Medical Aspects Of Disaster Management Health And Social Care Essay

medical exam Aspects Of tragedy counsel Health And Social C ar EssayOn December 26, 2004, a violent quake measuring 9 on the Richter scale smitten off the western coast of northern Sumatra. It initiated several tsunamis (tidal waves) that alikek more than 200,000 lives. It was the deadliest instinctive casualty in the past quarter of a century. But as horrible as it was, it was alone a ripple compargond to some quakes in recorded history.In 1556, an temblor in China took the lives of 830,000 people. In India, an earthquake in 1737 killed 300,000. Al ab appear thirty age ago (1976), a enormous quake in China left 655,000 dead.The Sumatra quake, which scientists have measured with new-fangled instruments, was so strong that it is believed to have moved some is charges about 50 feet. In addition, seismologists think that it wobbled the earth on its axis, accelerating the rotation speed, thus trim d ingest the length of our day by fr serves of a second which is remarkable in view of the throwets precision movements.The 2011 earthquake off the Pacific coast of Thoku (Thoku-chih Taiheiy Oki Jishin), often referred to in Japan as Higashi nihon daishin-sai was one of the five nearly powerful earthquakes in the man since modern record-keeping began in 1900.The earthquake triggered powerful tsunami waves that r individualisticlyed heights of up to 40.5 metres. The earthquake moved Honshu (the main island of Japan) 2.4 m vitamin E and transfered the Earth on its axis by estimates of between 10 cm and 25 cm. This earthquake claimed 15,878 lives, left 6,126 hurt, and 2,713 people missing . The earthquake and tsunami similarly ca utilise extensive and severe structural maltreat in north-eastern Japan . Japanese Prime Minister Naoto Kan said, In the 65 years after the shoemakers last of World War II, this is the toughest and the most difficult crisis for Japan. Around 4.4 million households in northeastern Japan were left without electricity and 1. 5 million without water. The tsunami caused nuclear accidents, in general the level 7 melt great deals at three re fallors in the Fukushima Daiichi Nuclear business office jutt complex, and the associated body waste zones affecting hundreds of thousands of residents. The World Banks estimated economic cost was US$235 cardinal, making it the most costly subjective mishap in world history.Besides these, on that point have been the super cyclone in Orissa, earthquakes in Latur and Gujarat every last(predicate) of which have caused muckleive loss of life, distress, discomfort, disease and disability. Inspite of all this, we still search the so called Diego Maradonnas Hand of God to bail us out of each indispensable crisis causing incident.DISASTER STATISTICSIn the past fifty years more than 10000 natural calamitys have been reported, more than five billion people have been ab mean(prenominal), more than twelve million persons have been killed and the economic costs hav e been greater than US dollars four trillion. In India during the point in time 1990 to 2006 more than 23000 lives have been broken in six major(ip) earthquakes(Uttarkasi, 1991Latur,1993Jabalpur,1997 Chamoli,1999Bhuj,2001JK ,2005.) large damage has been caused to post and public infrastructure. The twin super-cyclones that hit Orissa in Oct 1999 affected 24 Districts, 219 blocks and 18790 villages resulting in loss of 8495human lives, 450,000 lives of cattle and damaging ii million homes and 23000 schools. The Bhuj earthquake was a terrible human tragedy in which13,805 lives were lost that included 1031 school children and around 167,000 persons suffered multiple injuries This was in the wake of two consecutive years of drought. chance definedAt the cost of repeat in the text it is important for us to understand and comprehend the experimental condition tragedy. accident is a term very often figuratively used in day to day parlance. For instance, if, as professionals, you ar e making a presentation on some of your calculate which you highly value and the reaction of the audience is non exactly as per your expectations disrespect your utilizing all operable re rootages, you would generally refer to such a presentation as existence a adventure. Thus adventure is an unexpected emergence in which there is a explosive and massive disproportion between the hostile elements of whatever pleasing and the survival resources that are available to counterbalance these in the lightest period of time. on that point is no generally accepted definition of tragedys. A study by Debacker found greater than 100 definitions of misadventure. The variations occurred with professional role. The commonalities in all definitions are that disaster is a sudden and an extraordinary solvent wherein the demand for wellness carry off resources is greater than those that put forward be supplied, where after-school(prenominal) avail and resources are needed and which causes rift of infrastructure, loss of life, material damage and distress. In short disaster is an event where the response needed is greater than the response available. mavin of the more professional definitions of disaster (Humberside County Council UK) would determine as under- fortuity is a major incident arising with little or no word of advice causing or threatening death or serious reproach to or rendering homeless, such numbers of persons in excess of those which lowlife be dealt with by the public services operating under normal procedures and which calls for the special mobilization and organization of these services. internal DisastersAs we are deliberating on natural disasters, it may be worthwhile subscribeing out the accompaniment that the Indian subcontinent is amongst the worlds most disaster prone arenas with approximately 60 % of land mass is prone to earthquakes of moderate to high intensity, 8% of land unsafe to cyclones, 12% of land mass is vulnerabl e to floods and 68% of cultivable field of operation is prone to drought. The hilly nations are constantly at risk from landslides and avalanches and brasslike floods. With its vast territory, large population and unique geoclimatic conditions, the Indian subcontinent is exposed to natural calamities and catastrophies. While the vulnerability varies from region to region, a large part of the country is exposed to natural hazards which often turn into disasters causing signifi burn downt disruption of socio-economic life of communities and to loss of life and property.For the ease of understanding Natural disasters could be classified as depicted in the Figure.Classification of Natural Disasters(a) Natural phenomenon beneath the earths surfaceEarthquakes including TsunamisVolcanic Eruptions(b) Natural phenomenon at the earths surfaceLandslides roll down(c) Meteorological/hydrological phenomenonCyclones Typhoons HurricanesTornados Hailstorms SandstormsFloods Sea-surge DroughtsChar acteristics of DisastersBefore we proceed any further let us short enumerate the characteristic features of a disaster since these will help us subsequently in formulating an appropriate disaster focussing strategy. The enkindle characteristic features of a natural or any former(a) pillow slip of disaster are-(a) Suddenness of Occurrence.(b) Vastness of Damage.(c) Loss of Life and goodty.(d) fracture of Communication.(e) Panic and Anxiety. runner Day First Person Ground secret code Report From Military infirmary Bhuj GS SandhuMasses of humanity, crushed and mutilated limbs dangling, heads disassemble commit, shattered bones, and people coming in endless streams, tugging at the doctors sleeves to return the patients they were attending to come and see their near and dear ones, crying, sobbing, screaming. This is the lasting printing process of twenty-sixth January 2001 which I will carry with me for the rest of my life.- Extract of authors consultation in Indian Expre ss dated 8th February 2001.1. Though the cutch district of Gujarat is located in Seismic zone V, there was a general lack of awareness of the seismic risk and its implications among all sections of the society. The earthquake struck without warning at 0846 hrs on 26 Jan 2001. The epicenter was located 30 km north-east of Bhuj and measured 6.9 on the Richter scale. The impact was sudden and devastating. The local biotic community was overwhelmed by the magnitude of the disaster and its resources rendered non- berthal.2. Military hospital Bhuj is a small peripheral hospital, providing health check cover in the prefatory specialties. In the aftermath of the earthquake, this hospital acted as the first and sole responder, despite having suffered severe structural damage and its force happen and their families as well being victims of the natural calamity. The principal task was to ensure operational readiness of the hospital for mass casualty management. A number of concurr ent activities were initiated. Multiple reception, triage and resuscitation stations were organize up. Indoor patients were moved out because of recurring aftershocks. Salvage of equipment and stores from collapsed buildings was commenced. An improvised operative zone with makeshift operation delays was aline up on potent standing. Pre and post operative areas were marked adjacent to this zone. Patient holding and evacuation areas were demarcated. Doctors from the town came to help in looking after the sea of hurt humanity pouring into this sole medical checkup examination facility functioning in the disaster zone. The local army formation provided generator sets, water tankers, tents and personnel for crowd statement.3. A simple standardized patient management communications protocol adapted to the locally available resources and skills was devised. The aim of this protocol was to standardize discourse, hold back lives, prevent major secondary complications and prepare ca sualties to withstand evacuation to hospitals away(p) the disaster zone. Graded assessment was carried out, to cope with the sudden massive inflow of casualties. Paramedical personnel did the initial assessment by grading the casualties into major and minor injuries. All patients with major injuries were resuscitated with IV fluids and exhibited antibiotics and parenteral Diclofenac analgesia. The mendelevium and medical officers carried out airway management. The gynaecologist, who was also the administrative leader of the team, triaged the patients into those whose injuries could be handled locally and those who would require definitive management at specialized facilities. The last decision as to the salvage of limbs was performed by the surgeons at the operating table itself.4. An idea of the difficult circumstances in which this emergency brake humanitarian action was executed can be gauged by the watch outing military position in the immediate aftermath of the earthquak ea) Collapse of the civil command and entertain structure in face of the magnitude of the disasterb) Structural damage to Military infirmary Bhujc) Suboptimal / Inadequate surgical conditionsd) overlook of communicationse) Lack of water and electricity supply5. Despite these cons gearingts approximately 3000 casualties were handled at MH Bhuj in the beginning the first relief teams arrived around 2300 hrs on 26 Jan 2001. The problems encountered in handling casualties in these large numbers related toa) Crowd find outb) certificatec) Shortages of innate suppliesd) Biomedical waste disposale) Monitoring of the seriously injuredf) Disposal of dead bodiesg) Evacuation to specialized facilities6. zero(prenominal)country or community can be fully prepared to deal with sudden impact disasters. During the first few hours or even days, the affected community is isolated and essential cope up the best it can. In a disaster situation the functions of the fortify forces closely para llel those of the emergency services. The armed forces are trained to prepare quick response capabilities. Their management and administrative systems function in a self contained, self sufficient and merged musical mode. The armed forces medical services have contingency plans and training to run to mass casualty management. These capabilities allowed a small peripheral hospital to act as a sole responder to a disaster of evoke magnitude.The author was commanding the military hospital at Bhuj, Gujarat on 26th January 2001 medical examination Role and OrganizationAs we can see the management of natural disasters involves a host of disciplines operative together to combat the ills and unbecoming effects of the disaster incident .This text will, however, be restricted to the medical role and organization during disaster incidences. This, however, in no way, is meant to malign the enormousness of other public services and agencies which are equally essential and play a vital ro le in the management of natural disasters. In fact these agencies contribute immensely towards winnerful and effective implementation of any disaster management strategy and are complementary to the efforts of the medical organization.The medical role will depend upon -(a) Nature of the Disaster(b) Medical constitution set up for combating the natural disaster(c) The degree of involvement of the elements of the medical organization in the Disaster incidence ie whether a hospital providing relief and rescue assistance is knotted or not complicated in the disaster situationThe primary element of any health business concern delivery system that comes into operation during a natural disaster is the hospital. The role of a hospital will vary, depending upon the prevailing scenario -(a) The hospital itself is not involved in the disaster.(b) The hospital is directly involved in the disaster.(c) The hospital is indirectly involved in the disaster.(d) The disaster affects the hospital only.In end the hospital is not itself involved in the disaster situation it can be geared up fully to meet the demands of such an eventuality. In case the hospital is directly affected by the disaster situation it will then be affected in the same manner as the general population and will then have to disturb itself to provide medical aid not only to the community but also its own inmates and staff. In situations where the hospital is indirectly affected by disruption in some of its facilities and services like water and electricity supply, communication facility it will have to appropriately modify its own plan of action. These aspects have to be built into the disaster plan of the hospital.Aims and Objectives of Medical Role and composition During Natural DisastersThe aim of any medical organisation during a natural disaster is to provide prompt and effective medical give care to the largest number of people needing that care in order to bring about early recovery and reduce the death and disability associated with the disaster incident. A paradigm shift is needed from traditional approach to a casualty under normal circumstances. The approach has to shift from the traditional all FOR ONE to ONE FOR ALL.The primary objectives of the medical organisation during natural disasters are -(a) To prepare the staff and knowledgeablenessal resources for optimal performance in an emergency situation of authoritative magnitude.(b) To make the community and other counter disaster agencies aware of the capabilities, execution and benefits of the medical disaster plans.(c) To establish security, traffic control and public teaching arrangements.The medical role during a disaster incident includes(a) Sending Mobile Medical Teams / Quick Reaction Medical Teams / First aid teams to the site of the disaster.(b) Providing First Aid and basic Life stick up at the site of the incidence (Pre hospital stabilization)(c) Sorting out the struck victims into formerities for evacuation (Triage)(d) Safe and Speedy transportation from the site of incidence to the stead of providing definitive care.(e) Providing Advance Life Support and definitive care at the hospitals(f) Provisioning of Rehabilitation Services to the affected individuals(g) Care of the dead and moribund individuals.(h) measure of Epidemics and other related health hazards (Environmental health management).(j) Epidemiological and Health-surveillance efforts(k) Setting up Communication Centres for providing relevant information to the public, community and other agencies.To carry out the above roles to perfection at the time of a disaster event it is mandatory that all concerned in the medical organization must be aware of their roles and responsibilities. Thus arises the necessity of having a well knowing and integrated Disaster Plan. Failure to Plan is Planning to Fail when the event actually happens. Planning provides the opportunity to network and engage all participants prior to the event. It provides the opportunity to resolve issues outside of the heat of the battle. Experience tells us that mentation about and planning for disasters is not as painful as having to rationalize why we didnt.Principles of Natural Disaster Plan of a Medical OrganisationThe basic principles which form the template of a Natural Disaster Plan are -(a) Simplicity It should be simple and operationally functional(b) flexibleness It should be executable for various forms and dimensions of different disasters(c) Clarity It should lay down a clear definition of authority and responsibilities and not use too many technical jargons(d) Concise It should be suitable for the type of hospital and not be so voluminous that nobody will read it(e) Adaptability Although the plan is intended to provide standardized procedures, it should have an inherent scene for adaptability to different situations that can emerge during disasters(f) Extension of normal hospital working It should be made in such a way that the plan merges with the normal functioning of the hospital(g) Practiced Regularly to make it work and to recognize and reduce and eliminate the shortcomings.(h) Permanent and periodically updated found upon the experiences gained from rehearsals and disaster situations faced(j) A part of a Regional Disaster Plan.The recognize issues involved in any disaster plan are Preplanning, Communications, Co-ordination, educational activity and Regular practice. Without these elements no amount of technical skills and modern technology can mitigate the sufferings of disaster victims.Pre-requisites for Disaster PlanningThere are certain pre -requisites that require to be deliberated before planning for and managing disaster events. These are shortenedly described as under -(a) Hazard / Vulnerability Analysis This is based on past experiences and the vulnerability status of the localities that are within the cooking stove of the administrative and clinical jurisdiction o f the health care facility. For example if an area is prone to earthquakes it is important that the hospital building is earthquake proof and the Disaster Plan of the hospital is able to cater to the rescue and relief of the victims of the earthquake. It is also important to remember that Earthquakes, Accidents dont come with prior notice but Floods, Cyclones do. Pre disaster preparedness in later case can prove to be very useful.(b) The Role, Responsibilities and Work relationships amongst all the staff of the health care institution must be clarified.(c) hospital Capability Analysis It is also essential to be familiar with the hospital treatment capacity should mass casualties suddenly arrive without adequate prior notice. Generally as a sky rule the Hospital interposition Capacity is 3% of total Hospital Beds whereas the Hospital Surgical Capacity in an eight hourly shift can roughly be calculated as under-No. of operating rooms x 7 x 0.25(d) Hospital lodge cooperation in D isaster Planning This is also an essential precondition and the outside instigate must be kept on alert and must be signalled to move at appropriate time to be in position in affected area immediately before the stretch of the casualties.Who Should Make the Hospital Disaster Plan?This is the next obvious inquiry as to who should be responsible for making a hospital disaster plan. More often than not it is felt that this is the responsibility of the Hospital Administrators only. Well, the hospital administrators do play a major role in framing, coordinating, rehearsing and implementing the disaster plan but no single individual can efficaciously make the disaster plan of any health care set up since making the plan is a multidisciplinary affair and all disciplines should be involved in framing a plan for the implementation and success of which they are ultimately responsible.Herein lies the importance of constituting the Hospital Disaster charge Committee (HDMC). The Suggested Me mbership of this committee is as under -(a) Director/ executive director orient of the Hospital.(b) Departmental Heads.(c) Nursing Supdt./CNO/SNO(d) Hospital Administrator(e) O I/C Casualty Services.(f) Maintenance and Engineering Staff.(g) Staff Representative.(h) Representatives from other support services and utility services as inevitable.Functions of HDMCIt has been commonly said that school term on a committee is like sitting on a WC. One makes a lot of noise and ultimately drops the entire matter. Well, the function of HDMC goes much beyond this saying. For this committee to function effectively, its role and responsibilities and terms of mention must be understandably laid down. Broadly the role of HDMC is -(a) To develop the Hospital Disaster Plan.(b) To develop Departmental Plans in support of the Hospital Plan.(c) To plan Allocation of Resources.(d) To allocate duties to Hospital Staff.(e) To establish standards for emergency care.(f) To stand and supervise Training Programme.(g) To supervise Drill to Test the Hospital Plan.(h) To reappraisal and revise the Disaster Plan at regular intervals.Components of Hospital Disaster PlanThe various components of a well thought out disaster plan are enumerated below. These components will vary from one health care institution to other depending upon the capability and capacity as well as the hazard and vulnerability analysis. Notwithstanding this, the components should focus on the following aspects(a) competent system of tonic and Staff assignments.(b) Unified Medical Command.(c) Mobilisation of Resources(i) Medical Nursing, administrative Staff.(ii) Medical Stores Supply and Equipment.(iii) Conversion of useable space into distinctly defined areas for Reception, Triage observations and immediate care.(d) Procedure for prompt movement of patients within the hospital.(e) Procedures for forgive/referral/transfer of patients including transportation.(f) Prior establishment of Public Information Centre .(g) credential arrangements for inpatients, casualties, property of patients and the hospital etc.(h) Evaluation of Hospital Autonomy in terms of water, electricity, food and medical supplies including gases.(j) OT utilization planning.(k) Planning for roentgen ray, Lab and Blood Bank.The HDMC is unavoidable to prepare a disaster manual which should be crisp, easily silent by all and should contain the expand of the mode of execution of the Disaster Plan. The hospital disaster manual is a written statement of the disaster plan which is required to be activated during any type of disaster and is divided into five sections which though not sacrosanct and can be modified according to the needs and requirements but they form the template on which the hospital disaster plan can be prepared and executed. A prototype of the template is given belowSection I - cornerstone(a) Disaster Alert Code.(b) General Principles of conduct.(c) Brief abridgment of total plan.Section-II - distrib ution of Responsibilities(a) Requirement and responsibilitiesof individuals and departments.(b) activeness cards.Section-III - Chronological pull through Plan(a) Initial Alert.(b) activate hospital Disaster Plan.(i) Notify key personnel.(ii) Activate key Depts.(iii) lay out details of ResourceMobilisation.(iv) Pre-arranged wards/areas forcasualties.(c) Formation of a command centre(i) earlier near the casualtyreception.(ii) Define roles of hospital controller.(iii) Senior Nursing Officer, HospitalAdmin(iv) Clinical Principles of commissionof Casualties.(v) Reception.(vi) Triage(vii) Admission of Patients.(viii) Utilization of supportive services.(ix) Principles of treatment ofcasualties.Basic Life SupportAdvance Life SupportDefinitive Treatment(d) Specific problems of DisasterManagement.(i) Clinical Problems.Less, serious patients report first.Contaminated casualties.(ii) Administrative Problems.Documentation.Police Documentation Team.Communication.Friends and Relatives.Crowd control Convergenceeffect.Voluntary workers.Patients Property. touch and Media.Disposal of Dead.Section IV - Check List Of military group And Items.(a) appellative of overall medicalauthority.(b) Establishment of communicationnetwork.(c) Notification rosters.(d) Triage centre with Triage Officer.(e) Personnel Assignments.(f) Designation of medical teams areasof operations.(g) Routes of disposal.(h) Criteria for patient categorization.(i) Rapid documentation cards(j) Security arrangements.(k) Plans for logistics and supplies.(l) Records.(m)Evacuation system.(n) Information booth / Help deskSection V - Repeated Rehearsals.(a) To train(b) To test performance(c) To correct weaknesses and deviations.A brief explanation of the aforesaid(prenominal) template is given in the subsequent paragraphs for the ease of understanding entryThe introduction should include disaster alert code, general principles of conduct and brief synopsis of total plan. When the alert is given all personnel mus t report to duty and takeover their assigned jobs. A sample synopsis is placed at the end of this chapter.Distribution of Responsibilities(a) Authority and Command substance A small disaster management committee consisting of(i) Executive Head of the hospital(ii) District Health Officer/Civil Surgeon(iii) professor of Medicine/Surgery/Officer In Charge Accident and requisite Services(iv) Matron(b) put through Cards The duties of each individual and dept are clearly indicated on a Action Card. These cards describe in details the responsibilities and the actions to be taken by each and every member of hospital staff starting from hospital administration to stretcher bearers and ward boys. Action card can be carried at all times and/or kept at command centre. If the designated individual proceeds on run / out of station, then it should be the responsibility of the stand in individual to be aware of his role as per the action card.Chronological Action PlanFor efficient and effect ive implementation during a disaster installing the action plan must be listed in chronological order. The undischarged features of the Action Plan are briefly explained below(a) Initial Alert (i) Source of Alert(aa) Accident and Emergency department itself(ab) Through telephones or(ac) Through authorities like police etc.(ii) Action to be undertaken. On receipt of information, the concerned person must gather information regarding the place, time and type of disaster incident , the estimated number and type of casualties and the source of communication. He should also have a callback number if possible to remain in constant contact with the reporting personnel. This would help in determining the time available to prepare (response time) for the emergency and the necessary reorganisation of hospital services to cope up with the same.(b) Activate Hospital Action Plan The designated hospital staff activates the disaster plan. All the departments and people involved get into readi ness to attend to casualties and depending upon the nature and number of casualties, crisis expansion of hospital beds is undertaken, utilizing additional space, by discharge of minor /cold cases and transfer of cases to other hospitals/ health care centres.(c) Formulation of Command Nucleus The command nucleus should be formed immediately and located either in or close to the Accident and Emergency department.(d) Management of Casualties This deals with(i) Admission of patients(ii) Triage and(iii) Organization of clinical services.(iv) Further treatment(v) Collection of information for management and for relatives and media(e) Hospital Management Once a disaster call is made and the hospital control unit established, the mobilization of the hospital services may proceed at the speed required with the minimum loss of time. Usually a number of designated areas will need to be created.(i) ReceptionAn initial reception area acts as the first point of triage in the hospital and distr ibutes patients to appropriate treatment zones. In addition, the initial reception will involve the documentation for casualties.The most experienced surgeons available should be responsible for triage. If staffing permits, assign specific members to care of each patient needing urgent attention. Ambulatory patients and those needing less urgent care should go to a separate area to await treatment at a comfortable time.(ii) ResuscitationA large well lit open space is needed for effective resuscitation. Patients are prepared for surgery if required or sent to the wards as soon as their condition stabilizes. A senior anaesthetist is the best choice to supervise resuscitation and to prepare, with surgical advice, the field of operations schedules.(iii) Operation Theatres exacting sorting is necessary to avoid blocking battlefield space with patients with trivial injuries and who happen to arrive first. They may be toughened in a separate theatre (Minor O.T) or at convenient times w hen other major problems are dealt with. Treatment in wards or Intensive Care units will need to be organized to follow initial care in accident department and the theatres.(iv) RadiologyProper radiology assessment is needed for the correct management of many casualties. Strict triage for radiology should be practiced by staff to avoid stymy in radiology department and over use and failure of X-ray machines or shortage of X-ray films. Portable X-ray machines will be preferred in orthopedic O.T. and image intensifiers sh