Introduction

The shocking memories of Bhopal gas tragedy of 1984, the Latur earthquake of 1993,
Guarat earthquake of !""1 and the T sunami calamity of !""4 ha#e not faded from our
minds$ Those disasters killed and incapacitated tens of thousands of people and destroyed
properties %orth crores of rupees$
Definition
& 'ha(ard) can *e defined as any phenomenon that has the potential to cause disruption
or damage to people and their en#ironment$
Meaning of disaster
+ , +etection
- , -ncident command
. , .afety and security
& , &ssess
. , .upport
T , Traige and treatment
/ , /#aluation
0 , 0eco#ery
Classification of Disaster
+isatser has *een classified as natural and man made disasters$ There is a
comple1 relationship *et%een them
Natural Disasters:
2lood, cyclones, earthquakes, land slides, %ind storm, epidemic and droughts$
Man made disasters;
2ire, e1plosion, accidents of aircraft or ships, ordinary *om*ing, terrorism, riots and
#iolence$
Life of an individual:
-n general any emergency management is the continuous process *y %hich all
indi#iduals, groups and communities manage ha(ards in an effort to a#oid or ameliorate
the impact of disasters resulting from the ha(ards$
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3edical treatment for large num*er of casualities is likely to *e needed only after
certain types of disasters$
3ost inuries are sustained during the impact and thus greatest need for
emergency care occurs in the first fe% hours$
3ost immediate help comes from the uninured sur#i#ors$
The principle of 'first come, first treated) is not follo%ed in mass emergencies$
/mergency care is looking for air%ay, *reathing, circulation, disa*ility and
e1posure$
A- Airway
&ssessment of air%ay is al%ays an initial step in any care, *ecause of the potential
for cer#ical spine inury, air%ay is assessed$
3aintain the head and neck in natural position, %hile placing a rigid cer#ical collar
and immo*ili(ing the patient on a long spine *oard$
Listen for #ocali(ing indicating air mo#ements$ -f #ocali(ation is a*sent open the
patients air%ay using a chin4 lift or modified a% 4thrust maneu#er$ /1amine the
oropharyn1$ The air%ay may *e partially or entirely o*structed *y fluids$ -nner#e as
appropriate 5digital remo#al and repositioning6
B-Breathing
To assess *reathing, o*ser#e for spontaneous respirations and note their rate, depth
and effort$ /1amine the chest %all for use of accessory muscles$ 7isually inspect the
thora1$
&l%ays assume uncooperati#e or restless patients are hypo1ic, pro#ide supplemental
o1ygen, most of the #ictim8s *reath a little faster than normal 518 to !4
respirations9min6$ -n the presence of a*normal respiratory effort$ 5:asal flaring, supra
sternal, inter costal or su*sternal retractions the air%ay may *e partially o*structed$
ate:
.lo% 5*elo% 1" respirations9 minute6
0apid 5a*o#e !; respirations9minute6
!
C- Circulation
This in#ol#es e#aluation of *leeding, pulses and perfusion$
Bleeding:
-nspect for signs of e1ternal *lood loss and apply direct pressure of the effected area$ -f
possi*le ele#ate hemorrhaging e1tremities a*o#e the le#el of heart$ Large amounts of
*lood can *e lost internally$ <hen is a person hea#ily *leeding push clear cotton into the
%ound and hold if firmly$
!ulse;
=alpate carotid, radial and femoral pulse$ >heck the circulation of a person %hen his heart
is *eating *y checking the pulse rate at side of the neck$
!erfusion,
.e#eral non4specific sign include clammy skin, pallor, cyanosis, may indicate the
presence of hypo#olemic shock$ &ssess for skin colour, temperature, presence of
diaphoresis and capillary refill$
D-Disa"ility
>heck the papillary si(e, shape, equally reacting to light$ &ssess patients neurological
status like a%ake, unresponsi#e, #er*al stimuli, unresponsi#e to pain$
#- #$%osure and environmental control
>ompletely and rapidly remo#e the patients clothing to assess for inuries,
hemorrhage or other a*normalities$ ?*ser#e the clients o#erall general appearance,
*ody position, presence of any odors like urine$
&irst aid 'it
&ssem*le a first aid kit for your home and one for each car$ & first aid kit should
include,
.terile adhesi#e *andages in assorted si(es
&ssorted si(es of safety pins
>leansing agent9 soap
Late1 glo#es 5! pairs6
!4inch sterile gau(e pads 544;6
44 inch sterile gau(e pads 544 ;6
3
triangular *andages 536
! 4 inch roller *andages 53 rolls6
scissors
syringes
antiseptic
thermometer
tu*e of petroleum elly or other lu*ricant
Non %rescri%tion drugs:
aspirin or non aspirin pain relie#er
anti4 diarrhea medications
antacid 5 for stomach upset6
la1ati#e
#(ui%ment
>ertain equipment and materials should *e earmarked for dealing %ith disaster$ They
must *e checked periodically$
?1ygen cylinders %ith pressure gauge flo% meters and masks$
.panner for opening
.tretchers, %heelchairs and trolleys
.plints
3edications %hich include, anti*iotics such as ciproflo1acin and intra#enous, Ta*
do1ycyclines, *ronchial dilators, other fluroquinolones, 5oral and intra#enous6$
-7 fluids %ith sets, *lood sets for collection of *lood$
+ressing and suture materials
-nstruments for dressing, glo#es, face masks, colour tags and am*ulance must *e
kept ready$
)he am"ulance e(ui%ment includes;
&ir%ay management
7entilation de#ice
.uctioning unit
4
?1ygen deli#ery
Basic %ound care supplies, splinting supplies$
3edications
=atient transfer equipment
=ersonal safety equipment
Communication:
>ommunication is essential during emergency response nurse may ser#e as
communication link *et%een,
1$ the hospital and health department
!$ %ith the an1ious relati#es and friends of the #ictims
3$ %ith the pu*lic
4$ %ith the authorities and
@$ %ith media
one leaders should *e identified %ho %ill issue instructions$
*sual se(uence,
1$ information recei#ed at the health care 5situation6 institutions$
!$ the team leader and mem*ers of the team are informed$
3$ the team gets ready and is in position %ith all the necessary facilities$
4$ #ictims are recei#ed
@$ preliminary e1amination and sorting 5triage6$
Colour Coding;
*lack tags indicates #ictims %ho are already dead$
0ed tags indicate top priority %ho ha#e life threatening inuries *ut %ho
can sta*ili(ed and ha#e high pro*a*ility of sur#i#al$ =riority is gi#en to
inured rescue %orkers, hysterical persons and children$
Aello% indicate second priority are assigned to #ictims %ith inuries %ith
systematic complications %ho are a*le to %ithstand a %ait of 4@ to ;"
minutes, for medical attention also for #ictims %ho ha#e poor chance of
sur#i#al$
@
Green tags indicate #ictims %ith local inuries %ithout immediate
systematic complications %ho can %ait se#eral hours for treatment$
!rotect the %eo%le and loss of %ro%erty:
Turn off the electricity to reduce the risk of electrocution
&s soon as the disaster *egins, take any #ulnera*le people 5children, the
old, the sick and the disa*led6 to a safe place$
<hene#er possi*le, mo#e personal *elonging upstairs or go to raised
shelters pro#ided for use$
Listen to the information and ad#ise pro#ided *y the authorities$
&#oid storing hea#y o*ects and materials in high positions$
>omply %ith the authorities instructions and do not go out until there is
no longer any risk$
>arry out necessary decontamination measures$
Immediate trans%ortation of victims:
Triage is the only approach that can pro#ide ma1imum *enefit to the greater
num*er of inured in a maor disaster situation$
The most common classification uses intentionally accepted four color code
system, red indicates high priority treatment or transfer, yello% signals medium
se#erity, green indicates am*ulatory patients and *lack for dead or mori*und
patients$
Triage should *e carried out at the risk of disaster, in order to determine transportation
priority, and admission to the hospital or treatment centre, %here the patients needs
and priority of medical care %ill *e reassessed$
Bospital administrators should al%ays *e at hand, e#en if she9he is not the leader of
the team$ The administrator8s presence lends support to the team$ &nd he9she is ready
to ensure that the entire hospital and its resources are at the ser#ice of the afflicted
!hases and %rofessional activities;
The nature of emergency management depends on local economic and social
conditions$ .ome disasters are economic$ /1perts such as cuny ha#e long noted that
the cycle of emergency management must include long term %ork on infrastructure,
;
pu*lic a%areness and e#en human ustice issues$ This is particularly important in
de#eloping nations$ The process of emergency management in#ol#es four phases,
1$mitigation
!$ preparedness
3$ response and
4$ reco#ery$
!re%aredness %hase:
-n the preparedness phase, emergency managers de#elop plans of action for %hen the
disasters strikes$ >ommon preparedness measures include the
>ommunication plans %ith easily understanda*le terminology and methods$
+e#elopment and practice of multi 4agency coordination and incident command
=roper maintenance and training of emergency ser#ices, including mass human
resources such as community emergency response teams$
+e#elopment and e1ercise of emergency population %arning methods com*ined
%ith emergency shelters and e#acuation plans$
.tockpiling, in#entory and maintenance of supplies and equipment$
&n efficient preparedness measure is an emergency operation centre 5/?>6
com*ined %ith a practice region$ <ide doctrine such as the incident command
system for managing emergencies$
&nother preparedness measure is to de#elop organi(ations of trained #olunteers
among ci#ilian populations$ =rofessional emergency %orkers are immediately
o#er%helmed in mass emergencies, so trained, organi(ed, responsi*le #olunteers
can *e e1tremely #alua*le$ ?ne nota*le system is the community emergency
response team$ &nother is the 0ed >ross$ -f #olunteers are organi(ed, trained in
the incident command system, and agree to mo*ili(e, e1perience in the red cross,
C
and >alifornia communities has sho%n that they can *e utili(ed in responsi*le
positions, including as staff in /?>s$
&nother aspect of preparedness is casualty prediction, the study of ho% many
deaths or inuries to e1pect for a gi#en kind of e#ent$ This gi#es planners an idea
of %hat resources need to *e in place to respond to a particular kind of e#ent$
!hysiological needs during Disaster:
Nutrition:
& natural disaster may affect the nutritional status of the population *y affecting
one or more components of food chain depending on the type, duration and e1tent
of the disaster, as %ell as the food and nutritional conditions e1isting in the area
*efore the catastrophe$ -nfants, children, pregnant %omen, nursing mothers and
sick persons are more prone to nutritional pro*lems after prolonged drought or
after certain types of disasters$
The immediate steps for ensuring that the food relief programme %ill *e
effecti#ely includes
a6 &ssessing the food supplies after the disaster$
*6 Gauging the nutritional needs of the effected population$
c6 >alculating the daily food rations and need for large population groups
and
d6 3onitoring the nutritional status of the affected population$
+ater ,u%%ly:
The main pu*lic safety aspect of %ater quality is micro*ial contamination$ The first
priority of ensuring %ater quality in emergency situation is chlorination$ -t is the *est %ay
of disinfecting %ater$-t is ad#isa*le to increase residual chlorine le#el to a*out "$!4 "$@
mg9litre$
The e1isting and ne% %ater sources require the follo%ing protection measures$
1$ restrict access to people and animals, if possi*le, erect a fence and appoint a
guard
!$ ensure adequate e1creta disposal at a safe distance from %ater source
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3$ prohi*it *athing, %ashing and animal hus*andry, upstream of intake points in
ri#ers and streams$
4$ upgrade %ells to ensure that they are protected from contamination and
@$ estimate the ma1imum yield of %ells and necessary, ration the %ater supply$
-n many emergency situations, %ater has to *e tracked to disaster site or
camps$ &ll %ater tankers should *e inspected to determine fitness and should *e
cleaned and disinfected *efore transporting %ater$
Conclusion:
+isaster e#ents %ill continue to occur$ The risks, ha(ards and #ulnera*ility
%ill #ary$ +isaster preparedness pro#ides the opportunity to plan, prepare and
%hen need arises ena*les national response
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