Disaster Emergencies
Content
Introduction The shocking memories of Bhopal gas tragedy of 1984, the Latur earthquake of 1993, Gujarat earthquake of 2001 and the T sunami calamity of 2004 have not faded from our minds. Those disasters killed and incapacitated tens of thousands of people and destroyed properties worth crores of rupees. Definition A “hazard” can be defined as any phenomenon that has the potential to cause disruption or damage to people and their environment. Meaning of disaster D : Detection I : Incident command S : Safety and security A : Assess S : Support T : Traige and treatment E : Evaluation R : Recovery Classification of Disaster Disatser has been classified as natural and man made disasters. There is a complex relationship between them Natural Disasters: Flood, cyclones, earthquakes, land slides, wind storm, epidemic and droughts. Man made disasters; Fire, explosion, accidents of aircraft or ships, ordinary bombing, terrorism, riots and violence. Life of an individual: In general any emergency management is the continuous process by which all individuals, groups and communities manage hazards in an effort to avoid or ameliorate the impact of disasters resulting from the hazards.
Medical treatment for large number of casualities is likely to be needed only after certain types of disasters. Most injuries are sustained during the impact and thus greatest need for emergency care occurs in the first few hours. Most immediate help comes from the uninjured survivors. The principle of “first come, first treated” is not followed in mass emergencies. Emergency care is looking for airway, breathing, circulation, disability and exposure. A- Airway Assessment of airway is always an initial step in any care, because of the potential for cervical spine injury, airway is assessed. Maintain the head and neck in natural position, while placing a rigid cervical collar and immobilizing the patient on a long spine board.
Listen for vocalizing indicating air movements. If vocalization is absent open the patients airway using a chin- lift or modified jaw -thrust maneuver. Examine the oropharynx. The airway may be partially or entirely obstructed by fluids. Innerve as appropriate (digital removal and repositioning) B-Breathing To assess breathing, observe for spontaneous respirations and note their rate, depth and effort. Examine the chest wall for use of accessory muscles. Visually inspect the thorax. Always assume uncooperative or restless patients are hypoxic, provide supplemental oxygen, most of the victim’s breath a little faster than normal (18 to 24 respirations/min). In the presence of abnormal respiratory effort. (Nasal flaring, supra sternal, inter costal or substernal retractions the airway may be partially obstructed. Rate: Slow (below 10 respirations/ minute) Rapid (above 26 respirations/minute) C- Circulation: This involves evaluation of bleeding, pulses and perfusion. Bleeding: Inspect for signs of external blood loss and apply direct pressure of the effected area. If possible elevate hemorrhaging extremities above the level of heart. Large amounts of blood can be lost internally. When is a person heavily bleeding push clear cotton into the wound and hold if firmly. Pulse; Palpate carotid, radial and femoral pulse. Check the circulation of a person when his heart is beating by checking the pulse rate at side of the neck. Perfusion Several non-specific sign include clammy skin, pallor, cyanosis, may indicate the presence of hypovolemic shock. Assess for skin colour, temperature, presence of diaphoresis and capillary refill. D-Disability: Check the papillary size, shape, equally reacting to light. Assess patients neurological status like awake, unresponsive, verbal stimuli, unresponsive to pain. E- Exposure and environmental control: Completely and rapidly remove the patients clothing to assess for injuries, hemorrhage or other abnormalities. Observe the clients overall general appearance, body position, presence of any odors like urine. First aid kit: Assemble a first aid kit for your home and one for each car. A first aid kit should include: Sterile adhesive bandages in assorted sizes Assorted sizes of safety pins Cleansing agent/ soap Latex gloves (2 pairs) 2-inch sterile gauze pads (4-6) 4- inch sterile gauze pads (4- 6) triangular bandages (3)
2 - inch roller bandages (3 rolls) scissors syringes antiseptic thermometer tube of petroleum jelly or other lubricant Non prescription drugs: aspirin or non aspirin pain reliever anti- diarrhea medications antacid ( for stomach upset) laxative Equipment Certain equipment and materials should be earmarked for dealing with disaster. They must be checked periodically. Oxygen cylinders with pressure gauge flow meters and masks. Spanner for opening Stretchers, wheelchairs and trolleys Splints Medications which include, antibiotics such as ciprofloxacin and intravenous, Tab doxycyclines, bronchial dilators, other fluroquinolones, (oral and intravenous). IV fluids with sets, blood sets for collection of blood. Dressing and suture materials Instruments for dressing, gloves, face masks, colour tags and ambulance must be kept ready. The ambulance equipment includes; Airway management Ventilation device Suctioning unit Oxygen delivery Basic wound care supplies, splinting supplies. Medications Patient transfer equipment Personal safety equipment Communication: Communication is essential during emergency response nurse may serve as communication link between: 1. the hospital and health department 2. with the anxious relatives and friends of the victims 3. with the public 4. with the authorities and 5. with media one leaders should be identified who will issue instructions. Usual sequence: 1. information received at the health care (situation) institutions.
2. the team leader and members of the team are informed. 3. the team gets ready and is in position with all the necessary facilities. 4. victims are received 5. preliminary examination and sorting (triage). Colour Coding; black tags indicates victims who are already dead. Red tags indicate top priority who have life threatening injuries but who can stabilized and have high probability of survival. Priority is given to injured rescue workers, hysterical persons and children. Yellow indicate second priority are assigned to victims with injuries with systematic complications who are able to withstand a wait of 45 to 60 minutes, for medical attention also for victims who have poor chance of survival. Green tags indicate victims with local injuries without immediate systematic complications who can wait several hours for treatment. Protect the people and loss of property: Turn off the electricity to reduce the risk of electrocution As soon as the disaster begins, take any vulnerable people (children, the old, the sick and the disabled) to a safe place. Whenever possible, move personal belonging upstairs or go to raised shelters provided for use. Listen to the information and advise provided by the authorities. Avoid storing heavy objects and materials in high positions. Comply with the authorities instructions and do not go out until there is no longer any risk. Carry out necessary decontamination measures. Immediate transportation of victims: Triage is the only approach that can provide maximum benefit to the greater number of injured in a major disaster situation. The most common classification uses intentionally accepted four color code system, red indicates high priority treatment or transfer, yellow signals medium severity, green indicates ambulatory patients and black for dead or moribund patients. Triage should be carried out at the risk of disaster, in order to determine transportation priority, and admission to the hospital or treatment centre, where the patients needs and priority of medical care will be reassessed. Hospital administrators should always be at hand, even if she/he is not the leader of the team. The administrator’s presence lends support to the team. And he/she is ready to ensure that the entire hospital and its resources are at the service of the afflicted Phases and professional activities; The nature of emergency management depends on local economic and social conditions. Some disasters are economic. Experts such as cuny have long noted that the cycle of emergency management must include long term work on infrastructure, public awareness and even human justice issues. This is particularly important in developing nations. The process of emergency management involves four phases: 1.mitigation
2. preparedness 3. response and 4. recovery. Preparedness phase: In the preparedness phase, emergency managers develop plans of action for when the disasters strikes. Common preparedness measures include the Communication plans with easily understandable terminology and methods. Development and practice of multi -agency coordination and incident command Proper maintenance and training of emergency services, including mass human resources such as community emergency response teams. Development and exercise of emergency population warning methods combined with emergency shelters and evacuation plans. Stockpiling, inventory and maintenance of supplies and equipment. An efficient preparedness measure is an emergency operation centre (EOC) combined with a practice region. Wide doctrine such as the incident command system for managing emergencies. Another preparedness measure is to develop organizations of trained volunteers among civilian populations. Professional emergency workers are immediately overwhelmed in mass emergencies, so trained, organized, responsible volunteers can be extremely valuable. One notable system is the community emergency response team. Another is the Red Cross. If volunteers are organized, trained in the incident command system, and agree to mobilize, experience in the red cross, and California communities has shown that they can be utilized in responsible positions, including as staff in EOCs. Another aspect of preparedness is casualty prediction, the study of how many deaths or injuries to expect for a given kind of event. This gives planners an idea of what resources need to be in place to respond to a particular kind of event. Physiological needs during Disaster: 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. The immediate steps for ensuring that the food relief programme will be effectively includes a) Assessing the food supplies after the disaster. b) Gauging the nutritional needs of the effected population. c) Calculating the daily food rations and need for large population groups and d) Monitoring the nutritional status of the affected population. Water Supply: The main public safety aspect of water quality is microbial contamination. The first priority of ensuring water quality in emergency situation is chlorination. It is the best way of disinfecting water.It is advisable to increase residual chlorine level to about 0.2- 0.5 mg/litre. The existing and new water sources require the following protection measures.
1. restrict access to people and animals, if possible, erect a fence and appoint a guard 2. ensure adequate excreta disposal at a safe distance from water source 3. prohibit bathing, washing and animal husbandry, upstream of intake points in rivers and streams. 4. upgrade wells to ensure that they are protected from contamination and 5. estimate the maximum yield of wells and necessary, ration the water supply. In many emergency situations, water has to be tracked to disaster site or camps. All water tankers should be inspected to determine fitness and should be cleaned and disinfected before transporting water. Conclusion: Disaster events will continue to occur. The risks, hazards and vulnerability will vary. Disaster preparedness provides the opportunity to plan, prepare and when need arises enables national response
Medical treatment for large number of casualities is likely to be needed only after certain types of disasters. Most injuries are sustained during the impact and thus greatest need for emergency care occurs in the first few hours. Most immediate help comes from the uninjured survivors. The principle of “first come, first treated” is not followed in mass emergencies. Emergency care is looking for airway, breathing, circulation, disability and exposure. A- Airway Assessment of airway is always an initial step in any care, because of the potential for cervical spine injury, airway is assessed. Maintain the head and neck in natural position, while placing a rigid cervical collar and immobilizing the patient on a long spine board.
Listen for vocalizing indicating air movements. If vocalization is absent open the patients airway using a chin- lift or modified jaw -thrust maneuver. Examine the oropharynx. The airway may be partially or entirely obstructed by fluids. Innerve as appropriate (digital removal and repositioning) B-Breathing To assess breathing, observe for spontaneous respirations and note their rate, depth and effort. Examine the chest wall for use of accessory muscles. Visually inspect the thorax. Always assume uncooperative or restless patients are hypoxic, provide supplemental oxygen, most of the victim’s breath a little faster than normal (18 to 24 respirations/min). In the presence of abnormal respiratory effort. (Nasal flaring, supra sternal, inter costal or substernal retractions the airway may be partially obstructed. Rate: Slow (below 10 respirations/ minute) Rapid (above 26 respirations/minute) C- Circulation: This involves evaluation of bleeding, pulses and perfusion. Bleeding: Inspect for signs of external blood loss and apply direct pressure of the effected area. If possible elevate hemorrhaging extremities above the level of heart. Large amounts of blood can be lost internally. When is a person heavily bleeding push clear cotton into the wound and hold if firmly. Pulse; Palpate carotid, radial and femoral pulse. Check the circulation of a person when his heart is beating by checking the pulse rate at side of the neck. Perfusion Several non-specific sign include clammy skin, pallor, cyanosis, may indicate the presence of hypovolemic shock. Assess for skin colour, temperature, presence of diaphoresis and capillary refill. D-Disability: Check the papillary size, shape, equally reacting to light. Assess patients neurological status like awake, unresponsive, verbal stimuli, unresponsive to pain. E- Exposure and environmental control: Completely and rapidly remove the patients clothing to assess for injuries, hemorrhage or other abnormalities. Observe the clients overall general appearance, body position, presence of any odors like urine. First aid kit: Assemble a first aid kit for your home and one for each car. A first aid kit should include: Sterile adhesive bandages in assorted sizes Assorted sizes of safety pins Cleansing agent/ soap Latex gloves (2 pairs) 2-inch sterile gauze pads (4-6) 4- inch sterile gauze pads (4- 6) triangular bandages (3)
2 - inch roller bandages (3 rolls) scissors syringes antiseptic thermometer tube of petroleum jelly or other lubricant Non prescription drugs: aspirin or non aspirin pain reliever anti- diarrhea medications antacid ( for stomach upset) laxative Equipment Certain equipment and materials should be earmarked for dealing with disaster. They must be checked periodically. Oxygen cylinders with pressure gauge flow meters and masks. Spanner for opening Stretchers, wheelchairs and trolleys Splints Medications which include, antibiotics such as ciprofloxacin and intravenous, Tab doxycyclines, bronchial dilators, other fluroquinolones, (oral and intravenous). IV fluids with sets, blood sets for collection of blood. Dressing and suture materials Instruments for dressing, gloves, face masks, colour tags and ambulance must be kept ready. The ambulance equipment includes; Airway management Ventilation device Suctioning unit Oxygen delivery Basic wound care supplies, splinting supplies. Medications Patient transfer equipment Personal safety equipment Communication: Communication is essential during emergency response nurse may serve as communication link between: 1. the hospital and health department 2. with the anxious relatives and friends of the victims 3. with the public 4. with the authorities and 5. with media one leaders should be identified who will issue instructions. Usual sequence: 1. information received at the health care (situation) institutions.
2. the team leader and members of the team are informed. 3. the team gets ready and is in position with all the necessary facilities. 4. victims are received 5. preliminary examination and sorting (triage). Colour Coding; black tags indicates victims who are already dead. Red tags indicate top priority who have life threatening injuries but who can stabilized and have high probability of survival. Priority is given to injured rescue workers, hysterical persons and children. Yellow indicate second priority are assigned to victims with injuries with systematic complications who are able to withstand a wait of 45 to 60 minutes, for medical attention also for victims who have poor chance of survival. Green tags indicate victims with local injuries without immediate systematic complications who can wait several hours for treatment. Protect the people and loss of property: Turn off the electricity to reduce the risk of electrocution As soon as the disaster begins, take any vulnerable people (children, the old, the sick and the disabled) to a safe place. Whenever possible, move personal belonging upstairs or go to raised shelters provided for use. Listen to the information and advise provided by the authorities. Avoid storing heavy objects and materials in high positions. Comply with the authorities instructions and do not go out until there is no longer any risk. Carry out necessary decontamination measures. Immediate transportation of victims: Triage is the only approach that can provide maximum benefit to the greater number of injured in a major disaster situation. The most common classification uses intentionally accepted four color code system, red indicates high priority treatment or transfer, yellow signals medium severity, green indicates ambulatory patients and black for dead or moribund patients. Triage should be carried out at the risk of disaster, in order to determine transportation priority, and admission to the hospital or treatment centre, where the patients needs and priority of medical care will be reassessed. Hospital administrators should always be at hand, even if she/he is not the leader of the team. The administrator’s presence lends support to the team. And he/she is ready to ensure that the entire hospital and its resources are at the service of the afflicted Phases and professional activities; The nature of emergency management depends on local economic and social conditions. Some disasters are economic. Experts such as cuny have long noted that the cycle of emergency management must include long term work on infrastructure, public awareness and even human justice issues. This is particularly important in developing nations. The process of emergency management involves four phases: 1.mitigation
2. preparedness 3. response and 4. recovery. Preparedness phase: In the preparedness phase, emergency managers develop plans of action for when the disasters strikes. Common preparedness measures include the Communication plans with easily understandable terminology and methods. Development and practice of multi -agency coordination and incident command Proper maintenance and training of emergency services, including mass human resources such as community emergency response teams. Development and exercise of emergency population warning methods combined with emergency shelters and evacuation plans. Stockpiling, inventory and maintenance of supplies and equipment. An efficient preparedness measure is an emergency operation centre (EOC) combined with a practice region. Wide doctrine such as the incident command system for managing emergencies. Another preparedness measure is to develop organizations of trained volunteers among civilian populations. Professional emergency workers are immediately overwhelmed in mass emergencies, so trained, organized, responsible volunteers can be extremely valuable. One notable system is the community emergency response team. Another is the Red Cross. If volunteers are organized, trained in the incident command system, and agree to mobilize, experience in the red cross, and California communities has shown that they can be utilized in responsible positions, including as staff in EOCs. Another aspect of preparedness is casualty prediction, the study of how many deaths or injuries to expect for a given kind of event. This gives planners an idea of what resources need to be in place to respond to a particular kind of event. Physiological needs during Disaster: 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. The immediate steps for ensuring that the food relief programme will be effectively includes a) Assessing the food supplies after the disaster. b) Gauging the nutritional needs of the effected population. c) Calculating the daily food rations and need for large population groups and d) Monitoring the nutritional status of the affected population. Water Supply: The main public safety aspect of water quality is microbial contamination. The first priority of ensuring water quality in emergency situation is chlorination. It is the best way of disinfecting water.It is advisable to increase residual chlorine level to about 0.2- 0.5 mg/litre. The existing and new water sources require the following protection measures.
1. restrict access to people and animals, if possible, erect a fence and appoint a guard 2. ensure adequate excreta disposal at a safe distance from water source 3. prohibit bathing, washing and animal husbandry, upstream of intake points in rivers and streams. 4. upgrade wells to ensure that they are protected from contamination and 5. estimate the maximum yield of wells and necessary, ration the water supply. In many emergency situations, water has to be tracked to disaster site or camps. All water tankers should be inspected to determine fitness and should be cleaned and disinfected before transporting water. Conclusion: Disaster events will continue to occur. The risks, hazards and vulnerability will vary. Disaster preparedness provides the opportunity to plan, prepare and when need arises enables national response
