role of doctors in disaster

DISASTER MANAGEMENT

Dr .Shabbir2nd year PG

MD Emergency Medicine

• Introduction• Epidemiology• Disaster cycle• Role Emergency physician

• A "disaster" can be defined as "any occurrence that causes damage, ecological disruption, loss of human life or deterioration of health and health services on a scale sufficient to warrant an extraordinary response from outside the affected community or area"

EPIDEMILOGY

• More than 58.6 per cent of the landmass is prone to earthquakes of moderate to very high intensity;

• over 40 million hectares (12%) of its land is prone to floods and river erosion.

• 68% of its cultivable area is vulnerable to droughts.

C l a s s i fi c a t i o n o f D i s a s t e r s

Natural Disasters

MeteorologicalTopographicalEnvironmental

Natural Disasters

Meteorological Disasters

•Floods•Tsunami•Cyclone•Hurricane•Typhoon•Snow storm•Blizzard•Hail storm

Topographical Disasters

•Earthquake•Volcanic Eruptions •Landslides and Avalanches•Asteroids •Limnic eruptions

Environmental Disasters•Global warming•UVB Radiation•Solar flare

Man made Disasters

Technological

•Transport failure •Public place failure •Fire

Industrial•Chemical spills•Radioactive spills

Warfare•War•Terrorism

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Integrated

Disaster

Management

Prepared-ness

Response

Recovery

Mitigation

Activities prior to a disaster.• Preparedness plans• Emergency exercises• Training,• Warning systems

Activities during a disaster.• Public warning systems• Emergency operations• Search & rescue

Activities following a disaster.• Temporary housing• Claims processing• Grants• Medical care

Activities that reduce effects of disasters• Building codes & zoning• Vulnerability analyses• Public education

• Prevention/MITIGATION—Regulatory and physical measures to ensure that emergencies are prevented, or their effects mitigated.

• Preparedness —Arrangements to ensure that, should a disaster occur, all those resources and services which may be needed to cope with the effects, can be rapidly mobilised and deployed.

• Response —Actions taken in anticipation of, during and immediately after impact to ensure that its effects are minimised and that people are given immediate relief and support.

• Recovery—The coordinated process of supporting disaster-affected communities in reconstructing their physical infrastructure and restoration of emotional, social, economic and physical well-being.

DISASTER MEDICINE

• Preparedness• Response

HOSPITAL

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Medical Preparedness & Mass Casualty Management

Developing and capacity building of medical team for Trauma & psycho-social care, Mass casualty management and Triage. Determine casualty handling capacity of all hospitals.Formulate appropriate treatment procedures.Mark would be care centers that can function as a medical units. Identify structural integrity and approach routes.

MASS CASUALITY IN HOSPITAL

FIELD(INDIA)

Preparedness

• NMDA :The National Disaster Management Authority (NDMA) was initially constituted on May 30, 2005 under the Chairmanship of Prime Minister vide an executive order.

Disaster Management Structure in India

RESPONSE

• Incident Response System (IRS):• standardised method of managing disasters, • flexible and adaptable to suit any scale of

natural as well as man made emergency/incidents.

Incident Response System (IRS)

ROLE OF DOCTOR

SITE PERSONNEL

• Establishing Medical Control command, control, coordination and communication are vital.

• SITE ARRANGEMENTS• Casualty Collecting Area• Patient Treatment Post• Ambulance Loading Point

• Medical Triage Officer• Medical Team Leader• Nurse Commander• Ambulance Commander

Search, Rescue and First Aid

Field care

Triage

Tagging

Identification of dead

TRIAGE

• Triage is the process by which disaster casualties are sorted, prioritised, and distributed according to their need for first aid, resuscitation, emergency transportation, and definitive medical care.

• continuing process which begins in the field and continues into the hospitals

OBJECTIVE

• minimise the death and suffering that is the result of a disaster

• ensuring that available health resources are directed to those who will receive the greatest benefit.

TIMING

• when the casualty is first seen;• before movement from the incident site:;• within the forward treatment area;• before transportation to hospital;• on arrival at the hospital before surgery. In

addition, reassessment will be necessary; and• whenever the casualty’s condition is noted to

have altered

First Priority (Red)—Life threatening injuries in need of urgent medical care, requiring priority transport, with or without appropriate resuscitation.• Second Priority (Yellow)—Significant injuries, condition stable and treatment can wait. Or for casualties not expected to live, or whose resuscitation may over-utilise available resources and prejudice the survival of other patients.• Third Priority (Green)—Walking wounded who may not requireambulance transport according to priorities, to treatment centres. Casualty will not require hospitalisation. Psychological casualties are included in this category.• Deceased (Black/white)—Used for the dead.

THE PROCESS OF TRIAGE

• follow the ‘ABCDE’ approach as outlined in the Early Management.

• Revised Trauma Score (respiratory rate, systolic blood pressure and GCS),

• The triage tag forms the initial medical record and must not be removed until admission to hospital

TRIAGE

Time Delay to Resuscitation

• seconds to minutes (usually from unsurvivable head or major vessel damage);

• one to two hours (usually from major chest, head or abdominal injuries, and/or major blood loss);

• days to weeks (usually from brain death, sepsis and organ failure).

• resuscitation in the first hour may significantly peak of mortality.

Time Delay to Surgery

• for serious casualties, initial wound surgery should be performed as soon as possible, but certainly within the three hour limit.

RESUSCITATION

• airway and cervical spine care;• breathing and oxygenation;• circulatory support and control of

haemorrhage;• rapid neurological assessment; and• exposure to permit examination and

treatment.

BURNS

• Field priorities include the removal of burned clothing, cooling of burned tissue, oxygen therapy, covering of burns with clean dressings, establishment of IV access, volume resuscitation with N/Saline/Haemaccel, and titrated IV analgesia, wherever possible. Victims with respiratory burns should be prioritised for early evacuation to hospital because of the risks of insidious and progressive airway obstruction.

HYPOTHERMIA

• Remove wet clothing, wrap in blankets and protect from the wind whilst awaiting transport. Depending on resources, it may be reasonable to perform CPR on hypothermic victims without vital signs and with no obvious lethal injury, whilst rewarming.

CRUSH INJURY

• Priorities include rapid extrication and IV fluid resuscitation. If a victim has been crushed for a prolonged period, Medical Teams should consider premedication with bicarbonate and calcium chloride (to counteract hyperkalaemia) immediately prior to extrication.

• Forced alkaline diuresis may reduce the incidence of renal failure

WOUNDS

• The management of most soft tissue injuries can be delayed, but haemorrhage control should be effected through direct pressure.

• Wounds older than 6 hours, and grossly contaminated wounds should be irrigated, cleaned, debrided and left open for delayed primary closure at 48–72 hours.

• Booster vaccination against tetanus.

FRACTURES/DISLOCATIONS

• Ensure that all fractures are splinted so as to minimise pain, reduce haemorrhage and the risk of neurovascular damage.

• Reduce dislocations as soon as possible.• Definitive treatment of most closed fractures

can be deferred for 24–48 hours if necessary, provided that they have been correctly splinted.

CHILDREN

• A calm reassuring approach is imperative.• Fluid resuscitation and drug dosages should be

carefully calculated• paediatric tertiary referral centre

CHEMICAL INJURY

• removal of contaminated clothing and decontamination of exposed skin.

• continuous copious irrigation of eyes, mucus membranes and skin if chemical burns from acid or alkali;

• basic and Advanced life support as necessary;• administration of specific antidotes, if

available

TRANSPORT

• Patient transport vehicles should equipped if possible with at least basic resuscitation equipment including oxygen, suction, airway aids and a method for assisted ventilation.

• adequate lighting and temperature control,• Transport resources should be used to their

best advantage

• transport of sitting patients in addition to stretcher cases.

• The transport of living patients must take priority over the deceased.

• Patients should be accompanied by documentation-• triage category;• how the injury occurred;• clinical assessment and time;• treatment given; and

• PRINCIPLE• The quality of patient care during transport is

usually more important than the mode of transport.