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Disaster management in hospital ppt
1. DISASTER MANAGEMENT
IN HOSPITAL
By- Dr.Diksha Tewari
(MHA Trainee)
“Are we never to educate ourselves to foresee such dangers and to
prevent them before they happen?
Hospital- MGM Hospital, Kamothe, Navi Mumbai
2. SESSION 1
• Introduction
• Definition of disaster
• Definition of management
• Definition of disaster management
• Phases of disaster management
• Disaster action plan
• Disaster management plan
• Disaster management act, 2005
• Hospital disaster plan & committee
• Care at the site
• Internal disaster plan
• External disaster plan
• Different disaster zone
• Types of disaster
• Disaster management planning
3. INTRODUCTION
• Disaster Management refers to how we can
protect or preserve maximum number of lives
and property during a natural disaster.
• About 59% of the landmass is prone to
earthquakes of various intensities; over 40 million
hectares is prone to floods; about 8% of the total
area is prone to cyclones and 69% of the area is
susceptible to drought.
• In the decade 1990-2000, an average of about
4344 people lost their lives and about 30 million
people were affected by disasters every year.
4. What is disaster?
• A disaster is a sudden, calamitous event that
seriously disrupts the functioning of a community
or society and causes human, material, and
economic or environmental losses that exceed
the community’s or society’s ability to cope using
its own resources.
• Though often caused by nature, disasters can
have human origins.
• (VULNERABILITY+ HAZARD )/ CAPACITY = DISASTER
5. What is management?
• Management is a set of principles relating to
the functions of planning, organizing, directing
and controlling,
• And the application of these principles in
harnessing physical, financial, human and
informational resources efficiently and
effectively to achieve organizational goals.
6. What is disaster management?
• Disaster Management can be defined as the
organization and management of resources
and responsibilities for dealing with all
humanitarian aspects of emergencies, in
particular preparedness, response and recovey
in order to lessen the impact of disasters.
7.
8. PLANNING
A. PREDICT
Measures for efficient forecasting and warning systems
Developing GIS for early detection and warning
Information Technology for effective communication
network.
Pro-active measures for disaster preparedness and
mitigation – administrative, financial, Legislative &techno-
legal
Developing public awareness to build up society’s strength
to face disasters.
National networking for immediate medical response
Emphasis on risk reduction, mitigation & awareness, while
strengthening response.
9. CONT..
B. PREVENT-
Evoke existing system of response mechanism in the wake
of natural and man-made disasters at all levels of
government and steps to minimize the response time
through effective communication & measures to ensure
adequacy of relief operations.
Develop strategies for inclusion of disaster reduction
components in the on-going plan/ non – plan schemes.
Prepare the community to face the challenge and respond
in case of impending disaster.
Lay stress on preparedness including prevention/ mitigation
of Chemical Industrial Disasters while strengthening their
emergency response.
Stay up to date with the latest international best practices
and recent developments within the country.
Highlight the salient gaps evaluated based upon the critical
review of the present status for future action.
12. DISASTER ACTION PLAN
It is planned and systematic approach towards
understanding and solving the disaster to
minimize the effect.
The approach should be multi sectoral.
Plan should be realistic and easily adoptable
Plan should be clearly laid down defining the role
and responsibility of different agencies.
Should be exercised in between to evaluate it.
It should be prepared at the country, state,
district and institutional level.
National disaster management authority(NDMA)
facilitate state with support and advice while plan
and implementation by SDMA
13. Disaster Management Plan
• On 1 June 2016, Pranab Mukherjee, the Ex President
of India, launched the Disaster Management Plan of
India, which seeks to provide help and direction to
government agencies for prevention, mitigation and
management of disasters. This is the first plan
nationally since the enactment of the Disaster
Management Act of 2005.
14. The Disaster Management Act, 2005
The Disaster Management Act was passed by the Lok Sabha on 28
November 2005,
By the Rajya Sabha on 12 December 2005.
It received the assent of the President of India on 9 January 2006.
The Act calls for the establishment of a National Disaster
Management Authority (NDMA), with the Prime Minister of India as
chairperson.
The NDMA is responsible for "laying down the policies, plans and
guidelines for disaster management" and to ensure very timely and
effective response to disaster".
Under section 6 of the Act it is responsible for laying "down
guidelines to be followed by the State Authorities in drawing up the
country Plans".
15. HOSPITAL DISASTER PLAN
Hospital Disaster plan is prepared to reduce the
pressure on the hospital management when a large
number of casualties arriving suddenly in the hospital
at a time, requiring different level of care.
The plan should be activated immediately to provide
efficient care to the patients within a short span of
time.
Mock drill to be conducted periodically to acquaint the
staff to meet any eventuality.
The action plan begins with formation of Disaster
committee Keeping adequate storage of supplies in the
emergency department.
Keeping disaster SOP in the casualty.
18. CARE AT THE SITE
Do not allow Golden hour to expire,1st hour
It is best if services can be provided in first 10 minutes (Platinum minute)
BLS ABC= Air way. Breathing. Circulation
ALS DEF= Defibrillator. ET intubation, ECG . Fluid & electrolyte
Constitute the field team:
1.Ambulance
2.Anesthetist (To be identified and roaster made on daily)
3.OT Tech (Weekly and monthly basis).
4.Bearers
5.Drivers
Dispatch the team to site
Assess the situation in the site.
Render first aid at the site and during transport
Stabilize the serious cases.
Transport serious cases to the hospital under direct supervision.
19. INTERNAL DISASTER PLAN
• It is activated when the hospital buildings are effected
in disaster. Action plan should clearly mention:
Alternate site (dharmashala, Temple, Schools,
Playground nearby)
Folding tents, cots, trolleys for temporary shelters
Identify a nearby tent house to provide beds, blankets
TPT for transportation of cases to alternate sites or
hospital
First aid and drug kits, potable lights.
Portable communication system.
Identify local voluntary organization, who can provide
services of care, food and water.
20. Steps to follow during internal disaster:
• Step 1: - Press the disaster alarm from the source (anybody present in the source can press the alarm).
• Step 2: - Information should be passed through phone to the disaster management commanding
centre by any staff from the concerned department. - Announce the particular emergency code by any
staff from the concerned department (E.g.. Code RED in case of fire, Code ORANGE in case of disaster
etc.)
• Step 3: - Turn off the lift (done by lift operator) The nursing personals should; - Evacuate the patients
or personnel form the source. - Open the fire exit and direct the patients to use it. - Shift the bed
ridden patients to nearby safe zone. - Sequence of evacuation should be- a) Patients in immediate
danger b) Ambulatory patients c) Semi-ambulatory patients d) Non-Ambulatory patients.
• Step 4: - In case of fire, depending upon the nature, extinguisher should be applied by the staffs
available there. - Hospital security teams should control the crowd throughout the evacuation process.
Police and fire force should be informed by the security officer. - Turn off the power supply to the
source if needed.
• Step 5: - Hospital management is responsible for passing the messages to press and media. - Once all
the patients have been evacuated, all the staffs should leave the source. - Further extinguishing work
should be carried out by fire force. - When situation is under control announce Code GREEN.
21. EXTERNAL DISASTER PLAN
(TEN STEPS)=>
DISASTER RESPONSE
PUBLIC RELATION
AUTHENTICATE
TRAFFIC CONTROL SOURCE
PERSONAL
ACTIVATION OF PROTECTION DISASTER PLAN
CHEMICAL
CREATION OF DECONTAMINATION ADDITIONAL SPACE
AUGMENTATION OF SERVICES
MAINTENANCE OF RECORD
26. A good state of preparedness may reduce its impact.
However developed a country/State outside help beyond a
district in the initial brief period will be very difficult.
In the initial phase the involvement of the community is
paramount in reducing the impact.
Disaster awareness of the community can save the lives and
reduce the impact.
Forecasting and operation of the warning systems, and timely
communication.
IMPORTANCE OF DISASTER PREPAREDNESS
32. RECENT HOSPITAL DISASTERS CASES IN
INDIA
• On October 2018, a fire broke out in the dispensary of the
state-run Calcutta Medical College and Hospital.
• On October 2016, a major fire broke at Bhubaneswar's
Sum Hospital which claimed 22 lives.
• West Bengal's Murshidabad Medical College Hospital Fire
On October 2016,two persons died and seven others were
injured in the incident.
• Cuttack's Shishu Bhawan Hospital Fire On November 2015.
• Erwadi Village Mental Home fire, Tamil Nadu on August 6.
• BM Hospital, Bikaner on January 2013.
• Kolkata's AMRI Hospital Fire, 90 of them patients, had died
of asphyxiation
33. FAMOUS DISASTERS CASES IN INDIA
• 1999 Odisha Cyclone
• 2001 Gujarat Earthquake
• 2002 Indian Heat Wave
• 2004 Indian Ocean Tsunami
• 2007 Bihar Flood
• 2005 Mumbai Catastrophes
• 2010 Eastern Indian Storm
• 2013 Maharashtra Drought
• 2013 Uttarakhand Flash Floods
• 2014 Andaman boat disaster
• 2014 Beas River Tragedy
• 2014 Chennai building collapse
• 2014 GAIL pipeline explosion
• 2014 Hirakud boat disaster
• 2014 Malin landslide
• 2014 Patna stampede
• 2019 Karnataka Floods
• 2019 Cyclonic Storm Fani
• 2019Kerala Floods
• 2019 Bihar Floods
• 2019 Bihar Heat Wave
34.
35. WE ARE GOING TO STUDY ABOUT FOLLOWING TYPES OF
DISASTER
Accidents
Earthquake
Flood
Chemical
spills
Fire
37. WHAT IS FIRE?
• fire [ˈfi(-ə)r ] noun fire is a rapid oxidation process that
creates light, heat, and smoke, and varies in intensity.
• it is commonly used to describe either a fuel in a state
of combustion (e.g., a campfire, or a lit fireplace or
stove) or a violent, destructive and uncontrolled
burning (e.g., in buildings)
• The common term given to the combustion reaction
which results from interaction of HEAT + FUEL +
OXYGEN.
• This combination is called ‘Triangle of Fire’.
• Fuels involved can be in three states: SOLID, LIQUID,
GAS. HEAT, SMOKE, LIGHT, GASES are by-products of
the reaction.
42. • Every effort should be made to include evacuation considerations when designing or
retrofitting hospital facilities.
• Full evacuation of a hospital should generally be considered as a last resort when
mitigation or other emergency response efforts are not expected to maintain a safe care
environment.
• Simplicity is key; the staff will need a simple plan to follow in an emergency.
• Self-sufficiency at the unit level is important because timely communication from
hospital leaders may be difficult or even impossible; employees at every level must
know immediately what to do in their area.
• It may be necessary to evacuate patients to holding sites before transportation
resources and/or receiving destinations are available. If the medical facility cannot
accommodate a horizontal safe site (a location on the same floor safe from danger),
then assembly points located away from the main clinical areas should be identified and
designated.
KEY PRINCIPLES WILL HELP STAFF MEMBERS MAKE GOOD DECISIONS DURING A CHAOTIC EVENT.
43. • Flexibility is vital because the procedures must be adaptable to a
variety of situations.
• Safety is always the primary concern.
• Individual patient care units should stay together at the assembly
points whenever possible (instead of the patients in these units
being divided into separate groups according to their ambulatory
status). This is because the unit teams familiar with their patients
will be better able to manage them in a chaotic situation away from
the care unit.
• Emergency medical system (EMS) personnel and other external
patient transporters should generally not be asked to come into the
hospital to load patients because of the risks, time delays, and
inefficiency associated with this process when large numbers of
patients are involved. Instead, evacuating patients should be taken
to meet their transporting ambulances and other vehicles in rapid-
throughput staging areas.
• When difficult choices must be made, leaders and staff must focus
on the “greatest good for the greatest number.”
53. WHY FIRE SAFETY
The hospital, as an Institution is prone to fire because of:-
• Having many heat-dissipating equipments,
• Combustible gasses /fuel, chemicals, used in different areas.
• A lot of electrical wiring, high voltage connections.
• Fire prone articles like gauze, cotton, linen, books and
registrars.
• Heavy Equipments and electrical gadgets that are
inflammable and prone to hazardous incidents. Proper
precautions has to be taken while planning the
infrastructure.
• Adequate measures need to be considered, designed and
practiced to ensure safety to all.
• Indicators like architectural designs, interior designs,
electrical wiring, appropriate equipment planning and
proper waste management are considered while planning
such safety measures.
57. What to Do in Case of a Fire
• Immediately pull the nearest fire alarm pull
station as you exit the building.
• When evacuating the building, be sure to feel
doors for heat before opening them to be sure
there is no fire danger on the other side.
• If there is smoke in the air, stay low to the ground,
especially your head, to reduce inhalation
exposure. Keep on hand on the wall to prevent
disorientation and crawl to the nearest exit.
• Once away and clear from danger, call your report
contact and inform them of the fire.
• Go to your refuge area and await further
instructions from emergency personnel.
58. Fire Safety Precautions and Fire Systems
Equipment
• Keep doorways, corridors and egress paths clear and unobstructed.
Make sure that all electrical appliances and cords are in good
condition and UL approved. Do not overload electrical outlets. Use
surge protected multi-outlet power strips and extension cords
when necessary.
• Never store flammable materials in your room or apartment.
• Do not tamper with any fire system equipment such as smoke
detectors, pull stations or fire extinguishers. Doing so is a criminal
offense.
• Raising a false alarm is a criminal offense. It endangers the lives of
the occupants and emergency personnel.
• DO treat every fire alarm as an emergency. If the alarm sounds, exit
the building immediately.
63. INTRODUCTION
• Floods are natural disaster resulting from rainfall in
certain seasons because water levels of rivers and lakes
overflowed and went into the surroundings .
• Floods can create various of damage to property and
loss of life is significant. Scenario flooding and
destruction from flooding throughout the world.
• According to the World Meteorological Organization
(WMO), the flooding is three worst natural disasters in
the world and has claimed thousands of lives and
destruction of property valuation hundred thousand
million
64. Impact of floods on health services
• Flooding can either damage hospital facilities directly
or disrupt access to them.
• Damage may be direct costs such as losses in
infrastructure, expensive medical equipment, hospital
furniture, lifeline installations and medical supplies.
• Indirect costs are unforeseen expenses after
emergencies such as increased risk of outbreaks due to
loss of laboratory and diagnostic support, temporary
solutions like field hospitals and the loss income
normally generated by health care services.
65. Planning
Having an evacuation plan in place before a flood occurs can help avoid confusion and prevent
injuries and property damage. A thorough evacuation plan should include:
Conditions that will activate the plan
Chain of command
Emergency functions and who will perform them
Specific evacuation procedures, including routes and exits
Procedures for accounting for personnel, customers and visitors
Equipment for personnel
Review the plan with workers Warning Systems
Flood Watch: Flooding is possible.
Monitor radio and television stations
for more information.
Flash Flood Watch: Flash flooding is
possible. Be prepared to move to
higher ground; monitor radio and
television stations for more
information.
Flood Warning: Imminent threat -
Flooding is occurring or will occur
soon; if advised to evacuate, do so
immediately.
Flash Flood Warning: Imminent
threat - A flash flood is occurring or
will occur soon; seek higher ground
on foot immediately.
Equipping
Get emergency supply kits and keep them in shelter
locations
Training and Exercises
Ensure that all workers know what to do in case of an
emergency.
Practice evacuation plans on a regular basis.
Update plans and procedures based on lessons learned
from exercises.
66. Here are some guidelines for being prepared for disasters.
Organization is Key
In order to prepare for disasters, natural and other, it is important that healthcare
organizations have a disaster plan that is well documented and that they practice the
steps they will take. The most important piece of disaster preparedness is making sure
the patients are properly taken care of including their diagnosis, treatment, and follow
up. For this to happen, healthcare organizations must have a method of entering the
patient into their “system” so the procedures and care process can begin.
During disaster scenarios, typical procedures such as looking up patients in the master
index will not be possible, especially if the individual comes in unconscious. Instead, a
numbering system can be used as a temporary measure to get the patient entered. The
patient access and financial services personnel will be able to follow up once crisis has
subsided.
Collaborative Efforts Needed
Staffing needs will increase during a disaster. A properly prepared disaster plan for a
healthcare organization includes having access to a backup or reserve medical and
administrative staff network. The credentialing committee can implement a policy for
temporary privileges during emergency or disaster situations.
67. Prepare, Plan, Practice, Repeat
Advanced planning and practice is necessary so that when an emergency arises the
healthcare staff is prepared for it.
Organizing flood disaster preparedness drills similar to the practice for fire drills.
Walking through an emergency operations plan in advance of a real situation allows
the personnel to encounter problems that could occur during a real disaster and
allows for further refinement of the processes.
Executive leadership should consider allocating funds in advance for additional
resources during disasters.
Think outside of the box when anticipating needs.
For example, if the area is flooding and water has been contaminated and power is
off for a lengthy period, the people nearby may depend on the nearest hospital to
provide for their basic needs, especially if that hospital is one of the highest points in
the area. This may require bringing in a tractor-trailer with a tank full of water.
(Disaster planning should also include situations where the healthcare facility itself is
the victim of a disaster rather than the place where the victims can come for
treatment and refuge.)
70. An earthquake (also known as a quake, tremor or temblor) is the shaking of
the surface of the Earth resulting from a sudden release of energy in
the Earth's lithosphere that creates seismic waves.
Earthquakes can range in size from those that are so weak that they cannot be
felt to those violent enough to propel objects (and people) into the air, and wreak
destruction across entire cities.
The seismicity, or seismic activity, of an area is the frequency, type, and size of
earthquakes experienced over a period of time.
What is Earthquake?
71. Earthquakes are associated with significant mortality and morbidity within the community.
Fatal injuries commonly occur within the first minutes to 24 h of the earthquake.
The most common causes of deaths are usually head and/or chest injuries.
Other causes of death include asphyxia, crush syndrome and hemorrhagic shock.
Injured survivors usually have lower limb fractures.
Time is precious, as every minute could mean saving or losing lives.
Delays in the transport of victims to the nearest referral hospital by land ambulance due to
blocked roads directly impacts the chances of survival and recovery of the injured victims.
Air transportation obviously provides the best option for expeditious evacuation and
reduction of fatalities.
Earthquake Associated Morbidity & Mortality
72. Hospitals located within or near the epicenter, or in a region close to the affected area, may
serve as referral treating centers. In case of an earthquake, the referral hospital should be well-
prepared to respond quickly and healthcare planners should consider following elements:
1. Geography— The location of the referral hospital should be chosen with great care. It should be away
from the seaside, volcanic regions, and mountains, and should be near to and accessible by main roads.
2. Building Structure— Infrastructural developments have made available highly developed materials
capable of absorbing seismic waves during earthquakes and greatly decreasing the risk of sudden
collapse and giving occupants ample time to evacuate a building. This technology should be used in
hospitals located in high risk zones. In addition, such hospitals should have its own well-maintained
power and water resources and a helipad.
3. Medical and Paramedical Staff— The medical and paramedical staff should be qualified and well-
trained in responding to different types of injuries, including burns. There should be enough staff
members available 24 x 7.
4. Communication— An effective and proven network of satellite or cable communication should be
available to connect locally, nationally and internationally.
Hospital Preparedness
73. Cont….
5. Transportation—Air transportation is the method of choice. Therefore, special arrangements should be
made to plan for helicopter and aircraft transportation.
6. Education, Training, and Drills—Education and training are key. All staff members should understand
the nature and consequences of an earthquake. They should be familiar with all scientific terms used
internationally. Drills should be conducted frequently, and a regional drill should occur biannually.
Continuous training enables hospital staff to be prepared to respond quickly and appropriately. A ready, well-
informed, and well trained hospital staff is associated with drastic reduction in fatalities during such a
disaster.
7. Coordination Network- National, Regional, and International Coordination and Cooperation—Local
hospitals can become overwhelmed with quake victims. Therefore, it is essential to establish a network of
coordination at regional, national and even international levels between different healthcare providers or
organizations. The coordinating network members must meet and interact regularly, as meeting for the first
time during a disaster may cause confusion and delay in providing need-based services for victims
8. Aftermath— Regular follow-up of the cases is important as many of the victims as well as medical and
paramedical staff may experience post traumatic stress disorder (PTSD) and require psychological
counseling.
9.Documentation- All details of events should be well documented for extraction of data and facts to
draw lessons that can be presented at a latter day debrief and improve hospital response in future
catastrophes
74. Cont…
10. Research – Research is vital, especially in preventing or reducing risks and injuries.
Hospital Incident Command System (HICS) must be evolved to coordinate action during a major disaster.
The HICS is a standardized on-scene emergency management organization specifically designed to provide
for the demands of single or multiple incidents, without being hindered by jurisdictional boundaries.
It is the combination of facilities, equipment, personnel, procedures, and communications operating within
a common organizational structure, designed to aid in the management of resources during incidents.
The system includes defined responsibilities and reporting channels and uses common language to
promote internal and external communication and integration with community responders.
75. 1. Establishing a clear chain of command to manage all routine and planned events of any size or
type.
2. Integrating personnel from different agencies or departments into a common command structure
that effectively addresses issues and delegates responsibilities
3. Providing needed logistical and administrative support to operational personnel
4. Eliminating duplication of efforts .
5. Using clear language – eliminating industry codes/terms while managing an emergency situation .
6. Communication with the Medical Director of a hospital about the following.
7. Type and location of incident
8. Number and condition of expected patients and/or expected patients for evacuation
9. Estimated arrival time or departure time from facility
10. Unusual or hazardous environmental exposure
11. Requesting staffing assistance from the labor pool to determine hazard and safety information
critical to treatment and evacuation of patients.
12. Ensuring that patient identification and tracking practices are being followed. Communicating and
coordinating with logistics department to determine medical care equipment and supply needs,
transportation availability and needs (carts, cribs, wheel chairs, etc.) and ensuring that appropriate
standards of care are being followed in the clinical areas as appropriate for the emergency.
13. Ensuring that all attempts have been taken to reach patient family members if not on site to notify
them of the evacuation.
14. Liaising with media and public information domains to provide details of evacuation process.
The core principles of an Incident Command System are as follows:
76. There are several critical issues that need to be considered when evacuating a hospital:
1. Nature of threat
2. Risk to patients
3. Risk to staff and visitors
4. Need for continuing acute care
5. Demands for supplies
6. Demands for resources
In the event of a major quake, the hospital’s maintenance supervisor must assess the impact
and initiate corrective action to restore any damaged system to normal operational modes
expeditiously.
If the building or a portion of the building is deemed unsafe a partial or total evacuation will
be decided upon and the evacuation plan implemented.
Individual departments have the responsibility to report all life threatening situations to the
administrative staff immediately for assessment and corrective action.
Hospital Evacuation
77. The intensity of the seismic activity will determine the type of evacuation required as follows:
Horizontal - to an adjacent, safer site OR/AND
Vertical - Down ramps or stairs using cribs, stretchers, wheeled trolleys, vest pockets and
physical carriage methods.
Moving the most severely ill patients first, offers the advantage of lessening the burden on
hospital staff, since the patients who are the most seriously ill require the most resources.
Since resources are rapidly depleted after an earthquake, it makes sense to start by
transferring the patients whose care requires the greatest resources.
In the event of an immediate threat to patients' safety fearing the collapse of hospital
buildings, efficient evacuation is mandatory when the healthiest patients may be preferably
evacuated first, as this strategy permits the evacuation of large numbers of patients in a short
time.
Evacuation of the healthiest patients first is an effective strategy when speed is essential,
moving all patients through the stairwells using improvised transport devices such as blankets,
backboards, and mattresses.
Using these low cost alternatives, it may not be necessary to purchase specialized devices as
stair chairs, infant carriers, and earthquake slides.
Building inspectors may be consulted to confirm the integrity of hospital structures prior to
evacuation and before moving back in.
Evacuation Modes
Evacuation Protocols
78. A general approach to be followed in the event of an earthquake is as follows:
1. Remain calm. Do not panic or run through or outside the building. The greatest point of
danger is just outside doorways and close to outer structure walls due to the hazard of falling
debris.
2. If you are in the building, remain where you are. If possible, take cover under a desk, table,
or bench, or in doorways, hallways, or against inside walls. These areas are the most sound
structurally during an earthquake.
3. Keep visitors, patients, and other employees out of stairwells and elevators.
4. Reassure and assist patients and visitors.
5. DO NOT ABANDON YOUR PATIENTS.
6. If you are outside, stay away from the building. Stay clear of walls, electric poles, downed
wires, and trees. Check all utilities and electrical equipment and use telephones only for
emergencies.
7. Above all, use good judgment.
8. Following the earthquake employees shall assess damages specific to their assigned areas
and report all hazards to their supervisor. This information shall be reported to administration
for revaluation and corrective action.
79. A specific approach for patient evacuation is as follows:-
Move the least acute, most stable first .
Apply identity tags for all those being shifted .
Bag ventilate those dependent on ventilator and administer oxygen using portable oxygen
cylinders for those who need continuous oxygen administration.
Disconnect non essential I/V fluids or hand push i/v fluids using large syringe in transit
Improvisation during the disaster following the loss of electrical power includes patient
ventilation using Ambu bags, monitoring electrocardiograms of unstable patients using
defibrillator paddles, titrating IV rates using IV flow-rate devices like dial-a-drip etc, using
cell phones as light sources, using piston syringes fitted with cannulae for suctioning .
Monitor by hand or auscultation or utilize battery powered monitoring devices in transit
Wean I/V fluids where possible .
Connect chest tubes to an underwater seal drain assembly.
Gastric decompression can be maintained by aspiration with a syringe .
Drape infants with bonnets and blankets/ aluminum foil. For infants requiring additional
thermoregulation, chemical warming mattresses can be used. This should be covered with
a blanket prior to placing infant on it.
87. WHAT IS ACCIDENT ?
An accident is an unplanned event that sometimes has convenient or undesirable
consequences, other times being inconsequential. The term implies that such an event may
not be preventable since its antecedent circumstances go unrecognized and unaddressed.
Chemical spills commonly result from the
unsafe handling of chemicals, improper chemical
storage, chemical storage tank ruptures,
improper containers for chemical disposal, and
failure to dispose of chemicals in a timely
manner.
The successful management of a spill is
dependent upon the information about the
chemical and its ability to immediately impact
human health, groundwater, surface water, and
soils that the responders possess.
WHAT IS CHEMICAL SPILLS ?
88. Types Of Accidents :
Physical
Physical examples of accidents include unintended motor
vehicle collisions or falls, being injured by touching
something sharp, hot, dropping a plate, accidentally kicking
the leg of a chair while walking, unintentionally biting one's
tongue while eating, accidentally tipping over a glass of
water, contacting electricity or ingesting poison.
Non-physical
Non-physical examples are unintentionally revealing
a secret or otherwise saying something incorrectly,
accidental deletion of data, forgetting an appointment etc.
Accidents By activity
Accidents during the execution of work or arising out of it
are called work accidents
Accidents By vehicle
89. ISSUES TO BE ADDRESSED BY HOSPITAL
1. Surge capacity for additional space for treatment and evaluation.
2. Medication and supply stockpiles
3. Structural integrity
4. Trained staff
5. Response protocol and proper disaster response procedures. 6. Functional hospital based
disaster plan
Role of Hospital in Disaster Management
• A disaster will involve the entire hospital there will be increased demands upon equipment
and personnel
• The hospital’s response will have to be managed and coordinated
• Staff will need to be supported throughout response and recovery.
Steps in MCI Management
1. Triage
2. Primary Survey
3. Secondary Survey
4. Treatment
5. Documentation
90. Definition-
A method of quickly identifying victims who have immediately life-threatening injuries AND who
have the best chance of surviving.
• Aim of triage : To achieve the greatest good for the greatest number of casualty
Types of Triage
1. M.A.S.S. Triage : based on patients ability to move
2. S.T.A.R.T. Triage : determines severity of injuries
3. Advanced Triage : More fully assess injury priority
Concept of “Golden Hour”
• Golden Hour is a concept of trauma care developed by Dr Adams Cowley
• Refers to the amount of time from injury to definitive care that should be allotted to maximize
survival from traumatic injury.
• Most studies have shown, if care given within first hour of injury morbidity and mortality can
be reduced.
91.
92.
93. Primary Survey
• The first survey done to assess the life
threatening injuries and simultaneous treatment.
• Primary survey must be performed in no more
than 2-5 minutes.
Component of Primary survey :
ABCDE
• A = Airway with C spine
• B = Breathing
• C = Circulation
• D = Disability
• E = Exposure
94. Secondary survey
When the primary survey is completed, resuscitation efforts are well established, and the vital
signs are normalizing, the secondary survey can begin.
The secondary survey is a head-to-toe evaluation of the trauma patient, including a
complete history and physical examination, including the reassessment of all vital signs. Each
region of the body must be fully examined.
X-rays indicated by examination are obtained.
If at any time during the secondary survey the patient deteriorates, another primary survey is
carried out as a potential life threat may be present.
The person should be removed from the hard spine board and placed on a firm mattress as
soon as reasonably feasible as the spine board can rapidly cause skin breakdown and pain while
a firm mattress provides equivalent stability for potential spinal fractures
96. Disasters: Chemical Accidents and Spills
By their nature, the manufacture, storage, and transport of chemicals are
accidents waiting to happen. Chemicals can be corrosive, toxic, and they may
react, often explosively. The impacts of chemical accidents can be deadly, for
both human beings and the environment.
The source of many of these chemicals is petroleum, which is refined into
two main fractions: fuels and the chemical feedstock's that are the building
blocks of plastics, paints, dyes, inks, polyester, and many of the products we
buy and use every day.
Of the more than forty thousand chemicals in commercial use, most are
subject to accidental spills or releases. Chemical spills and accidents range
from small to large and can occur anywhere chemicals are found, from oil
drilling rigs to factories, tanker trucks to fifty-five-gallon drums and all the way
to the local dry cleaner or your garden tool shed.
Some of the most common spills involve tanker trucks and railroad tankers
containing gasoline, chlorine, acid, or other industrial chemicals.
Many spills occur during the transportation of hazardous materials
98. A train derailment near Milligan, Florida. The train carried chemicals, which were spilled
at the site.
99. To help emergency responders know what they are dealing with, the Department of
Transportation (DOT) has established a hazardous materials placard system.
The placard system is as follows:
Hazard class 1: Explosives (class 1.1-1.6, compatibility groups A–L)
Hazard class 2: Gases (nonflammable, flammable, toxic gas, oxygen, inhalation hazard)
Hazard class 3: Flammable liquids
Hazard class 4: Flammable solids (flammable solid, spontaneously combustible,
dangerous when wet)
Hazard class 5: Oxidizer and organic peroxide
Hazard class 6: Toxic/poisonous and infectious substances labels (PG III, inhalation
hazard, poison, toxic)
Hazard class 7: Radioactive (I, II, III, and fissile)
Hazard class 8: Corrosive
Hazard class 9: Miscellaneous dangerous goods
100. Rail cars and trucks carrying toxic or dangerous materials must display a diamond-shaped
sign having on it a material identification number, which can be looked up to determine what
hazardous materials are on board, and a hazard class number and symbol that tells whether
the contents are flammable, explosive, corrosive, etc.
Color codes also convey instant information:
blue (health),
red (flammability),
yellow (reactivity),
white (special notice).
REASONS FOR CHEMICAL DISASTER
•Human Error
•Improper Training
•Manufacturing Defects
•Improper Maintenance
•Equipment Failure
•Ignoring Warning Signs
101.
102. How Are Chemical Accidents Handled?
• Emergency response personnel are involved in assessing the risk of hazardous material
releases and working to avoid any harmful effects.
• Teams of workers evaluate the concentrations of the chemicals, where and how people
might be exposed, and potential toxic effects on the exposed people.
• If rapid spill cleanup is necessary, the emergency response team designs and implements
cleanup measures to protect exposed populations and ecosystems from toxic responses.
chemical incident zoning
103. 1. Legal/Institutional framework
• Regulatory provision/governance on labeling of hazardous substances/chemicals are
needed.
• Reporting system for chemical storage/handling and accidents/release has to be
harmonized and in common format in all the districts of the states, and in all the states/
UTs in the country.
• Legal framework for management of chemicals is already existing, the implementation is
main challenge.
• Need to dovetail the existing regulatory provisions with Disaster Management Act, 2005.
2. Tools and techniques in CDM
• Integration of safety risk assessment provisions in all environmental appraisal and site
clearance tools/process and developmental planning process
• Emphasis on health risk assessment of product and process to be given adequate
significance and practice
• A web based Chemical Accident Information and Reporting System developed by the NIC
with the support of MoEF needs wider demonstration for creating the data base on
chemical accident
104. 3. Risk Management Integration to Development
• Integration of chemical accident risk in multi-hazard risk assessments, land-use planning,
impact assessment studies, State/District DM plans, and visualization of total chemical risk at
spatial scales
• Consideration of chemical risk hotspots and vulnerability in urban management and
environmental governance of commercial, semi-urban and industrial areas
4. Capacity building needs and Options
• Strengthening the offices of the CIF/DISH and their Regional Offices responsible for
implementing the provisions of MSIHC Rules 1989.
• Strengthening of the National Institutes/agencies for training/education, research and
dissemination of information pool with a nationwide network
• Capacity strengthening of the Ministry of Environment with a dedicated Directorate/ Division
on Disaster Management
5. Information management & Knowledge networking
• Need for a common Information Management System on hazardous chemicals, location/
mapping, processes, storage, handling, decontamination, etc.
• A knowledge center to be created as a pool of relevant information resources including failure
data, reports, accident analysis records, etc.
• The Phase-Ill of GTS based Emergency Planning and Response System which involves
application of remote Sensing and GIS for vulnerability assessments and risk mapping be
extended to cover all districts having MAH units.
