Care of Clients in Cellular Aberrations, Acute Biologic Crisis (ABC), Emergency and Disaster Nursing (NCM106) Emergency and

Disaster IV

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Human Induced Hazard Management

Introduction Human made or induced hazards are threats having elements of human intent, negligence, error and involving a failure of a system Human induced disasters are a result of such as: o Technological Hazards o Environmental Hazards o Socio-economic Hazards o Political and Security Hazards

Topics Discussed Here Are: 1. Human Induced Hazard Management a. Structure Collapse b. Urban Fire c. Vehicular Related Accidents d. Food Poisoning (Red Tide) e. Bomb Threat 2. Hospital Disaster Preparedness

Technological Hazards
Have little or no warning to precede the incident These dangers originates from: o Industrial accidents o Dangerous Procedures (Bombing, Nuclear Weapons) o Infrastructure failures o Certain human activities which may cause the loss of life or injury, property damage, social and economic disruption

Environmental Hazards
Events that pose a threat from the surrounding environment encompassing the broad spectrum of acute and chronic effects due to: o Industrial, agricultural and naturally occurring chemicals o Radiation in soil, water, air, food o Waste products and rubbish accumulation

Socio-Economic, Political and Security Hazards

These hazards are caused by criminal and human violence which post threat to the security of a great number of people

STRUCTURE COLLAPSE
Structure collapse is often caused by engineering failures such as under design of structural components, by corrosion attack and by aerodynamic resonance in structures Preparedness and Mitigation (What to do Before~) o Conduct a general check on the condition of all buildings through the assistance of city or provincial or municipal engineers and bureau of fire protection o Repair or rehabilitate structures to put them in good condition o Adapt the existing warning system for a building certified as unsafe for occupancy o Cordon off and mark buildings found unsafe with off-limits Response (What to do During~) o Vacate the building immediately o Apply first aid and in cases of injuries or casualties bring the victims to the nearest hospital for medical treatment Recovery (What to do After~) o Secure the area o Evaluate and assess the damaged structure through the assistance of engineers o Report the extent of damages to authorities for proper action

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Recommend for approval the demolition of condemned buildings, subject to recommendation by proper authorities

UBRAN FIRE
Fire is composed of three elements Heat, Fuel and Oxygen which when combined will result in a chemical reaction called BURNING The leading cause of death in a fire by a three to one (3:1) ratio over burns is asphyxiation Inhaling carbon monoxide can cause loss of consciousness or death within minutes A fully developed room fire has a temperature of over 1,100 F Fire generates a black, impenetrable smoke that blocks vision and stings the eyes Sources of Fire: o BUILDING FIRE Building fire may be caused by human negligence or by ARSON. It can also be accidental other causes are electrical system overloading, faulty electrical wirings and connections and carelessness of users o FOREST FIRE Forest fire is generally started by lightning It may also be caused by human negligence or ARSON If major, it may burn thousands of square kilometers and intensify enough to produce its own wind and weather effect o ARSON Arson is a crime commonly defined by state as willful or malicious damage of property by means of fire or explosion It also refers to the burning of another persons dwelling under circumstances that endanger human life Preparedness and Mitigation (What to do Before~) o Develop a fire preparedness plan o Develop building evacuation plans for each building o Post evacuation plans in a strategic location o Install fire extinguishers and alarms o Educate by means of demonstration to teachers and students on the proper use of fire extinguishers o Maintain proper signage for fire exits o Clear and free fire exits from obstructions o Make sure that the public address systems are loud, clear and functional o Assist the professional fireman in their fire prevention and suppression frill program (Fire brigade members) o Conduct regular inspections and safety checks on electrical outlets o Assign personnel who will regularly check possible areas where fire may start such as stock room, laboratories and kitchens o Maintain a fire safety plan and an education program o Consider escape ladders from multi-storey school buildings o Conduct a school fire drill at least four times a year Response (What to do During~) o Dos When FIRE is detected: Sound the alarm Advise the fire department Fight the fire with available equipment Drop the fire extinguisher if you are using it and leave if the fire does not immediately die down Seek the nearest exit not blocked by fire Feel the door, cracks and doorknob with the back of your hand before opening the door if you are escaping through a closed door Close windows and doors as you escape from the fire scene to delay the spread of the fire

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Use your second way out if you see smoke or fire in your first escape route Get out as safely and quickly as you can and stay away from toxic smoke and gases Crawling with your head at a level of one to two feet above the ground will temporarily provide best air Once you are out, go to your safe meeting place and send one person to call the fire department, if not already alerted o Donts During Fire Incidents DO NOT PANIC DO NOT RUN DO NOT USE AN ELEVATOR DO NOT JUMP FROM AN UPPER FLOOR o Post Impact Conduct inventory of personnel and students Seek medical assistance for the injured Do not return inside the faculty once outside Coordinate with the bureau of fire protection and municipal or city engineering office for building assessment Conduct inventory of school personnel and students, equipment, fixtures and facilities Recovery (What to do After~) o Report damage(s) to proper authorities o Give first aid when needed and seek medical assistance for the seriously injured o Stay out of fire damaged buildings until local fire authorities say it is safe to re-enter

VEHICULAR RELATED ACCIDENTS

Term used to describe technological transport accidents involving mechanized modes of transport It comprises of four disaster subsets: o Vehicle Transport o Water Transport o Rail Transport o Air Transport Also known as Traffic Condition Occurs when vehicles collide with another vehicle, pedestrian, animal, road debris or other stationary obstruction such as a tree or utility pole Traffic collisions may result in injury, death and property damage Factors that contribute to the risk of collision includes: o Vehicle design o Speed of operation o Road design o Road environment o Driver skills o Impairments and driver behavior Preparedness and Mitigation (What to do Before~) o Observe traffic rules, drive defensively and practice road courtesy o Keep your vehicles in good condition. Always check brakes, wheels and tires o Never pick up or drop off passengers in the middle of the road o Never sleep inside the vehicle, if possible. Stay alert o Bring passengers out of the vehicle immediately

FOOD POISONING
This is contamination of food with biological contaminants such as bacteria, fungi viruses and parasites Chemical contaminants can also poison food in the form of: o Agricultural chemicals (Pesticides, insecticides, herbicides, fungicides) o Environmental pollutants (Mercury, lead)

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o Veterinarian products (Antibiotics, growth enhancers) o Food Additives (Preservatives and food coloring) Salmonella causes the most deaths Symptoms of food poisoning depend on the type of contaminant and amount eaten The symptom can develop rapidly within 30 minutes Preparedness and Mitigation (What to do Before~) o Encourage school and offices to have a health certified canteen for consumption of all food o Discourage patronage of junk foods, street foods and alike o Wash raw food thoroughly o Cook food properly o Eat cooked food immediately o Store cooked food properly o Keep al kitchen surfaces meticulously clean o Protect food from insects, rodents, and other animals o Ensure that policies related to canteen operation are strictly enforced o Store dangerous chemicals away from kitchen Response (What to do During~) o Do not panic o Increase fluid intake to prevent dehydration if not tolerated orally o Bring person to hospital for IV treatment o Induce vomiting o Seek medical assistance in cases of complications o Recovery o Advice student or personnel to bring their own utensils o Ensure cleanliness of facilities and food preparation

RED TIDE
Discoloration of water bodies due to presence of a high level of a group of algae called dinoflagellates Causes toxicity and responsible for paralytic shellfish poisoning The occurrence of red tides in some locations appear to be entirely natural Coastal water pollution produced by humans and animals have systemic increase in sea water temperature which had been implicated as a contributing factor in red tides Preparedness and Mitigation (What to do Before~) o Disseminate red tide information, symptoms and progressions o Keep tract of and warn media regarding the information on outbreaks of red tide, avoid ingestion of fish, shell fish, mollusks and crabs o Monitor progression of symptoms and seek medical advice o Avoid or refrain from eating sea food while danger exists

BOMB THREAT
A declaration of an intention to destroy or injure the target by means of a bomb It is usually through telephone or written notes claiming that a dangerous device such as a bomb or similar type of explosive has been or will be placed in a building, aircraft or other facility A bomb is a device capable of producing damage to material and injury or death to people when detonated or ignited Bombs are classified as: o Explosive Inflicting damage and injury by fragmentation, heat and blast waves o Incendiary Generates fire producing heat without a substantial explosion when ignited Preparedness and Mitigation (What to do Before~) o Prepare a school for facility bomb threat emergency o Encourage every personnel and students to be constantly alert o Provide security for the protection of property o Set up Bomb Threat Command Centers in areas o DO NOT JOKE ABOUT BOMBS

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Presidential Decree No. 1727 DECLARING AS UNLAWFUL THE MALICIOUS DISSEMINATION OF FALSE INFORMATION OF THE WILLFUL MAKING OF ANY THREAT CONCERNING BOMBS, EXPLOSIVES OR ANY SIMILAR DEVICE OR MEANS OF DESTRUCTION AND IMPOSING PENALTIES THEREFOR Response (What to do During~) o Treat all threats received as real and report immediately to authorities o Remain calm and courteous o Try to obtain as much information as possible such as: Identity of the caller Characteristics of the caller Ask the EXACT location of the BOMB Apply delaying tactics Report all details to a responsible person immediately o Practice bomb threat awareness Handle with CARE, DONT SHAKE or BUMP Isolate and look for indicators DO NOT OPEN or SMELL nor TASTE Treat it as suspicious and call the hotline Recovery (What to do After~) o Request proper authorities to search the building thoroughly o Implement security measures in the premises o Post incident stress debriefing if needed

Hospital Disaster Preparedness

Every year, many hospital and health facilities in the country are damaged and destroyed by disasters to which Philippines has a very high vulnerability The price to pay for the failure of health care facilities when disaster happens is too high in comparison to the cost of making these safe and resilient Francisco T. Duque III, MD Secretary of Health

Internal Hospital Disaster

Refers to incidents that disrupt the everyday routing services of the medical facility and may or may not occur simultaneously with an external event: o Ondoy UERMMMCI 2009 o Dengue Outbreak 2009

Potential Hazards and Risks

Hazards
Power failures Floods Water loss Chemical accidents Fire Explosions Violence Bomb threats *** SOOOO WHY PREPARE?

Risks
Mass gathering (Football games, concerts, festivals) School activities Government facilities Industrial facilities Major transportation system

A Need for Hospital Preparedness

Health facilities, whether hospital or rural health clinics, should be a source of strength during emergencies and disasters Hospitals should be ready to save lives and to continue providing essential health services even during times of disaster

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International Perspective The Hyogo-Framework for Action in 2005 o Emphasizes the importance of making hospitals safe from disaster by: Ensuring that all new hospitals are built with a level of resilience Strengthen the capacity of hospitals to remain functional in disaster situations Implement mitigation measures t existing health facilities, particularly those providing primary health care

Defining Safe Hospitals

Are facilities whose services remain accessible and functioning at maximum capacity within the same infrastructure during and immediately following disaster and emergencies or crises Department of Health Will not collapse in disasters, killing patients and staffs Will be able to continue to function and provide critical services in emergencies Will be organized, with contingency plans in place and health personnel trained to keep the network operational

Essentials of Hospital Safety

Supporting safe hospitals involves knowledge of many factors that contribute to their vulnerability which includes: o Buildings o Patients and Hospital Beds o Medical and Support Staff o Equipment and Facilities o Basic Lifelines and Services Buildings Location and design specifications Resiliency of the materials used Architectural ability to withstand adverse natural events Patient and Hospital Beds Disaster will inevitably increase the number of potential patients The availability of hospital beds frequently decreases even as the demand for emergency care increases Medical and Support Staff Loss of unavailability of personnel disrupts the care of the injured Hiring outside personnel to sustain the response capacity adds to the overall economic burden Basic Lifelines and Services Hospitals ability to function relies on lifelines and other basic services such as: Electrical power Waste treatment and Water and Sanitation Disposal

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Hospital Response During Disaster

Phases of Hospital Internal Disaster Plan o \

ALERT PHASE Events during which staff remains at their regular positions, service provision is uninterrupted Faculty and staff await further instructions from their supervisors RESPONSE PHASE Events during which designated staff report to supervisors or the command post for instructions The response plan is acticated

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Non-essential services are suspended (Radiology Exams) 0 2 Hours: Immediate Response 1. Assess situation 2. Contact key health personnel 3. Develop initial health response objectives and establish an action plan 4. Establish communication and maintain close coordination with the EOC 5. Ensure that the site safety and health plan is established, reviewed and followed 6. Establish communication with other key health and medical organizations 7. Assign and deploy resources and assets to achieved established initial health response objectives 8. Address health related requests for assistance and information from other agencies, organizations and the public 9. Initiate risk communications activities 10. Document all response activities 2 12 Hours: Intermediate Response 1. Verify that health surveillance systems are operational 2. Ensure that laboratories are likely to be used during response are operational and verify their analytical capacity 3. Ensure that needs of special populations like children, disabled persons, elderly, etc. are being addressed 4. Manage health related volunteers and donations 5. Update emergency risk communications messages 6. Collect and analyze data that are becoming available through health surveillance and laboratory system 7. Periodically assess health resource needs and acquire as necessary 12 24 Hours: Extended Response 1. Address psychosocial and mental health concerns 2. Prepare for transition to extended operations or response disengagement 3. Address risk related to environment 4. Continue health surveillance or epidemiologic services 5. Ensure that local health systems are preserved and access to health care including essential drugs and vaccines is guaranteed

Integrated Code Alert System

HEMS Central Office Code Declaration / Suspension External Emergencies Internal Emergencies HEMS Director or Division Chief (Response / Preparedness) Chief of Hospitals / Medical Center Chiefs HHEMS Coordinator Head of the Disaster Committee Regional Director RHEMS Coordinator DOH Sec upon recommendations of HEMS Director (for national emergencies) OR Directors of NEC and NCDPC (for epidemics/reemerging diseases) Secretary of Health HEMS Director Dissemination Telephone brigade Office Order (c/o Admin office) Procedures c/o hospital concerned

DOH Hospitals

Center for Health Development DOH Central Offices

Procedures c/o region concerned Dept. Memo Telephone brigade by HEMS OpCen

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Conditions for CODE ALERT Activation

HEMS Central Office (Health Emergency Management Staff) DOH Hospital (Department of Health) CHD (Center for Health Development) DOH Central Offices (Department of Health) CODE WHITE Strong possibility of military operation Mass action or demonstration, forecast typhoons National or local elections, national events or holidays with potential for MCI Emergency with potential 10 50 casualties, terrorist attack, unconfirmed report of reemerging diseases, any hazard that may result to an emergency CODE BLUE Any condition in CODE WHITE plus two below: o Mobilization of DOH resources o 30 50% health facilities affected o Incapability of LGU to respond o Geographic coverage and affected population > 30% o MCI with 50 100 casualties o High case fatality rate for epidemics o Confirmed Human-Human transmission of AVIAN flu/SARS Condition similar to HEMS Central Office plus: o 20 50 casualties (Red tags) brought to hospital o Internal emergency in hospital bringing down operating capacity to 50% and; o Evacuation of patients to a Field Hospital Condition similar to HEMS Central Office plus: o Present evacuation center > 1 week with public health implications, condition requiring mobilization of entire region Condition similar to HEMS Central Office

HEMS Central Office (Health Emergency Management Staff)

DOH Hospital (Department of Health)

CHD (Center for Health Development) DOH Central Offices (Department of Health)

HEMS Central Office (Health Emergency Management Staff)

DOH Hospital (Department of Health)

CHD (Center for Health Development)

DOH Central Offices (Department of Health)

CODE RED Any natural, manmade, technological, or societal disorder with all present: o Declaration of disaster in area > 100 casualties in 1 area o Regional health personnel incapable of handling entire population o Mobilization of health sector needed o Mobilization of DOH key offices o Uncontrolled Human-Human transmission of AVIAN flu/SARS Condition similar to HEMS Central Office plus: o > 50% (Red Tag) casualties brought to the hospital o Hospital services paralyzed due to 50% manpower are victims o Hospital damaged structurally requiring patient evacuation Condition similar to DOH Hospital plus: o Event resulting to mass dead and missing o Disaster declared in > 2 provinces or 30% of metro manila cities o Uncontrolled epidemic outbreak Condition similar to HEMS Central Office

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Rapid Health Assessment

Information should be made available for reference within 24 hours from the event Key Questions: o Is there an emergency or not? If so, indicate: Type, date, time and place of emergency Magnitude and size of affected area and population o What is the main health problem? o What health facilities or services have been or may be affected? o What is the existing response capacity? (Actions taken by the local authorities by DOH HEMS? o What decisions need to be made? o What information is needed to make these decisions? Situation Report Outline A. Executive Summary Main summary of the disaster event B. Main Issue C. Health Impact D. Vital Needs E. Critical Constraints F. Response Capacity G. Conclusions H. Recommendations for Immediate Action I. Emergency Contracts J. Annexes Phases of Hospital Internal Disaster Response Plan Events when additional personnel are required = Off-duty staff are called in Existing staff may be reassigned based on patients needs KEY POINTS (RAIN) Application: Recognize Rain Example #1: o Unusual activity or behavior o Recognize: Suspicious package o Hazardous weather conditions o Avoid: Do not touch object o Things out of place: o Isolate: Contain the area and keep Unexplained liquids others away from the hazard area Strange smells o Notify: Call for Help Abnormal fogs or mists Rain Example #2: Suspicious packages o Recognize: Chemical spill Avoid o Avoid: Do not touch, taste or smell o What do I stay away from? o Isolate: Contain the scene and keep o Four Donts: others away from hazard area Dont become a VICTIM o Notify: Call for help Dont RUSH IN Dont TEST (Taste, Eat, Smell and Touch) Dont ASSUME any Isolate o Keep others away from hazard area Notify o Immediate supervisor o Hospital emergency phone number (715-0816 UERM Hospital)

Department of Health (DOH) Initiatives

10 Ps o o o o Policies Plans Protocols, Guidelines and Procedures People

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o Promotion and Advocacy o Partnership Building o Physical (Facility Enhancement) o Program Development o Practices o Peso and Logistics AO 168: National Policy on Emergencies and Disasters AO 155: Implementing Guidelines for Managing MCI during Emergencies and Disasters Hospital Emergency Preparedness, Response and Rehabilitation Plan (HEPRRP) Development of Health Emergency Management Staff (HEMS) Designated Hospital HEMS coordinators and response teams. Institutionalized Hospital HEMS unit directly under the hospital director

International Partnership
Program for Enhancement of Emergency Response (PEER) Regional training program initiated in 1998 by the US agency for international development office of foreign disaster assistance (USAID and OFPA) GOAL: To strengthen disaster response capacities in four Asian countries: India, Indonesia, Nepal and the Philippines Hospital Preparedness for Emergencies (HOPE) Developed by Asian experts from the Philippines, Nepal, Indonesia and India in 1998 PURPOSE: TO enhance preparedness for mass casualties through the development of well designated hospital emergency response and recovery plan that will facilitate the continuous functionality of the facility after major emergencies and disasters Asian Disaster Preparedness Center (ADPC)

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