Contingency planning for natural disastersM. C. MartínezConcepción Blood Center, Chile

Introduction

A disaster may be defined as an event – usually sudden and

unexpected – that intensely alters the beings, objects and

localities under its influence. It results in loss of lives and

health in the local population, causes severe environmental

damage and the destruction or loss of material goods

resulting in a dramatic disruption of normal patterns of life.

Such disruption – which may be local, national – gives rise

to the need for immediate intervention and humanitarian

aid.

The definition adopted by the World Health Organization

(WHO), terms a disaster as ‘‘The result of a vast ecological

breakdown in the relations between man and his environ-

ment, a serious and sudden (or slow, as in drought) disrup-

tion on such a scale that the stricken community needs

extraordinary efforts to cope with it, often with outside

help or international aid’’.

Disasters may be caused by natural phenomena, human

actions, or industrial accidents. A natural disaster is the

effect of a natural hazard.

Managing the blood system in disasters is one of the

main challenges for any blood transfusion service exposed

to natural hazards.

The blood system may require a much larger amount of

blood than usual and the ability to collect, test, process,

and distribute blood may be impaired. Local population can

be temporarily restricted or prevented from donating blood,

or the use of the available inventory of blood products may

require immediate replacement or resupply of the region’s

blood inventory from another region. A sudden influx of

donors may occur, requiring accelerated drawing of blood

to meet an emergent need elsewhere.

Natural hazards

Natural Hazards can be classified into:

1. Geological hazards (avalanches, earthquakes, volca-

nic eruptions)

2. Hydrological hazards (floods, limnic eruptions, tsu-

namis)

3. Meteorological hazards (blizzards, cyclonic storms,

droughts; hailstorms, heat waves, tornados)

4. Fires

Vulnerability and losses (financial,environmental and human)

The factors that decide whether a natural hazard event

turns into a disaster or not, can be summarized in the term

vulnerability, which can be defined as the potential loss

from a natural hazard event. A natural hazard will never

result in a natural disaster in areas without vulnerability.

This understanding is concentrated in the formulation:

‘disasters occur when hazards meet vulnerability’, e.g. a

small earthquake in a poorly prepared country easily classi-

fies as a disaster, whereas a much stronger earthquake in a

well-prepared country does not.

A disaster causes both direct and indirect losses. The

physical destruction caused by a disaster is considered a

direct loss, and includes the human victims, environmental

degradation, building and urban spaces damage. Indirect

losses are generally divided into social and economic

effects. Social effects include the interruption of transporta-

tion, communications (including the mass media), and other

public services. They can include the negative image that a

country or region might acquire. Economic effects include

the cost of reconstruction and rehabilitation, the impact of

reduced production or consumption on trade and industry

and the potential discouragement of foreign investment.

A natural disaster leads to financial, environmental or

human losses. They happen because we are not adequately

prepared and can to a large extent be avoided.

In order to assess and mitigate the vulnerability of the

blood system a complete evaluation must be performed.

Structural vulnerability assessment considers the deter-

mination of areas that might be affected by different types

of hazards. (Structural elements that support the weight of

the building, e.g., beams, columns, and load-bearing walls,

are very important in an earthquake).

In order to diminish nonstructural elements vulnerabil-

ity, it is important to consider some architectural elements

such as false ceiling made of tiles or plaster and windows.

Secure gas tanks, oxygen tanks, and generators to the floor

or walls; attach diagnostic equipment and centrifuges to

counters walls or panels, and anchor heavy equipment with

Correspondence: M. C. Martínez, Concepción Blood Center, Julio Parada1862 Concepción ChileE-mail: cristinamartinez@ssconcepción.cl

ISBT Science Series (2011) 6, 212–215

STATE OF THE ART 4D-S23 ª 2011 The Author(s).ISBT Science Series ª 2011 International Society of Blood Transfusion

212

bolts or cables [1]. Store laboratory glassware in containers

and keep a reasonable amount of space between them.

Choose safe places for chemical and biological reagents to

minimize the risk of contamination and fire; store supplies

and tools in accessible safe places that allow for their rapid

retrieval in emergencies.

To assess organizational and administrative vulnerability

it is important to establish an appropriate layout and con-

nections between areas in the facility, identify and signpost

evacuation routes, emergency exits, danger zones areas

where there is risk of exposure to toxic substances, the

location of alarms and fire extinguishers, and similar sites

and determine administrative processes and routines to

guarantee adequate operation under both normal and

emergency conditions.

Blood supply system in natural disasters

The impact on the blood supply can be directly affected by

the severity of the disaster.

Blood usage may not be initially significant, but trau-

matic injuries may occur in coastline areas during a tsu-

nami and in earthquakes, resulting in an acute need for

trauma-related transfusions. Hospitals may temporarily

suspend elective surgeries, followed by a spike in such sur-

geries once operations are back to normal. Blood collectors

should make special preparations to ensure that operations

can be quickly resumed.

Blood collection schedules may be disrupted, depending

on the severity of the disaster as it may have a negative

effect on blood collections in the days before and after. On

the other hand, due to the tragic nature and magnitude of a

disaster many citizens may decide to donate blood, result-

ing in a donor surge.

Contingency planning

Contingency plans are devised by governments, including

the establishment of a reference blood centre to coordinate

operations in accordance to geopolitical conditions and a

secondblood centrewith similar technicalmanagerial capac-

ity in the event that the reference centre fails to function.

This national planning must organize the communica-

tions systems of the blood centres, transfusion services, and

the reference centre, ensure that information is transmitted,

about the need for blood and components, and organize the

transportation to the affected areas; and plan blood collec-

tion in accordance with needs.

Blood centres should prepare an Emergency Plan. Its

major objectives are to ensure containment of damage or

injury, loss of personnel and property, and continuity of

the key operations of the organization. Is a plan devised for

a specific situation when things could go wrong? All

departments’ heads and workers must be aware of their

duties in a state of disaster. All members of the Blood Cen-

ter are responsible to assume promptly their jobs.

This planning must consider the risk of disaster from natu-

ral causes, and should identify possible health scenarios and

needs based on previous experiences, physical and organiza-

tional vulnerability of the blood services, vulnerability of

the life lines that guarantee the operation (water and elec-

tricity supply, communications, and transportation), the

organizational and institutional response capacity, and must

identify the roles and duties of the key staff members. It must

consider the mechanisms for coordination between the net-

work of blood services and other related institutions such as

health services, military hospitals, and customs houses.

It is important to disseminate the emergency plan widely

and to train the staff that plays an important role in its exe-

cution, conduct periodic simulations to test the viability of

the plan, develop a budget for disaster preparedness and

response activities; and institutionalize, through ministerial

directives, the emergency plans for blood services.

National plan for management of shortagesof blood components

In times of severe shortages, when all efforts to increase the

available supply of blood components have been exceeded,

National Blood Services need to have a plan to determine

the equitable allocation of blood components.

Canadian Blood Services’ plans consider four phases of

inventory availability: Green, Amber, Red and Recovery

[2].Green Phase implies that normal blood component inven-

tory levels exist and supply generally meets demand. Amber

Phase implies that the national blood inventory is insuffi-

cient to continue with routine transfusion practices and hos-

pitals will be required to implement specific measures, in

order to reduce blood usage. Red Phase implies that blood

inventory levels are insufficient to ensure that patients with

non-elective indications for transfusion will receive the

required transfusion. Recovery Phase implies that blood

component inventories have begun to increase and are

expected to be maintained at a level which would enable the

return from Red to Amber and subsequently to Green Phase.

The plan of the National Health Service UK is structured

to provide a framework of actions for the NBS and hospitals

at three phases [3] [4]. Green, normal circumstances where

supply meets demand. Amber, reduced availability of blood

for a short or prolonged period. Red, severe prolonged

shortages.

Facing a natural disaster

There are several critical actions that must be undertaken,

among them:

Contingency planning for natural disasters 213

� 2011 The Author(s).ISBT Science Series � 2011 International Society of Blood Transfusion, ISBT Science Series (2011) 6, 212–215

• Evaluate the operational status of the blood centre,

assessing the impact of the disaster on the facility, as

well as any blood supply needs and provide this infor-

mation to the authorities.

• Be on the lookout for fires, as they are the most com-

mon earthquake-related hazards. Fires can be caused

by broken gas lines and damaged electrical lines.

• Notify staff, donors, customers, and vendors about the

status of the facility after the disaster.

• Define functions for the different working areas, tak-

ing into account higher demand, and reduced capacity

to provide services.

• Communicate with hospital customers in order to

assess their operational status and blood product needs

and confirm the number of units available for immedi-

ate release to the affected areas.

• Calculate fuel needs and ensure fuel supply for criti-

cal systems at the facility (e.g., generator), blood col-

lection and transportation vehicles, and essential staff

vehicles. Fuel for at least 3–5 days without assistance

from routine fuel sources must be in place in tanks

provided with fuel pumps with redundant power sour-

ces to operate the pumping mechanisms. Investigate

alternate fuel sources to fulfil future needs. During

extreme fuel shortages, consider the need to provide

security to prevent theft.

• Trace all systems linked to the facility’s emergency

power supply (e.g., generator) to ensure that all critical

systems are connected. It is important to consider that

all critical systems can be powered for at least 7–

10 days without outside assistance. Note: make sure

that systems critical to employee health and safety

(toilets, water and waste removal) can run properly.

• Analyse all systems relying on water ensuring that the

facility can conduct collections, processing, testing,

storage, and delivery of blood products to hospitals.

Ensure that the installation has sufficient water storage

capacity (such as a cistern or on-site gravity feed water

sources, e.g. water towers) to operate for at least 2 days

independently of external supply. Identify the areas

where a supply of water is vital and determine neces-

sary rationing. If needed, contact local and regional

providers to deliver water. Careful attention should be

given to subsystems needed for the health and safety of

staff, water for toilets and drinking water.

• Keep staff and board members informed about con-

tact information and emergency procedures and

regarding who is in charge of what during the emer-

gency, As routine communication channels (i.e., land

lines and cell phone) will fail or be overloaded, use

local radio and TV stations to broadcast messages to

staff and donors or use a private Web site hosted out-

side the affected area or text messaging and external

e-mail accounts (e.g., gmail.com, yahoo.com) if the

facility’s e-mail servers are offline. If restoration of

services is extensive, develop a process to communi-

cate with staff, board members, the public, and donor

groups about progress.

• Maintain timely, accurate and consistent communica-

tion with the public and media. Key messages will be

developed according to the blood shortage phase, but

in all phases messaging will need to be honest and seri-

ous about the situation; reassuring as possible, consid-

ering the situation, regarding safety and supply issues,

and providing an opportunity for audience education

about the blood system and the ongoing need for blood.

• Prioritize and develop procedures for using suitable

modes of communication such as landline phones,

wireless (cell) phones, portable two-way radios (some-

time called hand-held radios or walkie-talkies), voice

over internet protocol (VOIP) phones, satellite phones,

amateur (ham) radio and word of mouth (e.g. send

messengers) and electronic communication (fax, e-

mail through a local area network, e-mail through a

wireless connection, text messaging, website).

• Verify that the blood centre is equipped with a depot

of emergency supplies including food for 3 days,

water, first aid supplies, cots and blankets, flashlights,

and battery-powered radios and that mobile emer-

gency kits are available in the blood centre vehicles.

• Verify possible transportation modes and routes iden-

tifying alternatives (road, water, air and rail). Contact

local law enforcement and emergency organizations

as their assistance may be needed to transport blood to

hospitals in affected areas.

• Regarding staff, arrange alternative transportation for

essential employees, as routine routes may not be

available (e.g., because of fuel shortages or road dam-

age). Assist essential employees in developing a family

support plan to ensure that their needs are met while

they are on duty (e.g., care for children or elderly fam-

ily members). Provide sufficient food, water, and rest-

room facilities for essential employees while they are

on duty and make sleeping arrangements if they are

unable to return home after their shift.

• Put in place the emergency notification protocol with

staff who are operating a blood drive outside the facil-

ity and with distribution personnel who deliver blood

products to hospitals.

Procedure to evacuate and close the bloodcentre facilities

Consider the following:

• Ensure that all automated computer systems are

adjusted for facility closure.

214 M. C. Martınez

� 2011 The Author(s).ISBT Science Series � 2011 International Society of Blood Transfusion, ISBT Science Series (2011) 6, 212–215

• Notify second and third shift employees and contrac-

tors (e.g. cleaning services) about the status of the

facility.

• Consider using law enforcement or private security

firms to secure evacuated facilities.

• Consider the need to secure any special equipment

(i.e., irradiators) and to notify local management

authorities and national regulatory agencies.

• Consider the impact of evacuation and utility inter-

ruptions on the facility, supplies, and blood products

(both stored and in process). Areas to consider include

IT, storage systems, security systems, monitoring sys-

tems, and any timed systems, such as refrigera-

tors ⁄ freezers, door locks, lights, and sprinklers [5].

• Put in place the plan for an alternative blood centre

operations site (management team), along with the

required staff and volunteers and the required resour-

ces to ensure contact with customers, vendors, and

local emergency authorities until you can reoccupy

the blood centre.

Concepción blood centre during an 8Æ8earthquake

On 27th February 2010, a devastating 8Æ8 Richter earth-

quake struck Chile. The earthquake cause massive surface

destruction, and it also triggered a tsunami and numerous

and severe aftershocks (often exceeding a magnitude of

6Æ0). The earthquake’s epicentre was very close to Chile’s

second largest city Concepcion. The chaos after this

natural disaster was dramatic considering that all basic

services were damaged. Looting and arson incidents

occurring in its immediate aftermath in Concepcion. The

authorities needed several weeks to determine and evalu-

ate the damages.

At the Concepcion Blood Center, water, electricity and

fuel were not available for many days. After the disaster the

board organized emergency activities to maintain different

work areas. Some staff members were in charge of obtain-

ing fuel, water and food; others had e.g., the responsibility

of calibrating laboratory equipment. Fortunately the Blood

Center had a 7 days blood stock able to respond regional

demands.

It is important to apply the lessons learned and mistakes

made during this earthquake, such as in improving the tsu-

nami warning system, ensuring sufficient backup power

and establishing emergency communication systems, and

designating strategic locations for crucial human resources

and supply stocks around the country. Applying lessons

regarding standards for some types of construction. And

more generally, the looting and arson is a potent reminder

of the potentially explosive socio-economic tensions inher-

ent in an unequal society and under-employment among

the poor.

The disaster has led to some lessons for our blood cen-

tres:

• Communication within the blood centre is critical but

also communication with customers ordering blood

products.

• Breakdowns occur if protocols are not in place prior

to the situation: policies and procedures need to be in

place.

• In the face of chaos, there is a powerful tendency to

skip normal procedures and take drastic measures. It is

imperative to do exactly the opposite. Disaster man-

agement requires strict lines of authority.

• It is necessary to have an overall inventory manage-

ment within the country, a unified approach to com-

munication among blood facilities and adequate

transportation of blood and blood components.

• It is important to ensure that facilities maintain

inventories to be prepared for disasters at all times in

all locations. A 7-day supply of the combined inven-

tory of both blood collectors and hospitals is recom-

mended.

Disclosures

None.

References

1 Pan American Health Organization - Practical Guide. The role of

laboratories and blood banks in disaster situations. Washington,

DC, PAHO, 2002

2 National Advisory Committee on Blood and Blood Products and

Canadian Blood Services. National Plan for the Management of

Shortages of Labile Blood Components. 2009

3 Emergency Planning – development of an integrated plan for

the management of blood shortages. NHS Gateway ref 3344, To

Chief Excecutive of Trusts, Department of Health England, 23

July, 2004

4 NHS and NBS Chief Medical Officer’s National Blood Transfusion

Committee. Development of an integrated blood shortage plan

for the National Blood Service and hospitals. December 2004

5 Disaster Operations Handbook. Coordinating The Nation’s

Supply During Disasters and Biological Events. AABB Interor-

ganizational Task Force on Domestic Disasters and Acts of

Terrorism October 2008

Contingency planning for natural disasters 215

� 2011 The Author(s).ISBT Science Series � 2011 International Society of Blood Transfusion, ISBT Science Series (2011) 6, 212–215