Disaster Management

Medical Preparedness, Response and Homeland Security

Rajesh Arora, Preeti Arora, Rajesh Arora, Preeti Arora

• Publisher: CAB International
• Year: 2013
• ISBN:
  9781789243949
• Topic: Medicine
• Subtopic: Public Health, Administration & Care

Disaster management is an increasingly important subject, as effective management of both natural and manmade disasters is essential to save lives and minimize casualties. This book discusses the best practice for vital elements of disaster medicine in both developed and developing countries, including planning and preparedness of hospitals, emergency medical services, communication and IT tools for medical disaster response and psychosocial issues. It also covers the use of state-of the-art training tools, with a full section on post-disaster relief, rehabilitation and recovery.

Section 1

Disaster Management and Homeland Security: A Prologue

Chapter 1

Prologue:

A Holistic View to Managing the Inevitable in High-tech and Resource-poor Settings

Rajesh Arora and Preeti Arora

Introduction

Extensive preparedness for management of both natural and man-made disasters is the need of the hour. While natural disasters are inevitable, man-made disasters are avoidable to some extent and their impact can be mitigated to a large extent with proper management. With appropriate and well-timed preparedness, it is possible to mitigate the effects of both natural and man-made disasters and change the face of disasters. The increase in the number of man-made disasters has made it imperative that they be circumvented or their impact reduced by employing newer methods and tools.

Though disasters have been ubiquitous throughout history, the last decade has seen several disasters inflicting extensive financial and infrastructural damage. Some of the disasters have struck developing nations and others developed nations and some both. But the impact of nature’s fury on both types of nations has been substantial – what has been different is the way disasters have been managed. The costliest hurricanes that hit the US economy substantially include: Katrina (2005), which crossed southern Florida and struck Louisiana with great intensity, devastating New Orleans and resulting in damage that has been estimated to cost over US$108 billion, followed by Andrew (1992), which caused damage estimated to cost US$46 billion; Ike (2008) caused damage estimated at US$28 billion; Wilma (2005) resulted in damage estimated at US$29.5 billion; and Ivan (2004) inflicted damage estimated at US$19.8 billion. Just months before this book was envisaged, March 2011 witnessed a mega-disaster – the Tōhoku earthquake (and tsunami) – the costliest disaster of this century; while a few months prior in 2010 the Haiti earthquake inflicted extensive damage. While this book is nearing completion, the US has been struck by the 2013 Moore tornado, and man-made disasters like the West Fertilizer Company explosion and Boston marathon bombings have shook the world’s oldest surviving federation. As the final days of this book approach, it is June 2013 and the North Indian states of Uttarakhand and Himachal Pradesh, some regions of Western Nepal and their adjoining areas have experienced heavy rainfall due to cloud bursts, which has triggered devastating floods and landslides. Kedarnath, Badrinath and several areas in Uttarkashi in Uttarakhand (nearly 40,000 sq. km) have been severely hit by the floods. The incident has been dubbed the ‘Himalayan Tsunami’. Rescue and relief work is currently under way to evacuate nearly 100,000 people from the area. Twelve teams of National Disaster Response Force (NDRF) battalions have been deployed to various locations for response and relief operation in the states of Uttarakhand, Himachal Pradesh and Uttar Pradesh. The Indian Army has deployed about 5500 personnel, the Indo-Tibetan Border Police (ITBP) 2000 personnel and the Border Roads Organization 3000 personnel. Thirteen teams, comprising 300 personnel from the NDRF, have also been deployed. So far, the Indian Air Force has provided one C-130J aircraft, eight MI-17s, ten ALH, one AN-32 and one Avro to carry out rescue work. Almost 50 helicopters of the Indian defence forces have been deployed in Uttarakhand state for rescue missions, which are still ongoing. Disasters such as these pose a number of concerns that need to be addressed in earnest in times to come.

As per the World Health Organization (WHO) Collaborating Centre for Research on the Epidemiology of Disasters (CRED) Emergency Events Database (EM-DAT), during the first few months of 2012, over 143 natural disasters occurred, killing over 2500 people, affecting almost 61 million others and causing more than US$6.9 billion of economic damage. Over the same period, 86 countries have experienced at least one natural disaster, with the most affected countries being Afghanistan, the USA and the Philippines (CRED CRUNCH. No. 29 ‘Disaster Data: A Balanced Perspective’, September 2012). As per early estimates, the economic damages inflicted by Hurricane Sandy – a tropical cyclone of the 2012 Atlantic hurricane season that severely affected several regions of the Caribbean, mid-Atlantic and north-eastern USA in October 2012 as this book was being written, with lesser effects in the south-eastern and Midwestern states and eastern Canada – could reach US$50 billion in the USA alone. That would make the storm the second costliest in American history, after Hurricane Katrina. It is estimated that 8.5 million homes and businesses lost power during Hurricane Sandy.

In view of the widespread damage caused by disasters in recent years, there has been a worldwide upsurge of interest in disaster management, and it is now well recognized that only a proactive approach can help in mitigation of the deleterious effects of disasters and mass casualty incidents. Both natural and man-made disasters need to be managed and overall preparedness is indispensable since disasters are inevitable. Rapid advances in the area have been the hallmark of this ever-growing field; advances which, if documented, could lead to saving of precious human lives in critical moments. Keeping this in mind, the present book was envisaged.

Covering a wide span of disaster fundamentals, this book presents the state-of-the-art in the area. The content of the book ranges from disaster/mass casualty management, homeland security concerns, incident command systems, planning and preparedness of hospitals for disasters, emergency medical services, improving patient outcomes, communication and IT tools for medical disaster response, psychosocial issues, coordination between pre-hospital and hospital care, triage planning, use of state-of-the-art training tools and research in disaster management and chemical, biological, radiological and nuclear (CBRN) disasters – response, rescue and relief.

This book is divided into ten sections. The first section of this book is an introductory section that provides a prelude to disasters and mass casualty incidents (MCIs), the problems associated with them and their management, and summarizes the key issues in disasters and homeland security with a focus on medical management of disasters and MCIs.

Covering a range of cross-cutting issues, the book should interest a wide audience, including those involved in disaster rescue, response and relief.

Mitigation, Training and Medical Preparedness

The second section of this book discusses the importance of mitigation and how training and medical emergency preparedness can solve problems associated with disasters; modern state-of-the-art training tools are discussed. This section also covers the importance of primary care physicians, who often have to handle disaster victims in close proximity with limited resources, yet they play an important role in saving human lives.

All disasters are said to be local. As primary care forms the foundation of effective healthcare, during disasters or MCIs usually such primary healthcare centres can do wonders by saving precious human lives. The second chapter of this book by Mark K. Huntington discusses the important role of primary healthcare. Some areas that have been discussed in detail in the chapter are highlighted in the following section. The provision of comprehensive, compassionate, patient-centred care; the first point of contact interfacing between the patient and the often complex health system, is a hallmark of the work of primary care physicians. This is even more the case in extreme circumstances. When a disaster strikes, it is the local primary care physicians who are the first to respond, and it is they who continue to provide care when the outside response and relief agencies leave. In resource-poor settings, the primary care physician plays a cardinal role in disaster management. Chapter 2 addresses the role of primary care physicians during each phase of a disaster, both as the local care provider and as a part of an outside response effort. Aspects of involvement of the primary care physician in all phases of the disaster cycle, including preparedness and prevention, response, recovery and mitigation have been reviewed. Key areas of knowledge for disaster medicine include triage, emergency medical and trauma care, chronic disease management, basic maternity care, paediatric care, geriatric care, psychological care and care for injuries from CNRN causes; these are all concisely covered in this chapter. In addition, this chapter focuses on community preparation activities, special practice considerations and opportunities for more extensive involvement. The foundational skills, knowledge and philosophy of the primary care physician are ideally suited for involvement in a variety of capacities in disaster medical response, both locally, and as part of a larger concerted effort in areas outside their home community. The important role played by the primary care physician has been highlighted.

Natural and man-made disasters are increasing worldwide, creating a need to train healthcare workers to respond to MCIs. Chapter 3 of this book by Dale S. Vincent and Benjamin W. Berg discusses the significant role of simulation-based medical education (SBME) as an effective methodology for this purpose, creating an experiential, interactive and realistic educational environment that engages learners and effectively transfers new knowledge and skills. These authors opine that the analysis, design, development, implementation and evaluation (ADDIE) instructional design model can provide a useful template for the development of MCI training courses using SBME. Novice and experienced learners may be trained individually or in groups, depending on the objectives of the course. Equipment and faculty resources are significant drivers in the design of simulation scenarios. This chapter also deliberates on curriculum considerations, which must include the type of disaster to be modelled, the types of injuries to be simulated and whether teaching life-saving interventions will be included in the programme. Scenarios have to be tested to ensure that they trigger appropriate learner responses, and faculty must be trained to evaluate learners and provide feedback during debriefing sessions. Evaluation methods need to be developed and put into place to determine whether individual as well as institutional goals are being achieved. Lastly, it is possible to gain new insights into the development of MCI training programmes by reviewing the experiences of educators in conducting programmes with similar goals. The use of SBME techniques has great potential to engage learners, transfer knowledge and skills, and measure educational outcomes in programmes that train healthcare workers to respond effectively to natural and man-made disasters. With rapid advances in virtual reality and artificial intelligence, SBME will change the way disasters are handled by medical professionals and paramedics and greatly improve survival of disaster and MCI victims.

For training purposes, manikins have been of great use and can be utilized quite effectively to simulate real environments. The authors suggest that experiential learning using manikin-based simulation may be an effective way to train healthcare providers for MCIs. Experts have identified the applicability of simulation-based education to disaster health education. Educators who are planning a MCI training programme using manikins can use instructional design principles to guide course development. A systematic approach to the design of MCI training using manikin-based simulation may help to ensure the successful transfer of knowledge and skills to both novice and experienced learners. The cost constraint, however, currently restricts its usage as an effective and efficient training tool in developing and underdeveloped nations. With decrease in cost, it should be possible to introduce manikins for training in resource-poor nations. The usage of manikins for the training related to management of CBRN emergencies is another area where attention is being focused in several countries. However, more attention is needed in this area to make it affordable and accessible for the resource-poor developing nations. This would enable more effective training of medical and paramedical professionals.

Crucial Role of Communication in Disaster Management and Homeland Security

Section 3 of the book focuses on new developments in medical disaster preparedness and communication during/immediately after the disaster utilizing web-based applications and the mobile grid. Ways to improve communication to expedite the movement of patients and resources between entities in the event of a regional disaster event that impairs the ability of one of more major medical centres to care for its patients are also discussed in the three chapters of this section.

When any community suffers a disaster, the shock and destruction to its system drive that community into chaos, threatening its individuals and its social institutions. The community’s ability to recover is dependent on its resilience capability. Due to its hierarchical management systems, traditional disaster communications have wrestled with multiple issues of effective communication with the public, including trust. Marcia Trainer and Anju Goel in Chapter 4 of the book discuss the finer nuances of social networking in disaster management and homeland security. Recent technological innovations, advancements in Web 2.0 and peer-to-peer social networking have changed modes of communication all around the globe. Social networking’s webbed horizontal structure has democratized information sharing, and its multiple applications are defined by social connections. These various generally inexpensive, user-friendly tools have fast become a normal conduit for both routine and extraordinary communications between people, groups and public and private institutions, changing the world in the process. However, disaster preparedness and response fields have not kept pace with the rapid development and use of social networking. With a few exceptions, social networking has not yet been assessed or routinely incorporated into many plans for disaster management. Consequently, little research has been done to systematically evaluate its utility in this context. Despite this, anecdotal information exists of successful public spontaneous social networking emergency response in multiple types of disasters. The authors of this chapter propose that social networking should be incorporated into disaster management plans to help address well researched and persistent problems in effective communication during disaster response. Its nature, breadth and widespread use lend to its potential as a powerful tool for disaster response communities worldwide. This chapter examines the considerable social research in public response to disasters that demonstrates its utility; problems in conventional disaster communication; social networking’s definition and applications; its recent spontaneous successes in contemporary disasters; how to incorporate social networking into disaster plans; and disaster medicine applications built on Web 2.0 technology. This technology can be effectively used for better communication leading to efficient disaster response.

The communications and resource needs and allocations for high-risk and high-tech patients form the focus of the fifth chapter by Ronald S. Cohen. The chapter focuses on developing a resource-based triaged tool acceptable to all the hospitals in a region, and developing a region-wide approach to surge capacity. It is well recognized that disasters pose different threats and raise different issues for specialized medical professionals like neonatologists to those for physicians in surgery, emergency medicine or adult intensive care units. There are no likely scenarios that would result in a large number of preterm or term newborns, not already in hospital, becoming mass casualties. Thus far, no epidemic or pandemic has resulted in massive numbers of neonatal cases. There are, however, significant issues in disaster planning for those who work in newborn intensive care units. Specifically, neonatologists are likely to face one of three possible disaster scenarios: (i) the need to evacuate their own unit; (ii) the need to receive large numbers of neonates from neighbouring hospitals forced to evacuate; and (iii) the need to continue functioning in the face of marked depletion of staff. This chapter discusses possible ways to mitigate such scenarios. Preparing neonatal intensive care units (NICUs) for possible large-scale disasters, such as an earthquake or tsunami is essential. Clearly, this is an area of concern as far as neonatologists are concerned. Ways to improve collaboration and communication between NICUs to expedite the movement of patients and resources between units in the event of a regional disaster event that impairs the ability of one of more major medical centres to care for its patients are discussed. In addition, protocols to codify communications and focus on resource needs and allocations for high-risk and high-tech patients are evaluated.

Well organized responses to disasters like earthquakes, floods, terror incidents, etc. usually involve efficient coordination and collaboration among public safety/medical organizations, and sharing of emergency alerts and incident-related data between disparate systems. During the 2001 Gujarat earthquake and the 2004 Indian Ocean tsunami, as well as in the recent 2011 Great Eastern earthquake of Japan, the communication systems were severely disrupted for days together. During such emergencies, quite often extensive disruption of most infrastructure-based communication systems is witnessed. During such emergencies, rescue groups from different locations and medical departments gather together to implement their respective rescue operations. It is pertinent that these groups quickly establish networks among themselves, and exchange data, so as to complete their missions speedily and efficiently. Under such circumstances, mobile ad hoc networks (MANETs) are increasingly being perceived as the preferred types of networks because of their unique characteristics of independent network organization, dynamic topology, ease of deployment and no central nodes (see Chapter 6 of this book). A synergy of the resource-sharing potential of grid computing with the flexible, ubiquitous availability of MANETs can be used to create a mobile grid environment. A mobile grid would allow the networked mobile devices to accomplish a specific mission that maybe beyond an individual’s computing or communication capacity due to their inherent constraints in terms of processing power, node life or low resources, etc. The sixth chapter of this book by Monideepa Roy and Nandini Mukherjee covers the application of mobile grid for medical emergency management/disasters and terror incidents. The authors present in this chapter a unique perspective of a mobile grid application for the setting up of an efficient disaster recovery system. These technologies, when used appropriately, can effect better communication leading to efficient disaster relief, response and recovery.

Social networking can significantly improve disaster response and help to obtain contact information, speeding reunions for people, as has been evident from the 2011 Japan mega-disasters, Hurricane Sandy, the EF5 tornado that devastated Moore, Oklahoma in 2013 and the recent MCIs like the 2013 Boston Marathon bombings and the June 2013 Uttarakhand landslides/floods (Himalayan Tsunami), and needs incorporation in future disaster plans. Social media can significantly empower individuals, providing them a platform to share their experiences and information irrespective of time and place. The application of IT tools can make information management during the disaster support planning and execution phases faster and more reliable, affordable and accessible.

Disasters and Mass Casualty Incidents: Incident Site Command and Control, Point-of-care Testing

Section 4 of the book focuses on the role of Incident Command and Control Systems in the management of disasters and MCIs, and highlights practical guidance in planning and implementing reliable, clinically useful and cost-effective point-of-care procedures and systems. The role of the Incident Command System (ICS) is discussed and similar systems from other nations are also reviewed. Applications of point-of-care (POC) testing in disaster settings, benefits, limitations and cost-effectiveness of point-of-care testing are also highlighted.

In a changed global scenario, POC testing is being pushed forward as a useful modality in the management of emergencies of diverse nature. POC testing is performed at or near the site of care and is an ideal approach to accelerate decision-making in emergencies, disasters and public health crises. The seventh chapter of this book, by Gerald J. Kost, Corbin Curtis, Richard Louie and Ann Sakaguchi, provides fundamental conceptual principles and value propositions that will enable new POC technologies to be assimilated into challenging sites when infrastructure is severely compromised. At the same time, it proposes developing professional competence and team experience cost-effectively in the context of existing small-world networks of healthcare delivery. There is a need for environmental limitations to be addressed, since use of current POC devices and test kits must adhere to manufacturer specifications, which to date are not robust enough for the hot, cold and humid conditions encountered during field operations. The author presents strategic alternatives for placement of POC testing in appropriate settings that readers will find useful as they adopt solutions to fulfil critical need. Overall, POC testing promises to transform crisis standards of care by bringing enhanced evidence-based diagnosis and treatment to the sites most in need and by accelerating process steps, such as screening and triage, that are critical to effective emergency and disaster responses. The chapter highlights practical guidance in planning and implementing reliable, clinically useful and cost-effective POC procedures and systems. Applications in disaster settings, benefits, limitations and cost-effectiveness of POC testing are discussed. Potential operational benefits of POC testing include: more rapid decision-making and triage, reduced operating times, reduced high-dependency, post-operative care time, reduced emergency room time, reduced number ...

Table of contents

• Cover Page
• Dedication
• Title Page
• Copyright Page
• Contents
• Contributors
• Foreword
• Acknowledgements
• About the Editors
• Section 1: Disaster Management and Homeland Security: A Prologue
• Section 2: Training, Mitigation and Medical Preparedness
• Section 3: Crucial Role of Communication in Disaster Management and Homeland Security
• Section 4: Disasters and Mass Casualty Incidents: Incident Site Command and Control, Point-of-Care Testing
• Section 5: Medical Management of Complex Disasters and MCI Victims in Hospitals
• Section 6: Securing the Homeland: The Medical Way
• Section 7: Defeating Emerging Health Threats: Managing by Prophylactic and Therapeutic Approaches
• Section 8: Handling Psychosocial Issues: A Difference in Perspective (Developed and Developing Nations)
• Section 9: Bridging the Great Divide: The Challenge of Managing Disasters and MCIs in Resource-poor Settings
• Section 10: Post-disaster Relief, Rehabilitation and Recovery
• Index
• Footnotes