1. OPERATING PROCEDURE GUIDELINES AND STANDARDS

This part on “Operating Procedure Guidelines and Standards for Monitoring” includes :

· Procedures for warning

· Operating Procedures for evacuation

· Comprehensive Operating Procedure Guidelines for the Departments

. relief and recovery

. the standards of services

• Checklists for monitoring.

· Monitoring relief and rehabilitation

. standard arrangements for transit camps

. relief camps

. cattle camps

. feeding centres

. standards of service.

2. OPERATING PROCEDURE GUIDELINES FOR WARNING

Definition: Alert/ warning indicates the onset of a disaster for which a warning system is essential. This system may range from alarms (e.g., for fires), sirens (e.g., for industrial accidents) to public announcements through radio, television etc. (e.g., for cyclones, floods) and other traditional modes of communication (e.g. beating of drums, ringing of bells, hoisting of flags).

[In most disaster situations, experience has shown that loss of life and property could be significantly reduced due to preparedness measures and appropriate warning systems. The importance of warning systems therefore hardly needs any emphasis. However, not in all cases, the opportunity for warning exists. Indiscriminate warnings may result in non-responsiveness of the people. It is therefore necessary that with respect to every disaster a responsible officer is designated to issue the warnings].

2.1 Agencies authorised to issue warning

The district administration is the prime agency responsible for issuing the disaster warning.

Additionally the technical agencies authorised to issue warning are mentioned below.

Disaster                           Agencies

Earthquakes                  IMD, MERI, NGRI, GSI

Floods                            IMD, Irrigation Department

Cyclones                        IMD

Epidemics                     Public Health Department

Road Accidents            Police

Industrial and
Chemical Accidents    Industry, MARG, Police, BARC

Fires                              Fire Brigade, Police


2.2 Important Elements of Warning

The following aspects may be considered for dissemination of warning :

· All warning systems and technologies are maintained in working condition and checked regularly

· Communities in disaster prone areas are made aware of the warning systems.

· Alternate warning systems must be kept in readiness in case of technical failure (e.g., power failure)

· Only the designated agencies/officers will issue the warning.

· All available warning systems should be used

[each warning system has a limited reach and multiple warning systems will help in reinforcement]

· The warning should, to the extent possible, be clear about the severity, the time frame, area that may be affected.

· Warning statements should be conveyed in a simple, direct and non-technical language, and incorporate day-to-day usage patterns.

· The do’s and don’ts should be clearly communicated to the community to ensure appropriate responses.

· Warning statements should not evoke curiosity or panic behaviour. This should be in a professional language devoid of emotions.

· Rumour control mechanisms should be activated.

· All relevant agencies and organisations should be alerted.

· Wherever possible, assistance of community leaders and organised groups should be sought in explaining the threat.

· Once a warning is issued, it should be followed-up by subsequent warnings in order to keep the people informed of the latest situations.

· In the event of the disaster threat tiding away, an all clear signal must be given.

3. OPERATING PROCEDURES FOR EVACUATION

It is important to understand the nature of threat and the procedures to be adopted

All agencies involved in evacuation must have a common understanding of their roles and responsibilities in order to avoid confusion an panic behaviour.

Different situations demand different priorities and hence the responsibility for ordering evacuation is assigned to different agencies.

All evacuations will be ordered only by the Collector, Police, Fire Brigade or by the Industries Security Officer.

For appropriate security and law and order evacuation should be undertaken with assistance from community leaders.

All evacuations should be reported to Collector or District Superintendent of Police immediately.

3.1 Factors to be considered for Evacuation

3.1.1 Planning Assumptions

· Amount of time needed for evacuation will depend on the disaster.

· If the event can be monitored, like a cyclone, the GOM could have a day or two to get ready.

· In other disasters, it is mostly emergency evacuation of people .

3.1.2 Factors

· Shelter sites should be within one hour's walk and three miles (5 km) of dwellings.

· The evacuation routes should be away from the coast or flood-prone areas.

· Evacuation routes should not include roads likely to be submerged in flood, but may include pathways.

· Ensure proper evacuation by seeking community participation along the following lines:

.; Evacuation should be undertaken with assistance from community leaders and community based organisations (CBOs) for appropriate security and law and order

.; Care should be taken to see that evacuation routes are not blocked.

.; It is always preferable to encourage the entire family to evacuate together as a unit.

.; In case of inadequate transport or limited time, encourage community for emergency evacuation in the following order :

¨ seriously injured and sick
¨ children, women and handicapped
¨ Old
¨ Able-bodied.

[An evacuation plan on a priority basis helps avoid stampede and confusion.]

3.2 Emergency Evacuations

· Families should be encouraged to take along adequate supplies of water, food, clothing and emergency supplies.

· The families should be encouraged to assemble the following disaster supplies kit.

. Adequate supply of water in closed unbreakable containers
. Adequate supply of non-perishable packaged food and dry rations
. A change of clothing and rain gear
. Blankets and bedsheets, towels
. Buckets, plates, glasses, mugs made of plastic
. Soap, toothbrushes, toothpaste
. A battery-powered radio, torch, lantern, matches
. Cash and jewellery
. Personal medicines
. A list of important family documents including ration card, passport, bank passbook address/telephone book (of relatives), certificates, driving licence, property documents, insurance documents etc.
.; Special items including foods, for infants, elderly or disabled family members.

· Encourage people to keep fuel in their cars as petrol pumps may be closed during emergencies.

· Ask people to shut off electricity, gas and water at main switches and valves before leaving.

· Ask people to listen to a battery-powered radio and follow local instructions.

· If the danger is a chemical release, then people should be instructed to evacuate immediately.

· In other cases, advise people to follow these steps:

.Wear protective clothing
. Secure their homes. Close and lock doors and windows.
. Turn off the main water valve and electricity
. Leave early enough to avoid being trapped.
. Follow recommended evacuation routes. Shortcuts may be blocked.
. Not to move or drive into flooded areas.
. Stay away from downed power lines.
. Animals may not be allowed in public shelters.
. Community should set the livestock free
. If possible, the community may be advised to carry the livestock along
[ if the evacuation does not involve transportation by vehicles].

3.3 Evacuation of Marooned Persons

In the case of marooned persons, if necessary

· evacuation must be carried out within the shortest possible time

· the marooned persons must be transferred to transit camps.

· Within the shortest possible time (3 hours of the disaster), marooned people must be provided with

. water
. medicines
. first-aid
. cooked food.

[This can continue for 48 hours after the disaster].

· Emergency transport for the seriously injured by

. speed boats

· A senior medical officer should accompany the rescue team along with required medical kit and ensure priority for shifting of those seriously injured or requiring immediate medical attention.

· Water supplied must be in accordance with acceptable standards of potable water. It is the responsibility of medical officer to check the water quality..

· The procedures for tagging as given in the standards should be followed.
[Tagging is a process of prioritising transfer of injured based on first hand assessment of chance of survival by the medical officer on the disaster site. The identification of patients is done by attaching a tag to each patient, usually color coded to indicate a given degree of injury and the priority for evacuation].

· For food supplies, the standards as given in the “Standards for Food” should be followed.

4. OPERATING PROCEDURE GUIDELINES AND STANDARDS FOR DEPARTMENTS

4.1 Planning Assumptions

The standards of services have been adopted from internationally accepted norms and have been at times modified to suit local conditions. Although it is difficult to maintain efficient service standards in a disaster, which presents a fluid and confused situation, all efforts should be made to reach as close to these norms as possible. Some of the standards make a lasting impact on the communities whereas others have an immediate impact in the field situation, e.g., lack of adequate space per person in relief camps can lead to mental health issues and the absence of adequate sanitation facilities can lead to epidemics.

The operating procedures developed for each department refer to standards of services to be delivered and the appropriate checklists for field monitoring. Hence, the standards and checklists go hand in hand with the operating procedures for every department.

These departments include MSEB, police, public health, irrigation, agriculture, animal husbandry, MWSSB, PWD, MTNL, railways, and airport authority.

5. OPERATING PROCEDURE GUIDELINES FOR POLICE

5.1 Planning Assumptions

· For effective preparedness, the police department must have a disaster response plan or disaster response procedures clearly defined, in order to avoid confusion, improve efficiency in cost and time.

· Operating procedures for mobilising community participation during various stages of disaster management have been given in section on “Areas of Community Participation”. The department is required to study these and adopt appropriate measures to ensure that community participates substantially.

· Orientation and training for disaster response plan and procedures accompanied by simulated exercises will keep the department prepared for such eventualities. Special skills required during emergency operations need to be imparted to the officials and the staff. Select personnel can be deputed for training as “NODAL OFFICER - Police” and “Officer-in-charge - Police” at the state and district level respectively.

· To the extent possible, preventive measures as recommended in the preparedness and mitigation document of DMAP, should be undertaken to improve departmental capacity to respond to a disaster.

5.2 Normal Time Activity

· Assess preparedness level and report the same as per the format to District Control Room every six months

· Maintain a list of disaster prone areas in the district

· Organise training on hazardous chemicals for police officers to facilitate handling of road accidents involving hazardous materials

· Designate an area, within police station to be used as public information centre

Action Plan Objective in a Disaster Situation

· Maintain Law and Order

5.3 Activities On Receipt of Warning or Activation of District DMAP (DMAP)

· Within the affected district/taluka, all available personnel will be made available to the District Disaster Manager. If more personnel are required, then out of station officers or those on leave may be recalled.

· All personnel required for disaster management should work under the overall supervision and guidance of District Disaster Manager/District Magistrate.

· Establish radio communications (and assist in precautionary evacuation activities) with

. Emergency operations centre
. Divisional commissioner
. district control room and
. departmental offices within the division.

· All district level officials of the department would be asked to report to the Collector.

· Appoint one officer as “NODAL OFFICER - Police” at the state level

· Appoint one officer as “Officer-in-Charge - Police” at the district level

· The District Collector to provide “Officer-in-Charge - Police” or the field staff as the need be, with all needed authorisations with respect to

. Recruiting casual labourers.
. Procuring locally needed emergency tools and equipment and needed materials.
. Expending funds for emergency needs.

· The “Officer-in-Charge - Police” will ensure that all field staff and other officers submit the necessary reports and statement of expenditure in a format as required by District Collector

· Review and update precautionary measures and procedures and review with staff the precautions that have been taken to protect equipment and the post-disaster procedures to be followed.

· Fill department vehicles with fuel and park them in a protected area.

· Provide guards as needed for supply depots such as cooperative food stores and distribution centres.

· Provide convoys for relief materials.

· Identify anti-social elements and take necessary precautionary measures for confidence building.

5.3.1 Evacuation

All evacuations will be ordered only by the Collector, Police, Fire Brigade or by the Industries Security Officer.

For appropriate security and law and order evacuation should be undertaken with assistance from community leaders.

All evacuations should be reported to Collector or District Superintendent of Police immediately.

For evacuation follow the evacuation procedures as outlines in operating procedures for evacuation.

5.3.2 Relief and Rehabilitation

· Immediately after the disaster, dispatch officers to systematically identify and assist people and communities in life-threatening situations.

· Help identify the seriously injured people, and assist the community in organising emergency transport of seriously injured to medical treatment centres.

· Ensure that the police stations are functioning immediately after the disaster at all required locations, as may be requested by the district control room, and that staff are available for the variety of needs that will be presented.

· Assist and encourage the community in road-clearing operations.

· Identify roads to be made one-way, to be blocked, alternate routes, overall traffic management and patrolling on all highways, and other access roads to disaster site.

· Provide security in transit and relief camps, affected villages, hospitals and medical centres and identify areas to be cordoned off.

· Transport carrying transit passengers (that is, passengers traveling through trains or buses and passing through the district), should be diverted away from the disaster area.

· Provide security arrangements for visiting VVIPs and VIPs.

· Assist district authorities to take necessary action against hoarders, black marketers and those found manipulating relief material.


· In conjunction with other government offices, activate a public information centre to:

. respond to personal inquiries about the safety of relatives in the affected areas
. compile statistics about affected communities, deaths, complaints and needs
. respond to the many specific needs that will be presented
. serve as a rumor control centre
. Reassure the public.

· Make officers available to inquire into and record deaths, as there is not likely to be time nor personnel available, to carry out standard postmortem procedures.

· Monitor the needs and welfare of people sheltered in relief camps.

· Coordinate with military service personnel in the area.

The amount spent on disaster management in pursuance of these relief activities, after receipt of warning or disaster strike, will be submitted to the Relief Commissioner. The Relief Commissioner will book this expenditure under Budget Head ‘2245’ and reimburse the amount to police.


5.3.3 Preparedness Checklist for Police

(to be filled in by the Department Head and submitted to the District Collector before May every year.)

Reported By :
Designation
Signature
Date

5.3.4 Checklist for Police
(to be filled in by “Officer-in-Charge” and submitted to district control room and the department head.)

Inspected By :
Designation:
Signature :
Date:

6. OPERATING PROCEDURE GUIDELINES FOR PUBLIC HEALTH DEPARTMENT

6.1 Planning Assumptions

· There is no substitute for maintaining standards of services and regular maintenance during normal times. This affects the response of the department to any disaster situation.

· Operating procedures for mobilising community participation during various stages of disaster management have been given in section on “Areas of Community Participation”. The department is required to study these and adopt appropriate measures to ensure that community participates substantially.

· For effective preparedness, the department must have a disaster response plan or disaster response procedures clearly defined in order to avoid confusion, improve efficiency in cost and time.

· Ensure that every hospital follows “The Guide to Health Management in Disasters”. The plan should be specifically developed for the facilities, equipment and staff of that particular hospital.

· Orientation and training for disaster response plan and procedures, accompanied by simulated exercises, will keep the department prepared for such eventualities. Special skills required during disaster situations need to be imparted to the officials and the staff. Coordinate training for treatment of people affected due to hazardous spills. Select personnel can be deputed for training as “NODAL OFFICER - Health Services” and “Officer-in-charge - Health Services” at the state and district level respectively.

· To the extent possible, preventive measures as recommended in the preparedness and mitigation document of DMAP, should be undertaken to improve departmental capacity to respond to a disaster.

· Ensure that standby generator exists for every hospital.

· Insure that least one kerosene-powered refrigeration unit exists for vaccines.

Action Plan Objective in a Disaster Situation

· Providing efficient and quick treatment

· Preventing outbreak of epidemics.

6.2 Normal Time Activity

· Assess preparedness level and report the same as per the format to district control room every six months.

· Ensure that hospital staff are aware of which hospital rooms/ buildings are damage- proof.

· In the case of hospitals located in proximity to industrial areas obtain chemical data sheets from various industries.

6.3 Activities on Receipt of Warning or Activation of District DMAP (DDMAP)

· Within the affected district/taluka, all available personnel will be made available to the District Disaster Manager. If more personnel are required, then out of station officers or those on leave may be recalled.

· All personnel required for disaster management should work under the overall supervision and guidance of District Disaster Manager.

· Establish radio communications with emergency operations centre, divisional commissioner, district control room and hospitals (including private) within the division.

· Ensure thatl personnel working within the district come under the direction and control of the collector/civil Surgeon.

· Appoint one person as “NODAL-OFFICER – Health Services” at the state level.

· The civil surgeon will act as “Officer-in-Charge - Health Services” at the district level.

· All district level officials of the department would be asked to report to the Collector.

· The district collector to provide “Officer-in-Charge - Health Services” or the field staff as the need be, with all relevant authorisations with respect to

.; Recruiting casual labourers.
.; Procuring locally require emergency tools, equipments and materials.
.; Expending funds for emergency needs.

· The “Officer-in-Charge -Health Services” will ensure that all field staff and other officers submit the necessary reports and statement of expenditure in a format as required by the collector.

· Review and update precautionary measures and procedures, and review with staff, the precautions that have been taken to protect equipment and the post-disaster procedures to be followed.

· Fill department vehicles with fuel and park them in a protected area.

· Stock emergency medical equipment which may be required after a disaster.

· Determine type of injuries/ illnesses expected and drugs and other medical items required, and accordingly ensure that extra supplies of medical items be obtained quickly.

· Provide information to all hospital staff about the disasters, likely damages and effects, and information about ways to protect life, equipment and property.

· Discharge all ambulatory patients whose release does not pose a health risk to them. If possible, they should be transported to their home areas.

· Non-ambulatory patients should be relocated to the safest areas within the hospital. The safest rooms are likely to be:

. On ground floor
. Rooms in the centre of the building away from windows
. Rooms with concrete ceilings.

· Equipment supplies such as candles, matches, lanterns and extra clothing should be provided for the comfort of the patients.

· Surgical packs should be assembled and sterilised.

· A large enough number should be sterilised to last four to five days.

· The sterilised surgical packs must be stored in protective cabinets to ensure that they do not get wet. Covering the stock with polythene is recommended as an added safety measure.

· All valuable instruments, such as surgical tools, opthalmoscopes, portable sterilisers, CGS, dental equipments, etc., should be packed in protective coverings and stored rooms considered to be the most damage-proof.

· Protect all immovable equipment, such as x-ray machines, by covering them with tarpaulins or polythene.

· All electrical equipments should be unplugged when disaster warning is received.

· Check the emergency electrical generator to ensure that it is operational and that a buffer stock of fuel exists. If an emergency generator is not available at the hospital, arrange for one on loan.

· All fracture equipment should be readied.

· If surgery is to be performed following the disaster, arrange for emergency supplies of anesthetic gases (usually supplied on a daily basis).

· Check stocks of equipments and drugs which are likely to be most needed after the disaster. These can be categorised generally as:

. Drugs used in treatment of cuts and fractures, such as tetanus toxoid, analgesics and antibiotics .
. Drugs used for the treatment of diarrhoea, water-borne diseases and flu (including oral rehydrating supplies).
. Drugs required to treat burns and fight infections.
. Drugs needed for detoxication including breathing equipments.

· Assess the level of medical supplies in stock, including:

. Fissure materials
. Surgical dressings
. Splints
. Plaster rolls
. Disposable needles and syringes
. Local antiseptics.

· Request central warehouse immediate despatch of supplies likely to be needed, to hospitals, on an emergency priority basis.

· Fill hospital water storage tanks and encourage water savings. If no storage tanks exist, water for drinking should be drawn in clean containers and protected.

· Prepare an area of the hospital for receiving large number of casualties.

· Develop emergency admission procedures (with adequate record keeping) .

· Orient field staff with DDMAP, standards of services, procedures including tagging.

· Hospital administrators should

. Establish work schedules to ensure that adequate staff are available for in-patient needs.
. Organise in-house emergency medical teams to ensure that adequate staff are available at all times to handle emergency casualties.
. Set up teams of doctors, nurses and dressers for visiting disaster sites.


6.3.1 Evacuation

All evacuations will be ordered only by the Collector, Police, Fire Brigade, Health Department or by the Industries Security Officer.

For appropriate security and law and order evacuation should be undertaken with assistance from community leaders.

All evacuations should be reported to Collector or District Superintendent of Police immediately.

For evacuation follow the evacuation procedures as outlined in “Operating Procedures for Evacuation” and “Areas for Community Participation - Evacuation”

For Marooned Persons

A senior medical officer will ensure that water supplied is in accordance with acceptable standards of potable water and is packed under appropriate conditions and containers.

A senior medical officer should accompany the rescue team along with required medical kit and ensure priority for shifting of those seriously injured or requiring immediate medical attention (the procedure for tagging as given in the Annexure should be followed).

6.3.2 Relief and Rehabilitation

Field Office Priorities

· Transport should be arranged for the transfer of seriously injured patients from villages and peripheral hospitals to general hospitals. If roads are blocked, a method should be established to request helicopter transport.

· Establish health facility and treatment centres at disaster sites.

· The provision of medical services should be coordinated by the district civil surgeon with district control room and SOCs.

· Procedures should be clarified between

. Peripheral hospitals
. Private hospitals
. Blood banks
. General hospitals and
. Health services established at transit camps, relief camps and affected villages.

· Maintain checkposts and surveillance at each railway junction, ST depots and all entry and exit points from the affected area, especially during the threat or existence of an epidemic.

· An injury and disease monitoring system should be developed to ensure that a full picture of health risks is maintained. Monitoring should be carried out for epidemics, water and food quality and disposal of waste in transit and relief camps, feeding centres and affected villages.

· Plan for emergency accommodations for auxiliary staff from outside the area.

· Information formats and monitoring checklists should be used for programme monitoring and development and for reporting to Emergency Operations Centre. This is in addition to existing reporting system in the department.

· Seek security arrangements from district police authorities to keep curious persons from entering hospital area and to protect staff from hostile actions.

· Establishment of a public information center with a means of communication to assist in providing an organized source of information. The hospital is responsible for keeping the community informed of its potential and limitations in disaster situations.

· The local police, rescue groups, and ambulance teams should be aware of the resources of each hospital.

Head Office Priorities

On the recommendations of the EOC (“NODAL OFFICER-Health Services”)/ collector/ district control room/ the Public Health Department will

· Send required medicines, vaccines, drugs, plasters, syringes, etc.

· Arrange for additional blood supply.

· Provide for sending additional medical personnel equipped with food, bedding, tents.

· Send vehicles and any additional medical equipments.


The amount spent on disaster management in pursuance of these relief activities, after receipt of warning or disaster strike, will be submitted to the Relief Commissioner. The Relief Commissioner will book this expenditure under Budget Head ‘2245’ and reimburse the amount to Public Health Department.



6.4 Standards of Service

6.4.1 Tagging

Tagging is a process of prioritising transfer of injured, based on first hand assessment of the medical officer on the disaster site. It is based on the medical criterion of chance of survival . Decision is made regarding cases which can wait for treatment, these which should be taken to more appropriate medical units, and these which have no chances of surviving. The grouping is based on the benefit that the casualties can expect to derive from medical care, not on the seriousness of the injuries.

Whenever possible, the identification of patients should be accomplished concurrently with triage. This is done by attaching a tag to each patient, usually color-coded to indicate a given degree of injury and the priority for evacuation.

· Red Tag

This tag signifies that the patient has a first priority for evacuation. Red-tagged patients need immediate care and fall into one of the following categories:

1 ) Breathing problems that cannot be treated at the site.
2) Cardiac arrest (witnessed).
3) Appreciable loss of blood (more than a liter).
4) Loss of consciousness.
5) Thoracic perforations or deep abdominal injuries.
6) Certain serious fractures:
     a) Pelvis
     b) Thorax
     c) Fractures of cervical vertebrae
     d) Fractures or dislocations in which no pulse can be detected below the site of the fracture or dislocation
     e) Severe concussion
     f) Burns (complicated by injury to the air passages).

· Green Tag

Identifies these patients who receive second priority for evacuation. Such patients need care, but the injuries are not life-threatening. They fall into the following categories:

1 Second-degree burns covering more than 30 per cent of the body.
2 Third-degree burns covering 10 per cent of the body.
3 Burns complicated by major lesions to soft tissue or minor fractures.
4 Third-degree burns involving such critical areas as hands, feet, or face but with no breathing problems present.
5 Moderate loss of blood (500-1,000 cc)
6 Dorsal lesions, with or without injury to the spinal column.
7 Conscious patients with significant craniocerebral damage (serious enough to cause a subdural hematoma or    mental confusion). Such patients will show one of the following signs:

  a) Secretion of spinal fluid through ear or nose
  b) Rapid increase in systolic pressure
  c) Projectile vomiting
  d) Changes in respiratory frequency
  c) Pulse below 60 ppm
  f) Swelling or bruising beneath the eyes
  g) Anisocoric pupils
  h) Collapse
  i) Weak or no motor response
  j) Weak reaction to sensory stimulation (profound stupor).

· Yellow Tag

Used on patients who are given third priority for evacuation and who fall into the following categories:

Minor Lesions

1) Minor fractures (fingers, teeth, etc.).
2) Other minor lesions, abrasions, contusions.
3) Minor burns:
  a) Second-degree burns covering less than 15 per cent of the body
  b) Third-degree burns covering less than 2 per cent of the body surface
  c) First-degree burns covering less than 20 per cent of the body, excluding hands, feet, and face.

Fatal Injuries

1. Second and third-degree with burns over more than 40 per cent of the body, with death seeming reasonably certain.

2. Second- and third-degree burns over more than 40 per cent of the body, with other major lesions, as well as major fractures, major craniocerebral lesions, thoracic lesions, etc.

3. Cranial lesions with brain tissue exposed and the patient unconscious.

4. Craniocerebral lesions where the patient is unconscious and has major fractures.

5. Lesions of the spinal column with absence of sensitivity and movement.

6. Patient over 60 years old with major lesions.

[It should be noted that the line separating these patients from red-tag casualties is very tenuous. If there are any red-tag patients, this system will have to be followed. If there are none, the yellow-tag patients with apparently fatal injuries become red-tag candidates. The reason is simple: if there are many red-tag patients with a chance to survive and there are yellow-tag patients who. apparently cannot be saved because of their injuries, the time spent on the dying wounded could be better spent on the patients with a chance to survive].

· Black Tag

Black tags are placed on the dead, i.e., casualties without a pulse or respiration who have remained in that condition for over 20 minutes, or whose injuries render resuscitation procedures impossible.

Evacuation Procedures under the Following Conditions

1 ) Casualties not trapped or buried. Evacuate in the following order:

  a) Red-tag casualties
  b) Green-tag casualties
  c) Yellow-tag casualties

2) Casualties trapped or buried. Evacuate in the following order:

  a) Red-tag casualties
  b) Green-tag casualties
  c) Yellow-tag casualties
  d) Black-tag casualties not trapped or buried
  e) Trapped black-tag casualtie..

6.4.2 Vector Control Standards

Vector control programmes should be planned so as to cope with two distinct situations:

· The initial phase immediately following the disaster, when control work should concentrate on the destruction, by a physical or chemical process, of vermin on persons, their clothing, bedding, and other belongings, and on domestic animals. An emergency sanitation team should be available from the beginning for carrying out this disinfestation.

· The period after the disaster subsided, control work should be directed towards proper food, sanitation, safe disposal of wastes, including drainage, and general and personal cleanliness.

Suggested Vector Surveillance Equipment and Supplies

· Collecting bag
· Collecting forms
· Mouth or battery powered aspirators
· Tea strainer
· Flashlight and spare batteries
· Grease pencil
· Memo pad
· Sweep net
· Pencil
· Tweezers
· White enameled dipper
· Keys and other references
· Labels
· CDC light traps (optional)
· Collecting vials
· Aedes aegypti ovitraps (optional)
· Bulb syringe or medicine dropper
· Fly grill
· Mirror

Suggested Rodent Surveillance Equipment and Supplies

· Teaching aids
· Transfer bags
· Plastic bags
· Vials
· Plastic cups
· Alcohol
· Rubber bands
· Forceps
· Scissors
· Insecticide dusting pan
· Snap Traps
· Formaldehyde
· Live traps
· Acute rodenticides
· Gloves
· Anticoagulant rodenticides
· Flashlights and batteries.

6.4.3 Materials and Equipment

In the absence of clear indication from the field, a minimum kit comprising of the following materials and equipments should be carried by the advance party to the disaster site

1) Equipment for pediatric intravenous use :- 36
2) Tensiometers for children and adults :- 12
3) Assorted ferrules :- 2 boxes
4) Tracheal cannulae :- 36
5) Set of laryngoscopes for infants, children, and adults 1 each
6) Endotracheal tubes, No. 7 Murphy :- 36
7) Endotracheal tubes, No. 8 :- 36
8) Nasogastric probes :- 36
9) Oxygen masks, for adults and children :- 2 boxes
10) Large scissors for cutting bandages :- 3
11) Plastic linings :- 60
12) Phonendoscopes :- 15


Sterilization Unit Supplies

1) Tracheotomy set :- 6
2) Thorachotomy set :- 6
3) Venous dissection set :- 6
4) Set for small sutures :- 12
5) Bottles for drainage of thorax :-10
6) Hand scissors, No. 4 :- 6
7) Syringes (disposable) x 2 cc :- 60
8) Syringes (disposable) x 10 cc :- 90
9) Syringes (disposable) x 50 cc :- 60

Ambulance Fleet

The ambulances will carry the following equipment:

1) Oxygen, oxygen mask, and manometer.
2) Stretchers and blankets.
3) Emergency first aid kit.
4) Suction equipment.
5) Supplies for immobilizing fractures.
6) Venoclysis equipment.
7) Drugs for emergency use.
8) Minimal equipment for resuscitation maneuvers.

Each ambulance should be staffed by at least a physician, a nurse, a stretcher-bearer, and a driver. The medical and paramedical personnel should be experienced in procedures for the management of patients in intensive care units.

Equipment and Supplies required for Vermin control for a population of 10,000

Power sprayers :- 2
Hand-pressured sprayers, capacity 20-30 litres :- 50
Dusters (hand-operated, plunger type) :- 50
Dusters, power-operated :- 2
Space sprayer :- 1
Adequate supply of accessories and spare parts for the above equipment
Insecticides:
DDT, technical powder :- 0.5 tons
DDT, 75 % water wettable :- 1-2 tons
DDT, 10 % powder :- 1 ton
Dieldrin, 0.625-1.25 % emulsifiable concentrate or wettable powder :- 100 kg
Lindane, 0.5 % emulsifiable concentrate or wettable powder :- 100 kg
Chlordane, 2 % emulsifiable concentrate or wettable powder :- 100 kg
Malathion, 1 % emulsifiable concentrate or wettable powder :- 100 kg
Dichlorvos emulsion :- 100 litres
Rodenticides, anticoagulant type (warfarin, etc.) :- 1-2 kg
Rodent traps :- 100
Screen, for fly control :- 10 rolls
Garbage cans, capacity 50-100 litres :- 300-500


a* Quantity depends on availability and on distribution points

6.4.4 Preparedness Checklist for Public Health Department
(to be filled in by the Civil Surgeon and District Health Officer and submitted to the District Collector before May every year )

Reported By :
Designation:
Signature:
Date:

6.4.5 Checklist for Public Health Department
I. Checklist for Hospitals
(to be filled in by the OFFICER-IN-CHARGE and submitted to district control room and the department head)