WILL WE BE CAUGHT NAPPING?
DISASTER PREPAREDNESS BY DR. SYED AMIN TABISH
A disaster is a serious disruption in the functioning of a community or society, causing widespread human, material, economic, or environmental losses that exceed the ability of the affected society to cope using its own resources. Disasters come in all shapes and sizes, and have origins that range from natural to artificial (UNISDR, 2009). Natural disasters have been visiting every part of the globe at one time or the other. The world is becoming increasingly vulnerable to natural disasters. From earthquakes to floods and famines, mankind is even more threatened by the forces of nature.
Disasters can strike at any time, at any place. Nearly three million people worldwide may have been killed in past 20 years due to natural disasters such as landslides, earthquakes, floods, tsunamis, snow avalanches, cyclones etc. Ninety per cent of the natural disasters and ninety five percent of the total disaster related deaths worldwide occur in developing countries in which India has the second largest share.
Natural disasters and calamities throw up major challenges for national governments in many countries of the Asia-Pacific region. In disaster situations, the major challenge is the protection of life (human and animal), property, and the vital life-supporting infrastructure necessary for disaster mitigation. Any delay or laxity in disaster relief could escalate the magnitude of distress for the victims. Advanced disaster management technology could provide a critical support system for disaster management authorities at times of disaster-related crises. Such a technology also provides important inputs for any disaster management plan of action in modern times.
Natural disasters inflict severe damage on almost the entire spectrum of social and natural habitats, ranging from housing and shelter, water, food, health, sanitation, and waste management to information and communication networks, supply of power and energy, and transportation infrastructure. The major challenges faced in all disasters include pre- disaster early warning infrastructure; the supply of food and clean drinking water; health and sanitation; information and communication; power and energy for lighting and cooking; waste collection and disposal, including rapid disposal of dead bodies of humans and animals; disaster-proof housing and shelter; emergency and post- disaster shelters; rescue and relief operations; and transport infrastructure.
Rapid advancement of technology in all these sectors could be deployed in efficiently tackling the challenges emerging from disasters, minimizing the impact of disasters in terms of reducing the magnitude of death and casualties, improving the health and sanitary conditions of the affected population, rehabilitation of the victims, etc. Specific technological solutions can be utilized in all the phases of disaster management, namely, disaster preparedness, disaster reduction, disaster mitigation, and post- disaster rehabilitation.
There is a need for the application of modern technologies in disaster management, wherever and whenever possible. Many frontier areas such as space technology, modern information and communication systems, renewable energy, advanced medical diagnostics, and remotely operated robotic systems for rescue and relief operations, find useful applications in disaster management efforts. A number of advanced technologies and equipments that have already entered the marketplace in recent years could provide vital support to disaster management programmes.
Early Warning & Disaster Preparedness
In recent years, efforts in disaster management have gained impetus from the unprecedented development ininformation, communication, and space technologies (ICST), which have wide-ranging applications in disaster preparedness, reduction, mitigation, and management. ICSTs provide vital support for disaster management in many ways: observation, monitoring, data collection, networking, communication, warning dissemination, service delivery mechanisms, GIS databases, expert analysis systems, information resources, etc. ICSTs, especially remote sensing, have successfully been used to minimize the calamitous impact of disasters in all phases of disaster management.
The widespread and consistent availability of current and accurate data is fundamental to all aspects of disaster risk reduction. For correct decision-making at any stage of natural disasters – from prediction to reconstruction and rehabilitation – a considerable amount of data and information is necessary. The most important procedures relating to information for disasters are monitoring, recording, processing, sharing, and dissemination. A dynamic communication system would serve to integrate many different communication categories such as: data transfer from observatory stations; data exchange among suppliers and users; exchange of information and experience; training and video conferences; and tele-control (commands). Space technology is a crucial component of ICST-enabled disaster management systems because it remains largely unaffected during disasters whereas both information and communication technologies which are based on ground infrastructure are vulnerable to natural disasters.
The wide spectrum of ICSTs used in disaster preparedness, mitigation, and management include: Remote sensing; Geographical Information System (GIS); Global Positioning System (GPS); satellite navigation system; satellite communication; amateur and community radio; television and radio broadcasting; telephone and fax; cellular phones; internet, e-mail; and special software packages, on-line management databases, disaster information networks. Critical applications of ICSTs include the following: to develop and design early warning systems which include: understanding and mapping the hazard; monitoring and forecasting impending events; processing and disseminating understandable warnings to administrative authorities and the population, and undertaking appropriate and timely actions in response to the warnings.
Food Supply, Storage, & Safety
Storage, safety, and distribution of food in disaster-prone and disaster-affected areas require a package of best practices, technical know-how, technologies, equipment, and devices. While contamination can occur at any point of the food chain, inadequate washing, handling, and cooking of food just before consumption is still a prime cause of food-borne diseases. Many infections are preventable by observing simple, hygienic rules during food preparation whether in family settings or large food-catering facilities.
Under most conditions, the threats posed by polluted water and contaminated food are interrelated and cannot be separated. Therefore, water should be treated as a contaminated food and should be boiled, or otherwise purified, before it is consumed or used as an ingredient in food. Basic precautions, such as those specified in the WHO “Five Keys for Safer Food”, should be implemented by all food handlers, especially those involved in mass catering: keep clean (prevent growth and spread of dangerous microorganisms), separate raw and cooked food (prevent transfer of microorganisms), cook thoroughly (kill dangerous microorganisms), keep food at safe temperatures (prevent growth of microorganisms) and use safe water and raw materials (prevent contamination). Solar PV and/or mechanical wind pumps may be very effective for longer term solutions, pumping water from the surface or from relatively deep boreholes. For the treatment of non-saline water, solar PV pumping systems can be readily coupled to suitable membrane filter arrangements (gravity driven), with individual pump and filter units capable of providing up to 10,000 litres of potable water per day – sufficient for 300-500 people. Larger volumes can be delivered by using multiple units.
Healthcare for Disaster Victims
Modern healthcare management systems and equipment could provide vital support to the medical personnel engaged in post-disaster areas. The technological solutions considered helpful for disaster healthcare managers would include the following: diagnostic equipment; equipment for critical care; equipment for disaster health kits: basic, first-aid items; intravenous (IV) and feeding tube equipment; oxygen and breathing equipment; electrically-powered medical equipment; disaster relief response: robot-assisted medical reachback; telemonitoring; patient tracking systems; pre-hospital management systems; relief medical equipment vans; post-response rehabilitation systems; tele-medicine: disease surveillance systems; web-based tele-medicine; personal digital assistants (pocket tele-medicine); wearable computing (personal imaging); advanced sensors and medical monitoring; DICOM network services; and e-Film Video; and advanced systems for disaster medicine and medical relief.
Relief Medical Equipment Vans
In India, Accident Relief Medical Equipment (ARME) vans and Accident Relief Trains (ART), including a few self-propelled vehicles, are positioned at strategic locations for rushing to an accident site on top priority, along with doctors, paramedical staff, rescue workers, and engineers. The medical team attends to injured passengers, and the seriously wounded are transported to nearby hospitals. ARME vans are equipped with medicines, resuscitation machines, dressings, disposables, etc for use in emergencies and also have an
operation theatre with facilities for conducting minor surgeries.
Tele-medicine refers to the utilization of telecommunication technology for medical diagnosis, treatment, and patient care. A tele-medicine system is composed of customized medical software integrated with computer hardware, along with medical diagnostic instruments connected to the commercial VSAT (Very Small Aperture Terminal) at each location on fiber optics. Tele-medicine enables a physician or specialist at one site to provide healthcare, diagnose patients, treat and monitor them, give intra-operative assistance, administer therapy, and consult with another physician or paramedical personnel at a remote site, thereby ensuring convenient, site-independent access to expert advice and patient information. Transmission modalities include direct hard-wired connections over standard phone lines and specialized data lines (single/twisted pairs of metallic wires, coaxial lines, fiber optic cable) and “wireless” communications, using infrared, radio, television, microwave, and satellite-based linkages. Improved space- and ground-based technologies now form a communications infrastructure well suited to addressing ongoing disaster management needs.
The LSTAT is a self-contained, stretcher-type platform designed to aid in field stabilization and transport of severely injured patients. It incorporates a number of on-board devices for ongoing treatment, which include monitors for basic vital signs and blood chemistry; mechanical ventilation and oxygen supplementation for patients requiring endo-tracheal intubation; a self-contained, battery-powered infusion pump to deliver intravenous fluids; and a self-contained, battery-powered suction pump. An automated external defibrillator is also built into each of the LSTAT units. All patient medical data that is monitored by the on-board devices of the LSTAT can be data-linked to the receiving medical facility while the patient is being transported by air or ground ambulance.
New Technology for Hospital Readiness for Disasters
In the USA emergency medicine specialists from Johns Hopkins have developed a tool to help hospitals prepare for disasters with the potential to overwhelm services. The Electronic Mass Casualty Assessment & Planning Scenarios (EMCAPS) computer program calculates the impact of such crises as a flu epidemic, bio-terrorist attack, flood, and plane crash, accounting for such elements as the number of victims, wind direction, available medical resources, bacterial incubation periods, and bomb size. The program depends heavily on population density estimates to derive 'plausible estimates' of what hospitals may expect in the initial minutes or hours of a disaster.
Sanitation & Waste Management
In the aftermath of disasters, sanitation and waste management are placed next only to food and medical supplies in the list of priorities for the authorities in charge. The maintenance of appropriate sanitary conditions and hygienic waste disposal are critical because these efforts have a direct bearing on the health of disaster victims. If the sanitation and waste management systems and practices are below par, the survivors could be exposed to the danger of infections and diseases. Technologies and methodologies are a critical part of the response strategy that local governments need to have in place for disaster situations. They help to maintain optimum sanitary conditions and to handle large amounts of different kinds of wastes (including hazardous wastes) in an environmentally sound manner.
Disaster-Resistant Housing & Construction
Earthquakes, cyclones, and floods cause extensive damage to buildings, resulting in an overwhelming loss of life and property. Buildings prone to such disasters are the single most important cause of such loss. Therefore, vulnerable houses and other structures made of mud or stone or brick, which are common among the developing countries, must be adequately strengthened to withstand such disasters; and, even more important, existing buildings need to be strengthened or retrofitted to ensure that they are relatively safe.
Mitigation measures in the form of retrofitting could significantly reduce the chances of structural damage and casualty. Disaster-resistant construction and retrofitting technologies are already available in the public and private domains. The technologies range from simple techniques for retrofitting non-engineered buildings to modern and complex civil engineering solutions for constructing engineered building structures and bridges. The technology selected must suit the type of structure, extent of damage, and availability of materials, manpower, funds, etc.
Disaster Prevention and Mitigation
Reducing the impact of disasters requires a complex mix of technical and social endeavors, and no single prescription or discipline can provide all the answers. Indeed, disaster researchers have frequently expressed concerns that technology not be viewed as a panacea.
Disaster prevention can be thought of as taking measures to reduce overall vulnerability to natural hazards. These include measures taken to detect, contain, or forestall events or circumstances that, if left unchecked, could result in a disaster. Another essential part of the disaster risk management cycle is preparedness, which is also an effort to reduce vulnerability, though recognizing that impacts cannot be prevented entirely. Preparedness includes those strategies, activities, and actions taken before hazard events occur in order to lay the groundwork for effective response. Once a disaster has occurred, the focus changes to response, which includes the mobilization of emergency services during or after a disaster situation, in order to reduce impacts on the population. Recovery involves the restoration of the facilities, livelihoods, and living conditions of disaster-affected communities. This includes repairing or upgrading physical infrastructure, ensuring appropriate social services, and the provision of food and other resources. Recovery describes rehabilitation and reconstruction activities that save lives, address immediate needs, restore normal activities, and reduce future disaster risk.
Looking to the past to understand the future
Disasters cut across many boundaries, including organizational, political, geographic, professional, topical and sociological. A comprehensive disaster management system must allow access to many different kinds of information at multiple levels at many points of time. The disaster information infrastructure encompasses three subsystems: knowledge infrastructure, interconnectivity infrastructure and integration infrastructure. Knowledge infrastructure involves observation techniques for data collection and visualization, information analysis, event forecasting, knowledge modeling and information management. Interconnectivity subsystem relates to the mode of communication employed to retrieve and distribute data and dissemination of information products. Integration infrastructure addresses the operational system, standards and protocols, procedures for evaluation of quality and reliability and training of key personal.
We are not Prepared
India is not ready to handle natural disasters. The country has too few support systems and too few medical experts. Because the Himalayan belt was sitting on a major seismic zone, it was found that around 229 districts, more than a third of the country, falls under seismic zones IV and V, and was just waiting for a quake in the not too distant future. The National Disaster Management Authority (NDMA) has said India is not prepared to face natural disasters. Prevention is better than cure. The world stands united in war against disaster, whether man-made or natural. Knowledge is power. To know what to do at the time of an emergency can be life saving not only for you but also for many others who may need your help.
Hospital Emergency Preparedness
The objective is to provide policy for response to both internal and external disaster situations that may affect hospital staff, patients, visitors and the community, Identify responsibilities of individuals and departments in the event of a disaster situation and identify Standard Operating Guidelines (SOG's) for emergency activities and responses. Preparing for Mass Casualty Incidents is a daunting task, as unique issues must be considered with each type of event. For example, the systemic stress of a bio-threat is entirely different from that of a chemical disaster. These differences hold challenging implications for the hospital preparedness and training. Hospitals would be among the first institutions to be affected after a disaster, natural or man-made. Because of the heavy demand placed on their services at the time of a disaster, hospitals need to be prepared to handle such an unusual workload. This necessitates a well documented and tested disaster management plan (DMP) to be in place in every hospital. To increase their preparedness for mass casualties, hospitals have to expand their focus to include both internal and community-level planning. The disaster management plan of a hospital should incorporate various issues that address natural disasters; biological, chemical, nuclear-radiological and explosive-incendiary terrorism incidents; collaboration with outside organizations for planning; establishment of alternate care sites; clinician training in the management of exposures to weaponizable infectious diseases, chemicals and nuclear materials; drills on aspects of the response plans; and equipment and bed capacity available at the hospital. The most important external agencies for collaboration would be state and local public health departments, emergency medical services, fire departments and law enforcing agencies. The key hospital personnel should be trained to implement a formal incident command system, which is an organized procedure for managing resources and personnel during an emergency. The hospitals should also have adequate availability of personal protective hazardous materials suits, negative pressure isolation rooms and decontamination showers.
While responding to a mass casualty event, the goal of the health and medical response is to save as many lives as possible. Rather than doing everything possible to save every life, it will be necessary to allocate limited resources in a modified manner to save as many lives as possible. When a hospital responds to a large number of victims presenting over a short time, often without a prior warning, delivering care to the level of usual hospital standards or benchmarks may not be possible and "altered standards" may have to be acceptable. The term "altered standards" means a shift to providing care and allocating scarce equipment, supplies and personnel in a way that saves the largest number of lives in contrast to the traditional focus on saving individuals. For example, it could mean applying principles of field triage to determine who gets what kind of care. It could mean changing infection control standards to permit group isolation rather than single person isolation units. It could mean limiting the use of ventilators to surgical situations. It could mean creating alternate care sites in the waiting area, lobby or corridors which are not designed to provide medical care; minor surgical procedures in victims in these areas could mean altered level of asepsis. It could also mean changing who provides various kinds of care like enhancing the scope of nurses, physician assistants and hospital paramedics. Secondary triage also may be necessary within hospital, as demands on the system grow. Hospital DMP should consider the possibility that a hospital might need to evacuate partially or wholly, quarantine, or divert incoming patients. One of the key components of an effective health and medical care response is ensuring adequate supplies of a broad array of qualified health care providers who are available and willing to serve. Mass casualties will provide more work than any organization itself can address. Coordination is the key and the historic separation is a genuine disadvantage. Several strategies help ensure protection of staff handling disasters e.g. safety measures including personal protective equipment, prophylaxis, training specific for different events, adequate back-up staff for rotation to prevent burnout and fatigue related errors and care of families of staff.
A wide range of training of hospital staff is needed to ensure an effective health and medical response to a mass casualty event. Preparedness for disasters is a dynamic process. In addition to having a well documented DMP in place, it is prudent to have regular drills to test the hospital's DMP. The hospital preparedness can be enhanced more rapidly if standardized state and national guidelines for model hospital DMP, staff training, disaster drills and accreditation of hospitals based on DMP are developed and widely disseminated.
[Professor Syed Amin Tabish, FRCP, FAMS, FACP, FRCPE, is Chairman Accident & Emergency Department, Head Hospital Administration & Medical Superintendent of Sher-i-Kashmir Institute of Medical Sciences, Srinagar]
Lastupdate on : Tue, 10 Jan 2012 21:30:00 Makkah time
Lastupdate on : Tue, 10 Jan 2012 18:30:00 GMT
Lastupdate on : Wed, 11 Jan 2012 00:00:00 IST
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