412 SECTION 2: Theory Examinations

INTERESTING READING
Newer Biomedical Waste Management Modalities
" Biosanitization:
Principle:Bioconversion (biotransformation) refers to use of live organisms
more costly or not feasible non-biologically often microorganisms to carry out a chernical
Advantage: Generates usable products, energy sources reaction that is
Disadvantage: Requires scientific technology
Electron beaming:
Principle: Bombarding BMW with ionizing radiation
Advantage: No residual radiation causing damage to cells of microorganisms
Disadvantage: Radiation exposure possible during process
Hydroclaving:
Principle: Faster, higher steam penetration
Advantage: 70% volume reduction, low
Disadvantage: Not useful for anatonmical,operation cost, reusable water
cytotoxic waste
Microwaving:
Principle: Convection currents by heated water
Advantage: High efficiency, 30-40% molecules
Disadvantage: High cost to start volume reduction, minimal environment pollution, low
and run occupational risk, cost-effective
Plasma torch:
Principle: 6000 degrees temperature convert
waste to plasma
Advantage: Safe disposal, reduce landfill burden,
Disadvantage: High cost useful by-products

II. DISASTER MANAGEMENT

DISASTER
1. Definitions
* Disaster (WHO): Is any
occurrence that causes damage, ecological disruption,
and health services on a scale sufficient to loss of human life or deterioration of health
warrant an extraordinary response from outside
Disaster (Colin Grant): Is catastrophe causing the affected community or area
hospital emergency treatment 'injury or illness simultaneously to at least 30 people, who will requre
Features of disaster:
> Most commonly reported disease in
> Most practical and effective strategy ofpost-disaster phase is Gastroenteritis
disease prevention and control in post-disaster phase is
water and proper disposal of excreta' 'supplying sate drinkis
> Foremost step for disease prevention and
> Level of residual chlorine to be maintainedcontrol in post-disaster phase is chlorination of all
in all water bodies in post-disaster phase is > 0.7 water bodies
> A common micronutrient deficiency in mg/L(>0.7 ppm)
disasters is Vitamin A deficiency: It occurs due to deficient
and diarrhea (gastroenteritis) relief diets, metsie
> Other common deficiencies include scurvy
(Vitamin C), anemia (iron) and pellagra (Vitamin B4 -niacin)

[Link] of Disaster
According to speed of onset:
> Slow-onset disaster: A disaster that unfolds
with development processes
Hazard can be felt as an ongoing stress for many days,
months or even year
Examples: Drought, pest infestations, famines
> Rapid-onset disaster: A disaster that is
triggered by an instantaneous shock
Impact may unfold over the medium or long-term
Examples: Earthquakes, cyclones, floods, volcanic eruptions
According
>
to origin/cause:
Natural disaster: A serious disruption triggered by a natural hazard causing losses, which exceed the ability of those

affected to cope
Meteorological/Hydrological disasters: Storms, cyclones, hailstorms, hurricanes, tornados, typhoons,
S n o w s t o r m s ,

floods, tsunamis, heat waves and droughts

 CHAPTER 18: Allied Disciplines in Public Health 413
Topological disasters:
1 Natural phenomena beneath earth's surface: Earthquake, volcanic eruptions
Natural phenomenon at earth's surface: avalanches, landslides and floods
Bidogical disasters: Epidemicsof communicable diseases and insect swarms (e.g. locust swarms)
Examples: 2004 Indian Ocean Tsunami, 200i Gujarat earthquake, 1999 Orissa super cyclone, 2013 floods
Iltarakhand, 2014 floods Jammu and Kashmir
Human-induced/Anthropogenic disasters: Aserious disruption triggered by ahuman-induced hazard causing human,
material, economicor environmental losses, which exceed the ability of those affected to
cope
Accidents: Transportation accidents (Land, air and sea), collapse of buildings, dams and other structures, mine
disasters and technological failures, vehicular, drowning, collapse of buildings, explosions, fires, biological, chemicals
(incl. poisoning)
Civildisturbances: Riots and demonstrations
Warfare: Conventional warfare (Bombardment, blockage or siege); Non-conventional warfare
and chemical warfare, guerrilla warfare including terrorism) (nuclear, biological
Refugees: Forced movements of large no. of people across frontiers
Examples: 1984 Bhopal Gas Disaster, 1997 Uphaar Cinema Fire in Delhi, 1993 and 2006 Mumbai
Express train derailment, 2008 Mumbai terror attack. blasts, 2002 Rajdhani

IMAN-MADE DISASTERS
1. Few Man-made Disasters (World)
* The Bhopal Gas Leak, Bhopal, India (1984): Union carbide pesticide
plant in Bhopal resealed 30 metric tons of methyl
isocyanite (MIC) into the atmosphere leading to l5,000 deaths and affecting 5 lac people
* The Chernobyl tragedy, Ukraine (1986): The worst nuclear disaster in
history [level 7 on the International Nuclear Event
Scale (INES)] both in cost and casualties leading to 30 immediate deaths
* Fukushima Daiichi nuclear disaste, Fukushima, Japan (2011): l death and 350,000 people were evacuated
with 154,000 evacuations level7 on the International
Nuclear Event Scale (INES)]
* London's Great Smog, London, United Kingdom (1952): Smog
covered
combination of industrial pollution and high-pressure weather conditions;thethecity of London for five days caused by a
he city t0 a near standstill and resulted in thousands of deaths combination of smoke and fog brought
* The Minamata Disease, Minamata, Japan (1932-1968):A
neurological disease
Dy the release of methylmercury in the industrial wastewater from a chemicalcaused
factoryby severe mercury poisoning caused
* The Jilin Chemical Explosion, Jilin, China (2005): Petrochemical
plant in Jilin was the site of series of explosions the
explosions killed six. iniured dozens, and caused the evacuation of tens of thousands of residents
*The Tennessee Coal Ash Spill. Tennessee, UDSA (2008): Millions of dollars worth
of property were damaged and many
Operties were rendered uninhabitable; it costed more than $1 billion to clean up
Ihe Sidoario mud volcan0, East Java, Indonesia (2006): Mud flow will continue likely for the
next 25-30 vears
Ihe North PacificGarbage Patch. North Pacific Ocean: Wastepatch covers 1.6 million square kilometers
ne GulfWar Spill. Persian Gulf (1991): The spill likely was about 4,000,000 US barrels
* The Deepwater
§ The rHorizon Oil Spill, Mexican Gulf (2010): 780,000 cubic meters of oililin the Gulf of Mexico claimed seven lives
Exxon Valdez Oil Spill, ILong Beach, California (1989)
The Guiyu E-Waste Dump in China: 52 square kilometers of land is buriedin electronic devices.

[Link] Man-made Disasters

* The (India)
Bhopal(MIC)
isocyanide
Gas Leak, Bhopal, India (1984): Union carbide pesticide plant in Bhopal resealed 30 metric tons of methyl
intothe atmosphere leading to 15,000 deaths and affecting 5lac people
*
Mumbai terror attacks--26/11 (2008): 10 members of a terrorist organization carried out 12 coordinated shooting and
bombing attacks lastingfour days across the cityleading to death of total of 175 people and injuries to 300 people
Pulwama
the terror attack, Pulwama, Jammu Kashmir (2019): Aconvoy of vehicles carrying Indian security personnel on

*
Jammu-Srinagar
Reserve National
Police Force (CRPF)
(
Highway was attacked
personnel being martyred
by a vehicle--borne suicide bomber resulting in 40 Indian Central
AMRI Hospital fire, Kolkata(201l): The fire claimned 89 victims and was thought to have been caused by a short circuit in
the basement
Uriattacks, Jammu &Kashmir (2016): A set of grenade:e attacks carried out by four terrorists against an Indian Army Brigade
Headquarters killed 19 soldiers and injured 30 others
414 SECTION 2: Theory Examinations

Visakhapatnam Gas Leak Tragedy, Vishakhapatnam (2020): An industrial accident that

chemical plant at Gopalapatnam neighborhood with the resulting Styrene gas vapor cloud ocCurred at the ILG
spread over ar
ofpolaround
ymen
3km; the resulting death toll was 1l, and more than 1,000 people became sick
Kumbh Mela stampede, Allahabad, Uttar Pradesh (1954, 2013): Astampede thatafter being exposed to theradius
gas
100 injured (1954) and 42 people dead and over 300 injured (2013). left more than
t 800 people dead
and er
DISASTER MANAGEMENT
1. Stages of aDisaster (ycle and Management (Fig. 18.7)
Disaster impact and response:
Search, rescue and first aid Disaster
Field care Preparedness
impact
Triage
Tagging
> ldentification of dead
Stage of health and medical relief: Disaster
containment
Primary phase (0--6 hours): First aid, medical care
Secondary follow-up (6-24 hours): Transportation,
sanitation and immunization
Tertiary clean-up (1-60 days): Food, clothing, shelter
assistance, social service, employment, rehabilitation
Rehabilitation: Mitigation
Water supply
Sanitation and personal hygiene Rehabiitation
º Food safety
> Vector control
* Mitigation: Measures designed to either
prevent hazards
from causing emnergency or to lessen the effects of emergency -Reconstruction
* Disaster preparedness: Continuous, ongoing, Fig. 18.7: Disaster cycle.
multi-sectoral
activity to strengthen capacity to manage efficiently all types of disasters
º Risk evaluation of area from past
experiences
º Localization of disaster-prone areas
º Organize communication, information, warning
º Develop coordination, response mechanisms systems
º Coordination with meteorology, health system,
º Trainings, simulation exercises.

2. Disaster Management in India

media

National Institute for Disaster Management (NIDM) (Fig. 18.8):

º Established: 1995 (under Indian Institute of Public
nidm
Towards a disaster free India..

Administration) Institute for Disaster

Fig. 18.8: National
º Ministry In-charge: Ministry of Home Affairs Management.
Head: Union Home Minister
Purpose:
1. To work as a think tank for government by
providing assistance in
policy formulation
2. To facilitate in reducing the impact of disasters NAL DISASTER RESPONSA
National Disaster Response Force and Civil Defence (NDRF) (Fig.
º Established: 2006 18.9):
> Composition: 10battalions from CRPE BSE, ITBP, CISF
> Purpose:
1. Civil defence: To safeguard the life and property of the
population and also to maintain the continuity of productive civilian
and
economicactivity of the nation during war-time crisis
2. Home guards: To assist the police in controlling civil disturbance
and
communal riots (maintenance of internal security)
3. Fire cell: To organize fire prevention and Force.

fire-fighting services, and

to render technical advice on fire protection,
Response

fire prevention and fire Fig. 18.9: National Disaster

legislation
 CHAPTER 18: Allied Disciplines in Public Health 415

National Crisis Management Committee (NCMC): Gives directions for action

,Cabinet Secretary, highest executive officer (Chairman)
Members: Secretaries of all concerned Ministries/Departments/Organizations
> Management Group: Review contingency plans/measures, coordination
& Crisis Relief Commissioner (CRC-MHA) Chairman
Central
>> Senior nodall oficers: From various concerned Ministries
rol Room (Emergency Operation Room), MHA: Asist the CRC, collection and transmission of information, keeping
lose contact and facilitate interaction
afional Contingency Action Plan (CAP): Facilitate launching of relief operations without delay
crate Relief Manuals: Reviewed and updated periodically based on experience
Funding mechanisms:
Reviewed bythe Finance Commission
Calamity Relief Fund (CRF): State level
National Calamity Contingency Fund (NCCF);: National level
New institutional mechanisms:
National level: National Emergency Managenment Authority
> State level: Disaster Management Authorities
District level: District Coordination and Relief Committee
Block/Taluka level: Block/Taluka Disaster Management Committees
Village level: Disaster Management Committees, Disaster Management
Teams
Holistic and proactiveapproach:
>Ministry/Department to set appropriate quantum of funds
> Mitigation measures shall be built into on-going
> Community involvement and awareness schemes/program
generation
> Close interaction with corporate sector, NGOs, media
> Institutional structures/appropriate chain of command
>Training imparted at various levels to ensure coordinated and quick
> Culture of planning and preparedness response
º Standard operating procedures, disaster management plans
º Construction designs corresponding to relevant Indian standards
7 All lifeline buildings in seismiczones III, IV and Vtobe evaluated, modified
Existing relief codes revision institutionalizing the planning process.

TRIAGE
[Link]
*Iriage: Consists of rapidly classifying the injured 'on the basis of severity of their injuries and
With prompt medical intervention likelihood of their survival'
" Frst come first serve' is NOT followed in emergencies
i Tnage yields best results when carried out at the site of disaster
Triage sieve: Quick<survey to separate the dead and the walking from the injured
i*
Triageesort: Remaining casualties are assessed and allocatedto categories
Triage system: Most commonly uses FOUR color code system:
Highest Priority): Immediate resuscitation or limb/life-saving surgery in next 6 hours
> OW(High Priority): Possible resuscitation or limb/life-saving surgery in next 24 hours
Green (Low Priority): Minor illness/AMBULATORY patients
º
* Black (Least Priority): Dead and moribund patients
Tagging procedure where identification, age, place of origin, triage category, diagnosis and
tagged onIstotheevery victim of disaster through a COLOUR CODING. initial treatment are

2Types of Triage
Simple triage: Simple triage is used in ascene of mass casualty, in order to sort patients into those who need critical
attention
º
and limmediate transport to the hospital and those with less serious injuries
Step is required before transportation becomes available
Categorization of patients based on the severity of their injuries can be aided with the use of printed triage tags or
colored flagging
416 sECTION 2: Theory Examinations
is a simple triage system that carn beperforrmed by lighthy-trained
3 Rapid triage: START (Simple Triage and Rapid Treatment)
lay and emergency personnel in emergencies
medical personnel or techniques
> lt is not intended to supersede or instruct
> Itmay serve as an instructive example and bus accidents.
been field-proven in mass casualty incidents such as train wrecks
> lt has
IlI. 0CCUPATIONAL HEALTH

OCCUPATIONAL HEALTH HAZARDS AND CONTROL

1. Physical Hazards
>106° F)
High temperature: > Heat exhaustion (body temperature
up to 110° F)
> Heat cramps
temperature <102° F) > Heat stroke (body temperature
> Heat hyperpyrexia (body
Low temperature:
> Chilblains
> Trench foot
> Frost bite
LowW pressure:
> Caisson disease
Vibration:
> Vibration sickness
> Neurogenic damage
Non-ionizing radiation
Microwave injuries
Laser injuries.

2. Chemical Hazards stibine), inert

(arsine,
sulfur dioxide), toxic(
(carbonn monoxide, hydrogen sulfide), irritants (chlorine,
Gases: Asphyxiants
methane)
gases (carbon dioxide,
> Poisoning
> Irritation, inflammation

Dusts:
> Pneumoconioses

Aerosols:
Nickel, chromium
Group A intoxications:
intoxications: Lead, mercury.
> Group B

3. Biological Hazards
Environmental origin:
workers)
Histoplasmosis (agriculture, construction
Schistosomiasis (agriculture workers)
>
Zoonotic origin: workers)
(poultry
Leptospirosis (sewer workers,
fishermen) > Avian influenza HSNI, H7N9
> sorters)
wool
Psittacosis (poultry workers, zoo keepers) > Anthrax (butchers, tanners,
workers)
> Q-fever (slaughterhouse
Disorders
4. Other Occupational Health
Occupationalskin disorders Occupational cancers
Contact dermatitis (Acid, alkali, solvent) " Skin cancer (Radiation, tar, UV light)
Skin infections (Bacterial, fungal) " Lung cancer (Nickel, chromium, tar)
. Skin cancer (Radiation, tar) " Bladder cancer (Aniline dyes)
Psychological/Behavioral disorders Occupational accidents
Sickness absenteeism " Head injuries
Traumatic neurosis " Extremities injuries