DISASTER PROGRAMMES

1. DISASTER PROGRAMMES Dr. R.C. Gajria

2. INTRODUCTION • The term disaster means calamity or great misfortune. • WHO in 1990 gave a theme “Should disaster strike-Be prepared” • MIC leak in Bhopal was one greatest man-made disaster in the world. • Disaster causes too great load for normal medical & hlth. Relief system of the district to cope with. • Multi-dimensional relief efforts & multi institutional approach is needed for its Mgt.

3. DEFINITION • Sudden & widespread disturbance of the social system of the community by some agent or event, over which, those involved have little or no control. • An event or series of events which seriously disrupts normal activities. • A disaster is an event ,located in time & space which produces the conditions whereby the continuity of the structure & processes of social units become problematic. • An overwhelming ecological disruption occurring on a scale sufficient to require outside assistance.

4. TYPES OF DISASTERS • Natural disasters:-Earthquake,volcanic;landslides,Avalanches;Windstorms,tornadoes,hailstorms,floods,droughts; Locusts swarms,Epidemics. • Manmade disasters:- Conventional,Bio/Chem/Nuclear warfare;accidents viz vehicular,plane,train,drowning,collapse of Bldg, explosions, fires, chemicals/poisoning.

5. Effect of disasters • Deaths • Severe injuries requiring extensive care. • Increased communicable diseases(potential increase in transmission of disease) in proportion to density of population& displacement) • Food Scarcity. • Population displacement. • Initial reaction among the survivors is shock • Exposure to climate,food/ crops may get damaged,Anxiety/neurosis & depression(preserve family & social structure if possible),

6. DISASTER Mgt. • Disaster Mgt. is not merely extension of Emergency service or casualty but something more. However the casualty/emergency has to work more effectively. • Good state of preparedness before striking of disaster may reduce its impact. • Greatest numbers of lives can be saved during the first few hours after a disaster has struck.Since out side/international aid may take time to reach hence it is essential that community should be well prepared,educated,well organized & actively involved so as to tackle the hlth problems effectively.

7. Disaster Mgt. • People who are to take early action are,local hlth pers,community,local authorities & indls/groups. • Action of local community is most Imp.but not enough & help from intermediate level/National/Inter national will be required. • In the time of disaster conflicts &class difference often dies down & sense of community solidarity develops.

8. Stages of Disaster Mgt • Warning stage: When meteorological,seismological& other forecast are made e.g. few Hrs. to 48 Hrs.before cyclone & a week before floods. • Stage of Impact:Time during which disaster actually strikes. • Stage of rescue operations: Should be completed efficiently not taking more than 2-3 days(Evaluation of pts.is done). • Stage of hlth& medical relief:m It is most crucial phase of disaster Mgt.to prevent further disaster of the survivors. • Rehabilitation stage: In their original settings

9. Planning for Disaster Mgt. • Plg. Culminates in preparing a Disaster Manual. Principles are : simple,flexible,clear &concise,adaptable for all hours incl.holidays,& it should be an extension of normal hosp.&public hlth care working.

10. Disaster Manual: • Introduction • Distribution of responsibilities • Chronological action plan:initial alert,activation of hosp,command nucleus,clinical Mgt. of casualties(Admission,Clinical services&triage),Mgt. of specific disaster problems • Checklist of personnel & items. • Rehearsal & conclusion.

11. Mgt. of specific Problems of disaster • Documentation • Communication • Crowd Control • Involvement of NGOs • Patient’s Property • Press/Media • Ambulance /Emergency Light • Coordination with other hlth agencies/institutions/Govt agencies/Vog • Managing Public hlth relief during disaster.

12. HOSPITAL HAZARDS • “Hazard” means risk or danger or source of this. • Hosp.Waste: “It refers to all waste, biological or Non Biological that is discarded & is not intended for further use in the hosp”. • Infectious Waste:It is the portion of Bio-Med.waste which may transmit viral,bacterial or parasitic disease,if concentration& virulence of pathogenic organisms is sufficiently high.

13. Bio-Med Waste: “Any solid,liquid waste including it’s container& any intermediate product,which is generated during the diagnosis, tmt, or immunization, of human beings or animals,pertaining therein,research activities,or in the production or testing of biological & animal waste from slaughter houses & any other such establishments”

14. WHO Classification of Waste • General waste: poses minimal risk e.g.kitchen waste, packaging materials, waste water from laundries. It doesn’t require special handling. • Pathological Waste: Consists of tissues organs, body parts,animal carcasses, blood & body fluids. • Radioactive waste: One which is contaminated with radionuclides.It may be solid/liquid/gas. • Chemical waste:chemicals from diagnosis or experimental work,disinfectants,detergents etc.Hazardous chemical waste is toxic,corrosive,flammable,reactive & genotoxic.Non toxic sugars,amino acid,salt etc.

15. Infectious waste: Contains pathogens in sufficient conc.to cause disease. It includes cultures,stocks of infec.agents, waste from autopsies/surgeries. • Sharps • Pharmaceuticals • Pressurized containers. Note In WHO classification for developing countries onlyGeneral/Infected/sharps/chem.&Pharmaceuticals/Other hazardous wastes (Radioactive & cytotoxic) wastes have been included.

16. Classification by committee on urban solid waste Mgt • General /Non hazardous:-Comprises of 80-85% which is has minimal or least infection potential can be disposed off by municipal authorities. • Hazardous Waste: a) potentially infectious e.g.dressings,swabs,Lab waste,instruments Equip used e.g.probes,catheters, iv cannulae,needles & sharps,placenta, tissue,organs,limbs,infected animals used for R&D. b)Potentially toxic wastes Radioactive, Chem&pharmaceuticals wastes.

17. Routes of infection • Absorption/Adsorption/Inhalation/Ingestion • Categories of pers.who are at higher risk if exposed to potentially infectious waste are Pts, Patients with bleeding or clotting diseases,pt on dialysis, I V drug abusers,Staff who comes in close contact.

18. Public Hlth Risks of BMW • AIDS • Hepatitis B &C • Gastro-enteric infections • Respiratory Infections • Blood stream infections • Skin infections • Effects of Radio-active substances • Intoxications. • Physical/Chemical/Radiation Injuries.

19. Impact of improper hosp waste Mgt. • Risk of pollution of Air, Water & soil besides aesthetics. • Gen.public is very sensitive about incidents Involving bio-waste/HCW & also visual impact e.g. parts of body or foetus etc. Rats,flies cockroaches feed on hosp.waste particularly organic waste.

20. Envt. Related legislative Measures • Water (prev.&control of pollution)act1974 • Water (prev.&control of pollution)cess act,1977. • Air (prev.&control of pollution)act,1981. • Envt. Protection act1986. • Hazardous waste (Mgt.&handling) Rules,1989. • Public liability Insurance act,1991 • National Envt. Tribunal act,1995 • National Envt. Appelate authority act,1997.

21. BWM • Segregation • Collection • Treatment • Disposal • Education of staff. • Training

22. Segregation: It is key to effective waste Mgt. It is done as close as possible where generated Yellow bag: Human Anatomical waste viz. parts of body,fetus, placenta,biopsy tissues. Red bag: cotton gauze,bandages adhesive plasters etc.which are soaked in blood,pus,urine or body fluids. Blue: Plastic & rubber disposables.I V sets,syringes,Folley’s catheters,aspiration tube,gloves. Black : General waste.

23. Waste should be collected daily & transported to the site in the hosp. • No bags should be removed unless properly labelled with their point of production. • The bags or containers should be replaced immediately. • Storage:Pt is designated & located inside the hosp.,easily accessible,impervious, plenty of water supply,drainage, enclosed with lock,inaccessible to insects,animals, well ventilated&lighting etc.

24. Treatment & Disposal • Double chamber Incineration • Autoclaving/Steam Sterilization • Chemical Dis-infection • Microwaving • Hydroclaving • Plasma Technology • Irradiation • Grinding & Shredding • Disposal

25. Composition Hosp waste • 80-85% is Non infectious waste • 10-15% is infectious waste. • 5% is chemical waste is Non infectious but hazardous waste.

26. Medical Care • Need: Organised public hlth & med.care services is V.Imp determinant of hlth. Need & demand of Med. Care is on rise because of public awareness regarding hlth & improved tech in hlth industry, increase in income, rise in education.It is not only the realisation of the needs by the Govt. but also the pressure of public opinion demanding care which leads to drafting of the legislation. • With advancement in Technology cost is increasing day by day. • Distribution of services is lopsided. • Hospital & Medical care system.

27. Because of different geographical situations & pattern of population settlment each country has own module of Hlth care. • In any country at least 3 types of “Geo-demographic”situations or patterns, namely the rural areas, the medium sizetowns & large cities.

28. Current Trends in structuring & operations of HCS • Comprehensive Hlth care for entire population. • Mix of Pvt. & Public Hlth care services.Whole time salaried persons with appropriate career prospects. • Hlth Insurance. • Progressive integration of prev.,promotive & curative services & special disease program. • More expensive personal Hlth surveillance & mass screening. • A systematic planning & organisation of Hlth care services.

29. THANK YOU