Day 7: It's All About Disaster

As I’ve promised, I’ve made a post especially about Disaster.

First thing should be mention is the definition of ‘Disaster’. What is disaster?

Disaster can be defined as:

“Sudden ecological phenomenon of sufficient magnitude to require external assistance”

[WHO]

“Destructive effect of natural and manmade force overwhelm the ability of given area or community to meet the demand for health care”

[American College of Emergency Physicians]

 “A serious disruption of the functioning of a society, causing widespread human, material or environmental loses which exceeded the ability of the affected society to cope using its own resources”

[United Nations Disaster Management Training Programme (UNDMTP)]

Those are the various definition of Disaster, yet they carry similar understanding to us. It’s an unexpected turn of event (natural or manmade) that causes damage and requires external aid. These are the 3 main points that I want to stress on about the definition of Disaster.

Disaster can be classified as: Natural Disaster and Man-made Disaster.

Natural disaster:

• Earthquake
• Volcanic eruption
• Tsunami, Flood
• Hurricanes, Cyclones, Typhoons
• Famine
• Winter Storm

Man-made disaster:

• Airplane crash
• Terrorist attack
• Nuclear-Radiologic

From the examples given, there are many casualties involved. In order to reduce or minimized the possible damage to people, their properties and the environment; Disaster Medicine is introduced.

Disaster Medicine

Disaster medicine is a discipline resulting from the fusion of emergency medicine and disaster management. Because of its unpredictable nature of a disaster, it is not possible to predict who will be in charge of providing help during a disaster. Therefore, it is imperative for all who practice in emergency health services to have a working knowledge of the basics of disaster medicine and disaster management. Example: in the case of a terrorist threat, in which the attack may involve exotic chemical, biological or nuclear agents and modalities; most clinicians will have limited knowledge on these agents. Therefore, it is important to educate the potential disaster responders on their specific.

The field of disaster medicine involves the study of subject matter from multiple disciplines. Disasters may result in varying injury and disease patterns, depending on the type of event that has occurred. Example: earthquakes can cause entrapment and resultant crush syndrome; tornadoes may cause penetrating trauma from flying debris; and disease outbreak (either natural or intentional), can result from many different bacteria, viruses and fungi. Because of the potential variability in casualty scenarios, the disaster medicine specialist must have training in the many injury and illness patterns seen in disaster victims. Even though the expanse of knowledge is vast, the focus on areas specifically related to disaster medicine allows it to be manageable. A disaster medicine specialist is always a practicing clinicians from another field of medicine first and a disaster specialist second. By integrating these many disciplines, one is prepared for the variety of injury and illness patterns that may be faced.

Disaster medicine also presents unique ethical situations not seen in other areas of medicine. Disaster medicine is predicated on the principle of providing care to the most victims possible as dictated by the sources available and by patient condition and likelihood of survival (meaning the triage during a disaster). Disaster triage involves assigning patients into treatment categories based on their predicted survivability. This triage process may dictate that the most severely injured patient not given medical care but rather it be provided to a less critically injured patient.

A comprehensive understanding of disaster management procedures will yield a well-rounded and better-prepared disaster responder.

Disaster Management

Disaster management can be defined as:

“The body of policy and administrative decisions and operational activities which pertain to the various stages of a disaster at all levels”

Disaster management can be divided into 3 stages:

1. Pre-disaster

It’s the activities taken to reduce human and property losses caused by the hazard and to ensure that these losses are also minimized when the disaster strikes. Risk reduction activities are taken under this stage and they are termed as mitigation and preparedness activities.

Risk reduction can take place in 2 ways:

Mitigation

Mitigation is the process of recognizing risks and vulnerabilities and then working to both reduce the vulnerability and the effects of the hazard itself; and strengthen society’s ability to withstand an unstoppable event or to reduce the effects from a disaster. Therefore, mitigation activities can be focused on the hazard itself or the elements exposed to the threat. Example of mitigation activities include: hardening structures against blast, or the placement of surveillance systems to increase early detection of infectious diseases in a hospital setting. Early warning offers the benefit of a rapid response and reduction in morbidity and mortality. In addition to these physical measures, mitigation should also be aimed at reducing the economic and social vulnerability to threats and the underlying causes for this vulnerability.

[Note:

Vulnerability is defined as: “The extent to which a community, structure, service or geographic area is likely to be damaged or disrupted by the impact of particular hazard, on account of their nature, construction and proximity to hazardous terrain or a disaster prone area”.]

Preparedness

Preparedness is the process of developing a formal program of response. This protective process embraces measures which enable governments, communities and individuals to respond rapidly to disaster situations to cope with them effectively. Preparedness have many components, including: training and staff development; identification and classification of public health resources including personnel, supplies and facilities; development of standard operating procedures (SOPs), emergency response plans and communications plans; and pre-placement of key supplies and protective equipment. Preparedness therefore encompasses those measures taken before a disaster event which are aimed at minimising loss of life, disruption of critical services and damage when the disaster strikes.

This phase should also include the participation in table-top and functional exercises. Public health personnel must be integrated and participate with other response agencies during drills and exercises to better familiarize each stakeholder with their respective roles and abilities.

The Centers for Disease Control and Prevention (CDC) is one reference source where planners can obtain basic guidelines for disaster preparedness. These include:

• Form mutual-aid agreements and close relationships with local, regional, state and federal partners
• Conduct a hazard and risk assessment
• Conduct a capacity assessment, identifying resources in your system
• Obtain those identified resources and surge capacity
• Develop surveillance, registries and data archiving systems
• Plan for public affairs and risk communication
• Ensure personnel are trained and certified to use personal protective equipment and other health practices
• Orientation for volunteers and personnel on procedures, guidelines, and command and management systems
• Participate in and conduct exercises
• Participate in after-action reviews of exercises and incidents

2. During disaster

Activities taken during a disaster occurrence are to ensure the needs and provisions of victims are met and suffering is minimized. Activities taken under this stage are called as emergency response activities.

Response is the phase in which agencies and sections with responsibility to respond activities its emergency response plan to the specific threat or situation and can incorporate local, regional and federal response. For example, in response to a biologic or chemical terrorist event, public health agencies would respond by: conducting site surveys, recommending public safety measures and communicating risk, providing epidemiologic investigations, providing medical treatment of prophylaxis for those exposed and initiating disease prevention and environmental decontamination measures.

3. Post-disaster

Activities taken to achieve early recovery and does not expose the earlier vulnerable conditions. Public health agencies must identify what resources may be available to assist in restoring the operation as well as address other physically and emotionally affected populations. Public health recovery operations are multidisciplinary and involve multiple sectors of society (law enforcement, military, public policy, public works), and they vary depending on the extent of the disaster’s societal impact.

Recovery efforts comprise several components, some of which are Search and Rescue (SAR) in the case of earthquake, bombing or landslide; reinstitution of medical services if clinics and hospitals are destroyed; and establishment of corrupted lifelines like sanitation, electricity and water. It goes far beyond clean-up and infrastructure restoration. It includes the management of the far less visible chronic health effects and mental health impact of each disaster.

These 3 aspects of disaster management is consistent with the phases referred to as the “Disaster Cycle”

Disaster Cycle

REFERENCES:

1. Disaster Medicine; 3rd Edition. Mosby Inc; 2006
2. Disaster and Public Health: Planning and Response. Elsevier Inc; 2009