DISASTER

DR JAMA
• Definition :
• disaster can be defined 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 extraordinary
response from outside the affected community or
area.
Cont…
• A hazard can be defined as any phenomenon that has the
potential to cause disruption or damage to people and
their environment.
• Emergencies and disasters do not only affect health and
well-being of people; frequently, large number of people
are displaced, killed or injured, or subjected to greater
risk of epidemics.
• Considerable economic harm is also common.
• Disasters cause great harm to the existing infrastructure
and threaten the future of sustainable development.
• Disasters are not confined to a particular part of the world ;
• they can occur any where and at any time.
• Major emergencies and disasters have occurred throughout history
and as the world's population grows and resources become more
limited, communities are increasingly becoming vulnerable to the
hazards that cause disaster.
• Statistics gathered since 1969 show a rise in the number of people
affected by disasters.
• Since there is little evidence that the actual events causing
disasters are increasing in either intensity or frequency,
• it can only be concluded that vulnerability to disaster is growing.
• There are many types of disasters:
• earthquakes, floods, volcanic eruptions, fires,
hurricanes, snow storms, severe air pollution (smog),
heat waves, famines, epidemics, building collapse,
toxicologic accidents (e.g. release of hazardous
substances), nuclear accidents and warfare etc.
• Some can be predicted several hours or days before-
hand, as in the case of floods, others such as
earthquakes occur without warning.
• The relative number of injuries and deaths differ, depending on a number of
factors such as the type of disaster, the density and distribution of the
population, condition of the environment, degree of the preparedness and
opportunity of the warning.
• Injuries usually exceed death in explosions, earthquakes, hurricanes, fires
etc.
• In earthquakes, there is a high level of mortality, as a result of people being
crushed by falling objects.
• Consequently earthquakes at night are more deadly.
• During the night fractures of pelvis, thorax and spine are common, because
earthquake strikes while people are lying in bed.
• In the daytime injuries to the arms and skull are common.
• There may be injuries, burns and suffocation.
• In floods, mortality is high only in case of sudden
flooding
• Fractures, injuries and bruises may occur.
• If weather is cold, · cases of accidental hypothermia may
occur.
• The combined, effect of wind and rain may cause houses
to collapse.
• In draughts, mortality may increase considerably in areas where
drought cause famines,
• there may be protein-calorie malnutrition and vitamin deficiencies
particularly vitamin A deficiency, leading to xerophthalmia and
blindness.
• In famine conditions measles, respiratory infections, diarrhea
accompanied by dehydration may bring about a massive increase
in infant mortality.
• When people migrate and settle down on the outskirts of famine hit
areas, poor hygiene and overcrowding may facilitate the spread of
endemic communicable diseases e.g., tuberculosis, parasitic
diseases and malaria .
Historical drought disasters in
Somaliland
Morbidity which results from a disaster
situation can be classified into four types :
a. Injuries
b. Emotional stress
c. Epidemic of disease
d. and increase in indigenous diseases.
• DISASTER MANAGEMENT
• There are three fundamental aspects of disaster
management :
a. disaster response ;
b. disaster preparedness; and
c. disaster mitigation.
These three aspects of disaster management
correspond to different phases in the so-called
disaster cycle
 Disaster impact and response
• Medical treatment for large number of casualties is likely to
be needed only after certain types of disaster.
• Most injuries are sustained during the impact, and thus, the
greatest need for emergency care occurs in the first few
hours.
• The management of mass casualties can be further divided
into search and rescue, first aid, triage and stabilization of
victims, hospital treatment and redistribution of patients to
other hospitals if necessary.
• Search, rescue and first-aid
• After a major disaster, the need for search, rescue and first
aid is likely to be great that organized relief services will be
able to meet only a small fraction of the demand.
• Most immediate help comes from the uninjured survivors.
• Field care
• Most injured persons converge spontaneously to health facilities,
using whatever transport is available, regardless of the facilities,
operating status.
• Providing proper care to casualties requires, that the health service
resources be redirected to this new priority.
• Bed availability and surgical services should be maximized.
• Provisions should be made for food and shelter.
• A center should be established to respond to inquiries from
patient's relatives and friends.
• Priority should be given to victim's identification and adequate
mortuary space should be provided.
 Triage
• When the quantity and severity of injuries overwhelm the operative
capacity of health facilities, a different approach to medical
treatment must be adopted.
• Triage consists of rapidly classifying the injured on the basis of the
severity of their injuries and the likely hood of their survival with
prompt medical intervention.
• It must be adopted to locally available skills.
• Higher priority is granted to victims whose immediate or long-term
prognosis can be dramatically affected by simple intensive care.
• Moribund patients who require a great deal of attention, with questionable
benefit, have the lowest priority.
• Triage is the only approach that can provide maximum benefit to the
greatest number of injured in a major disaster situation.
• the most common classification uses the internationally accepted four color
code system.
• Red indicates high priority treatment or transfer, yellow signals medium
priority, green indicates ambulatory patients and black for dead or
moribund patients.
• Triage should be carried out at the site of disaster, in order to determine
transportation priority, and admission to the hospital or treatment center,
where the patient's needs and priority of medical care will be reassessed.
• Ideally, local health workers should be taught the principles of triage as part
of disaster training.
 Cont…
• Persons with minor or moderate injuries should be treated
at their own homes to avoid social dislocation and the
added drain on resources of transporting them to central
facilities.
• The seriously injured should be transported to hospitals
with specialized treatment facilities.
Tagging
• All patients should be identified with tags stating their
name, age, place of origin, triage category, diagnosis, and
initial treatment.
Identification of dead
• Taking care of the dead is an essential part of the disaster
management.
• A large number of dead can also impede the efficiency of the rescue
activities at the site of the disaster.
• Care of the dead includes :
( 1) removal of the dead from the disaster scene;
(2) shifting to the mortuary;
(3) identification;
(4) reception of bereaved relatives.
Proper respect for the dead is of great importance
• The health hazards associated with cadavers are minimal
if death results from trauma, and corps are quite unlikely
to cause outbreaks of disease (typhoid fever, cholera or
plague).
• If human bodies contaminate streams, wells, or other
water sources as in floods etc.,
• they may transmit gastroenteritis or food poisoning to
survivors.
• The dead bodies represent a delicate social problem.
• Relief phase
• This phase begins when assistance from outside starts to
reach the disaster area.
• The type and quantity of humanitarian relief supplies are
determined by two main factors :
(1)the type of disaster, since distinct events have different
effects on the population,
(2)and the type and quantity of supplies available locally.
• Immediately following a disaster, the most critical health supplies
are those needed for treating casualties, and preventing the spread
of communicable diseases.
• Following the initial emergency phase, needed supplies will
include
food, blankets,
clothings, shelter,
sanitary engineering equipment and construction material.
• A rapid damage assessment must be carried out in order to identify
needs and resources.
• Disaster managers must be prepared to receive large quantities of
donations.
•There are four principal components in
managing humanitarian supplies:
(a) acquisition of supplies
(b) transportation
(c) Storage
and
(d) distribution
 Epidemiologic surveillance and
disease control
• Disasters can increase the transmission of communicable
diseases through following mechanisms :
1. Overcrowding and poor sanitation in temporary
resettlements.
 increase in acute respiratory infections etc.
2. Population displacement may lead to introduction of
communicable diseases to which either the migrant or
indigenous populations are susceptible.
 Cont…
3. Disruption and the contamination of water supply, damage to sewerage
system and power systems are common in natural disasters.
4. Disruption of routine control programmes as funds and personnel are
usually diverted to relief work.
5. Ecological changes may favour breeding of vectors and increase the vector
population density.
6. Displacement of domestic and wild animals, who carry with them zoonoses
that can be transmitted to humans as well as to other animals.
7. Provision of emergency food, water and shelter in
disaster situation from different or new source may itself be a source of
infectious disease.
Outbreak of gastroenteritis, which is the most
commonly
reported disease in the post-disaster period, is closely
related to first three factors mentioned above.
Increased incidence of acute respiratory infections is
also common in displaced population.
 Vector-borne diseases will not appear immediately
but may take several weeks to reach epidemic levels.
• Displacement of domesticated and wild animals increases
the risk of transmission of zoonoses.
• Dogs, cats and other domestic animals are taken by their
owners to or near temporary shelters.
• Some of these animals may be reservoirs of infections
(leptospirosis, rickettsiosis etc).
• Wild animals are reservoirs of infections which can be fatal
to man such as equine encephalitis, rabies, and infections
still unknown in humans.
• The principals of preventing and controlling
communicable diseases after a disaster are to –
(a) implement as soon as possible all public health
measures, to reduce the risk of disease transmission;
(b) organize a reliable disease reporting system to
identify outbreaks and to promptly initiate control
measures; and
(c) investigate all reports of disease outbreaks rapidly
Nutrition
• A natural disaster may affect the nutritional status of the population
by affecting one or more components of food chain depending on
the type, duration and extent of the disaster, as well as the food
and nutritional conditions existing in the area before the
catastrophe.
• Infants, children, pregnant women, nursing mothers and sick
persons are more prone to nutritional problems after prolonged
drought
• or after certain types of disasters involving damage to crops, to
stocks or to food distribution systems
• The immediate steps for ensuring that the food relief
programmes will be effective include:
(a} assessing the food supplies after the disaster;
(b} gauging the nutritional needs of the affected population ;
(c} calculating daily food rations and need for large
population groups ; and
(d} monitoring the nutritional status of the affected
population.
 Rehabilitation
• The final phase in a disaster should lead to restoration of the
pre-disaster conditions.
• Rehabilitation starts from the very first moment of a disaster.
• Provisions by external agencies of sophisticated medical care
for a temporary period.
• Water supply
• A survey of all public water supplies should be made.
• This includes distribution system and water source.
• The main public safety aspect of water quality is microbial
contamination.
• The first priority of ensuring water quality in emergency situations
is chlorination.
• It is the best way of disinfecting water.
• Chemical contamination and toxicity are a second concern in water
quality and chemical potential contaminants have to be identified
and analyzed.
• Food safety
• Poor hygiene is the major cause of food-borne diseases in disaster
situations.
• Personal hygiene should be monitored in individuals involved in food
preparation.
• Basic sanitation and personal hygiene
• Many communicable diseases are spread through faecal contamination of
drinking water and food.
• Emergency latrines should be made available to the displaced, where toilet
facilities have been destroyed.
• Washing, cleaning and bathing facilities should be provided to the displaced
persons.
• Vector control
• Control programme for vector-borne diseases
should be intensified in the emergency and
rehabilitation period, especially in areas where such
diseases are known to be endemic.
• Of special concern are dengue fever and malaria
(mosquitoes), leptospirosis and rat bite fever
(rats), typhus (lice, fleas), and plague (fleas).
• Disaster mitigation in health sector
• Emergency prevention and mitigation involves measures
designed either to prevent hazards from causing
emergency or to lessen the likely effects of emergencies.
• These measures include flood mitigation works,
appropriate land-use planning, improved building
codes, and reduction or protection of vulnerable
population and structures
• Disaster preparedness
• Emergency preparedness is a programme of long-term
development activities whose goals are to strengthen
the overall capacity and capability of a country to
manage efficiently all types of emergency.
• It should bring about an orderly transition from relief
through recovery, and back to sustained
development.
• Disaster preparedness is an on-going multisectoral activity.
• It forms an integral part of the national system responsible
for
developing plans and programmes for disaster
management,
prevention,
mitigation,
preparedness,
response,
rehabilitation
and reconstruction.
• The system, known by a variety of names depending on
the country, depends on the coordination of a variety of
sectors to carry out the following tasks:
1. Evaluate the risk of the country or particular region to
disaster;
2. Adopt standards and regulations ;
3. Organize communication, information and warning
systems;
4. Ensure coordination and response mechanisms.
 Cont…
5. Organize communication, information and warning systems;
4. Ensure coordination and response mechanisms ;
5. Adopt measures to ensure that financial and other resources are
available for increased readiness and can be mobilized in disaster
situation ;
6. Develop public education programmes ;
7. Coordinate information sessions with news media and
8. Organize disaster simulation exercises that test response
mechanisms