1. DISASTER
MANAGEMENT
Professor Syed Amin Tabish
FRCP(London), FRCP(Edin.), FAMS, MD

2. Disasters: the
scenario
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A global problem: a major disaster
occurs somewhere in the world almost
on a daily basis
Affects the advances being achieved
health & socioeconomic development
Increased vulnerability to natural
disasters due to environmental
degradation, industrialization, pollution,
threat to biodiversity
Rapid climate change
Population explosion (overexploitation
of resources)

3. Disasters
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Ecological disruption
Loss of human life
Military expenditures: 6 month’s of world’s
arms spending would pay for a 10-year
program proving food & health services in
developing countries
Deterioration of health services
to warrant an extraordinary response
from outside the affected community or
area.
Result in significant morbidity

4. Diversity of the Planet
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The vastness and diversity of the planet
makes it difficult to build up an overall
picture of what needs to be done and the
impact of what has been done.
The same vast distances make it hard to
react rapidly and effectively to sudden
events - an earthquake - in parts of the
world with shifting populations and poor
communications.
New technology - fast bandwidth reliable
communications, the internet, high
resolution satellite imagery - can provide
support in these situations.

5. Classifying Disasters

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Natural: earthquakes, floods, fires,
hurricanes
Technological (number of nuclear
arsenals has exceeded 50,000), deadlier
weapons, laser-guided missiles, carpet
bombs, etc ……Hiroshima (Aug 6,1945) &
Nagasaki (Aug 19, 1945); Nuclear reactor
Accident in Chernobyl (Ukraine); Toxic
gas leak in Bhopal (India)…..improper
management of industrial technologies
Chemical & Biological Weapons
Complex Emergencies (conflict-related):
Afghanistan (2.5 m), Iraq (1991, 2004-6) –
hi-tech war [2,10,000 tons of bombs in 43
days dropped in 1991

6. Disaster Planning
 Pre-disaster:
the identification,
understanding & analysis of natural &
other hazards
 Disaster Management System: to
reduce the vulnerability of people to
damage (disaster prevention), injury and
loss of life & property resulting from
catastrophes; to prepare for prompt &
efficient rescue, care and treatment of
victims; response & recovery
 Disaster planning starts with community
awareness

7. Disaster Management
 Disaster
Preparedness: activities that are
carried out prior to the advance notice of a
catastrophe to facilitate the use of available
resources, relief & rehabilitation
 Disaster mitigation: ongoing effort to lesson
the impact disasters have on people &
property
 Disaster Management: the process of
addressing an event that has the potential to
seriously disrupt the social fabric of commun.

8. Pre-hospital Emergency
Preparedness
 Efficient
system of providing
prompt medical care to injured to
save many lives or limbs by
beginning treatment before the
patient reached the hospital:
CPR, ATLS, ACLS, closed chest
cardiac compression
 Emergency Medical Services
 Individual Protective Equipment

9. Natural Events
 Avalanches
 Cyclones
 Droughts
 Earthquakes
 Dust
 Sand
Storm
 Epidemic Diseases

10. Natural Disaster
 Famines
 Floods
 Heat
waves
 Hail Storms
 Hurricanes (Katrina, Rita)

11. Natural Disasters
Land
Slides
Severe Storms
Tornados
Tsunamis
Volcanic Eruptions

12. Man-made Disasters
 Air
Safety
 Fire Emergencies
 Nuclear Accidents & Radiation
(blast, heat)
 Hazardous material (chemical &
biological)
 Bioterrorism
 Conflict / Terrorism

13. BCW: possible weapons
against humans
Biological Agents:
Bacteria
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Bacillus Anthracis
Brucella Species
Bartonella QuintanaVibrio Cholerare
Plague
Fungi
-
Coccidiodes immitis
Viruses
-
Hanta virus
Ebola virus
Smallpox
Protozoa
- Naeglaeria fowleri

14. BCW
Routes of exposure
Inhalation hazard (Respiratory System)
 Contact hazard (Skin)
 Digestive system (contaminated food or
drinking water)
Degree of hazard will depend on the agent &
amount released/method by which agent is
disseminated
Biological agents have the ability to multiply
in the host
Chemical agents may be harassing agents,
incapacitating agents or lethal agents


15. Recent Outbreaks & Incidents
 Hurricane
(the USA)
 Avian Flu (
 Earthquakes (Pakistan)
 Floods (Bangladesh)
 Mad Cow Disease (the UK)
 Marburg Virus Hemorrhagic Fever
 Anthrax (the USA)
 Tsunamis (Indonesia, Sri Lanka)
 SARS (30 countries)

16. Earthquakes
 Surviving
an earthquake and
reducing its health impact
requires preparation, planning,
and practice.
 Far
in advance, you can gather
emergency supplies, identify and
reduce possible hazards in your
home, and practice what to do
during and after an earthquake.

17. How are avian, pandemic, and seasonal flu
different?

Avian Flu is caused by avian influenza
viruses, which occur naturally among
birds.

Pandemic Flu is flu that causes a global
outbreak, or pandemic, of serious illness
that spreads easily from person to
person.

Seasonal Flu is a contagious respiratory
illness caused by influenza viruses

18. What Injuries Occur Most Often?
The most severe injuries in
mass casualty events are
fractures, burns, lacerations,
and crush injuries. However,
the most common injuries
are eye injuries, sprains,
strains, minor wounds, and
ear damage.

19. Impact of Disasters
 Disasters
have a major impact on
the living conditions, economic
performance and environmental
assets and services of affected
countries or regions.
 Consequences may be long term and
may even irreversibly affect
economic and social structures and
the environment

20. Impact
 In
industrialized countries, disasters cause
massive damage to the large stock of
accumulated capital while losses of human
life are limited due to the availability of
effective early warning and evacuation
systems, as well as better urban planning
and the application of strict building codes
and standards.
 In developing countries, on the other
hand, fatalities are usually higher
owing to the lack or inadequacy of
forecast and evacuation programmes.

21. Impact
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Whether disasters are essentially natural or
man-made in origin, their consequences
derive from a combination of human action
and interaction with nature’s cycles or
systems.
Disasters can lead to widespread loss of life,
directly and indirectly (primarily or
secondarily) affect large segments of the
population and cause significant
environmental damage and large-scale
economic and social harm
the deterioration in the social well-being of the
population

22. Disaster Management
EMERGENCY
PREPAREDNESS

23. Goal of
Emergency Preparedness
To reduce:
loss
of lives
damage to property
impact on environment
impact on community

24. Activation of External
Disaster Plan
 Information
from the Red
Crescent Ambulance authorities
 Arrival of casualties without prior
warning
 Doctor on Duty to inform ED Chief
 ED Chief to contact the Disaster
Executive Committee (Hospital
Director, Executive Director,
Medical Director, Nursing
Director)

25. Activation of External
Disaster Plan
 Disaster
Executive Committee
[DEC] will assess the situation &
determine the activation of the
plan
 DEC to initiate Code Black/Green
through the Switchboard
 Switchboard will start Page
announcement for Code Black,
Bleep 555 for all concerned

26. Activation of DM Plan
 Beep
to Transport Department for
arranging 2 Ambulances
 Advise Transport Section to send
Ambulances around the hospital
housing to alert residents about
disaster
 To send cars to commute staff
 Contact all other DM personnel
 Inform Nursing Director to arrange
nurses

27. Activation of the plan
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Chief of each department to arrange
return of off-duty personnel
Ambulance to commute 2 medical teams
(disaster Site triage team) to site of
disaster
Other departments (radiology, Labs,
Blood Bank, Pharmacy, Medical Records,
Patient Services, Security, Emergency
Supplies, Nutrition, etc will activate their
DM plan
Security personnel to regulate traffic to
& from the Reception area

28. Main Disaster Teams
RESPONSIBILITIES

29. Disaster Executive
Committee
 Coordination
all Disaster Management
activates
 Coordinate all aspects of clinical
management
 Notify local authorities
 Receive regular updated progress of DM
 Media management
 To announce ‘All Clear’ at the end of
Disaster

30. Coordination Team
 Assess
the number of casualties
& Beds available
 Maintain contact with Triage
teams, Treatment teams & wards
 Allocate Medical staff in different
teams
 Give updated info to Disaster &
Executive Committee

31. Disaster Site Triage Team
 Triaging
patients (Red, Yellow,
Green, Black) to give priorities
for evacuation
 Inform the Disaster Executive
Committee about the situation to
take decision for activation of
Disaster Plan
 Give frequent updates on the
situation at the scene

32. Hospital Triage Team
Receiving
the Disaster
Patients
Screening (Triaging)
Transferring all incoming
disaster patients to
different treatment areas

33. Red Area Team
To
resuscitate, stabilize
patients on red area and
shifting them to
definitive care areas

34. Yellow Area Team
 To
resuscitate and stabilize
patients with serious non lifethreatening injuries
 Provide care to those patients
who are seriously injured and
likely to die
 Transferring resuscitated
patients to definitive care areas

35. Green Area Team
Care
of patients with
minimal injuries

36. ED Patients Team
Treating
of the
normal ED patients

37. Evacuation Team
Making
beds available for
casualties from the
disaster by bed expansion
and discharging current
cold patients

38. Evaluation Team
Monitoring
the
management of the
disaster and forward a
final report to the Chief of
the Disaster Management
Committee.

39. Triage Team
 Hospital
triage is team
responsible for:
 receiving the disaster
patients
 screening the disaster
patients
 transferring all incoming
disaster patients to different
treatment areas

40. Responsibility of the Yellow area team
 to
resuscitate patients with serious
non-life threatening injuries
 stabilize patients with serious nonlife threatening injuries
 to provide care to those patients
who are seriously injured and likely
to die
 transferring resuscitated patients
to definitive care areas

41. National Policy-making
 Risk
and vulnerability assessment
 Development of training
programmes
 Public health in disasters
 The management of programmes
involving refugees and internally
displaced people
 Shelter needs in disasters

42. National Policy-making
 The
development of disaster management
policy and plans
 Aspects of the management of disasters
resulting from conflict
 The role of the military in disaster
management
 The management of civil emergencies and
transport accidents
 Co-ordination in disaster management
 The establishment of control rooms

43. National Policy-making
 Leadership
and decision making
in disaster management
 Managing incidents involving
terrorism or civil unrest
 Crowd management
 The development context of
disaster management
 Disaster relief logistics

44. CBW
 Identify
the hazard
 Evaluate the hazard
 Introduce risk reduction strategies
(control contamination)
 Chemical detection & identification (lab
dx. By DNA based & othe molecular
methods)
 Risk communication & dissemination of
information
 Contamination control (entry & exit
control)

45. BCW
 Decontaminate
both materials &
persons
 Triage
 Medical care & evaluation of
casualties
 Definitive decontamination (a
final decontamination of the site)
 Command, control &
communication

47. Taste of Tears

52. THE CHANGING FACE OF
DISASTER MANAGEMENT

53. 
The confirmed death toll from the 7.6-magnitude
earthquake that was centered near Muzaffarabad,
the capital of Pakistan-controlled Kashmir (PcK) on
October 8 stands at over 73,000 in Pck and in
NWFP, while the unconfirmed death toll has climbed
to over 86,000. (Nov-8, AP, Dawn) Over 79,000
people injured and estimated 3 million displaced or
homeless. The earthquake affected nine districts in
total: Abbottabad, Batagram, Mansehra, Shangla,
and Kohistan in the North West Frontier Province
(NWFP) and Muzaffarabad, Neelum, Poonch and
Bagh in PcK.

54. India
 The
latest official death toll is 1,309 in Indiancontrolled Kashmir (IcK). Officially, 6,622
people reportedly injured and 150,000
displaced (Oct-17, AFP). Worst-hit areas are
around Tangdhar and Uri towns in Kupwara
and Baramulla districts respectively, along
the disputed Line of Control (LoC). Third
worst-hit area is Poonch district.

55. Tsunami

The overall focus of attention is on rebuilding and long-term recovery
and rehabilitation for the December 26, 2004 earthquake and tsunami
disaster. The dead and missing toll from tsunamis triggered by the
undersea earthquake measuring 9.0 on the Richter scale off the west
coast of Indonesia’s Sumatra Island was estimated to be some 232,000
people along the coastal areas of 12 countries in the Indian Ocean,
although a true toll will likely never be known. At least 1.7 million are
reported to be homeless with estimates over 2 million. Tsunami-related
deaths were recorded in Indonesia, Sri Lanka, India, Thailand,
Malaysia, Myanmar, Maldives, Bangladesh, Somalia, Tanzania, Kenya
and the Seychelles. The loss of life was particularly severe in Indonesia,
Sri Lanka, India and Thailand. Nearly 166,000 dead and missing are
from worst-hit Aceh province in Indonesia. The dead and missing toll in
Sri Lanka is nearly 39,000. In India, at least 10,672 died in Tamil Nadu
State and the Andaman and Nicobar Islands. The death toll in Thailand
is around 5,400, including about 1,953 foreigners from at least 36
countries. More than 400 combined deaths have been reported in the
other countries.

57. South Asia Earthquake
January 2005

58. South Asia earthquake (India)

77. Natural Disaster

78. Villages wiped out

79. Bodies recovered

80. Grim situation

82. Tsunami Catastrophe 2004-05

83. Tsunami: Satellite photos

84. Tsunami December 26 2004

85. Tsunami 2004/5: Indian Ocean

86. Tsunami: Indonesia

87. Tsunami

88. Tsunami Disaster of Indian
Ocean 2005
 It
is said that some kids were playing on a
bridge when suddenly the earthquake came,
the bridge broke down into 2 pieces, all those
kids went down inside the bridge and died.
The mothers of those kids were standing
besides the bridge and helplessly watching
their kids die.

89. Iraq Tsunami: body in
mortuary

90. Iraq: legs oeaten by dogs

91. Iraq: a dead woman covered