Systems of Disaster Management

Helps us to the existing framework within every district.

How does our government respond during times of disaster?

In the event of any disaster, the decision making authority must be as decentralised as possible, in order to ensure quick communication and better understanding of the field conditions. This ensures that the decisions made by the authority are quickly implemented on the field.One of the key decision-making authorities during the time of any disaster is the District Collector.

Every district has rural and urban areas.Urban areas are divided into

Corporations/Municipalities/Panchayats and further divided into divisions.The rural areas are divided into Blocks, Panchayats and Wards.

Every ward has a Ward Level Team. The official members of this team are:

Ward Member who is an elected representative from the public.
ASHA Worker (Accredited Social Health Activist) is a community health worker who is trained by the Health Department and nominated by the Local Self Government Department (LSGD).

Asha Workers report to the Subcenter (a grassroot level office of the health department for approximately 5000 population) where there is a Junior Health Inspector (JHI) and Junior Public Health Nurse (JPHN). Higher on the hierarchy is the Primary Health Centre (PHC), at Panchayat level, it's called Family Health Centre or Community Health Centre (CHC). These centres have a doctor, a pharmacist and a lab with basic support systems. At Least 10-20 people work here. These centres take care of the public health needs. Above this is the Taluk hospital, and further above is the Jilla or General Hospital. At this level there is usually a separate centre for Women and Children.

The medical colleges that we commonly hear about are part of a separate Medical Education system under the Director of Medical Education (DME). Nursing colleges may be under either the medical education system or under the general hospitals.

We shall read about the structure of the health system in the coming chapters.

Anganwadi Worker is appointed by the Social Justice Department to work for the welfare of Mothers and Children. They are in the payroll of the State Government.

Anganwadi workers are monitored by ICDS (Integrated Child Development Services) Supervisor and Child Development Project Officer (CDPO). They have officers at block and the district levels.

The Department of Social Welfare has a special wing in the collectorate. Social Security Mission is a program/wing similarly supported by the Social Welfare Department under the State Government Program. They supervise and support the ICDS and CDP. It is ultimately under the control of the Health Minister.

Kudumbashree ADS Chairperson ( Applicable to the state of Kerala )

The objective of Kudumbashree is Poverty Alleviation through Women Empowerment. Women in the community can form their own Self-Help groups(Ayalkootam). An ayalkootam has 10-20 women members. An average ward may have 10-15 such Self-Help Groups (Ayalkootam).

Each Self-Help Group (Ayalkootam) nominates 1 person to form an Area Development Society (ADS) within every ward. The ADS has a Secretary and a Chairperson. The ADS Chairperson will have direct control over all the Self-Help Groups (Ayalkootam) within the ward. This ADS chairperson is also part of the Ward Level Team.

Kudumbashree is an independent society that has its own election mechanism till the Panchayat Level. Above the Ward Level there is CDS (Community Development Society). From each Self Help Group, one nominated person forms the ADS (Area Development Society) at the Ward level and one person from each ADS is nominated to form the CDS.

Although only women from the community form these groups, the benefits reach the whole family. Therefore, out of 400 families in a ward, on an average, at least 100-150 families will be part of this society. Thus, the benefit reaches to at least 30% of the community.

Ward Level Team also includes other stakeholders like:Non Governmental Organisation (NGOs), Community Based Organisations (CBOs) Eg: Rotary club, Lions Club, may even be political organisations, Residents Associations, representatives of churches, temples etc.These are individuals or groups who are actively involved in various sectors and activities in the community.The different members of the team may have their own agendas or designated roles but in the time of crisis, they all come together and work with unity.

This team is self-sufficient to a large extent in dealing with any problem within the community without much external support.This team is the most effective body at the field level.They are the ones who ultimately work with the community. Many times, we underestimate the power and effectiveness of the ward level team. Our goal is to empower this team to be more efficient and work alongside them to overcome various challenges.

These four official members of the ward level team belong to different arms or departments of the state and community. The hierarchy of the system must be understood from bottom to top. This will be explained in detail in the coming chapters.

Introduction

India is prone to a number of disasters. The super cyclone of Odissa(1999),the Gujarat earthquake(2001), the Tsunami(2004) and Kerala floods( 2018,2019) were just a few of the disasters that led to heavy loss of life and left many stranded. We need to be aware of potential hazards, their frequency of occurring, where they might occur and the problems that may result in a disaster.

The National Disaster Management Authority (NDMA), headed by the Prime Minister of India is responsible for the management of disasters in the country. As per the Disaster Management Act, 2005, State and District statutory bodies are created for smooth functioning.Every state in the country has a State Disaster Management Authority that is responsible for taking steps towards mitigating the damage and destruction after a disaster and to make sure the state is prepared.

A well-coordinated and unified response of various departments of the State, its agencies, the Central Government, its departments and agencies appropriate to the demands of the district administration minimizes the loss of time wasted in response and improves the process of recovery.

What is a disaster and how is it classified?

Disaster Management

Disaster Management can be defined as the preparedness, response and recovery methods in order to lessen the impact of disasters. A disaster disrupts the normal function of the society to the extent that it cannot function without outside help.Disasters can be classified as natural, technological or complex emergencies. Let's take a look at the natural disasters in Kerala.

In August 2018,Kerala was hit by incessant rains followed by one of the worst floods that the state has witnessed in decades. All the dams of the state were filled to capacity and gates had to be opened to keep the dams safe. Hundreds died and thousands of homes were affected and damaged. More than a million people had to take shelter in relief camps. Normal life came to a standstill. The heavy rain acted as a trigger for more than 600 landslides in the state.

The entire nation came forward to lend a helping hand to the Kerala flood victims. Central Government, State Governments, Union Territories, Multi National Corporations, Big Business Houses, Celebrities, Sportsmen and women, schools, colleges, and common people have contributed to Kerala’s Chief Minister’s Relief Fund generously. Apart from these generous donations, it was the local community coming together for rescue missions and volunteering in relief camps that had an enormous impact on the return to normalcy.Awareness and preparedness are the most effective prevention and mitigation measures against all disasters.

Prevention Of Natural disasters

Floods and Landslides being the most common natural disaster in the state, prevention methods of floods and landslides can be categorised into three.

Vegetative measures: Preserving vegetation, grasses and trees can minimize the amount of water infiltrating into the soil, slow the erosion caused by surface-water flow, and remove water from the soil.
Structural Measures: Retaining and Diverting water using dams,floodplains,levees etc Constructing piles & retention walls Improving surface & subsurface drainage Rock-fall protection
Management measures: Integrated river basin approach Public awareness, participation and insurance Land use zoning & risk assessment Flood forecasting and warning systems

However, it is impossible to be prepared for any kind of disaster since it is impossible to predict or foresee it. The Corona Pandemic took the world by surprise. There may occur many more kinds of disasters that may require the community and state to respond to differently.

Disaster Preparedness:

The community is the first responder to any disaster. It is important that we prepare ourselves to face and respond to disasters.

Community Contingency Plan

A community contingency plan is a set of activities that a neighbourhood, community or group of people agree to follow inorder to respond well in times of an emergency. Developing a contingency plan involves making decisions in advance about the management of human and financial resources, coordination and communications procedures, and being aware of a range of technical and logistical responses.The planning process can be answered with three questions.What is going to happen?What are we going to do about it?What can we do ahead of time to get prepared?

Prepare:

Planning should be specific to each context and take into consideration a number of factors including: the government’s disaster-response plans and capacity; reception and coordination of national, regional or global inputs; potential sources of donor support; the likelihood of disaster occurrence; and the vulnerability of the population.

Analyse:

Determining the risk of disaster to a population and its potential impact starts with an analysis of the likely hazards faced by a country or region. Once this has been done an assessment of vulnerabilities and capacities at local, national or regional levels can be undertaken.

Develop:

Based on the analysis, this step understands what the organisation has to do in response to the disaster which includes who needs to do what, when and where and what they will need to enable them to do it.

Implement:

Practising the plan, will help organizations and communities understand its main elements, and will help planners see what works and what doesn’t.

Review:

Keeping the disaster-response or contingency plan current and relevant is a challenging task, but can be achieved by scheduling regular reviews. The plan should specify the frequency of such reviews and the persons responsible for this.

Disaster Management System within a state:

Every state in the country has a state disaster management authority (SDMA) that is responsible for activities within the state under the Chairmanship of the Chief Minister of the respective states. All SDMAs have state committees and District DMAs under their leadership. Kerala State Disaster Management Authority(KSDMA) is one of the 29 SDMAs of India.

State Control Rooms

The control rooms of the two above-mentioned departments function under the administrative control of the respective Department Heads, they being Commissioner Land Revenue and the Director-General of Police, respectively.

State Emergency Operating Centre

The government of Kerala has established the State Emergency Operating Centre (SEOC) as a state-level dedicated disaster management facility. The SEOC caters to varying levels of disasters with a multidisciplinary team who have hands-on experience in managing major disasters, a well-structured Decision Support System (DSS) and GSM, terrestrial and Satellite-based audio, video and data communication network.

District Emergency Operations Centres

The DEOC is under the direct control of District Incident Commander. The first dedicated district emergency operations centre with 24 hours staff from Revenue, Police and Fire & Rescue and a full-time medical doctor on-call started functioning at Alappuzha district of Kerala on 5th September 2014. Presently all DDMAs have operating District Emergency Operations Centres.

Rainfall

Several states in India witness very heavy rainfall during the months from June to September. Most vigil actions are to be taken and sustained till warning is withdrawn, in the districts predicted to be affected by the rainfall.

Landslides

Landslides are caused by rain, earthquakes or other factors that make the slope unstable. They are of four types - fall and toppling, slides (rotational and translational), flows and creep.

Flood

Floods are the most common natural disaster in India. Several states have been affected over the years by heavy floods. Recent examples include 2015 Gujarat floods and 2018-19 Kerala floods.

Man-made Disasters:Disasters that are caused by human beings are called man-made disasters. Examples are nuclear bombs, transportation accidents etc.

The most serious threats occur due to nuclear, biological and chemical warfare which are collectively known as WMD or Weapons of Mass Destruction.

Nuclear Weapons

Nuclear weapons are the most dangerous weapons on earth. One can destroy a whole city, potentially killing millions, and jeopardizing the natural environment and lives of future generations through its long-term catastrophic effects. The dangers from such weapons arise from their very existence. Although nuclear weapons have only been used twice in warfare—in the bombings of Hiroshima and Nagasaki in 1945—about 13,400 reportedly remain in our world today and there have been over 2,000 nuclear tests conducted to date. Disarmament is the best protection against such dangers, but achieving this goal has been a tremendously difficult challenge.

Biological Weapons

Biological weapons disseminate disease-causing organisms or toxins to harm or kill humans, animals or plants. They can be deadly and highly contagious. Diseases caused by such weapons would not confine themselves to national borders and could spread rapidly around the world. The consequences of the deliberate release of biological agents or toxins by state or non-state actors could be dramatic. In addition to the tragic loss of lives, such events could cause food shortages, environmental catastrophes, devastating economic loss, and widespread illness, fear and mistrust among the public.

Chemical Weapons

The modern use of chemical weapons began with World War I, when both sides to the conflict used poisonous gas to inflict agonizing suffering and to cause significant battlefield casualties. Such weapons basically consisted of well known commercial chemicals put into standard munitions such as grenades and artillery shells. Chlorine, phosgene (a choking agent) and mustard gas (which inflicts painful burns on the skin) were among the chemicals used. The results were indiscriminate and often devastating. Nearly 100,000 deaths resulted. Since World War I, chemical weapons have caused more than one million casualties globally.

Petrochemical Transportation Accidents

Warning Systems

Emergency Response Vehicles of Oil Companies are under the control of State Emergency Operations Centre.

Standard Operating Procedure

Revenue department will Evacuate 500 metre radius and ensure compliance of all procedures by concerned departments along with informing SEOC for availing the services of the Emergency Response Vehicle of Indian Oil Corporation.
Fire & Rescue Services Will Avoid ‘Boiling Liquid Expanding Vapor Explosion (BLEVE)’ by continuous cooling with water and foam till the fuel is removed by the Emergency Response Vehicle or until the containment gets exhausted.

Cyclones:

Cyclones account for 30% of the total occurrences of disasters in India. It is defined as a region of low atmospheric pressure surrounded by high atmospheric pressure resulting in swirling atmospheric disturbance and accompanied by powerful winds. The Odissa super-cyclone in 1999 had a wind speed of 260-300 km/hr and killed thousands.

Relied Camps

Setting up and managing camps is one of the most challenging tasks when a disaster occurs. They are indispensable and require proper planning and execution. The process is dynamic in nature. The camps need to be constructed such that the physical, emotional, cultural and social well-being of the camp inhabitants are ensured.Relief camps are usually considered temporary, with an aim to provide basic necessities in an efficient manner. The site of construction, climatic changes etc will affect the stability and maintenance of the camps.In this level, we look at the general guidelines of constructing a camp during a disaster as well as the setting up of an FLTC.

Standard Operating Procedure for Relief Camps

Location

The site should not be vulnerable to natural disasters like landslides, earthquakes etc.Preferably accessible by motor vehicles

Shelter

Inhabitants should be protected from adverse effects of the climate.Sufficient warmth, air, security and privacy must be maintained

General administration of the camp

A camp officer should co-ordinate and supervise the day-to-day activities in the camp.Any government officer can be asked to assist depending upon the requirements in the camp.

Management of the camp

Treat every inhabitant of the camp with dignity and respect.Make effective arrangement for distribution of food and aid to the people in the camp
Special care should be taken to ensure that vulnerable people like disabled, elderly, pregnant women and children get adequate aid and supply of food and other facilities.Voluntary Organizations and leading citizens may be encouraged and involve in management of relief camp

Basic Facilities

Lighting Arrangement and Generator Set,Water Facilities,Sanitation,Food and clothing,Medical Facilities & Psycho-social Support,Security.

Setting up of a FLTC

Relief camps play a big role in disaster management. However, the nature of such relief camps must also depend on the nature of the disaster.Here, as an example, we bring to you the process of setting up a specialised medical camp, in the model of the COVID FIRST LINE TREATMENT CENTERS.This example may be used as a reference in setting up any type of camp.

Briefly, these are the following steps involved in Setting up a FLTC:-

Identifying a suitable building
Procurement of goods
Setting up of Doffing & donning areas
Creating partition and Laying of beds
Prepping of washrooms, drinking water facility, recreational area
Setting up of the nursing station
Demarking and sealing isolation area
Setting up of Administrative area
Identifying the staff and training them

A First-Line Treatment Centre(FLTC) is a facility where the most mildly symptomatic or asymptomatic COVID patients are treated. 70-80% of COVID patients are asymptomatic and only exhibit mild symptoms.

All such patients will be admitted into the FLTCs so that hospitals may be reserved for the most critically ill. FLTCs are not hospitals in the strict sense but only makeshift healthcare centres.

FLTCs are usually created as and when the need arises for such a facility within the Panchayat. A suitable Community Hall or any building is identified and the same is converted into a FLTC for a definite time period.

The following steps must be followed to set up the physical infrastructure required to create an FLTC:

Demarcate the isolation area as per the facility layout
Identify separate entry and exit points for patients and staff
Place the furniture and fittings as per the facility layout.
Set up enclosed Doffing and Donning areas
Set up an administrative office. The office must have a computer, a printer and one smart phone.
Set up a room for medical staff and non-medical staff each and a store room
Arrange for charging points both inside the isolation area for the patients and at the officer space outside the isolation area
Internet connectivity through Wi-Fi must be enabled both for the patients as well as staff
Drinking water must be made available in the isolation area
The electric lines and plumbing must be checked
Place signages to clearly establish a circulation flow for patients staff as well as stock
Place one smart phone permanently within the isolation area and the other smart phone in the administrative office outside the isolation area. This will be the primary mode of communication between the staff within the isolation area and the administrator stationed outside the isolation area securely.:
Facility Layout
A.RECEPTION AREA:
Most patients who reach the First Line treatment centers are Covid 19 cases who have mild symptoms. With minimum but efficient use of PPE, triage the patient into stable & unstable.
All patients should sanitize their hands & wear masks before entry.
If a patient is a direct entry case and not referred through the Telehealth Helpline Unit, then a screening questionnaire needs to be applied for initial categorization and admission to FLTC.
B.COVID CARE AREA
The isolation area should have 3 entry/exit points:
1. STAFF ENTRY
2. STAFF EXIT
3. PATIENT ENTRY/EXIT
The area is completely sealed shut at all other places to ensure that no unauthorised entry or exit takes place.
C. ISOLATION AREA
The isolation patient area should have
1.Nurse Station
2.Sample Collection Area
3.Utility Area (Dining Area and Recreational Area)
4.Cots should be kept at least 2-3 m apart
5.Separate personal properties to be given to each patient
(Disposable bed sheets,face masks,roll tissue paper,disposable plates and glass, bucket and mug,toothpaste and brush,soap, bath towel,nutritious diet)
D. DONNING AREA
This is for the staff to wear personal protective equipment (PPE). This space should have
1. One table and stool
2. Hand washing area
3. Disinfectant dispenser(preferably with Lysol, in 10% *dilution)
4. Hand sanitizer dispenser (containing 60-80% Isopropyl alcohol)
5. Micropore tape dispenser
6. Hanging Mirror (for checking proper positioning of PPE )
E. DOFFING AREA This is for the staff to safely remove PPE to safely dispose of them later.
1. Stool
2. Laundry Bins
3. Disinfectant spraying units
4. Hand washing area
5. Wash rooms (For staff to take bath after doffing. Each wash room to be disinfected after every use.)
IMPORTANT POINTS

Ideally there must be CCTV cameras in the patient isolation area
A separate phone (ideally a smart phone with internet service) must be kept in the isolation unit to enable communication with the outside world
Inflow and outflow of patients
A clear circulation flow for patients must be set on the ground. The patients will be taken in the ambulance straight till the entry into the isolation area. If the FLTC also has a triage facility, then to the Triage Area.
Once the patient enters the isolation area, the door must be secured to avoid any unauthorised entry or exit
Inflow and outflow of Staff
Staff must enter the facility through the staff entry close to the administrative area. They must then wear PPE Suits in the Donning area before entering the Isolation area. While exiting the isolation area, they must first doff within the doffing area, bath in the washroom and exit through the separate staff exit only.
Flow of stock and consumables
The inventory management component of the CARE system is used in managing inventory within a FLTC. A secure Store room is identified to store all the durables.
The flow of goods must also be clearly laid out. The goods must be dropped off close to the store room near the reception area. The same must be transported to the store room. As per need this stock must be drawn while recording the same in the inventory management tool.
If such goods need to be taken into the isolation area, the same must be done by a staff donning the PPE suit. The channel of entry and exit will be the ones marked for staff.
Contributions from individuals/groups

"How can an individual contribute to the society or community?" is a question that can be best answered by oneself.
Every individual can contribute in various ways by innovating or finding solutions to fill the lacuna or sufficiency of the existing systems at the grass-root level of a community.
This process can only be started once there is a clear idea of the existing system that has been functioning to solve the problems and obstacles that have popped up in the past and present scenarios.
You can contribute in three ways.
Cooperate with courtesy and patience with healthcare workers in the smooth working of the public health system. Always cooperate with law enforcement officials and other public servants.
Communicate to your family and friends how our public governance system works. May this knowledge and awareness flow from you to many others.
Contribute your time and efforts by engaging with your local community to find unique solutions for the unique problems that your community faces. Engage with your locale panchayat/ ward level team to see where you can step in and contribute. Put your skills and knowledge to use within your own community.
Depending on your interest and skill sets there are umpteen number of ways in which you can contribute to making the system better and more efficient.
Every individual will definitely have a role or way in which they can contribute to this fight. Let us look at some examples of how people from various walks of life have contributed.
Software Engineer - There are multiple software engineers who have built systems to track or integrate multiple processes in the healthcare system/ambulance network to improve the efficiency of the existing system. Especially in the backdrop of COVID we have seen many software engineers come forward with smart and intuitive tools to revolutionise field like healthcare, law enforcement, communication etc.
Farmers - Many farmers have started giving advice to homemakers and youngsters about the basic steps and knowledge required to cultivate vegetables at home. Thereby promoting the concept of self-sufficiency. Today, micro-farms are trending and people have started farming in their own homes. Any farmer can contribute towards imparting knowledge of farming into the general population and may even get into supplying seeds, biofertilizers or any service relating to farming.
Artists - Creative illustrations have been made to improve public health awareness campaigns. Art plays a major role in influencing the public. Moreover, art as an activity also supports mental health. Therefore as an artist, you may be able to contribute by creating meaningful art spreading positive messages or important information among the public. You may even choose to contribute by spending a little time every day to teach children art.
These are just a few examples of contributions that can be made by people from varied backgrounds with varied skill sets. individuals from various sectors of our society who have come together to work for a better tomorrow. These volunteers have paved the way for an efficient health management system and it's operation during the pandemic.

CNR 101-Disaster Management and Relied Camps