Disaster Management

preparedness, response, recovery, mitigation

Principal Causes of Disasters
– Natural Disasters

1. Rain and wind storms

2. Floods
3. Biological agents (micro-organisms, insect or vermin infestation)
4. Earthquakes
5. Volcanic eruptions

Man-Made Disasters
1. Acts of war and terrorism
2. Fires
3. Water (broken pipes, leaking roofs, blocked drains, fire extinguishing)
4. Explosions
5. Liquid chemical spills
6. Building deficiencies (structure, design, environment, maintenance)
7. Power failures
 The Four Phases of Emergency Management
Mitigation Includes any activities that prevent an emergency, reduce the chance of an
Preventing future emergencies emergency happening, or reduce the damaging effects of unavoidable
or minimizing their effects emergencies.
Buying flood and fire insurance for your home is a mitigation activity.
Mitigation activities take place before and after emergencies.
Preparedness Includes plans or preparations made to save lives and to help response and
Preparing to handle an rescue operations.
emergency Evacuation plans and stocking food and water are both examples of
preparedness.
Preparedness activities take place before an emergency occurs.
Response Includes actions taken to save lives and prevent further property damage in an
Responding safely to an emergency situation. Response is putting your preparedness plans into action.
emergency Seeking shelter from a tornado or turning off gas valves in an earthquake are both
response activities.
Response activities take place during an emergency.
Recovery Includes actions taken to return to a normal or an even safer situation following an
Recovering from an emergency.
emergency Recovery includes getting financial assistance to help pay for the repairs.
Recovery activities take place after an emergency.
Biological warfare (BW)—also known as germ warfare—is
the use of biological toxins or infectious agents such as
bacteria, viruses, and fungi with the intent to kill or
incapacitate humans, animals or plants as an act of war.

Biological Warfare agents are microorganisms like virus,

bacteria, fungi, protozoa or toxins produced by them, that give
rise to diseases in man, animals or plants, when deliberately
dispersed in an area
These agents can cause large-scale mortality, morbidity and
can incapacitate a large number of people in the shortest
possible time and have adverse effects on human health.
 HOSPITAL EMERGENCY INCIDENT COMMAND SYSTEM
It is a system which employs
• a logical management structure
• defined responsibilities
• clear reporting channels
• a common nomenclature to help unify hospitals with other emergency
responders

Features
HEICS, the standard for health care disaster response, offers the following features
1. Predictable chain of management
2. Flexible organizational chart which allows flexible response to specific
emergencies
3. Prioritized response checklists
4. Accountability of position function
5. Improved documentation for improved accountability and cost recovery
6. Common language to promote communication and facilitate outside
assistance
7. Cost-effective emergency planning within health care organizations
Personnel

The HEICS has five (5) basic personnel consisting of an

1. Incident Commander
2. Operations Officer
3. Planning Officer
4. Finance Officer
5. Logistics Officer

Three other personnel serve as staff to the Incident Commander and

altogether compose the command staff.
6. Security Officer
7. Liaison Officer
8. Public Information Officer
 Basic Hospital Emergency Incident Command System (HEICS) Structure
Activation
The hospital may revise the structure according to the need of the facility and available
human resources.

• If the facility is not affected by the disaster, a designated group shifts to an emergency/
disaster mode for the HEICS, while the rest of the staff conduct normal or regular hospital
transactions/ services.

• If the hospital raises its alert status to Code Blue normal office transactions are
suspended and the hospital is shifted to emergency/ disaster mode
Personal Protective Equipment (PPE) is anything used or worn by a
person to minimize a risk to the person's health or safety. PPE includes: eye protection, like
goggles, glasses and face shields. hearing protection, like ear plugs and ear muffs.
A hazardous material is any solid, liquid,
or gas that can harm people,
other living organism, property,
or the environment.
Hazardous materials (hazmat) may be
1. radioactive
2. flammable
3. explosive
4. toxic
5. Corrosive
6. Biohazardous
7. an oxidizer
8. an asphyxiant
9. a pathogen
10. an allergen
The Hazards and types of PPE
1. Eyes
Hazards:
• Chemical or metal splash
• dust
• projectiles
• gas and vapor
• radiation

PPE:
1. Safety spectacles, goggles, face-shields, visors.
• Make sure the eye protection has the right combination of
impact/dust/ splash/molten metal eye protection for the task
and fits the user properly.
2. Head
Hazards:
• Impact from falling or flying objects, risk of head bumping, hair
entanglement.
PPE
• A range of helmets, hard hats and bump caps.
• Some safety helmets incorporate or can be fitted with specially-
designed eye or hearing protection..
3. Breathing

Hazards:
• Dust, vapor, gas, oxygen-deficient atmospheres.
PPE
Disposable filtering face-piece or respirator, half- or full-face respirators, air-
fed helmets, breathing apparatus.

4. Protecting the body

Hazards:
• Temperature extremes, adverse weather, chemical or metal splash, spray from
pressure leaks or spray guns, impact or penetration, contaminated dust,
excessive wear or entanglement of own clothing.
PPE
• Conventional or disposable overalls, boiler suits, specialist protective clothing, e.g.
chain-mail aprons, high-visibility clothing.

Note:
The choice of materials includes flame-retardant, anti-static, chain mail, chemically
impermeable, and high-visibility. Don’t forget other protection, like safety
harnesses or life jackets.
A. Hands and arms
Hazards:
• abrasion, temperature extremes, cuts and punctures, impact, chemicals, electric shock, skin
infection, disease or contamination.
PPE
Gloves, gauntlets, mitts, wrist-cuffs, armlets.

Note:
Avoid gloves when operating machines such as bench drills where the gloves could get caught. Some
materials are quickly penetrated by chemicals so be careful when you are selecting them

B. Feet and legs

Hazards:
Wet, electrostatic build-up, slipping, cuts and punctures, falling objects, metal and chemical
splash, abrasion.
Options:
Safety boots and shoes with protective toe caps and penetration-resistant mid-sole, gaiters, leggings,
spats.
Note:
Footwear can have a variety of sole patterns and materials to help prevent slips in different conditions,
including oil or chemical-resistant soles. It can also be anti-static, electrically conductive or thermally
insulating. It is important that the appropriate footwear is selected for the risks identified
• the process of removing or neutralizing
contaminants that have accumulated on
personnel and equipment - is critical to health and
safety at hazardous waste sites.

• Decontamination protects workers from hazardous

substances that may contaminate and eventually
permeate the protective clothing, respiratory
equipment, tools, vehicles, and other equipment
used on site

• it protects all site personnel by minimizing the

transfer of harmful materials into clean areas; it
helps prevent mixing of incompatible chemicals;
and it protects the community by preventing
uncontrolled transportation of contaminants from
the site.
Decontamination Methods
All personnel, clothing, equipment, and samples leaving the
contaminated area of a site (generally referred to as the Exclusion Zone)
must be decontaminated to remove any harmful chemicals or infectious
organisms that may have adhered to them. Decontamination methods
either
(1) physically remove contaminants
(2) inactivate contaminants by chemical detoxification or
disinfection/sterilization
(3) remove contaminants by a combination of both physical and
chemical means.

1. Physical Removal
In many cases, gross contamination can be removed by physical means
involving dislodging/displacement, rinsing, wiping off, and evaporation.
Physical methods involving high pressure and/or heat should be used
only as necessary and with caution since they can spread contamination
and cause burns. Contaminants that can be removed by physical means
can be categorized as follows:
• Loose contaminants. Dusts and vapors that cling to equipment
Decontamination Kit
and workers or become trapped in small openings, such as the
weave of the clothing fabrics, can be removed with water or a
liquid rinse
 Adhering contaminants. - such as glues, cements, resins, and muds have much greater
adhesive properties than elemental mercury and consequently, are difficult to remove by
physical means. Physical removal methods for gross contaminants include scraping,
brushing, and wiping. Removal of adhesive contaminants can be enhanced through
certain methods such as solidifying, freezing (e.g., using dry ice or ice water), adsorption or
absorption (e.g., with powdered lime or kitty litter), or melting.
 Volatile liquids. Volatile liquid contaminants can be removed from protective clothing or
equipment by evaporation followed by a water rinse. Evaporation of volatile liquids can be
enhanced by using steam jets. With any evaporation or vaporization process, care must be
taken to prevent worker inhalation of the vaporized chemicals.
INACTIVATION

 Chemical Detoxification
o Halogen stripping
o Neutralization
o Oxidation/reduction.
o Thermal degradation.

 Disinfection/Sterilization
o Chemical disinfection
o Dry heat sterilization
o Gas/vapor sterilization
o Irradiation.
o Steam sterilization.
 LRT
BOMBING
Dec. 31,
2000
22 deaths
115 injured
A blast injury is a complex type of physical trauma
resulting from direct or indirect exposure to an
explosion.
Blast injuries occur with the detonation of high-order
explosives as well as the deflagration of low order
explosives. These injuries are compounded when the
explosion occurs in a confined space.
 DIAGNOSIS CRITERIA FOR PTSD
Photo: This Sept. 29, 2009
photo shows U.S. Marine
Lance Cpl. Greg Rivers, 20,
of Sylvester, Ga., waiting to
take psychological tests at
the Marine Corps Air Ground
Combat Center in Twenty
nine Palms, Calif. (Jae C.
Hong/ASSOCIATED PRESS)

 Criteria A
• The person experienced, witnessed, or was confronted
with an event involving actual or threatened death,
serious injury or a threat to physical integrity of self or others
• The person’s response involved intense fear, helplessness or
horror
 Criteria B
• The traumatic event is re-experienced in one or more of
the following ways
 Recurrent images, thoughts or perceptions
 Recurrent distressing dreams of the event
 Acting or feeling as if the event was recurring
 Intense psychological distress OR physiologic reactivity
at exposure to cues that symbolize or resemble an
aspect of the event
 Criteria C
• Persistent avoidance of stimuli associated with trauma and numbing as indicated by
3 or more:
 Avoiding thoughts, feelings, or discussion, activities, places or people that bring
back recollections; sense of foreshortened future
 Inability to recall; restricted affect
 Diminished interest or participation
Feeling detached or estranged
 Criteria D

• Persistent symptoms of increased arousal by 2 or more:

 Difficulty falling or staying asleep
 Irritability or outbursts of anger
 Difficulty concentrating
 Hypervigilance
 Exaggerated startle response
 Criteria E
• Duration for more than 1 month
DEFINING DEBRIEFING
 Merrian-Webster (1945)
 1 : to interrogate (as a pilot) usually upon return (as from
a mission) in order to obtain useful information
 2 : to carefully review upon completion <debrief the
flight>
 Wikipedia, the free encyclopedia
 A debriefing or psychological debriefing is a one-time,
semi-structured conversation with an individual who has
just experienced a stressful or traumatic event. In most
cases, the purpose of debriefing is to reduce any SAF commandos receiving
possibility of psychological harm by informing people debriefing
about their experience or allowing them to talk about it.
DEBRIEFING STARTS WITH THE
“PREBRIEFING” The instructor should be
prepared
To understand that learners will come
Prebriefing 
with their own experiences and frames

 Describe the purpose of the

simulation
 The learning objectives
 How the process of debriefing will
occur
 The learner will in turn:
 Know the expectations of the
simulation
 Know the ground rules for their
experience
LEARNING AND DEBRIEFING IN SIMULATION
I hearand I forget
I see and I remember
I do and I understand
 Confucius

I trust and discuss

 Fanning, Gaba*

* Fanning, RM, Gaba, DM, The Role of Debriefing in Situation-based Learning, Simulation in Healthcare, 2007
DEBRIEFING PRINCIPLES
 Foster Discussion in a non-threatening fashion
 Capture and leverage “golden or ah-ha” moments
 Seek similar real-world experiences
 Help apply the experience to real-world practice
REFLECTIVE PRACTICE

 Method used to scrutinize one’s own taken-for granted

assumptions and professional work practices.
 The theory of reflective practice draws on cognitive science,
social psychology, and anthropology.
 People make sense of external stimuli through internal cognitive
“frames” (or frame of reference, mental models, etc), internal
images or external reality.
ELEMENTS OF A GOOD DEBRIEFING
 Opened ended questions
 Positive reinforcement (but not false positive)
 Use of cognitive aids
 Good use of AV capability