DISASTERS AND THEIR MEDICAL MANAGEMENT
The term “ Disaster ” originated from a French word , which is a combination of two terms
“ des ” meaning bad or evil and “ astre ” meaning star . The expression of the tem disaster is bad or evil star .
According to the W.H.O ; Disaster can be defined as “ any occurrence that causes damage , economic disruption , loss of human life and deterioration in health and health services on a scale sufficient to warrant an extraordinary response from outside the affected community or area ” .
The disasters may be the second major human problem after war , in terms of monetary damage and the number of people killed or affected . Millions of people are affected annually by natural disasters and results in number of deaths , suffering and economic losses . Disasters have their greatest economic and social impact in the poorest countries . It is estimated that the disaster events globally costs about 50,000 million US dollars each year and results in approximately 2,50,000 deaths in a year . The spectrum of occurrence of disasters indicates that nearly twenty major disasters strike the world every year resulting in many deaths and several casualties . Besides the major disasters , innumerable moderate and minor disasters strike the world community every year .
India manifests natural disasters like floods , earthquakes , cyclone and drought regularly due to the vast variation in geographical terrain and climatic conditions . India with 2.4 % of world land area , seventh largest country in the world , with vast population makes the effect of the disasters very serious . India is one the most flood prone countries in the world . On an average , the area affected by floods annually is about nine million hectares and accounts for one fifth of the global death accounts due to floods . The country has about 56.3 % of its total area amounting to 3.3 million square kilometers as vulnerable to seismic activities of varying intensity . The entire northern part of the Indian subcontinent from Hindukush to Eastern Himalayas lies in an earthquake prone belt of violent subterranean volcanic activity . From Kasmir to the northeast the geological processes of rock formation and uplift makes the area earthquake prone . The 8041 kilometer long coastline of India is vulnerable to tropical cyclone arising in the Bay of Bengal and Arabian sea . Cyclonic storms have been causing considerable damage to life and property in the coastal areas of India . The havoc caused by the cyclone is mostly due to strong winds , accompanied by torrential rains , tidal waves , and the resultant inundation . Every year five to six cyclones occur out of which two or three may be severe . The funnel shape of the Indian coastline and the shallow off shore waters acts as catalysts in intensifying the cyclone storms . Due to the high density of population along the coastal areas the devastation is also on a large scale . We all know that the massive devastation caused by Tsunami on 26th December , 2004 which had affected the coastline of 11 countries of Asia and Africa including Indonesia , Thailand , Sri Lanka and India is an example of worst recent catastrophe . Due to erratic nature of rainfall in India ,drought is a perennial feature in many part of our country . Again India has been witnessing an increasing incidence of man- made disasters . The list of man-made disasters like train accidents , aircraft crashes , fire , mine disasters, industrial and
chemical disasters , various terrorists activities are ever increasing for various reasons .
Medical Management
Disaster management is a multifaceted activity which calls for mobilization of all available resources . It has long been realized that all disasters inevitably have health consequences . To a large extent , a well- planned health delivery system is the most important preparedness for a catastrophe . Rapid recovery from a large scale disaster requires that a health care preparedness be in place before the disaster occurs . Planning , organizing and coordinating health care in advance needs the utmost priority in order that disaster stricken population may be attended in a more rational way . The aim of the medical management of disaster plan is to provide prompt and effective medical care to the maximum possible in order to minimize morbidity and mortality . Organization of medical care for disaster has two distinct facts : pre -hospital and hospital care . Depending upon the location and magnitude of the catastrophe , first level care is generally organized at the disaster site to provide relief and first aid to the victims . The definitive care phase is usually carried out in the hospitals . The first aid at the disaster site is limited to primary life support measures with the aim to maintain airway , breathing and circulation to preserve life . The principles of mass casualty management are universal in application , which provide the means to benefiting large number of casualties in a disaster situation . Medical care at site involves command and control , communication and coordination at the scene of the disaster as well as linkage to the definitive care hospitals . Medical disaster teams on site require a coordinator , triage team , first aid team and casualty evacuation team . The transportation and communication for mobilization are crucial issues for onsite teams . In order to provide effective services to the victims of floods , cyclones , earthquakes , wars , accidents and such other calamities emergency department came into being in hospitals in modern times . The passed cyclone in Orissa , the earthquakes in Latur & Gujarat and the last tsunami has highlighted the need for emergency medical services ( EMS ) too .
For effective utilization of resources and efficient management of casualties it is essential that the sorting process as is done under a triage protocol should carried out . Appropriate triage decisions save the lives and limbs of a large number of patients . It sorts casualties into various priority groups and holds the key to their management . Over the years many different triage systems have emerged . Although various nomenclatures and systems are in common use throughout the world , commonalties do exist . Most systems of triage sort patients into four major categories of priority designated by colors .
Priority – I ( Color – Red ) : – Patient is classified in this category , whose injury is critical but who can be cared for with only minimal time or resources and who after treatment would have a good prognosis for survival . Examples include a patient with massive haemorrhage ( bleeding ) that could be controlled with a simple intervention or one with a tension pneumothorax who needs
only a needle thoracostomy and chest tube for stabilization .
Priority – II ( Color – Yellow ) : – This category includes patients whose injuries are significant but who are able to tolerate a delay in care without the risk of substantial morbidity . A patient with a isolated simple femur or humerus fracture would be placed in this category .
Priority – III ( Color – Green ) : – In this category minimal or non urgent patients are those whose injuries are minor enough that they can wait for treatment . These patients injuries can be addressed after caring for patients with more serious injuries . Examples include isolated abrasions , contusions , sprains , minor fractures , or an isolated laceration with bleeding that has been controlled without the loss of a significant amount of blood .
Priority – IV ( Color – Black ) : – Expectant patients includes those whose injuries are so severe that they have only a minimal chances of survival even if significant resources are expanded . Examples of expectant patients are those with massive head injuries or a 95% coverage with third degree burns .
In managing disasters promptly and effectively training and education are the areas of utmost importance . Disaster prevention , preparedness and response require close collaboration of a diversity of people and organizations . It demands managerial , technical and coordination of skills of different persons . Carefully structured and ongoing programs are needed to organize the development of competence and skills . A competent , skilled and well trained health professionals can provide prompt attention , appropriate care and constant supervision required for seriously injured and ill preventing death , disability and suffering .
Disasters can occur at any time or any place and affect anyone irrespective of age and sex . Though it is difficult to prevent the occurrence of disasters , their adverse impact can be reduced to a great extent by undertaking preparatory and mitigation measures in time . Brahma Kumaris World Spiritual University , being a socio – spiritual organization had participated actively in many such disaster management activities through out the globe in the past and there is a great potential and profound scope for the Medical Wing of RERF to work in this emerging aspect of health care in coming days and to glorify Bapdada and his work .
