# General Concepts and Definitions Leaders course Jamaica February 11, 2003 “Knowledge comes, but wisdom lingers”( Tennyson)

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General Concepts and Definitions Leaders course Jamaica February 11, 2003 “Knowledge comes, but wisdom lingers”( Tennyson)

General Concepts Disasters: low probability-high impact eventsDisasters: low probability-high impact events  “Sudden ecological phenomenon of sufficient magnitude to require external assistance” (WHO)  “I know a disaster when I see one” Risk Management vs. Disaster ManagementRisk Management vs. Disaster Management Attitude Change vs. Product ImprovementAttitude Change vs. Product Improvement

General Concepts Risk: Probability of harmful consequence or expected loss of lives/property resulting from interaction between natural or human induced hazards and vulnerable conditions.Risk: Probability of harmful consequence or expected loss of lives/property resulting from interaction between natural or human induced hazards and vulnerable conditions. Hazard: Probability of occurence of a given threatHazard: Probability of occurence of a given threat Vulnerability: Degree of susceptibility of the element exposed.Vulnerability: Degree of susceptibility of the element exposed. Capacity: Ability of people to cope with the situation.Capacity: Ability of people to cope with the situation. Risk = H x V/CRisk = H x V/C

The Disaster Cycle Mitigation Preparedness Prevention Rehabilitation Reconstruction Response BEFORE AFTER DURING

Definitions Preparedness - Pre-disaster activities aimed at strengthening the capacity for rescue, relief, and rehabilitation.Preparedness - Pre-disaster activities aimed at strengthening the capacity for rescue, relief, and rehabilitation. Prevention - Measures designed to provide complete protection from natural disasters by controlling effects of natural phenomena.Prevention - Measures designed to provide complete protection from natural disasters by controlling effects of natural phenomena. Mitigation - Prevention in an imperfect world! Reduction of the impact! (Structural, non-structural and functional)Mitigation - Prevention in an imperfect world! Reduction of the impact! (Structural, non-structural and functional)

Disasters and Health Effects Disasters and Health Effects World-wide: 3.4 mil deaths due to natural disasters in 25 yearsWorld-wide: 3.4 mil deaths due to natural disasters in 25 years Japan: 63 deaths/eventJapan: 63 deaths/event Peru: 2,900 deaths/eventPeru: 2,900 deaths/event Population: 6 bil increase = 1.33% yearly increase (the poor outnumber the rich)Population: 6 bil increase = 1.33% yearly increase (the poor outnumber the rich) Trends:Trends:  Increase in # of hazards  Deaths toll per event reduced  Financial toll increased What Matters More??What Matters More??

Global Trends Climate change and variables – El Niño El Niño Poverty Poverty Ignorance Ignorance Environmental degradation Environmental degradation Urban growth Urban growth Increasing un-sustainability Increasing un-sustainability Increasing obstacles to development Increasing obstacles to development Increased value of constructed environment Increased value of constructed environment EXTREME EVENTS EXTREME EVENTS VULNERABILITY

Source: OFDA/CRED International Disaster Database Current Trends

Source: OFDA/CRED International Disaster Database Current Trends

Disasters and Health Effects General Effects on HealthGeneral Effects on Health  Natural vs Technological  Potential Effects vs. Inevitable Threat (ex. BCR)  Sudden vs Creeping/Slow Development  Requirements for food, shelter and primary health care vary with type & length of event.

Disasters and Health Effects Disasters and Health Effects General Effects on SocietyGeneral Effects on Society  Deaths and Injuries  Damage to Health Infrastructure  Water Supply and Sanitation  Communicable Diseases (overcrowding, vectors, water supply, waste management, PH programs)  Social Burden (poverty, age and gender)  Food Shortage  Population Displacement  Mental Health Impact

Disasters and Health Effects FloodsFloods  Most Frequent Natural Hazard  Most Deaths (flash floods) 146/year in USA  Drowning - 77%  Cardiac arrest - 10%  Trauma - 10%  Hypotermia - 3%  Public Health: water quality, waste disposal, vectors, disease  Associated Hazards: electrical, chemical

Disasters and Health Effects Volcanic EruptionVolcanic Eruption  Most Deadly  Pyroclastic flows - 70% from blast, heat or asphyxiation  Rock fall injuries, BURNS  Difficult Access for First Responders  Damage to Health Infrastructure  Water Contamination

Disasters and Health Effects TsunamiTsunami  Water and Debris = Damage to Structures  More deaths then injured (50-80%)  Drowning -Vulnerable Groups  Trauma Injuries  Dehydration  Sunburn

Disasters and Health Effects HurricanesHurricanes  Most Deadly  Hurricane Flora 1963 - Haiti & Cuba → 8,000  Hurricane Fifi 1974 -Honduras → 10,000  Hurricane Mitch 1998 - Central America → 11,000  Injuries  Lacerations - 80% (during the clean up phase)  Damage to Infrastructure and Public Health Systems

Disasters and Health Effects EarthquakesEarthquakes  Most Costly - Life and Property  No Warning  Evacuation Not Possible  Initial Medical Response - Delayed  Health Infrastructure - Damaged  Most Deaths - Collapsed Buildings  95% Survivers are Rescued in First 24 hours  Injuries - Simple fractures to crush injury

Disasters and Health Effects Disasters and Health Effects TechnologicalTechnological  Biological, Chemical, Radiological  Accidental or Intentional Release  Terrorist Threat  Possible? Plausible? Probable?  Effective Use of Resources  Personnel  Funding  Infrastructure

Disasters and Health Effects Disasters and Health Effects TechnologicalTechnological  Enhancing Capabilities  Training  Infrastructure  Shifting Priorities in Preparedness  Cost Effective  Social Consequences  Reality or Perception

Health Sector and Disaster Management

Recurring Issues Success is Difficult to QuantifySuccess is Difficult to Quantify Management of International AssistanceManagement of International Assistance Information ManagementInformation Management More Actors on the SceneMore Actors on the Scene

Recurring Issues Mass Casualty ManagementMass Casualty Management Care for VictimsCare for Victims Dual Wave PhenomenonDual Wave Phenomenon  Walking Patients - 30 min  Priority 1 Patients - 2 hours Geographic Effect (closest facilities most impacted)Geographic Effect (closest facilities most impacted) BABEL Effect (communication, people, or equipment problem??)BABEL Effect (communication, people, or equipment problem??)

Recurring Issues Laymen EnthusiasmLaymen Enthusiasm Disaster Supply ManagementDisaster Supply Management  Local Sources  Donations TetanophobiaTetanophobia Fear of EpidemicsFear of Epidemics Management of Human and Animal RemainsManagement of Human and Animal Remains Field HospitalsField Hospitals

Planning Assumptions NO “Best Option”NO “Best Option” PlansPlans  Adapted to Disaster  Improvisation Can Be Costly  First Responders Are Not Always First Infrastructure CapacityInfrastructure Capacity Specialized Care May Be NeededSpecialized Care May Be Needed

Planning Assumptions Local Capacity Response CapabilityLocal Capacity Response Capability Stockpile of Equipment & SuppliesStockpile of Equipment & Supplies Shortage or Flood of Supplies and StaffShortage or Flood of Supplies and Staff Decentralization of AuthorityDecentralization of Authority Private Business/Organization SupportPrivate Business/Organization Support

Health Sector Actors Government Sector: Min of Health, Min of Foreign Affaires, Min of Finance, Min of Environment, Water Authorities, Fire Services, Police, Defense Force, Public Works, National Disaster Office, Airport Managers, MEDIA……..Government Sector: Min of Health, Min of Foreign Affaires, Min of Finance, Min of Environment, Water Authorities, Fire Services, Police, Defense Force, Public Works, National Disaster Office, Airport Managers, MEDIA…….. Private Sector: Hospitals, Ambulances, Doctors, Manufacturers,……..Private Sector: Hospitals, Ambulances, Doctors, Manufacturers,…….. Local Authorities: Mayors, Community Groups….Local Authorities: Mayors, Community Groups….

Health Sector Task Promotion of Disaster Reduction ActivitiesPromotion of Disaster Reduction Activities Include Risk Management Concept in Development ProjectsInclude Risk Management Concept in Development Projects Staff, Fund, and Prepare Response ResourcesStaff, Fund, and Prepare Response Resources  Care of Victims  Enviromental Needs (water, food, vector control)  Inform Public

Health Sector Task Coordinate With All SectorsCoordinate With All Sectors Plan for RehabilitationPlan for Rehabilitation  Window of Opportunity for Reform

Ministry of Health Disaster Reduccion Program Mandate:Mandate:  Promote, Coordinate, and Support Efforts of the Entire Health Sector to Reduce Impact of Disasters Scope:Scope:  Multi-Hazard and Inter-Disciplinary

Functional Areas of Responsibility Functional Areas of Responsibility Promote Health & Social Issues with Other SectorsPromote Health & Social Issues with Other Sectors Include Reduction/Mitigation Measures into Development ActivitiesInclude Reduction/Mitigation Measures into Development Activities Equitable Access to HealthcareEquitable Access to Healthcare Public AwarenessPublic Awareness

Normative Functions Normative Functions Develop Construction StandardsDevelop Construction Standards Develop Contingency Planning, Response, and Simulation Standards/GuidelinesDevelop Contingency Planning, Response, and Simulation Standards/Guidelines Develop Criteria for Disaster Preparedness and Safety Accreditation of Health FacilitiesDevelop Criteria for Disaster Preparedness and Safety Accreditation of Health Facilities Develop Communications ProtocolDevelop Communications Protocol Develop Standards/Guidelines for Registration of Humanitarian Assistance Organizations (NGO´s, external military forces)Develop Standards/Guidelines for Registration of Humanitarian Assistance Organizations (NGO´s, external military forces)

Educational Functions In-Service Training of Health StaffIn-Service Training of Health Staff Include Disaster Management into Pre- and Post-Graduate Curriculum Medical SchoolInclude Disaster Management into Pre- and Post-Graduate Curriculum Medical School Presentation of Health Related Topics in Training of Other SectorsPresentation of Health Related Topics in Training of Other Sectors

Coordination/Liaison National Disaster Office (Civil Protection)National Disaster Office (Civil Protection) Disaster Focal Points of Other AgenciesDisaster Focal Points of Other Agencies Disaster Programs in Neighboring CountriesDisaster Programs in Neighboring Countries Humanitarian and Developmental Organizations (national, international)Humanitarian and Developmental Organizations (national, international)

Operational Functions Mobilize and Coordinate Immediate ResponseMobilize and Coordinate Immediate Response Coordinate Health Sector AssessmentCoordinate Health Sector Assessment Formulate Priorities and Assign ResourcesFormulate Priorities and Assign Resources Mobilize External ResourcesMobilize External Resources Contribute to Formulation of Rehabilitation Plans (include mitigation)Contribute to Formulation of Rehabilitation Plans (include mitigation) Compile and Disseminate Lessons LearnedCompile and Disseminate Lessons Learned

Reporting Channels Staff and Budget Reporting Channels Staff and Budget Highest Decision-Mmaking Level in the MOHHighest Decision-Mmaking Level in the MOH Access to All Administrative Areas and Technical Departments in HealthAccess to All Administrative Areas and Technical Departments in Health Funds to be Assigned Specifically for Risk Reduction ProgramFunds to be Assigned Specifically for Risk Reduction Program Staff Trained, Qualified/Certified, and Full- TimeStaff Trained, Qualified/Certified, and Full- Time

General Concepts and Definitions Leaders course Jamaica February 11, 2003 “Knowledge comes, but wisdom lingers”( Tennyson)

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