries are disproportionately
affected because they may lack resources, infrastructure, and disaster-
preparedness systems. India has been traditionally vulnerable to natural
disasters on account of its unique geo-climatic conditions.

 



c Natural. Eg : earthquake, floods, hurricane, tsunami.

c Manmade.Eg: nuclear accidents, industrial accidents
c Hybrid Eg: spread of disease in community, global warming.

^  



c Level iii disaster ± considered a minor disaster. These are involves

minimal level of damage
c Level ii disaster- considered a moderate disaster. The local and
community resources has to be mobilized to manage this situation
c Level i disaster- considered a massive disaster- this involves a
massive level of damage with severe impact.

½
 




Disaster mitigation refers to actions or measures that can either prevent the
occurrence of a disaster or reduce the severity of its effects. (American Red
Cross).
Mitigation activities include:

c Awareness and education, such as holding community meetings on

disaster preparedness
c Disaster prevention-such as building a retaining wall to prevent
flood water from the residences
c Advocacy such as supporting actions and efforts for effective
building codes or proper land use.

½
 
 


  

 
 


c Prevention phase
c Preparedness phase
c Response phase
c Recovery phase

 


 

The task during this phase is to identify community risk factors and to
develop and implement programs to prevent disasters from occurring.
Programs developed during this phase may also focus on strategies to
mitigate the effects of disaster that cannot be prevented such as earth
quakes, cyclones etc. Task force includes are local and national government,
social service providers, police & fire department, major industries, local
medias etc.

 

 

 
 

:Health care professionals with client responsibilities
can also become disaster victims. Conflicts arise between client related and
work related responsibilities. Personal and family preparation can help to
ease of some of the conflicts.

  

 

: Professional preparedness requires that health
care professionals become aware of and understand the disaster plans at
their work place and community. Adequately prepared professionals can
function as leaders in the disaster management areas. Personal items that
are recommended for a professional to keep for the disaster management
are- copy of professional license, personal equipments such as stethoscope,
flash light and extra batteries, cellular phone, warm clothing or heavy jackets,
protective shoes, pocket sized reference books, watch etc.

  





  





 
 

   



c hospitals
c Mental health professionals
c Pharmacies
c Public health departments
c Rescue personnel


   



c Clergy
 c Fire fighters
c Municipal or government officials
c Media
c Medical examiners
c Medical supply manufactures
c Police

º

 



c The level of community preparedness for a disaster is only as high

as the people and organization in the community make it. Some
communities stay prepare for disaster with written plans and by
participating in disaster drills. Community must have adequate
warning system and a back up evaluation plan to remove people
from the area of danger

S 
   

The level of disaster varies and the management plans mainly based on the
severity or extent of the disaster.

c Level iii disaster- considered a minor disaster. The disaster is

classifies as one that involves a minimal level of damage
c Level ii disaster- considered a moderate disaster that is likely to
result in major disaster. Mobilizations of support system are
necessary at this level.
c Level i disaster- considered a massive disaster. This disaster
involves a massive damage to lives and property.

S   

During this phase the community take actions to repair, rebuilt, or reallocate
damaged homes and businesses and restore health and economic vitality to
the community. Psychological recovery must be addressed. The emotional
scars of witnessing a disaster may persist for long duration. Both victims and
relief workers should be offered mental health activities and services

½
 
 


Prevention ------> preparedness

I v

Recovery <--------- response

½
 
 



Although no disaster management plans can be made to fit every emergency

but protocols and chronological action plans to prove to deal emergency
situation efficiently if executed in coordinated manner.




 


c to provide prompt and effective medical care to the maximum

possible in order to minimize morbidity and mortality
r

 

c To optimally prepare the staff and institutional resources for

effective performance in disaster situation
c To make the community aware of the sequential steps that could
be taken at individual and organizational levels

º





 
 



The following members would comprise the disaster management committee

under the chairmanship of medical superintendent/ director

c Medical superintendent/ director

c Additional medical superintendent
c Nursing superintendent/ chief nursing officer
c Chief medical officer (casualty)
c Head of departments- surgery, medicine, orthopedics, radiology,
anesthesiology, neurosurgery
c Blood bank in charge
c Security officers
c Dietitian
c Transport officer
c Sanitary personnel

The disaster management committee is overall responsible for managing the

disaster situation, take administrative decisions, review the disaster plans
and inform authorities.

½
 
  

In the eventuality of a disaster the existing casualty would be referred as the

disaster control room. It would be managed round the clock.

S

 
  

The medical superintendent will identify various specialists, nurses and

pharmacological staff to respond within a short notice depending up on the
time and type of disaster. The list of members and their telephone numbers
should be displayed in the disaster control room.

ë
 







the disaster control team would be
responsible for collecting, coordinating and disseminating the information
about the disaster situation to the all concerned. Information would be sort on
time, place and nature of the disaster, approximate number of the
causalities.

½
 


Requirement of beds depends up on the magnitude of the disaster. Some

beds can ear marked as disaster beds. The efforts should be created to
allocate additional beds by-

c Utilization of vacant beds, day care beds, and pre-operative beds

c Convalescing patients, elective surgical cases and patients who
can have domiciliary care or opd management should be
discharged
c Utility areas to be converted in to temporary wards such as wards
 with side rooms, corridors, seminar rooms etc.
c Creating additional bed capacity by using trolleys, folding beds and
floor beds

^

  

Separate cupboards marked as disaster shelf and should be kept in disaster

control rooms, equipped with all essential medicines and surgical supplies.
The disaster cupboard should contain-

c Resuscitation equipments
c Iv sets, iv fluids,
c Disposable needles, syringes and gloves
c Dressing and suturing materials and splints
c Oxygen masks, nasal catheters, suction machine and suction
catheters
c Ecg monitors, defibrillators, ventilators
c Cut down sets, tracheostomy sets and lumbar puncture sets
c Linen and blankets

Keys of these cupboards should be readily available at the time of disaster

 









Mock exercise and drills at regular intervals to ensure that all the staff in the
general and those associated with management of causalities are fully
prepared and aware of their responsibilities.

 


 

A disaster plan should have the following elements

c Chain of authority
c Lines of communication
c Routes and modes of transport
c Mobilization
c Warning
c Evacuation
c Rescue and recovery
c Triage
c Treatment
c Support of victims and families
c Care of dead bodies
c Disaster worker rehabilitation






 
 



A standard operating procedure should be developed that defines how each

task would be accomplished. As soon as the information regarding disaster
is received emergency control room officer on duty in consultation with ms/
director would activate the disaster plan.

S  

 - the disaster control room will act as the reception area to
receive the causalities and to screen them.


  a predetermined triage should be undertaken to classify the

causalities. For large number of casualties the triage team should
incorporate a surgeon, an orthopedic surgeon, physician and an
anesthesiologist.

c Priority one- needing immediate resuscitation, after emergency

treatment shifted to intensive care unit
c Priority two- immediate surgery, transferred immediately to
operation theatre.
c Priority three- needing first aid and possible surgery- give first aid
and admit if bed is available or shift to hospital
c Priority four- needing only first aid-discharge after first aid.

½


-A comprehensive documentation is essential.
Documentation will be done at the casualty by cmo and attending health care
professionals. All mlcs will be recorded as per the institutional policy.
However the treatment of patients will get priority over the paper work.

 
 

- the identified officer would liaison with relatives of the
victims to inform them on their clinical status. The list of casualties along with
their status displayed at prominent place outside casualty in both english and
local language and should be update regularly. The ms or the authorized
person should brief the media (press, radio, tv).



 
 adequate provision should be made to meet additional
requirement of water & power supply and other services prominent to patient
care.

º 

 
 
 
 
immediate mobilization of
security staff available within the hospital campus to ensure security of
admitted patients, their belongings, hospital staff equipments and crowd
management. The local police station should be informed to provide
assistance in managing the crowd.

½
 
 

    





  



Assess the local climate conducive for disaster occurrence, past history of
disasters in the community, available community disaster plans and
resources, personnel available in the community for the disaster plans and
management, local agencies and organizations involved in the disaster
management activities, availability of health care facilities in the community
etc.

½

 



  

Determine the actual and potential disaster threats (eg; explosions, mass
accidents, tornados, floods, earthquakes etc).

º



 



c Develop a disaster plan to prevent or deal with identified disaster

threats
c Identify local community communication system
c Identify disaster personnel, including private and professional
 volunteers, local emergency personnel, agencies and resources
c Identify regional back up agencies and personnel
c Identify specific responsibilities for various personnel involved in
the disaster plans
c Set up an emergency medical system and chain for activation
c Identify location and accessibility of equipment and supplies
c Check proper functioning of emergency equipments
c Identify outdated supplies and replenish for appropriate use.

ë 


 


c Focus on primary prevention activities to prevent occurrence of

manmade disasters
c Practice community disaster plans with all personnel carrying out
their previously identified responsibilities (eg: emergency triage ,
providing supplies such as food, water, medicine, crises and grief
counseling)
c Practice using equipment; obtaining and distributing supplies

-  
 



c nurses can act as shelter managers

c listen to the victims and retell their feelings related to disaster
c encourage victims to share their feelings
c help victims to over come the crisis
c delegate tasks to team members and coordinate activities
c provide the basic necessities(food, water, shelter etc)
c provide compassion and dignity to the victiM

   



 

c Critically evaluate all aspects of disaster plans and practice drills for
speed, effectiveness, gaps and revisions.
c Evaluate the disaster impact on community and surrounding
regions
c Evaluate the response of personnel involved in disaster relief
efforts.

º



Disaster is an emergency situation, therefore coordination of actions and

various departments is an essential requisite for efficient management of
mass casualties.