INTRODUCTION

We often first hear about a natural disaster through a story of Noah and flood in the books of
Genesis. Disasters are sudden catastrophic events that disrupt pattern of life and in which
there is possible loss of life and poverty and addition to multiple injuries.
No community is immune to the emergencies caused by disasters. The disaster events result
in number of deaths, injuries amongst the community, widespread destruction of property,
economic loses etc and community requires immediate assistance to overcome its effects.
Both in man-made disasters and natural disasters the role of nurse shifts from direct care to
that of providing directions to and teaching and supervision of non personnel available to
tackle the disaster. She is reset to a doctor best equipped with knowledge and skill to estimate
the potential of such situations and ensure effective management.
DISASTER alphabetically means
D Destructions
I Incidents
S Sufferings
A - Administrative, Financial Failures
S Sentiments
T Tragedies
E - Eruption of Communicable diseases
R - Research programme and its implementation
THE GLOBAL SCENARIO
Impact of natural disaster in the last 30 years.
Death of 3 million people
Economic loss increased due to disaster like flood
In Indian scenario, 34million people affected per year and 5116 death per year

DEFINITION
DISASTER
A disaster can be defined as any occurrence that causes damage, ecological disruption, loss
of human life or deterioration of health and health services on a scale sufficient to warrant an
extraordinary response from outside the affected community area.
-WHO
Disaster can be defined as the occurrence of a sudden or major misfortune which disrupts
the basic fabric and normal functioning of a society or community.
-UN
DISASTER MANAGEMENT
Disaster management is the body of policy, administrative decisions and operational activities
required to prepare for, migrate, respond to, and repair the effects of natural or man-made
disasters.
-UN
DISASTER NURSING
Disaster nursing can be defined as the adaptation of professional nursing skills in
recognizing and meeting the nursing, physical and emotional needs resulting from a disaster.
The overall goal of disaster nursing is to achieve the best possible level of health for the
people and the community involved in the disaster.
FACTORS AFFECTING DISASTER
Disasters are affected by the following factors:
Poverty: Rich people are less affected by disaster as they get themselves immediately
secured. Normally poor people get much affected because they are insecure and dont have
shelter or enough resources for protection.
Environmental deterioration: Many disaster happens due to deterioration in environment
and become more serious. Deforestation, removal of upper soil, over grazing all these factors
make disaster more serious.
Population explosion: There would be more harm in more population, through disaster. The
place where large number of people resides in number of buildings, then effect of disaster is
more.
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Rapid urbanisation: People from villages or deprived places comes to cities in search of
financial opportunities and security. Due to intense and unorganised urbanisation, disaster
like landslide and floods use to happen. Because of intense and uncontrolled urbanisation,
families of low income group are obliged to live in slopes and banks of rivers which are not
safe.
Lack of vigilance and information: Lack of vigilance and information turn hazards into
disaster. Some people dont know rescue measures to save themselves. Lack information,
education and communication leads them to be the victim of disaster.
Unsecured shelter: Wrong selection of land for houses or ignoring the possibility of
earthquake at the time of construction or ignoring the quality of soil, all these invites
disasters.
Apart from these reasons, disaster get affected by excessive exploration of natural
resources, environmental imbalance, global warming, climatic changes etc.
TYPE OF DISASTERS
Mainly there are two types of disasters.
Natural disasters
Includes earth quake, floods, hurricanes, tsunami, cyclones, tidal waves, volcanic
eruptions, tornadoes, snow storms, drought, famine, deforestation
Man made disasters
Includes nuclear accident, industrial accident, war fare
Disaster can be categorised into five. They are:Category 1- Water and Climate related disasters
a) Flood
b) Drought
c) Costal erosion
d) Thunder and Lightening
e) Cyclone and Storms etc.
Category 2 - Geologically related Disasters
a) Landslides and Mudflows
b) Earthquakes
c) Dam failures
d) Tsunami
e) Dam bursts etc.
Category 3 - Chemical Industrial and Nuclear related disasters
a) Leakage of hazardous materials at the time of their manufacture, processing and
transportation.
b) Disasters due to manufacture, storage, use and transportation of products, pesticides
etc and waster produced during the manufacturing process etc.
Category 4 - Biological related disasters
a) Epidemics
b) Cattle epidemics
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c) Food poisoning
d) Pest attacks etc.
Category 5- Man-made disasters
a) Forest fire
b) Urban fire
c) Village fire
d) Festival related disasters
e) Road, Rail and Air Accidents
f) Boat capsizing
g) Oil spill
TYPES OF MORBIDITY
On the whole, morbidity which results from a disaster situation can be classified into four
types:

Injuries
Emotional stress
Epidemic of disease
Increase in indigenous diseases

DISASTER MANAGEMENT
GOALS OF DISASTER MANAGEMENT
1. Reduce, or avoid losses from hazards
2. Assure prompt assistance to victims
3. Achieve rapid and effective recovery
PRINCIPLES OF DISASTER MANAGEMENT
Disaster management is a full time, continuous and ongoing process. In many cases it is not
predictable. The management of disaster is dependent upon the following principles.

Prevent the occurrence of disaster whenever possible.

Minimize the number of casualties if the disaster cannot be prevented.

Prevent further casualties.

Rescue the victims.

Provide first aid to the injured

Evacuate the injured to the medical facilities.

Provide definitive medical care.

Promote reconstruction.

FUNDAMENTAL ASPECTS OF DISASTER MANAGEMENT

There are three fundamental aspects of disaster management:
Disaster response
Disaster preparedness
Disaster mitigation

DISASTER CYCLE
The disaster management cycle illustrates the ongoing process by which government,
businesses, and civil society plan for and reduce the impact of disasters, react during and
immediately following a disaster, and take steps to recover after a disaster has occurred.
Appropriate actions at all points in the disaster lead to greater preparedness, better warnings,
reduced vulnerability or the prevention of disaster during the next iteration of cycle. The
complete disaster management cycle includes the shaping of public policies and plans that
either modify the causes of disasters or mitigate their effects on people, property, and
infrastructure.

DISASTER IMPACT AND RESPONSE

Medical treatment for large number of casualties is likely to needed only after certain types
disaster. Most injuries are stained during the impact, and thus the greatest need for emergency
care occurs in the first few hours. The management mass casualties can be further divided
into search and rescue, first aid, triage and stabilization of victims hospital treatment and
redistribution of parents to other hospitals if necessary.
The first step in the disaster management programme is to assess the situation.
The situational analysis is done under the following steps:
The impact which a hazard has had on a population
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 The needs and priorities for immediate emergency measures to save and sustain the
lives of survivors
The resources available
The possibilities for facilitating
Long term recovery and development
Assessment is a crucial management task which contributes directly to effective decision
making, planning and control of the organised response. Assessment of needs and resources
is required in types of disasters, irrespective of the type or size of the disaster. Assessment is
required during all phases of a disaster from the start of emergency life saving through the
period of stabilisation and rehabilitation and into long term recovery, reconstruction and
return to normalcy.
Search, rescue and first aid
After a major disaster, the need for search, rescue and first aid is likely to be so great that
organized relief services will be able to meet only a small fraction of the demand. Most
immediate help comes from the uninjured survivors.
Field care
Most injured persons converge spontaneously to health facilities, using whatever transport is
available, regardless of the facilities and operating status. Providing proper care to casualties
such that the health service resources be redirected to this new priority. Bed availability and
surgical services should be maximised. Provisions should be made for food and shelter. A
centre should be established to respond to injuries from patients relatives and friends.
Priority should be given to victims identification and adequate mortuary space should be
provided.
Triage
When the quantity and severity of injuries overwhelm the operative capacity of health
facilities, a different approach to medical treatment must be adopted. The principle of first
come, first treated, is not followed in mass emergencies. Triage consists of rapidly
classifying, the injured on the basis of the severity of their injuries and the likelyhood of their
survival with prompt medical intervention. It must be adopted to locally available skills.
Higher priority is granted to victims whose immediate or long term prognosis can be
dramatically affected by simple intensive care. Moribund patients who require a great deal of
attention , with questionable benfit, have to the greatest number of injured in a disaster
situation.
Although different triage systems have been adopted and are still in use in some countries,
the most common classification uses the internationally accepted four colour code system.
Red indicates high priority treatment or transfer, yellow signals medium priority, green
indicates ambulatory patients and black for dead or moribund patients.

Triage should be carried out at the site of disaster, in order to determine transportation
priority, and admission to the hospital or treatment centre, where the patients needs and
priority of medical care will be reassessed. Ideally, local health workers should be taught the
principles of triage as part of disaster training.
Persons with minor or moderate injuries should be treated at their own homes to avoid social
dislocation and the added drain on resources of transporting them to central facilities. The
seriously injured should be transported to hospitals with specialised treatment facilities.
Tagging
All patients should be identified with tags stating their name, age, place of origin, triage
category, diagnosis, and initial treatment.
Identification of dead
Taking care of the dead is an essential part of the disaster management. A large number of
dead can also impede the efficiency of the rescue activities at the site of the disaster. Care of
dead includes:

Removal of the dead from the disaster scene

Shifting to the mortuary
Identification
Reception of bereaved relatives.

Proper respect for dead is of great importance.

The health hazards associated with cadavers are minimal if death results from trauma,
and corps are quite unlikely to cause outbreaks of disease such as typhoid fever, cholera or
plague. If human bodies contaminate streams, wells, or other water sources as in floods etc,
they may transmit gastroenteritis or food poisoning to survivors. The dead bodies represent a
delicate social problem.
Relief phase
This phase begins when assistance from outside starts to reach the disaster area. The type and
quantity of humanitarian relief supplies are usually determined by two main factors:

The type of disaster, since distinct events have different effects on the population, and
The type and quantity of supplies available locally.

Immediately following a disaster, the most critical health supplies are those needed for
treating casualties, and preventing the spread of communicable diseases. Following the initial
emergency phase needed supplies will include food, blankets, clothings, shelter, sanitary
engineering equipment and construction material. A rapid damage assessment must be carried
out in order to identify needs and resources. Disaster managers must be prepared to receive
large quantities of donations. There are four principal components in managing humanitarian
supplies:
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a.
b.
c.
d.

Acquisition of supplies
Transportation
Storage
Distribution

Epidemiologic surveillance and disease control

Disease can increase the transmission of communicable diseases through following
mechanisms:
1. Overcrowding and poor sanitation in temporary resettlements. This accounts in part,
for the reported increase in acute respiratory infections etc following the disasters.
2. Population displacement may lead to introduction of communicable diseases to which
either the migrant or indigenous populations are susceptible.
3. Disruption and the contamination of water supply, damage to sewage system and
power systems are common in natural disasters.
4. Disruption of routine control programmes as funds and personnel are usually diverted
to relief work.
5. Ecological changes may favour breeding of vectors and increase the vector population
density.
6. Displacement of domestic and wild animals, who carry with them zoonoses that can
be transmitted to humans as well as to other animals. Leptospirosis cases have been
reported following large floods (as in Orissa, India, after super cyclone in 1999).
Anthrax has been reported occasionally.
7. Provision of emergency food, water and shelter in disaster situation from different or
new source may itself be a source of infectious disease.
Outbreak of gastroenteritis, which is the most commonly reported disease in the postdisaster period, is closely related to first three factors mentioned above. Increased
incidence of acute respiratory infections is also common in displaced population. Vectorborne diseases will not appear immediately but may take several weeks to reach epidemic
levels.
Displacement of domesticated and wild animals increases the risk of transmission of
zoonoses. Veterinary services may be needed to evaluate such health risks. Dogs, cats and
other domestic animals may be reservoirs of infections such as leptospirosis, rickettsiosis
etc. Wild animals are reservoirs of infections which can be fatal to man such as
encephalitis, rabies, and infections still unknown in humans.
The principles of preventing and controlling communicable diseases after a disaster are to
a) Implement as soon as possible all public health measures, to reduce the risk of disease
transmission
b) Organize a reliable disease reporting system to identify outbreaks and to promptly
initiate control measures
c) Investigate all reports of disease outbreaks rapidly
Nutrition
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A natural disaster may affect the nutritional status of the population by affecting one or more
components of food chain depending on the type, duration and extent of the disaster, as well
as the food and nutritional conditions existing in the area before the catastrophe. Infants,
children, pregnant women, nursing mothers and sick persons are more prone to nutritional
problems after prolonged draught or after certain types of disasters like hurricanes, floods,
land or mudslides, volcanic eruptions and sea surges involving damage to crops, to stock or
to food distribution systems.
The immediate steps for ensuring that the food relief programme will be effective include:
a)
b)
c)
d)

Assessing the food supplies after the disaster

Bridging the nutritional needs of the affected population
Calculating daily food rations and need for large population groups and
Monitoring the nutritional status of the affected population

Rehabilitation
The final phase in a disaster should lead to restoration of the pre disaster conditions.
Rehabilitation starts from the very first moment of a disaster. Too often, measures decided in
a hurry, tend to obstruct re-establishment of normal conditions of life. Provisions by external
agencies of sophisticated medical care for a temporary period has negative effects. On the
withdrawal of such care, the population is left with a few level of expectation which simply
cannot be fulfilled.
In first weeks after disaster, the pattern of health needs, will change rapidly, moving from
casualty treatment to more routine primary health care. Services should be recognised and
restructured. Priorities also will shift from health care towards environmental health
measures. Some of them are as follows:
Water supply
A survey of all public water supplies should be made. This includes distribution system and
water source. It is essential to determine physical integrity of system components, the
remaining capacities, and bacteriological and chemical quality of water supplied.
The main public safety aspect of water is microbial contamination. The first priority of
ensuring water quality in emergency situations is chlorination. It is the best way of
disinfecting water. It is advisable to increase residual chlorine level to about 0.2- 0.5 mg/litre.
Low water pressure increases the risk of infiltration of pollutants into water mains. Repaired
mains, reservoirs and other units require cleaning and disinfection.
Chemical contamination and toxicity are a second concern in water quality and potential
chemical contaminants have to be identified and analysed.
The existing and new water sources require the following protection measures;
1. Restrict access to people and animals, if possible, erect a fence and appoint a guard.
2. Ensure adequate excreta disposal at a safe distance from water source.
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3. Prohibit bathing, washing and animal husbandry, upstream of intake points of rivers
and streams
4. Upgrade wells to ensure that they are protected from contamination.
5. Estimate the maximum yield of wells and if necessary, ration the water supply.
In many emergency situations, water has to be trucked to disaster site or camps. All water
tankers should be inspected to determine fitness and should be cleaned and disinfected before
transporting water.
Food safety
Poor hygiene is the major cause of food borne diseases in disaster situations. Where feeding
programmes are used kitchen sanitation is of utmost importance. Personal hygiene should be
monitored in individuals involved in food preparation
Basic sanitation and personal hygiene
Many communicable diseases are spread through faecal contamination of drinking water and
food. Hence, every effort should be made to ensure the sanitary disposal of excreta.
Emergency latrines should be made available to the displaced, where toilet facilities have
been destroyed. Washing, cleaning and bathing facilities should be provided to the displaced
persons.
Vector control
Control programme for vector borne disease should be intensified in the emergency and
rehabilitation period, especially areas where such diseases are known to be endemic. Of
special concern are dengue fever, malaria, leptospirosis, rat-bite fever, typhus and plague.
Flood water provides ample breeding opportunities for mosquitoes.
A major disaster with high mortality leaves a substantial displaced population, among whom
are those requiring medical treatment and orphaned children. When it is not possible to locate
the relatives who can provide care, orphans may become the responsibility of health and
social agencies. Efforts should be made to reintegrate disaster survivors into the society, as
quickly as possible through institutional programmes coordinated by ministries of health and
family welfare, social welfare, education and NGOs.
DISASTER MITIGATION IN HEALTH SECTOR
Emergency prevention and mitigation involves measures designed either to prevent hazards
from causing emergency or to lessen the likely effects of emergencies. These measures
include flood mitigation works, appropriate land use planning, improved building codes, and
reduction or protection of vulnerable population and structures.
In most cases mitigation measures aims to reduce the vulnerability of the system. Medical
casualties can be drastically reduced by improving the structural quality of houses, schools
and other public and private buildings. Although mitigation in these sectors has clear health
implications, the direct responsibility of the health sector is limited to ensuring the safety of
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health facilities and public health services, including water supply and sewage systems. When
water supplies are contaminated or interrupted, in addition to the social cost of such damage,
the cost of rehabilitation and reconstruction severely strains the economy. Mitigation
complements the disaster preparedness and disaster response activities. Mitigation activities
actually eliminate or reduce the probability of disaster occurrence, or reduce the effects of
unavoidable disasters. Mitigation measures include building codes, vulnerability analyses
updates, zoning and land use management, building use regulations and safety codes,
preventive health care and public education. Mitigation will depend on the incorporation of
appropriate measures in national and regional development planning. Its effectiveness will
also depend on the availability of information on hazards, emergency risks, and the
countermeasures to be taken, the mitigation phase, and indeed the whole disaster
management cycle, includes the shaping of public policies and plans that that either modify
the causes of disasters or mitigate their effects on people, property and infrastructure.
DISASTER PREPAREDNESS
The goal of emergency preparedness programs is to achieve a satisfactory level; of readiness
to respond to any emergency situation through programs that strengthen the technical and
managerial capacity of governments, organisations and communities. These measures can be
described as logistical readiness to deal with disasters and can be enhanced by having
response mechanisms and procedures, rehearsals, developing long term and short time
strategies, public education and building early warning systems. Preparedness can also take
the form of ensuring that strategic reserves of food, equipment, water, medicines and other
essential are maintained in cases of national or local catastrophes.
During the preparedness phase, governments, organisations and individuals develop plans to
save lives, minimise disaster damage and enhance disaster response operations. Preparedness
measures include preparedness plans, emergency exercise\ training; warning systems,
emergency communications systems; evacuations plans and training, resource inventories;
emergency personnel/contact lists; mutual aids agreements and public information/education.
As with mitigations efforts, preparedness actions depend on the incorporation of appropriate
measures in national and regional developments plans. In addition, their effectiveness
depends on the availability of information on hazards, emergency risks and the
countermeasures to be taken and on the degree to which government agencies, nongovernmental organisations and the general public are able to make use of this information.
PERSONAL PROTECTION EDUCATION IN DIFFERENT TYPES OF
EMERGENCIES
In addition to considering the rescuers, thought must be given to personal protection
measures in different types of emergencies. Making people aware of what is expected of them
in case of an emergency can make large difference to the organised management efforts. By
taking precaution, the individual assists the collective effort to reduce the efforts of an
emergency.
A number of measures must be observed by all persons in all types of emergency:
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 Do not use the telephone, except to call for help, so as to leave telephone lines free for
the organization of response.
Listen to the message broadcast by radio and the various media so as to be informed
of development.
Carry out the official instructions given over the radio or by loudspeaker.
Keep a family emergency kit ready.
In all the different types of emergency, it is better:
To be prepared then to get hurt.
To get information so as to get organised
To wait rather than act too hastily.
Floods
What to do before hand
While town planning is a government responsibility, individuals should find out about risk in
the area where they live. For example, people who live in areas downstream from a dam
should know the special signals used when a dam threatens to break. Small floods can be
foreseen by watching the water level after heavy rains and regularly listening to the weather
forecast.
Forecasting of floods or tidal waves is very difficult, but hurricanes and cyclones often occur
at the same time of the year, when particular vigilance must be exercised. They are often
announced several hours or days before they arrive.
During a flood
Turn off the electricity to reduce the risk of electrocution
Protect people and property
As soon as the flood begins, take any vulnerable people to an upper floor.
Whenever possible, move personal belonging upstairs or go to raised shelter
provided for use in floods.
Beware of water contamination if the taste, colour, or smell of the water is
suspicious, it is vital to use some means of purification. Evacuate danger zones
ordered by the local authorities, it is essential to comply strictly with the
evacuation advice given. Authorities will recommend that families take with the
emergency supplies they have prepared.
After a flood
When the flood is over, it is important that people do not return home until told to do so by
the local authorities, who will have ensured that buildings have not been undermined by
water. From then on it is essential to;

Wait until the water is declared safe before drinking any that is untreated.
Clean the room that has been flooded.
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Sterilize or wash with boiling water all dishes and kitchen utensils.
Get rid of any food that has been in or near the water, including canned foods, any
food kept in refrigerators and freezers.
Get rid of consumables.

Storms, Hurricanes And Tornadoes

What to do beforehand

Choose a shelter in advance, before the emergency occurs a basement, or may be

suitable.
Take measures against flooding.
Prepare a family emergency kit.

During an emergency

Listen to the information and advice provided by the authorities.

Do not go out in a car or boat once the storm has been announced.
If possible, tie down any object liable to be blown away by the wind.
In a thunderstorm keep away from doors, windows, and electrical conductors, unplug
electrical appliances and television aerials. Do not use any electrical appliances or the
telephone.
Anyone who is outside should:
Look for shelter in a building (never under a tree)
If out in a boat, get back to the shore
Keep away from fences and electric cables
Kneel down rather than standing

After an emergency

Follow the instructions given by the authorities

Give first aid to injured
Make sure that the water is safe to drink and check the contents of the refrigerators
and freezers
Check the exterior of dwelling and call for assistance if there is a risk of falling
objects.

Earthquakes
What to do beforehand

Build in accordance with urban planning regulations for risk areas.

Ensure that all electrical and gas appliances in houses, together with all pipes
connected to them, are firmly fixed.
Avoid storing heavy objects and material in a high position.
Hold family evacuation drills and ensure that the whole family knows what to do in
case of an earthquake.
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Prepare a family emergency kit.

During an earthquake

Keep calm, do no panic

People who are indoors should stay there but move to the central part of the building.
Keep away from the stairs that might collapse suddenly.
Anyone in a vehicle should park it, keeping away from bridges and buildings.

After an earthquake

Obey the authoritys instructions

Do not go back into damaged buildings since tremors may start again at any moment.
Give first aid to the inured and alert the emergency services in case of fire, burst pipes
etc.
Do not go simply to look at the stricken areas: this will hamper rescue works.
Keep emergency packages and a radio near at hand.

Clouds of toxic fumes

What to do beforehand

People in a risk area should:

- find out about evacuation plans and facilities;
- familiarize themselves with the alarm signals used in case of emergency;
- equip doors and windows with the tightest possible fastenings;
- prepare family emergency kits.

During an emergency
- Do not use the telephone; leave lines free for rescue services.
- Listen to the messages given by radio and other media.
- Carry out the instructions transmitted by radio or loudspeaker.
- Close doors and windows.
- Stop up air intakes.
- Seal any cracks or gaps around windows and doors with adhesive tape.
- Organize a reserve of water (by filling wash basins, baths, etc.).
- Turn off ventilators and air conditioners.
After an emergency
- Comply with the authorities' instructions and do not go out until there is no longer any

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risk.
- Carry out necessary decontamination measures.

DISASTER MANAGEMENT IN INDIA

According to government of India, Ministry of Home Affairs Disaster
Management division the STANDARD OPERATING PROCEDURE describes five phases.
They are:
i.

Early Warning Phase

ii.

Response Phase

iii.

Relief Phase

iv.

Restoration

PREPAREDNESS PHASE
This phase will include taking all necessary measures for planning, capacity building and
other preparedness so as to be in a state of readiness to respond, in the event of a natural
disaster. This Stage will also include development of Search & Rescue Teams, mobilization
of resources and taking measures in terms of equipping, providing training, conducting mock
drills/exercises etc.
INSTITUTIONAL MECHANISM
In our federal system of governance, in the aftermath of a disaster, the primary
responsibility for undertaking the rescue, relief and rehabilitation measures rests with the
concerned State Governments. The role of the Central Government is supportive, in terms
of physical and financial resources and complementary in sectors such as transport, early
warning systems, etc.
The Disaster Management Act 2005, lays down a three tier" institutional structure for
disaster management at the national, state and district levels in the form of
NDMA, SDMA and DDMA. National Policy on Disaster Management (NPDM) has further
specified the roles and responsibilities of various organizations for disaster response.
NATIONAL LEVEL
National Crisis Management Committee (NCMC)
At the National Level, the Command, Control and Coordination of the disaster
response will be overseen by the National Crisis J\1anagementCommittee (NCJ\1C) under
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the Cabinet Secretary. NCMC will issue guidelines from time to time as required for effective
response to natural disasters.
All Ministries/Departments/Agencies at the national level shall comply with the
instructions of NCMC. The NPDM prescribes that NCM C shall deal with 'major disasters
that have serious or national ramifications.
Ministry of Home Affairs (MHA)
The Ministry of Home Affairs is the nodal agency at the National level for
coordination of response and relief in the awake of natural disasters (except drought, pest
attack & hailstorm). MBA will provide financial and logistic support to the State
Governments, keeping view, their resources, the severity of the natural disaster and the
capacity of the State Governments to respond in a pat1icular situation.
National Executive Committee (NEC)
Disaster Management Act stipulates that the NEC under the Union Home Secretary will
'coordinate response in the event of any threatening disaster situation or disaster. NEC may
give directions to the concerned Ministries/Departments of the Govt. of India, the State
Governments and the State Authorities regarding measures to be taken by them in response to
any specific threatening disaster situation or disaster.
Other Central Ministries/Departments
The other concerned Central Ministries/Departments/Organisations will render Emergency
Support Functions (ESF) wherever Central intervention and support are needed by the State
Governments.

STATE LEVEL
State Executive Committee (SEC)
It will be the primary responsibility of the State Government to respond to natural
disasters and provide relief to the affected people Disaster Management Act stipulates that the
SEC under the State Chief Secretary shall 'coordinate response in the event of any threatening
disaster situation or disaster'. SEC shall give directions to any Department of the State
Government or any other authority or body in the State regarding actions to be taken in
response to any disaster.
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Department of Relief/ Disaster Management shall be the nodal department for

disaster management and Secretary of the Department/Relief Commissioner shall implement
the decisions of the SEC pertaining to State level Response to natural disasters. State
Governments will provide emergency support in their relevant domains at the State/District
levels.
DISTRICT LEVEL
District Disaster Management Authority (DDMA)
Disaster Management Act stipulates that the DDMA under the chair of the Collector
or District Magistrate or Deputy Commissioner, as the case may be and the co-chair of the
elected Representative of the local authority shall 'coordinate response to any threatening
disaster situation or disaster'. The Collector/District Magistrate/Deputy Commissioner, as the
head of administration at the district, shall be the focal point in the command and control for
disaster response at the district level, in accordance with the policies/guidelines/instructions
from the national and state levels. Depending on the nature of disaster and response he will
be the Incident Commander himself or delegate the responsibility to some other officer. All
the Departments/Agencies of the Central and State Governments in the District/City involved
in response and relief will work in accordance with the directions of the Incident
Commander.
The lower administrative units of Districts viz; Subdivisions under the
administrative control of a Sub-divisional Magistrate/Officer and Blocks and
Tehsils under the administrative control of the Block Development
Officers/Tehsildars will coordinate the functioning of the various departments in
their respective jurisdiction.
The Incident Command Teams at Subdivision and Block levels under SDO/SDM or
BDO/Tehsildar as the case be will be responsible for all response and relief works.

Mechanism for International Assistance

As a stated policy of the Government of India no appeals shall be made seeking foreign
aid for disaster response. However if the foreign national governments voluntarily offer
assistance as a goodwill gesture in solidarity of the disaster victims, the Ministry of Home

18

Affairs will coordinate with the Ministry of External Affairs for obtaining and channelizing
such assistance..
All national and international non-government agencies while rendering emergency
support functions on the ground will function under the' overall command of the State
Government through the Incident Commander.

HOSPITAL PREPAREDNESS
Hospital preparedness is crucial to any disaster response system. Each hospital need to
have an emergency preparedness plan to deal with mass casualty incidents and the hospital
administration/doctor trained for this emergency.
EARLY WARNING PHASE
This phase will include all necessary measures to provide timely, qualitative and
quantitative warnings to the disaster managers to enable them to take preemptive measures
for preventing loss of life and reducing loss/damage to the property. On the occurrence of a
natural disaster or imminent threat thereof, all the concerned Agencies will be
informed/notified for initiating immediate necessary follow up action.
RESPONSE PHASE
This phase will include all necessary measures to provide immediate succor to the
affected people by undertaking search, rescue and evacuation measures.
RELIEF PHASE
This phase will include all necessary measures to provide immediate relief and
succor to the affected people in terms of their essential needs of food, drinking water,
health &hygiene, clothing, shelter.

RESTORATION STAGE
This phase will include all necessary measures to stabilize the situation and restore the
utilities.

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HOSPITAL DISASTER PLAN

The hospital is an integral part of the society and it a has great role to play in the
disaster management; Every hospital small or big, public or private has to prepare a disaster plan.
The disasters in the hospital perspective can be grouped into two categories:
1. Internal Hospital disaster like fire, building collapse, terrorism, etc.
2.External disasters like; earthquakes, floods, etc.
Objectives of the Hospital Disaster Plan
1. Preparedness of staff, optimizing of resources and mobilization of the logistics and supplies
within short notice.
2. To make community aware about the hospital disaster plan and benefits of plan. Training and
motivation of the staff.
3. To carry out mock drills.
4. Documentation of the plan and making the hospital staff aware about the various steps of plan.
Designing of Hospital Disaster Plan
Disaster management committee; The hospital disaster management committee is the decision
making body for formulation of the policy and plan for disaster management.
The committee is constituted with the following members;
a. Director of the Hospital
.
b. HOD of Accidents and Emergency Services
c. All heads of the department
d. Nursing Superintendent
e. Hospital administrator
f. Representatives of the staff.
Functions of the disaster management committee:
The functions of the committee can be enumerated as;
a. To prepare a hospital disaster plan for the hospital.
b. To prepare departmental plan in support of the hospital plan.

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c. Assign duties to the staff.

d. Establishment of criteria for emergency care
e. To conduct, supervise and evaluate the training programs.
f. To supervise the mock drills.

g. Updating of plans as need arises.

h. Organise community awareness programs, through mass media.

i. Assist in Information Education Communication (lEC) programs in respect of the disaster

preparedness, prevention and management.

Role and functions:

The effective implementation of the program will depend upon the clarity of the plan, role and
functions of the different members and staff. These are being enumerated as follows.
a. Disaster coordinator: The coordinators' role will be:
i.

Organising

ii.

Communicating

iii.

Assigning duties

iv.

Deployment of staff

v.

Taking key decisions

..

b. Administrator: The responsibilities of the administrator will be; to execute the authority
through the departmental heads.
c. Departmental heads: Development of departmental plans.
d. Nursing superintendent: Deployment of nursing staff.
e. Medical staff: Specific role of rendering medical care both pre hospital land hospital care.
f. Nursing staff: Nursing care and support critical care.
Important departments: The important departments of the hospital have to play a key role in the disaster
management;
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a. Accident and Emergency department

b. Operating department
c.

Critical care units

d. Radiology departments
e. Laboratory
f. Blood bank
Support areas: Logistics and prompt supply of drugs, linen, surgical items, fluids are required in
the hospital and due care has to be taken to incorporate the role and function of the following units:
a. Laundry
b. CSSD
c. Dietary department
d. Housekeeping services
e. Medical records
f. Public Relation
g. Communications
h. Transportation
i.

Mortuary

j.

Medic-social worker

k.

Engineering department

l. Security and safety services

m. Media relations
Organising Disaster Facilities
1. Triage: This is very important part for successful implementation of the disaster management
program in the hospital. This is located in the; emergency services, where triage team
consisting of physician, surgeon, nursing personnel, handle the incoming patients.
Rapid assessment of the injury and extent of severity of the casualty is done by doctors/ nurses
and assign the casualty to an appropriate treatment area based upon the medical/nursing
needs of the patients. To identify different categories of casualty, colour coding is preferred.
2. Primary treatment area: The treatment areas are divided into: ..
a. Immediate care
b. Urgent care
c. Non-urgent care
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3. Secondary treatment areas: It will include all wards, critical care units, operating and
diagnostic units. The casualties requiring treatment will be taken from primary treatment
area to ICU, OT or Wards.
4. Inpatient evacuation holding area: To open one or two wards to receive all the admitted
victims of a disaster is essential. Additional beds are made available in other wards or
sometimes creating temporary wards in nearby schools or buildings can also be considered
if the intake is much.
5. Additional facilities: In addition to the existing facilities of the hospital some additional
facilities are also created:
a. Control room
b. Information Public Relation counter
c. Relative's waiting area
d. Media room
e.

Volunteers reception

DISASTERS IN INDIA
With a wide range of topographic and climatic conditions, India is the highly
disaster-prone country in Asia-Pacific region with an average of 8 major natural calamities a
year. While floods, cyclones, draughts, earthquakes and epidemics are frequent from time to
time, major accidents happen in railways, mines and factories causing extensive damage to
human life and property.
Northern mountain regions, including the foot hills are prone to snow-storms,
land slides and earthquakes. The eastern coastal areas are prone to severe floods and cyclones
(Andhra Pradesh, West Bengal, Orissa, etc.). Bihar, Assam and Uttar Pradesh get major
floods almost every year. Western desert areas are prone to draughts. There is hardly a year
when some or the other part of the country does not face the spectre of drought, floods or
cyclone. Orissa had super cyclone on 29th October 1999, when thousands lost their lives and
many more became homeless. Gujarat had a severe earthquake in which about 16480 people
died and lacs became homeless. More recently, Tsunami killed more than 200,000 persons in
India in Dec. 2004 and major earthquake in Jammu & Kashmir (7.4 RS) left 2100 dead and
30,000 injured. India also saw world's worst man-made disaster in 1984, when methyl
isocyanate gas leaked at Union Carbide Pesticide Plant in Bhopal killing about 3000 people.
People are still suffering from variety of diseases, as an after effect of this tragedy.
In the federal structure of India, the state governments are responsible for
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the execution of relief work in wake of natural disasters. Government of India plays a
supportive role, in terms of supplementation of final resources to the states. An administrative
system has been developed to combat and minimize the adverse impact of the natural
disasters. At the centre, the Ministry of Agriculture is the nodal ministry for coordination of
all activities during a natural disaster. Since health is an important part of disaster
management, in the DGHS under the ministry of Health and Family Welfare there is a special
wing called the Emergency Medical Relief Wing which coordinates all activities related to
health.
In a vast country like India, it is not practicable for the government machinery
alone, to undertake disaster reduction programmes without involvement of NGOs. Public
education and community involvement plays a vital role here. As part of the International
Decade for Natural Disaster Reduction activities, every year, the second Wednesday of
October has been designated as World Disaster Reduction Day.
Indian Meteorological Department (IMD) plays a key role in forwarning the
disaster. It has five centres in Kolkata, Bhubaneshwar, Vishakhapatnam, Chennai and
Mumbai for detection and tracing of cyclone storms. Satellite imagery facilities and cyclone
warning radars are provided to various Cyclone Warning Centres. In addition, it has 31
special observation posts set up along east coast of India. For all ships out at sea, warnings
are issued six times a day. Insat Disaster Warning System (DWS) receivers have been
installed primarily in the coastal areas of Tamil Nadu and Andhra Pradesh. This has proved
very reliable for.n of communication system. The Snow and Avalanche Study Establishment
(SASE) in Manali has been issuing warning to people about avalanches 24 to 48 hours in
advance.

RESEARCH STUDIES
1. Perceptions of knowledge of disaster management among military and civilian
nurses in Saudi Arabia.
Al Thobaity A, Plummer V, Innes K, Copnell B
Abstract
BACKGROUND:
It is generally accepted that nurses have insufficient knowledge about disaster preparedness
due to a lack of acceptance of core competencies and the absence of disaster preparedness
in nursing curricula.1 This study explored nurses' knowledge and sources of knowledge, and
skills as they relate to disaster management in Saudi Arabia, where more than 4660 people
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have died, 32,000 people have been affected, and US$4.65 billion in damage has been caused
by disaster since 1980.2 METHODS: A quantitative, non-experimental, descriptive research
design.
RESULTS:
Nurses in Saudi Arabia have moderate knowledge concerning disaster preparedness.
However, nurses in military hospitals possess more knowledge than those who work in
government hospitals. The majority of nurses gained their knowledge and skills
from disaster drills.
CONCLUSIONS:
Nurses need more education in all areas of disaster management, most importantly in their
roles during response to disasters. Nurses perceive themselves as not well-prepared but they
are willing to improve their skills in disaster preparedness if educational opportunities are
provided.
2) Design and development of compact monitoring system for disaster remote health
centres.
Santhi S1, Sadasivam GS.
Abstract
PURPOSE:
To enhance speedy communication between the patient and the doctor through newly
proposed routing protocol at the mobile node.
MATERIALS AND METHODS:
The proposed model is applied for a telemedicine application
during disaster recovery management. In this paper, Energy Efficient Link Stability Routing
Protocol (EELSRP) has been developed by simulation and real time. This framework is
designed for the immediate healing of affected persons in remote areas, especially at the time
of the disaster where there is no hospital proximity. In case ofdisasters, there might be an
outbreak of infectious diseases. In such cases, the patient's medical record is also transferred
by the field operator fromdisaster place to the hospital to facilitate the identification of
the disease-causing agent and to prescribe the necessary medication. The heterogeneous
networking framework provides reliable, energy efficientand speedy communication between
the patient and the doctor using the proposed routing protocol at the mobile node.
RESULTS:
The performance of the simulation and real time versions of the Energy Efficient Link
Stability Routing Protocol (EELSRP) protocol has been analyzed. Experimental results prove
the efficiency of the real-time version of EESLRP protocol.
CONCLUSION:
The packet delivery ratio and throughput of the real time version of
EELSRP protocol is increased by 3% and 10%, respectively, when
compared to the simulated version of EELSRP. The end-to-end delay and
energy consumption are reduced by 10% and 2% in the real time version
of EELSRP.

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3) Post-tsunami relocation of fisher settlements in South Asia: evidence

from the Coromandel Coast, India.
Bavinck M1, de Klerk L, van der Plaat F, Ravesteijn J, Angel D, Arendsen H, van Dijk T, de
Hoog I, van Koolwijk A, Tuijtel S, Zuurendonk B.
Abstract
The tsunami that struck the coasts of India on 26 December 2004 resulted
in the large-scale destruction of fisher habitations. The post-tsunami
rehabilitation effort in Tamil Nadu was directed towards relocating fisher
settlements in the interior. This paper discusses the outcomes of a study
on the social effects of relocation in a sample of nine communities along
the Coromandel Coast. It concludes that, although the participation of
fishing communities in house design and in allocation procedures has
been limited, many fisher households are satisfied with the quality of the
facilities. The distance of the new settlements to the shore, however, is
regarded as an impediment to engaging in the fishing profession, and
many fishers are actually moving back to their old locations. This raises
questions as to the direction of coastal zone policy in India, as well as to
the weight accorded to safety (and other coastal development interests)
vis--vis the livelihood needs of fishers.

4) Strategic planning and designing of a hospital disaster manual in a

tertiary care, teaching, research and referral institute in India.
Talati S1, Bhatia P2, Kumar A3, Gupta AK1, Ojha CD1
Abstract
BACKGROUND:
As per the "Disaster Management Act, 2005" of India, it is mandatory for government
hospitals in India to prepare a disaster plan. This study aimed to prepare a disaster manual of
a 1 900 bed tertiary care hospital, in consultation and involvement of all concerned
stakeholders.
METHODS:
A committee of members from hospital administration, clinical, diagnostic and supportive
departments worked on an initial document prepared according to the Act and gave their
inputs to frame a final disaster manual.
RESULTS:
The prepared departmental standard operating procedures involved 116 people (doctors and
paramedical staff), and were then synchronized, in 12 committee meetings, to produce the
final hospital disaster manual.
CONCLUSIONS:
The present disaster manual is one of the few comprehensive plans prepared by the
stakeholders of a government hospital inIndia, who themselves form a part of
the disaster response team. It also helped in co-ordinated conduction of mock drills.

26

5) Multiple shocks, coping and welfare consequences: natural disasters and health
shocks in the Indian Sundarbans.
Mazumdar S1, Mazumdar PG2, Kanjilal B3, Singh PK1.
Author information
Abstract
BACKGROUND:
Based on a household survey in Indian Sundarbans hit by tropical cyclone Aila in May 2009,
this study tests for evidence and argues that health and climatic shocks are essentially linked
forming a continuum and with exposure to a marginal one, coping mechanisms and welfare
outcomes triggered in the response is significantly affected.
DATA & METHODS:
The data for this study is based on a cross-sectional household survey carried out during June
2010. The survey was aimed to assess the impact of cyclone Aila on households and
consequent coping mechanisms in three of the worst-affected blocks (a sub-district
administrative unit), viz. Hingalganj, Gosaba and Patharpratima. The survey covered 809
individuals from 179 households, cross cutting age and gender. A separate module on healthseeking behaviour serves as the information source of health shocks defined as illness
episodes (ambulatory or hospitalized) experienced by household members.
KEY FINDINGS:
Finding reveals that over half of the households (54%) consider that Aila has dealt a high,
damaging impact on their household assets. Result further shows deterioration of health
status in the period following the incidence of Aila. Finding suggests having suffered multiple
shocks increases the number of adverse welfare outcomes by 55%. Whereas, suffering either
from the climatic shock (33%) or the health shock (25%) alone increases such risks by a
much lesser extent. The multiple-shock households face a significantly higher degree of
difficulty to finance expenses arising out of health shocks, as opposed to their counterparts
facing only the health shock. Further, these households are more likely to finance the
expenses through informal loans and credit from acquaintances or moneylenders.
CONCLUSION:
This paper presented empirical evidence on how natural and health shocks mutually reinforce
their resultant impact, making coping increasingly difficult and present significant risks of
welfare loss, having short as well as long-run development manifestations.

CONCLUSION
Disasters are of different types which can happen anytime, anywhere, in the world
causing tremendous after effects such as loss of human life, economical imbalances, food
scarcity, epidemics, forced relocation of population etc. Disasters usually affect the
developing countries comparing with the developed countries. While deserting the matter
we could come to the conclusion that the adverse effects of natural disasters can be
minimized by proper preventive measures alert technologies at high risk areas, proper
27

mobilization of resources, and decreased corruption in the field and also the mock
training programmes in the community.
BIBLIOGRAPHY
Tener Goodwin Veenema, Disaster Nursing and Emergency Preparedness for
Chemical, Biological, and Radiological Terrorism and Other Hazards, 1st edition,
Springer publishers, Page No. 3-168.
Park K;PREVENTIVE AND SOCIAL MEDICINE;2005;18th edition; Jabalpur;
Banarsidas Bhanot publishers; pp 600-605.
Swarankar . Community Health Nursinf, 3rd edition, N.R.Brothers publication, page
no: 870-885.
http://www.ncbi.nlm.nih.gov/pubmed/25170846
http://www.ncbi.nlm.nih.gov/pubmed/25657125
http://www.ncbi.nlm.nih.gov/pubmed/25215145

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