Emergency Preparedness and Response : The Role of Health Workers in Disaster Mgt .

1. Emergency Preparedness and Response: The Role of Health Workers in Disaster Mgt. Dr. Saka M.J MB;BS,MPH,MBA,FMCPH, Dip. Health Systems (Israel) Presented on 7th July 2011 by Dr Saka M.J Dept.of EPID UITH sakamj1@yahoo.com

2. Outline • Brief overview of Disaster emergencies Situation a)Organization of Medical Services for Emergencies , (b)Legal Status;-NEMA, c) Health Bill C context of Emergency situation etc Resources, Funding for Emergency • (PREPAREDNESS) Enhancing effective Management (a) Hospital preparedness and drills, (b)Social Services and Support, (c)General Public Health Effects of a Natural DisasterDISASTER Mass Casualty Situation (i) Evacuation Chain; The Event, Triage, Evacuation, Local Hospital, Trauma Center (ii) Medical Treatment on site • AFTERMATH OF DISASTER • Technology (GIS, GPS and Remote Sensing) and Disaster • Media and Disaster Presented on 7th July 2011 by Dr Saka M.J Dept.of EPID UITH sakamj1@yahoo.com

3. Definations/ Terminology Outbreak :- more cases of disease than expected in a given area among a specific group of people over a particular period of time Epidemic :- same as outbreak or more widespread/prolonged, more political. Hazard :- “Is the potential for a natural or human-caused event to occur with negative consequences” (key words), A hazard can become an emergency; when the emergency moves beyond the control of the population, it becomes a disaster. Emergency: “Is a situation generated by the real or imminent occurrence of an event that requires immediate attention Disaster: “Is a natural or human-caused event which causes intensive negative impacts on people, goods, services and/or the environment, exceeding the affected community’s capability to respond” (key words) Presented on 7th July 2011 by Dr Saka M.J Dept.of EPID UITH sakamj1@yahoo.com

4. Presented on 7th July 2011 by Dr Saka M.J Dept.of EPID UITH sakamj1@yahoo.com

5. CLASSIFICATION OF DISASTERS • Disasters are often classified according to their: a causes – natural vs. human • NATURALMAN-MADEHUMAN-NAT * Avalanche * Aviation * Land Deg. * Arson * Desertification * Disease * Technology * Drought * Civil Disorder * Siltation * Earthquake * Power Outage * Famine * Public Relation * Fire * Radiation * Flood * Siltation * Hailstorm * Space Disasters * Windstorm * Telecom Outage * Hurricane * Terrorism * Impact Event * War * Limnic Eruption * Landslide * Mudslid * Thunderstorm * Tornado * Tsunami * Volcanic Eruption * Winterstorm Presented on 7th July 2011 by Dr Saka M.J Dept.of EPID UITH sakamj1@yahoo.com

6. Prevalent Hazards In Nigeria The wide range of hazard in Nigeria includes: • Frequent oil spills; pipe line vandalisation • Increasing levels urban industrial pollution and waste • Rise in the number and severity of floods, especially in Jigawa, Kano, Sokoto, Kebbi, Zamfara, Gombe and Southern States • Threat of desertification & pest infestation as in quella birds and locusts in Sokoto and the Yobe - Borno axis • The not too long reported outbreak of the dreaded avian influenza H5N1 (bird flu) loss of livelihoods Presented on 7th July 2011 by Dr Saka M.J Dept.of EPID UITH sakamj1@yahoo.com

7. Prevalent Hazards In Nigeria • Droughts and general land use degradation • Gully erosion traditionally in South Eastern states and becoming pronounced in Auchi and Bida. • Wind storms in the northern parts of the country • The rampant air crashes of 1992 to 2009 • Fire disasters especially market infernos Sokoto, Jos etc • Cases of collapsed buildings in Lagos, Abuja & PH • Ethno-religious conflicts • Threat to oil/gas explorations by militia Niger Delta. • Bomb Blast (Abuja, Maiduguri) • RTA Presented on 7th July 2011 by Dr Saka M.J Dept.of EPID UITH sakamj1@yahoo.com

8. Presented on 7th July 2011 by Dr Saka M.J Dept.of EPID UITH sakamj1@yahoo.com

9. INSTITUTIONAL AND POLICY FRAMEWORK FOR DISASTER MANAGEMENT IN NIGERIA • Institutional response to disaster in Nigeria can be traced back to 1906 when the Fire Brigade (now Federal Fire Services) was established, with its functions going beyond fire fighting to saving of lives and property and provision of humanitarian services during emergencies. Presented on 7th July 2011 by Dr Saka M.J Dept.of EPID UITH sakamj1@yahoo.com

10. INSTITUTIONAL AND POLICY FRAMEWORK FOR DISASTER MANAGEMENT IN NIGERIA • Between 1972 and 1973 Nigeria was hit by a devastating drought with socio-economic consequences that caused the nation loss of lives and property worth millions of Naira. • This made it important for the Government to consider a response body to take care of disaster issues. Thus, the establishment of National Emergency Relief Agency (NERA) by Decree 48 of 1976, charged with the task of collecting and distributing relief materials to disaster victims. Presented on 7th July 2011 by Dr Saka M.J Dept.of EPID UITH sakamj1@yahoo.com

11. National Disaster Cont’d • NEMA was established in March 1999 via Act 12 of 1999 as amended by Act 50.The Agency was saddled with the responsibility of coordinating disaster management activities for the country. Presented on 7th July 2011 by Dr Saka M.J Dept.of EPID UITH sakamj1@yahoo.com

12. FUNCTIONS & RESPONSBILITIES OF NEMA • Disaster preparedness and mitigation; • Notifying, activating, mobilizing, deploying staff and setting up the necessary facilities for response; • Evaluating and assessing disaster damage and requests; • Managing Disaster Management funds; • Public Information and Enlightment; • Formulating policy/guidelines for Disaster Management in the country; • Liaising with State Emergency Management Committees (SEMCs), Regional, International bodies and NGOs to assess and monitor, and where necessary, distribute Relief materials to disaster victims. Presented on 7th July 2011 by Dr Saka M.J Dept.of EPID UITH sakamj1@yahoo.com

13. NEMA achieves its Disaster Management NEMA achieves its Disaster Management objectives by collaborating with: • State Governments. • Local Governments. • Voluntary Organizations and • The international specialized and donor agencies. • 57 Disaster Response Units Presented on 7th July 2011 by Dr Saka M.J Dept.of EPID UITH sakamj1@yahoo.com

14. OTHER FACILITIES ON GROUND FOR PREPAREDNESS AND MITIGATION • The Geographic Information System (GIS) + • Vulnerability study of Nigeria • Emergency Lines • Rescue Helicopter • Contingency stockpiling • 6 Zonal Offices in the 6 Geo-Political Zones of the Country. Presented on 7th July 2011 by Dr Saka M.J Dept.of EPID UITH sakamj1@yahoo.com

15. Disaster Response Unit In Nigeria Presented on 7th July 2011 by Dr Saka M.J Dept.of EPID UITH sakamj1@yahoo.com

16. Presented on 7th July 2011 by Dr Saka M.J Dept.of EPID UITH sakamj1@yahoo.com

17. General Public Health Effect of Disaster Victims of a disaster often suffer great loss: • Home • Family • Friends • Pets, Animals • Possessions etc An understanding of family dynamics by the physician is needed to deal appropriately with disaster situations. Presented on 7th July 2011 by Dr Saka M.J Dept.of EPID UITH sakamj1@yahoo.com

18. General Public Health Effect of Disaster • Unexpected numbers of deaths, injuries, illnesses, exceeding local capacity • Destruction of local health infrastructure • Destruction of homes and public buildings • Spontaneous displaced population movements • Interruption of communication • Water supply interruption / contamination • Power outages Presented on 7th July 2011 by Dr Saka M.J Dept.of EPID UITH sakamj1@yahoo.com

19. General Public Health Effect of Disaster Cont’d • Food/Water Shortage or Safety • Inadequate / insufficient shelters • Crowding of displaced populations • Inadequate Sanitation • Environmental Effects • Identification and management of the dead (assistance to police) • Psycho-Social Reactions • Abandoned animals Presented on 7th July 2011 by Dr Saka M.J Dept.of EPID UITH sakamj1@yahoo.com

20. What HWs can Do Physicians can provide the expertise to address the needs and special problems of disaster victims in all three phases of a disaster: •Before, •During and immediately after (day 0-2) •During aftermath and recovery (day 3 on) Presented on 7th July 2011 by Dr Saka M.J Dept.of EPID UITH sakamj1@yahoo.com

21. The diagram below shows the Disaster Management Cycle Presented on 7th July 2011 by Dr Saka M.J Dept.of EPID UITH sakamj1@yahoo.com

22. Disaster Mgt Circle • Mitigation: Measures put in place to minimize the results from a disaster. Examples: building codes and zoning; vulnerability analyses; public education. • Preparedness: Planning how to respond. Examples: preparedness plans; emergency exercises/training; warning systems. • Response: Initial actions taken as the event takes place. It involves efforts to minimize the hazards created by a disaster. Examples: evacuation; search and rescue; emergency relief. • Recovery: Returning the community to normal. Ideally, the affected area should be put in a condition equal to or better than it was before the disaster took place. Examples: temporary housing; grants; medical care. Presented on 7th July 2011 by Dr Saka M.J Dept.of EPID UITH sakamj1@yahoo.com

23. Preplanning for a Disaster Presented on 7th July 2011 by Dr Saka M.J Dept.of EPID UITH sakamj1@yahoo.com

24. Hospital Preparedness • Mitigation;- Reducing or minimizing an impact of a hazard or disaster. • Basic considerations: • treatment potential based on manpower, space and means • medical care differs from regular procedures • treatment priorities based on saving salvageable patients • stabilization and inter- hospital transfer of patients – as needed Presented on 7th July 2011 by Dr Saka M.J Dept.of EPID UITH sakamj1@yahoo.com

25. Hospital Preparedness • main hospital deployment areas: • triage - entrance to (ambulance bay) • decontamination and triage area • treatment area for non-urgent cases • area for acute post traumatic stress cases • treatment area for urgent cases: • trauma room - resuscitation area • treatment area for stretcher cases • holding - treatment area for transfer cases Presented on 7th July 2011 by Dr Saka M.J Dept.of EPID UITH sakamj1@yahoo.com

26. Hospital Preparedness • treatment areas (cont.): • operation theatres • ICUs • hospitalization wards • imaging facilities • laboratory and blood bank services • public information and social services • command, control and communication center Presented on 7th July 2011 by Dr Saka M.J Dept.of EPID UITH sakamj1@yahoo.com

27. Hospital Preparedness • activation of emergency hospital plan when: • casualties appear without warning • short warning before admission of patients • immediate response: • sounding internal alarm - call up staff • discontinue regular operations (inc. in OTs) • vacate beds in Emergency Dept. • distribute equipment to treatment areas • start emergency registration and recording Presented on 7th July 2011 by Dr Saka M.J Dept.of EPID UITH sakamj1@yahoo.com

28. Hospital Preparedness • treatment level and surgery: • temporary decline in treatment standards • priority to life-saving surgical procedures • about 2/3 of admissions will be discharged within hours • about 1/10 will require immediate surgery ICU and hospitalization • a senior surgeon will decide on priorities for surgery Presented on 7th July 2011 by Dr Saka M.J Dept.of EPID UITH sakamj1@yahoo.com

29. Hospital Preparedness • registration and medical recording: • shorten registration procedures • prepare emergency patient charts, forms for imaging, laboratory and blood bank • briefly record vital signs, findings, treatment procedures and disposition • record surgical procedures • record external findings and photos of dead Presented on 7th July 2011 by Dr Saka M.J Dept.of EPID UITH sakamj1@yahoo.com

30. Social Services and Support • Establish information desk (near entrance to hospital) • Provide social counseling to next of kin • Update information on hospitalized patients • Collect information on missing persons • Present pictures or particulars of un-identified persons Presented on 7th July 2011 by Dr Saka M.J Dept.of EPID UITH sakamj1@yahoo.com

31. Hospital Preparedness • medical and general equipment: • prepare emergency equipment on trolleys • prepare replenishment of disposables • prepare drugs and i.v. fluids • ensure medical gas supplies and uninterrupted power and water supply Presented on 7th July 2011 by Dr Saka M.J Dept.of EPID UITH sakamj1@yahoo.com

32. Hospital Preparedness • command and control: • activate emergency operational center • request information and update staff aids • delegate authority to medical directors and administrative managers • activate emergency radio communication • public information: • activate information center and emergency telephone – fax and computer inf. lines Presented on 7th July 2011 by Dr Saka M.J Dept.of EPID UITH sakamj1@yahoo.com

33. Hospital Preparedness Volunteers • Plan for call-up of local, regional and international volunteers • Inform volunteers on requirements and specific and defined tasks • Screen qualifications • Educate and train volunteers in hospitals / possible work places Presented on 7th July 2011 by Dr Saka M.J Dept.of EPID UITH sakamj1@yahoo.com

34. Hospital preparedness and drills • Conduct periodic exercises in General Hospitals: • Education and training of hospital personnel (doctors, nursing staff, administrators, technical and laboratory staff) • Conduct internal drills in classrooms (table top) Presented on 7th July 2011 by Dr Saka M.J Dept.of EPID UITH sakamj1@yahoo.com

35. Hospital preparedness and drills • Once a year conduct a general drill of all sectors with simulated casualties • Conduct debriefing sessions after all real emergencies and drills • Conduct external auditing procedure by NEMA and MOH etc • Disseminate lessons learned to all hospitals within the State or in the country Presented on 7th July 2011 by Dr Saka M.J Dept.of EPID UITH sakamj1@yahoo.com

36. Summary of Mgt / Investigation of Epidemic outbreak • Prepare for field work • Verify the diagnosis • Establish existence of an epidemic • Identify and count cases • Data analysis: time, place and person • Formulate and test hypothesis • Assess the local response capacity • Set up immediate control measures • Address the resource gaps • Report writing • Dissemination of findings • Intensify surveillance Presented on 7th July 2011 by Dr Saka M.J Dept.of EPID UITH sakamj1@yahoo.com

37. SUMMARY OF PREPAREDNESS MEASURES INCLUDE: • Preparedness plans • Emergency exercises/training • Warning systems • Emergency communications systems • Evacuations plans and training • Resource inventories • Emergency personnel/contact lists • Mutual aid agreements • Public information/education Presented on 7th July 2011 by Dr Saka M.J Dept.of EPID UITH sakamj1@yahoo.com

38. Priority diseases, conditions and events(Epidemic prone diseases) • Cholera • Diarrhoea with blood • Measles • Meningitis • Viral haemorrhagic fevers • Human influenza caused by new subtype • Cholera • Diarrhoea with blood • Measles • Meningitis • Viral haemorrhagic fevers • Human influenza caused by new subtype Presented on 7th July 2011 by Dr Saka M.J Dept.of EPID UITH sakamj1@yahoo.com

39. Priority diseases, conditions and events (other diseases of public health importance) • Poliomyelitis • Dracunculiasis • Leprosy • Neonatal tetanus • Lymphatic Filariasis • Tuberculosis • HIV • Malaria • Onchocerciasis • STIs • Trypanosomiasis • Buruli ulcer • Diarrhoea in children < 5 years • Pneumonia in children < 5 years • Asthma • Diabetes Mellitus • Epilepsy • High blood pressur Presented on 7th July 2011 by Dr Saka M.J Dept.of EPID UITH sakamj1@yahoo.com

40. Organization of incident Site Objectives • To organize the confusion on site,prevent un-authorized access and possible additional injuries by second bombing (body protection of medical teams) • Priority access for police bomb squads, fire fighters, EMS and rescue teams • Rescue and removal of victims from immediate danger (fire, Hazardous Materials Management (HAZMAT), explosion) • Primary survey and assessment of the scene (numbers and location of victims, types of injuries) • Initial report to EMS dispatch center and to hospitals • Organization of site (allocation of teams) and treatment of patients Presented on 7th July 2011 by Dr Saka M.J Dept.of EPID UITH sakamj1@yahoo.com

41. Presented on 7th July 2011 by Dr Saka M.J Dept.of EPID UITH sakamj1@yahoo.com

42. Medical Treatment on Site • establish casualty collecting area • transfer casualties to collecting area • assign responsibilities to medical staff • establish medical triage point(s) • provide ATLS to casualties, according to priorities: • Airway control & cervical spine splinting • Breathing - ventilation - O2 • Circulation - bleeding control - i.v. fluids Presented on 7th July 2011 by Dr Saka M.J Dept.of EPID UITH sakamj1@yahoo.com

43. First Aid Treatment • Assume command-be visible! • Triage and Tagling • primary assessment and performing life-saving procedures • prioritization of victims for immediate evacuation in urban areas (scoop and run) • pronouncing of death Presented on 7th July 2011 by Dr Saka M.J Dept.of EPID UITH sakamj1@yahoo.com

44. First Aid Treatment Cont’d • establish casualty collecting area • transfer casualties to collecting area • assign responsibilities to medical staff • establish medical triage point(s) • provide ATLS to casualties, according to priorities: • Airway control & cervical spine splinting • Breathing - ventilation - O2 • Circulation - bleeding control - i.v. fluids Presented on 7th July 2011 by Dr Saka M.J Dept.of EPID UITH sakamj1@yahoo.com

45. Medical Evacuation • Transport salvageable casualties first (airway!) • “Scoop and Run”-and treat during transportation (airway, i.v. line) • Decide on hospital according to: • type of injury • level of trauma care • distance to facility • Report to hospital through dispatch center • Provide continuous care Presented on 7th July 2011 by Dr Saka M.J Dept.of EPID UITH sakamj1@yahoo.com

46. Helping during theAftermath Presented on 7th July 2011 by Dr Saka M.J Dept.of EPID UITH sakamj1@yahoo.com

47. Refugees Hospital wards in open tents working in shifts daily rounds (5-6 hrs) Presented on 7th July 2011 by Dr Saka M.J Dept.of EPID UITH sakamj1@yahoo.com

48. Following a disaster, the hospital and the community will need to recover. The length of the recovery period depends on the nature of the disaster and the extent of the damage. Presented on 7th July 2011 by Dr Saka M.J Dept.of EPID UITH sakamj1@yahoo.com

49. The healthcare community, including physicians should be prepared to deal with continued disruption of services that will affect their ability to care for patients. Presented on 7th July 2011 by Dr Saka M.J Dept.of EPID UITH sakamj1@yahoo.com

50. Develop plans to provide on-site emergency and primary health care at emergency shelters: • In-Patient & Out-Patient treatment • Infectious Disease Control • Logistics and lost supplies • Physical and Mental Rehabilitation • Critical Incident Stress Debriefing for victims and • Healthcare providers. Presented on 7th July 2011 by Dr Saka M.J Dept.of EPID UITH sakamj1@yahoo.com