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

1. Emergency Preparedness and Response: The Role of Physicians 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 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. Def. Con’td A disaster is a situation in which the community is incapable of coping. It is a natural or human-caused event which causes intense negative impacts on people, goods, services and/or the environment, exceeding the affected community’s capability to respond; therefore the community seeks the assistance of government and international agencies. An emergency is a situation in which the community is capable of coping. It requires immediate attention Presented on 7th July 2011 by Dr Saka M.J Dept.of EPID UITH sakamj1@yahoo.com

5. Vulnerability Factor for Disaster • Risk “Is the probability that loss will occur as the result of an adverse event, given the hazard and the vulnerability” • Risk (R) can be determined as a product of hazard (H) and vulnerability (V). i.e. R = H x V Vulnerability: “Is the extent to which a community’s structure, services or environment is likely to be damaged or disrupted by the impact of a hazard” (key words) • Tangible/Material (easy to see; value easily determined) People -- Property –Economy –Environment – water, soil, air, • Intangible/Abstract (difficult to see; value difficult to determine) Social structures, Cultural practices, Cohesion, Motivation Presented on 7th July 2011 by Dr Saka M.J Dept.of EPID UITH sakamj1@yahoo.com

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

7. 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

8. B. SPEED OF ONSET • Sudden onset: little or no warning, minimal time to prepare. For example, an earthquake, tsunami, cyclone, volcano, etc. • Slow onset: adverse event slow to develop; first the situation develops; • the second level is an emergency; the third level is a disaster. For example, drought, civil strife, epidemic, etc. Presented on 7th July 2011 by Dr Saka M.J Dept.of EPID UITH sakamj1@yahoo.com

9. 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

10. 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

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

12. 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

13. 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

14. 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

15. 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

16. 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

17. Operational Procedures and Policy Guidelines of the National Emergency Management Agency (NEMA) • The National Disaster Response Plan (NDRP) The NDRP was approved by the Federal Executive Council (FEC) of Nigeria to serve as a policy guideline for managing disasters in Nigeria. The Plan establishes a process and structure for the systematic, coordinated and effective delivery of Federal assistance, to address the consequences of any major disaster or emergency declared by the President of the Federal Republic of Nigeria. • Now we also have Search and Rescue and Epidemic evacuation plan Presented on 7th July 2011 by Dr Saka M.J Dept.of EPID UITH sakamj1@yahoo.com

18. Cospas-Sarsat Mission Control Center The Cospas-Sarsatis a satellite based distress alert system with locational facility that provides data to assist in aviation and maritime Search and Rescue operations. Presented on 7th July 2011 by Dr Saka M.J Dept.of EPID UITH sakamj1@yahoo.com

19. Cospas-Sarsat Mission Control Center • Based on the Unique Advantage of Nigeria as central to Africa Presented on 7th July 2011 by Dr Saka M.J Dept.of EPID UITH sakamj1@yahoo.com

20. 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

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

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

23. The Physician’s Role in Disaster Preparedness & Response Presented on 7th July 2011 by Dr Saka M.J Dept.of EPID UITH sakamj1@yahoo.com

24. 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

25. 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

26. 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

27. What Physicians 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

28. 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

29. 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

30. Mitigation • Mitigation refers to all actions taken before a disaster to reduce its impacts, including preparedness and long-term risk reduction measures. • Mitigation activities fall broadly into two categories: 1 Structural mitigation – construction projects which reduce economic and social impacts 2 Non-structural activities – policies and practices which raise awareness of hazards or encourage developments to reduce the impact of disasters. Presented on 7th July 2011 by Dr Saka M.J Dept.of EPID UITH sakamj1@yahoo.com

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

32. 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

33. 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

34. 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

35. 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

36. 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

37. 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

38. 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

39. 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

40. 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

41. 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

42. 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

43. 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

44. Summary of Preparedness During the preparedness phase, governments, organizations, and individuals develop plans to save lives, minimize disaster damage, and enhance disaster response operations. 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

45. 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

46. Emergency Operations Plan • Physicians should participate, individually or collectively as part of the community or hospital in the development of a community disaster response plan Emergency Operations Plan • Communication • Resources and Assets • Safety and Security • Staff Responsibilities • Utilities • Patient/Clinical Support Activities Presented on 7th July 2011 by Dr Saka M.J Dept.of EPID UITH sakamj1@yahoo.com

47. Governance for Disaster Mgt. • NEMA Regional offices in Nigeria • Terrorism Preparedness Committee • Hospital Disaster Preparedness Committee • Hospital Committee • UITH Emergency Management Committee Contact – Safety Officer Phone ------- Presented on 7th July 2011 by Dr Saka M.J Dept.of EPID UITH sakamj1@yahoo.com

48. Operation of pre-hospital medical services in mass casualty situations (terrorism) • Volunteers • by-standers, first-aiders (Red cross ), nurses, doctors, medics - army • EMS • standard (white) and MICU ambulance teams • MDA volunteers with “mobile first aid station” on motorbikes • MDAcommand post on site • Home Front Command • army mobile medical posts, command and control Presented on 7th July 2011 by Dr Saka M.J Dept.of EPID UITH sakamj1@yahoo.com

49. 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

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