HELPFUL TIPS ON DISASTER MANAGEMENT

1. You should constantly aware of the political, social,

cultural and economic factors at work during any
disaster situation. You should approach the health
aspects of disasters as you would approach health
problems using a primary health care framework. This
means that you have to look into the multifactorial
causes of the health conditions of your community
members.

As health managers, you should be familiar with

the socio-cultural factors in the community. Health
interventions should be appropriate to the
communitys cultural and social means.

In human made disasters, you should be aware of

the political issues. You may be ill-prepared to
enter an affected community. A careless remedy
with political innuendoes issue, may cause trouble
instead of facilitating disaster relief work. You
should therefore be sensitive to the political
climate and practices in the community
2. You must give priority to basic needs they include
shelter, security, food, later, environmental sanitation,
mental and physical health. A sound assessment of
needs will determine the priority needs of the affected.
By determining the basic needs and prioritizing them,
your request for external support will then be
appropriate and relevant.
3. You must work with, rather than for the victims at all
stages The affected community will appreciate it if
you involve them directly and work with them, instead
of treating them as simply recipients of aid/assistance.
4. You have to establish good coordination and good
support with the government and other
nongovernment agencies. Local executives may
expect that all your activities be known to them and
that you secure their approval to activities in the
community. Remember to work through the local gov
structure.
5. You should be flexible You should build
opportunities as ther arise. You should always respect
local knowledge, experience, and expertise. You maybe
an outsider who does not know the social dynamics of
the community. What you may insist may even be
harmful to the community that you intend to help.
HEALTH SEVICES ORGANIZATION:
Structure of a health services organization:

The types of structure used in dealing with the

disaster is the same as the basic structure of the
Health Care Delivery System The Rural Health
Unit, headed by the Municipal/ Rural Health Officer.

In the absence of such health care delivery system,

one can use either the Modules or Program
approach.

The module approach can either be preventive

or curative in nature. Preventive activities focus
on public health aspects like basic sanitation and
environmental health.

The Curative approach on one hand may use the

quantitative or qualitative approach to health care.
Certain basic questions like the number of
outpatients or inpatients who will need health care
facilities has to ascertained. For assessing the

quality of health care, you have to look into the

medical consultations. You can also construct
clinical pathways based on symptoms described by
the patients or you can develop a checklist for
assessing the performance of a health care worker
to improve health care services.

In program approach, on the other hand, you focus

on certain basic health programs to address basic
problems in the disaster or evacuation sites. You
can identify health care providers depending on
what level they are working in
The Role of Health Services:

The main concern of health services are to ensure

as much as possible the survival and treatment of
the greatest number of disaster victims and to
prevent and control epidemics, poisoning and/or
other public health consequences of disasters. The
health services takes care of:
1. Triage and patient care of the disaster site
2. Transporting the patient to the hospital
3. Certifying that deaths have occurred and
removing bodies (in collaboration with the
police and military)
4. Conveying health supplies and equipment and
providing health care to evacuees in temporary
shelters and encampments
Staffing of Health Services Organization:

The chief medical officer in-charge of the area

where disaster occurs is usually the Municipal
Health Officer. He has to coordinate with the
municipal or city disaster coordinating council,
headed by the mayor. The mayor in consultation
with the medical officer decides on the supplies
and materials needed to be brought to the areas. If
the chief medical officer is not around, the first
physician to reach the disaster site assumes the
duties indicated in the disaster management plan
until the arrival of the chief medical officer.
The responsibilities of the chief medical officer:
1. Organizing the claim of medical aid and triage
2. Transport of patient to hospital
3. Identifying personnel requirements; vehicles,
equipment, and supplies; and requesting additional
support when needed,
4. Over-all supervision and representing health
services at operational base headquarters.
5. Sanitation and over-all public health control
measures
6. Evaluation of records
7. Protection of health personnel and prescribed
decontamination in an event of chemical or nuclear
disaster
Search and Rescue Operation:

As the person responsible for the emergency

management, you should have some basic
knowledge about it, although yu may not be doing
the work yourself

The Search and Rescue Operation Team to

compose of personnel properly trained in first aid
and organized to move immediately to the disaster
site.
Aside from the general role of providing medical
support to rescue teams, the members of the team
should be ready to the ff:

1.

2.
3.
4.
5.

Do limited surgery or anesthesia, such as

performing amputation to free trapped victims to
increase their chances of survival (emergency
intensive care)
Relive pain and anxiety of the injured making
rescue ___ and limiting physiological damage
caused by stress
Advise on the benefits, risks, and damages of the
different rescue operations/options
Indicate order of how casualties must be
rescued/freed according to the medical condition
(presenting)
Provide emergency treatment to injured colleagues
in rescue team

workers, health educators, and perhaps a health

promoter, if available.
EMERGENCY SETTLEMENT:
A.

TRIAGE AND FIRST AID

The objective of the triage personnel is not to save

lives but rather to relieve the suffering of as many
people as quickly as possible. If lives are saved in
the process so much the better.
It is necessary procedure when there is a very large
number of casualties and they threaten to
overwhelm the resources available. Usually the
limited medical resources cannot sustain the
overwhelming emergency conditions. Therefore,
quick and critical decisions should be made as to
which cases can wait, which should be taken to
more appropriate medical care units and which
have no chance of surviving. Hence, triage is based
on benefits, not on seriousness of injury as is.

GUIDELINES FOR EFFECTIVE TRIAGE

1. Should attend to all victims of an emergency at
once.
2. Should begin as soon as possible in the chain of
medical aid, and should continue along the chains
whole stretch.
3. Should be done by experienced doctors, surgeons
or those who have had regular and long experience
in emergency medical /traumatology.
4. Should have logical examination of patients in the
quickest possible time so thjat everybody can
benefit from it.
5. Should end with proper categorization and tagging
of patients/casualties (color-coding). For this
purpose, absolute and/or relative emergency is
enough for admission
6. Once in the post, conditions must be redefined
according to categories.
ORGANIZATION OF THE RURAL HEALTH SERVICES IN
THE DISASTER AREA:

Primary Health Care Centers serve mainly for

disease prevention and health promotion. These
cases requiring further treatment are referred to
more specialized centers. Available equipments are
simple and essential drugs not be more than 100
types.

The physician who is a Family Physician/General

Practitioners, is assisted by the usual line-up staff.
Services are ably supplemented by a dentist, social

Emergency Shelter- Since the Philippines seems to

be a Country of Disaster, somehow our people
have the instinct of knowing the safe places during
emergencies. We call them Emergency Shelters,
and these places, are usually schools, churches,
municipal bldgs, and other govt structures. The
purpose of Emergency Shelters is to provide short
term communication, not usually > 7 days, for a
large number of people. Besides, being big enough
to accommodate the significant numer of people,
these emergency shelters must have the ff
characteristics:
1. Safe- not likely to be threatened by the
disaster
2. Provide areas for sleeping, cooking and
washing
3. Provide a place where food supply can be
safely stored
4. Have a space where the evacuation
personnel can set-up an office.
5. Have some means of communication

Usually these emergency shelters do not have

enough toilet facilities, thus you m8st be ready
to provide portable toilets.

In the same manner, water supply may be

inadequate. In such case, you have to do water
rationing like for drinking and domestic use.

Even in situations where the town has no

existing disaster preparedness program. These
places are still the ones chosen by the town
leaders as the safest place for the affected
popn. On the other hand, if you are asked to
identify existing bldgs which are suitable for
emergency shelters in times of disasters, how
much would you go about the selection?

SEVEN AREAS OF CONCERN used to determine

the suitability of the blgs for emergency
accommodation for displaced persons.
1. Building suitability
2. Area suitability
3. Sanitation
4. Bathing and laundry facilities
5. Vermin control
6. Fire control
7. Provision of water

SITE SELECTION FOR A TEMPORARY CAMP

If you are the Health Officer (and not the disaster

coordinators) of the Community, you are actually
not the responsible for the evacuation of the
people, neither in the establishment and
administration
of
emergency
settlements.
However, as a Health Practitioner, you can take an
active role in the selection and in the mngt team
when issues in health are concerned. Acc to the
UNICEF these are the criteria for the choice of

appropriate campsite: to the extent possible, a

campsite for a displaced popn should be located
where:
a) Adequate watet is available
b) Space is sufficient for the number of persons
expected (30sq.m per person if possible. This
takes into account all the activities of the
person; 3.5 sq.m minimum floor space per
person)
c) Drainage is good (avoiding flat and marshy
ground as much as possible above flood level)
d)
There are no major environmental health
hazards like high winds, extremes of weather
or risks of flooding.
e) There
is
fair
accessibility
to
roads,
communications and to supplies of food,
cooking fuels and shelter materials.
f) Shades and soil conditions make possible for
vegetation gardening
g) Good security and little possibility of the popn
being affected by hostilities, or coming into
conflict with other residents.
REQUIREMENT FOR HEALTHY HABITAT

1.
2.
3.
4.
5.

Acc to the WHO, failure to meet there reqts would

endanger the physician and mental health of the
occupants
Protection against extremes of heat and cold,
noise, invasion of dust, rain, insects and rodents.
Provision for disposal and subsequent mngt of
excreta and solid or liquid waste
Avoidance of overcrowding, as factor aggravating
accidents and disease transmission
Protection from indoor pollution from fuel used for
cooking and heating.
5. provision for food storage and protection against
spoilage (particularly for stockpiled food supply)

6. protection from vectors and hosts associated with

environment (flies, mozquitoes, ratsm cockroaches,
etc)
Planning for temporary settlement layout:
1. See to it that the houses are built in the safest
part of the site (not at the edge of the cliff). You
you organize them into smaller units like the
barangays and later assign them to people from
the same place. This will help you when you are
into community organization. If you happen o find
yourself among different ethnic groups, consider
their socio-cultural practices and habits.
2. You need an office, a storage for your food stocks
and other materials and your clinic. In some cases
you may even have to provide for a feeding
center. All this should be accessible to all. It
should be like a dome, it requires a big space.
Second best is a rectangular lay-out. Flexibility is
the answer.
3. Locate facilities to be shared. One latrine per 20
persons? Not more than 50 m from any house
with a minimum distance 6m from a house. It
should be 10-15m away from the water source.

4.
5.

6.
7.
8.

Provide enough space for common cooking and

washing.
Ideally there should be 10 rooms per bunkhouse.
One family per room. If the average number of
persons per family is six, then 6x10x10= 600
persons.
Each toilet house must have 5 bowls and 2
bathing cubicles (at least one bathroom per 50
persons)
Cooking and washing spaces can be set at the
back of houses. Dont forget provision for
adequate drainage of waste water.
Use spaces at the back of the camp or between
houses and latrines for vegetable gardens

TENTED CAMPS -designed for emergency shelters for

a displaced community for a short period of time (no
longer than 7 days)
Guidelines for tented camps
1. The site selection criteria are similar to those
given by unicef and who.
2. Tents should be arranged in rows separated by
road of at least 10 m wide to permit easy traffic.
Provide 2 m space between the edge of the road
and the tents. The tents should be 8 m apart so
that people can [ass freely. The spacing provides
safety measures against spread of fire.
3. Minimum floor area of 3 square meters per
person.
4. Tents should face the prevailing wind for adequate
natural ventilation. Provide community service
area (clinic, feeding center, etc)
5. drainage ditches should be around the tents and
along the side of the roads to prevent
accumulation of water when I t rains.
6. If there is no piped water, install water tanks on
both sides of the road. Tanks should have a
capacity of 200L or more. Several taps fixed to
each tank may ease distribution. Tanks can be
placed on wooden stands.
7. Toilets and other types of excreta disposal should
be placed behind the tents.
8. Ablation areas. Provide ablation bench (3 m long)
for 50 persons. Locate them at one side of the
camp where drainage is adequate.
9. Garbage collection
can (50-100 L) with tight
fitting lids should be placed in strategic places, at
least one per 4-8 tents (1:25-50 persons)
ENVIRONMENTAL HEALTH
Impacts of natural disasters on environmental health:
1. Damaging facilities and installations
2. Interrupting normal services
3. Changing population densities relative to
facilities or services
Environmental health priorities:
FIRST PRIORITIES:
1. Water supply
2. Basic sanitation
3. Excreta disposal
4. Shelter
SECOND PRIORITIES:
1. Safety of food supply
2. Vector control
3. Promotion of personal hygiene
WATER SUPPLY
Provide safe drinking water

Crystal clear water may contain millions of

bacteria per liter
Portable water cannot harm the consumer
whentaken under normal condition; must be free
of e. coli
If you are the coordinator:
o Do a rapid survey of possible water source
o Water source should be far away from
sewage disposal. If the place is hilly, toilets
are constructed on lower grounds belowe
water service
o Asses if the water supply needs treatment

If there is tap water, no problem. Only

gets contaminated when water stored is
dirty and uncovered. Most common
problem is tap water may not be
available at a given time. You may have
to do rationing.
The success of rationing depends on 2 factors:

1.

Water should be adequate for the basic

requirement of an individual (for drinking, food
prep, hygiene)
AVERAGE DAILY WATER REQUIREMENT:
Individual water needs 15-20 L/person
When there is Feeding center 30 L/person
Clinic 40-60L/person
2. Community should have clean containers.
Ways to keep water free from contamination:
a. Collect and store in clean containers
b. Empty and rinse containers daily
c. Keep them covered
d. Do not allow children and animals to drink
from it
e. Do not allow children to play with the
water in the storage container
f. Use a dipper
Other sources of water:
1. Rain
2. Ground water
a. Natural spring
b. Deep well