Disaster Management: Mitigating Risks and Ensuring Resilience, Study notes of Physiotherapy

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DISASTER MANAGEMENT

Disaster has been defined by the UN as a serious disruption of the functioning of a community or a society involving widespread human, material, economic or environmental losses and impacts, which exceeds the ability of the affected community or society to cope using its own resources. Hazard : It is a dangerous phenomenon or a physical condition that has the potential to cause fatalities, injuries, property damage, loss of livelihoods and services, social and economic disruption, or environmental damage. Risk : Likelihood Consequences (Therefore by decreasing either likelihood or consequences incurred we may reduce the probable risk) Vulnerability : The extent to which a community, structure, service, and/or geographical area is likely to be damaged or disrupted by the impact of particular hazard, depending on their nature, construction and proximity to a disaster-prone area. TYPES OF DISASTER 1 ) Depending upon its nature of occurring Natural Disaster : Result of natural phenomena Further classified on the basis of origin. Anthropogenic Disaster: Result of man's interaction with artificial environment Hybrid Disaster: Arises from linkage of man-made and natural events 2) Depending on the basis of onset Sudden onset

Rapid onset: Little or no warning Slow onset Damaging effects sustained Within hours or days Effects can persist for months Geological and Climatic Hazards: Earthquake, volcanic eruptions Creeping onset Slow onset Effects can persist for months Environmental Hazards: Drought, Famines CAUSES OF DISASTER

• Geological or Climatic Changes
• Poverty
• Population Growth Rapid Urbanization
• Transitions in Cultural Practices
• Environmental Degradation
• Lack of Awareness and Information
• War and Civil Strife
• Technology

GOALS OF DISASTER MANAGEMENT

Disaster management can be defined as the organization and management of the resources and responsibilities for dealing with all humanitarian aspects of emergencies, in particular – preparedness, response and recovery in order to lessen the impact of disasters OR It is a systematic process that aim to reduce the negative impact or consequences of adverse events.

MITIGATION :

• Mitigation refers to all actions taken before a disaster to reduce its impacts on nation or community.
• Mitigation = Prevention + Preparedness
• Four vital tools that could be used to prevent or mitigate disaster  Hazard management and vulnerability reduction  Economic diversification  Political intervention and commitment  Public awareness PREPAREDNESS :
• Preparedness refers to pre-disaster activities that are undertaken within the context of disaster risk management and are based on sound risk analysis. • It includes –  Emergency exercises / training  Emergency communication systems  Emergency personnel or contact lists o Warning systems  Evacuation plans and training  Mutual aid agreements  Public information / education  Disaster drills / Mock tests: Well planned, organized and coordinated. It can be scheduled periodic or unannounced. RESPONSE:
• Disaster response is the sum total of actions taken by people and institutions in the face of disaster.
• The focus is on meeting the basic needs of people until more permanent and sustainable solutions can be found.
• Main Goal – Promotion of sustainable livelihood and their protection so as to enhance the capacity of the affected to deal with disasters and promote a rapid and long-lasting recovery.
• Aims –  Survival of maximum number of victims

 To re-establish self-sufficiency and essential services  Repair or replace damaged infrastructure  Regenerate viable economic activities  Protect and assist the civilian population during civil or international conflicts in compliance with national and international conventions. Disaster response activities –

• Warning – evacuate or secure property
• Evacuation and migration
• Search and rescue
• Post disaster assessment-relief needs
• Relief – material aid and emergency medical care
• Logistics and suppl
• Communication and information management
• Survivor response and coping – new and special needs
• ⚫ Security rights and safety
• Emergency operations management – Policies and procedures Rehabilitation – resume functioning
• Reconstruction – permanent construction
• Revitalization of the economy RECOVERY :  Return the community to normal.  Types – Short term recovery-R estore interrupted utility services, clear roads, temporary housing, public information, health and safety education, provide food and shelter (those displaced by disaster) – few weeks o Long term recovery – Complete re- development of damaged areas of the community-months/years
• Steps to recovery-  Gathering basic information  Organizing recovery  Mobilizing resources for recovery  Administering recovery  Regulating recovery  Co-ordinating recovery  Evaluating recovery TRIAGE

The word Triage is of French origin which means selection or categorization • Triage consists of rapidly classifying the injured on the basis of severity and likelihood of their survival with prompt medical intervention. Aim of Triage -  To identify priority cases  To organize, streamline case management  To minimize complications, and save limbs and organs  To utilize resources effectively

• Components o Personnel: Responsible, knowledgeable, critical thinking, physical assessment skills - Physician, surgeon, nurses, physiotherapist, auxiliary staff. o Space requirement: Large enough to hold supplies, equipment and patients. It should be easily accessible. o Equipment and supplies: Tailor made for specific triage treatment protocol, should even include diagnostic assessment tools. o Communication and information: Direct link between incoming ambulances and emergency vehicles, closed circuit TV monitoring, computerized information storage, important phone numbers. o Documentation: Patients complaints, history, objective assessment, vital findings. Acuity rating-life threatening, urgent, semi-urgent, referral. ROLE OF PHYSIOTHERAPY IN DISASTER MANAGEMENT INTRODUCTION: Physiotherapists are well placed and have ideal qualificat i ons and training to optimize health and function in vulnerable populations thereby increasing their adaptability in adverse conditions during disaster. Physiotherapist can be a valuable asset not just in rehabilitation but also in mitigation and response stage too. VICTIM EVACUATION TECHNIQUES: Required to evacuate injured person from an emergency scene to a location of safety. Types of Lifts, Carries and Drags: One person  Tied Hands Crawl  One Person Arm Carry

 One Person Pack Strap Carry  Fireman’s Carry  Ankle Pull/Drag  Clothes Drag  Shoulder Pull Two person  Blanket Drag  Two Person Carry  Chair Carry  Two Handed Seat Carry  Four Handed Seat Carry  Human Crutch Three or more person  Three Person Carry  Improvised Stretcher Blanket Stretcher CARDIOPULMONARY RESUSCITATION (CPR) 2010 AHA guidelines for CPR: Consists of these main parts  Chest compressions  Airway  Breathing  Defibrillation PHYSIOTHERAPISTS ROLE IN MEDICAL CENTER IN CASE OF SCI (Tertiary care)  Reassure person with SCI and their family (Give them hope)  Tell them importance of breathing exercises  Encourage to stay active and use UL actively  Passive ROM of LL, ankle mobility to prevent DVT  Learn to handle LL with active use of UL  Educate caregivers about 2 hourly change in position to prevent bed sores  Guide for long sitting and high sitting  Teach bed side transfers, level transfers posteroanterior, lateral, pivot transfers, wheelchair transfers.

 Learn to proper wheelchairs – indoors, outdoors and over gentle slope.  Guidance about architectural modifications and design-house and work place.  Physiotherapists emphasizes on functional training, bed and mat activities, wheelchair activities, self-care activities, ambulation, orthosis, travel, aids for communication, guidance for bowel and bladder care. IN CASE OF AMPUTATION (Tertiary care)  Quick assessment of the injury  Motor and sensory status  Plan a preoperative program – breathing exercise, strengthening all innervated musculature.  Edema management – elevation, bandaging  Proper positioning – to prevent contractures  Discuss with surgeon and prosthetist about the nature of prosthesis  Teach bandaging techniques to patient, family or caregivers  Counselling  Gait training  Desensitization ROLE OF PHYSIOTHERAPIST DURING EACH STAGES OF DISASTER MANAGEMENT