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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.
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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.]
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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.
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· 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.
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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
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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.
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· 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.)
| Preparedness measures taken |
Details/Remarks |
| The department is familiar with disaster response plan and disaster response
procedures are clearly defined. |
|
| Orientation and training
for disaster response plan and procedures
undertaken.
Special skills required during emergency operations
imparted to the officials and the staff. |
|
| Reviewed and updated
·
Precautionary measures and procedures
·
the precautions to be taken to protect equipment
·
the post-disaster
procedures to be followed. |
|
| Adequate warning mechanisms
established for evacuation. |
|
| A officer has been designated
as Nodal Officer for disaster management. |
|
| Sources of materials
required for response operations have been identified. |
|
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.)
| Action Taken |
Y/N |
Details/Remarks |
| Radio communications
established with
·
Emergency operations centre
·
Divisional commissioner
·
District control room
·
Other police headquarters within the division. |
|
|
| An
officer appointed as “OFFICER-IN-CHARGE - Police” |
|
|
| Police
stations are functioning immediately after the disaster at all required
locations as requested
by the district control room.
|
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| Anti-social
elements identified
Precautionary
measures for confidence building taken.
|
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| Community
assisted in organising emergency transport of seriously injured
to medical
treatment centres. |
|
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| Community
assisted in road-clearing
operations. |
|
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| Overall
traffic management and patrolling on all
highways and other access roads to disaster site being carried
out. |
|
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| The
following roads have been identified
·
To be made one-way
·
To be blocked
·
Alternative routes. |
|
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| Transport
carrying transit passengers (that is, passengers travelling through
trains or buses and passing through the district), are diverted
away from the disaster area. |
|
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| Security being provided
in
·
Transit camps
·
Feeding centres
·
Relief camps
·
Cattle camps
·
Affected areas
·
Hospitals and medical centres.
Areas to be cordoned
off identified. |
|
|
| Guards
provided for supply depots
such as cooperative food stores and distribution centres. |
|
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| Security
arrangements provided for visiting VVIPs and VIPs. |
|
|
| District
authorities assisted for taking necessary action against hoarders, black
marketers and those found manipulating relief material. |
|
|
| A
public information centre activated. |
|
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| Officers
made available to inquire into and record of deaths. |
|
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| Coordination
with military service personnel in the area being carried
out. |
|
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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.
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· 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.
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· 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.
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· 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
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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
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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 )
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|
| Preparedness
Measures taken |
Details/
Remarks |
| The
department is familiar with
disaster response plan and disaster response procedures are
clearly defined. |
|
| A hospital plan for the facilities, equipment and staff of that particular
hospital based on “The Guide to Health Management in Disasters”
has been developed. |
|
| Orientation and training for disaster response plan and procedures undertaken.
Special skills required during disaster situations
are imparted to the officials and the staff. |
|
| Hospital staff are aware of damage-proof hospital rooms/ buildings. |
|
| Reviewed and updated
·
Precautionary measures and procedures.
·
Precautions that have
to be taken to protect equipment.
·
the post-disaster procedures to be followed. |
|
| All hospital staff have been informed about the possible disasters in the district,
likely damages and effects, and information about ways to protect life,
equipment and property. |
|
| An area of the hospital has been identified for receiving large number of casualties. |
|
| Emergency admission procedures with adequate record keeping developed. |
|
| Field staff oriented about
·
DDMAP
·
Standards of services
·
Procedures for tagging. |
|
| An officer has been designated as Nodal Officer for Disaster Management. |
|
| Sources of materials required for response operations have been identified. |
|
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)
| Actions Taken |
Y/N |
Details/Remarks |
| Radio communications
established with
·
Emergency operations
centre,
·
Divisional commissioner,
·
District control
room
·
Hospitals
·
Private hospitals |
|
|
| The Civil surgeon
designated as “OFFICER-IN-CHARGE - Health Services” |
|
|
| The following emergency medical equipment are stocked
·
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. |
|
|
| Discharge of all ambulatory
patients whose release does not pose a health risk to them.
|
|
|
| Non-ambulatory patients
relocated within the hospital to
safest areas. |
|
|
| Equipment supplies such
as candles, matches, lanterns and extra clothing provided for the
comfort of the patients. |
|
|
| Emergency Generator available. |
|
|
| Adequate supplies of anesthetic gases for surgery
cases available. |
|
|
| The
hospital water storage tanks were filled. |
|
|
| An
area of the hospital designated for receiving large number
of casualties. |
|
|
| Emergency admissions
·
Procedures developed.
·
Records maintained.
·
Work schedules to
ensure availability of adequate staff.
|
|
|
| In-house emergency medical
teams to ensure that adequate staff
available at all times to handle emergency casualties.. |
|
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