SECTION – I

1. Discuss the role of various epidemiological methods in lessening the adverse health
consequences of disasters.
Answer- Epidemiological methods help in measuring and describing the causes and
consequences of the natural and man-made disasters. With the help of
epidemiological methods, it is possible to gauge the needs of populations affected
by disaster, relate the resources to their needs, check the adverse effects, review
the efficacy of various health programmes and prepare better plans for the
future. They help in:

● Preparing strategies to lesson morbidity and mortality in future, by identifying

the risk factors,

● Planning warning and evacuation system, Developing guidelines, and education and
training programmes for generating public awareness and preparedness,

● Anticipating the future health consequences of disasters, and

● Data collection and analysis for taking short term and long term decisions.

The common tools recognized for this purpose are rates, ratios, and proportions.
They have been recognized by international bodies and national health agencies.These tools
help to describe the distribution and magnitude of health and disease in the population.We will
discuss these tools individually.

Rates- They measure the occurrence of a given disease or event in a population over
a period of time. The common rate used in our country is the crude birth rate
or the crude death rate. The crude birth rate can be calculated by dividing the
number of births during the year by the mid year population and multiplying it
with thousand. Similarly, the crude death rate can be calculated as follows:

Number of deaths during the year × 1000

___________________________
Mid year population

Crude death rate give a very general picture of the death rates in the population.
Hence, in order to determine more specific issues of health, specific rates are
calculated e.g. age specific death rates, death rates due to specific causes
(e.g. malaria) etc. Thus, in disasters the crude death rate will only be general
indicator nevertheless it should be calculated first.
Specific death rates will give a clearer picture of the magnitude of health
problems. Such death rates are calculated to determine the total number of deaths from specific
diseases or events. More advanced techniques for comparing data or rates between two
populations include the adjusted or standardized rates.

Ratios - They are relation between two quantities, which is expressed by dividing the magnitude
of one by that of the other. Ratios are important for tackling various
health policy issues e.g. comparing the ratio of doctors to the population of an
area will help us in knowing the medical care available to the people of that area, and how many
doctors are required to cater to the health needs of the population. Likewise, with the help of
ratio the relation between malnutrition and health of the people, and the susceptibility of the
people of disaster prone area to various diseases can be known.

Proportions - They describe the magnitude of the problem in relation to a population. For
example, by calculating the percentage of the number of T.B. persons of the total population will
give the magnitude of such persons in relation to the total population.

Number of persons with Tuberculosis × 100

_____________________________
Total population

Besides the above tools, the presence of disease in the population is measured
by its Incidence and its Prevalence.

Incidence
The number of new cases of a disease occurring in a population during a specified
time is the incidence of the disease.
Incidence rate is calculated as:

Number of new cases of specific disease in a given time period / Population at risk during the
period ×1000

This will help us to know the breakout of any disease in a particular segment of
the population.

Prevalence - It refers to the total number of cases of a disease at a given point of time. We can
calculate the prevalence of a disease in the population by the following
formula.

Number of all cases of a specified disease existing at a given point of time/ Estimated
population at that time×100

The information on the prevalence of disease in a particular population at a

particular point of time will enable the formulation of strategy for the prevention
and preparedness of the same.

Thus, epidemiological methods help in assessing the health of the population

and the distribution and determinants of disease in them.

3. Describe medical preparedness plan in hospitals.

Answer- Hospitals form the backbone for the management of casualties during
disasters.Hospital disaster plans are formulated on the basis of geographical locations,and the
vulnerability analysis of the area. Capacity and capability of hospitals are also taken in account.

The lead hospital is expected to organise a referral system between hospitals of the area and
also help establish communication links between field command posts and hospitals. In the post
disaster phase a hospital is expected to undertake long-term rehabilitation measures and
programmes for restoration of mental health of victims and disaster relief workers.

Action on receipt of information of disaster- Hospital should be so trained that all services
get activated in the shortest frame of time on the very first receipt of information. One of the first
tasks that will
be to sound alert.

Alert
An alert is sounded by the duty medical officer or the casualty officer on receiving the
information from disaster relief coordination sources. Every hospital
should ideally have various grades of alert. Alerts may be graded as Red, Amber
or Green. Red alert will signify a major disaster wherein complete hospital staff will have to be
recalled for duties any time of the day or night. Amber alert will require designated staff to
augment the resources available in the hospital. Green alert conveys to the duty staff present in
the hospital to concentrate in the treatment areas. As part of response, hospital is expected to
despatch teams to the disaster
area.

Communication - As a next step, the communication system is activated. The off duty staff Will
be contacted and asked to report on duty. The treatment areas, accident and emergency
department, and operation theatres will be informed to come in state of readiness. Special
phone lines will be made available for inquiries by the public and messages sent across through
the media- radio and TV.

Control room - A control room will be established in every hospital. The control room will act as
the information centre for the public, and media and interact with other disaster relief agencies.
All communication aids will be made available in the control room. The control room will have
lists and status of patients admitted to
the hospital, updated regularly. Staff reporting status will also be kept in the
room. Volunteer duty assignment will be undertaken under the supervision of a
disaster coordinator.The roles and responsibilities of control room is also diagrammatically
presented.

Treatment areas - Assignment of wards and shifting of patients will be undertaken on the basis
of the type of alert. Operation theatres will be kept ready. Various areas will be assigned for
various purposes in the accident and emergency department. Supply stocks should be reviewed
and procured from stores if needed.

There are two types of treatment areas, namely, primary treatment area, and
secondary treatment area. We will discuss them individually.

A) Primary Treatment Area - Accident and Emergency Department, A&E An accident and
emergency department is the first point of interaction of disaster victims with the hospitals. With
the high volume load of the patients in disasters, this is also the very area, which can end up as
a chaotic zone. The primary concern of any disaster coordinator should be to organise the A&E
department in a way that it causes least inconvenience to the medical and para medical staff in
the department. The A&E dept will have a reception area. This will be followed by the area for
triaging and resuscitation. There can also be an immediate treatment area as well as a non-
urgent treatment area.

Reception area- It is important that the reception area has a controlled traffic flow, which can
be one way. Security staff should be deployed to control traffic, and general
public should be prevented from reaching the zone. Adequate number of stretchers, trolleys,
and wheelchairs must be available right next to reception areas. Hospital staff to lift patients,
and nurses available to check the identification, tagging, triaging, and documentation of the
victims should be
assigned for the zone.

Triage area - The triage area should ideally have a doctor and an experienced nurse. In case
of shortage of doctors, nurses should be assigned the role. A rapid assessment is done and
patients may be allocated to various areas based on priority. Dead cases are taken to mortuary.
Resuscitation/ Immediate treatment area
All priority one cases are brought to this area. Immediate treatment is essentially
of lifesaving nature. Doctors, nurses and paramedics are always available here.
Laboratory assistants, blood bank personnel, and documentation assistants are Medical
Preparedness Plan also available to carry out respective tasks.

Urgent cases - Special treatment may form a part of the treatment area and constitute
treatment for burns, fractures, smoke inhalation, radioactive contamination, and psychologically
disturbed.

Non-urgent cases - A separate area possibly out patient department is earmarked for the
treatment of all casualties who will be discharged after required treatment. A majority of victims
are of this nature and it is important that the area for treatment of such cases is away from the
resuscitation area to avoid overcrowding.

B) Secondary Treatment Area - The secondary treatment areas are the operation theatres,
intensive care unit,
and wards. The secondary treatment areas are the decisive areas for long-term
prognosis of the victims.

Operation theatres - Operation theatres constitute an important component of this area. The
operation theatres will be required to function almost 24 hours a day. The limitations can be the
number of operation theatres, number of surgical teams including anaesthetist, and the
availability of instrument sets. A surgical team is able to function for 12 hours with 8 hours of
rest.

Wards
Wards will be earmarked for the disaster victims. Old patients admitted to the
hospitals will have to be discharged or relocated to other hospitals in the area.
A system of grading will have to follow where the more serious victims are admitted to wards.
This helps in concentrating resources. Standardised protocols are established for the treatment
of various types of cases.

Optimal definitive treatment - Optimally, the initial definitive treatment (IDT) must be
completed within 12 hours and should not be delayed beyond 24 hours.

Supporting Staff - The disaster programme in the hospital will be coordinated by disaster
coordinator
who will be based in the control centre. The disaster coordinator will ensure that staff are in
place in various treatment areas, and any requirements for human and material resources are
met with.

Administrator of hospital will be the linkage between hospital and public and press. He will be
the information and press officer, and will organise the deployment of volunteers. Hospital will
also require activating the support staff for catering linen, Central Sterilisation and Supply
(CSSD), pharmacy, housekeeping, medical records and mortuary. Supply distribution from
pharmacy and CSSD should be as per
standardised lists and should be in pre-packed boxes for ease of distribution
and accounting.

Social workers may be asked to help the patients and their relatives. Security staff will be
required at almost all areas to control crowd. Placement of security staff should be ensured at
the A&E department, control centre, volunteer reception, morgue, traffic, and main lobby.

Documentation - Documentation is required to keep a check and control on the multifarious

activities taking place in the hospital. Documentation may be in the patient zones and
administrative zones.

Patient zones - Documentation will pertain to tagging of the patients at the reception area,
admission chart, and medical records. Also, information pertaining to patients
will be available at the control room of the hospital. Here, the patient status and
their diagnosis will be made available to the relatives. Broad figures on number
of casualties, and type of injuries and location will be displayed for information
of press. List of dead will also be made available.

Administrative zones - Staff reporting and duty assignment cards will be kept ready for off duty
staff. Requirement for more volunteers will also be made available.

Disaster manual - A disaster manual is a written document, which should be available in every
hospital. The manual should detail the various duties and responsibilities of the staff at the time
of disasters. It should be available to every member of the hospital.

The manual will contain:

1) Staff alert system – a detailed procedure for staff alert including who should
do it. Meaning of Red/Amber/Green alert. 2) Policies and procedures of the hospital for patient
care areas and hospital Medical Preparedness Plan services.
3) Accident and Emergency Department – division of zones and staff deployment with duties
and responsibilities in each zone.
4) Wards – assignment of wards for disaster victims. Procedure for referral
patients, discharge of old patients, and relocation of victims.
5) Command and Control Centre – setting up of command centre and laying down its functions.
6) Operation theatres – the functioning and the procurement of stores.
7) Supply department – duties and responsibilities, constituents of packages,
and procurement including emergent procurement.
8) Nursing staff – assignment of duties including relocation of duties and
responsibilities.
9) Security arrangements.
10) Public Information Centre.

Disaster drill - Disaster drill is an important component to test readiness of hospital in dealing
with disasters. Drill sensitises the hospital staff to the requirements and
expectations in disasters.

4. Examine inventory control in logistics management.

Answer- INVENTORY CONTROL -Inventory is the quantum of goods or materials on hands. It
may also be described as the stock of materials of any kind, stored for future use. Inventories
may be classified in three groups:

1) Speculative motive affords ample scope for holding large amount of Logistics Management
inventories. The motive will be advantageous for areas, which are disaster prone and require
the use of resources at extremely short notice without
any reliable forecast mechanisms.Speculative motives are high on prices,
hence best avoided.

2) Transaction motive results from desire to match inflow and outflow of materials under certain
controlled conditions. Disaster isn’t a controlled condition as there are surges in demands. Such
surges cannot be managed only with transaction motives. Transaction motives will come into
the act
after the initial period of disaster has absorbed the impact of demand of materials, and the
utilisation turns to a more predictable nature.

3) Precautionary motive arises out of inability to predict future demands precisely and getting
materials ready on time without incurring some extra costs. Most disaster prone areas will rely
on the precautionary motives to manage disaster requirements, especially in the initial stages.
Such inventories can be supplied at short notice and form important element of initial support
to disaster relief agencies.

Certain terms, which are applied in inventory control, are:

Lead-time – is the duration of time from placing an order and receipt of materials.

Safety Stock – is the quantity of stock, which is kept in the inventory to safeguard against
sudden increases in demands or uncertainties in lead-time. The safety stock should neither be
too high resulting in overstocking nor too low resulting in stock outs.

Inventory carrying costs – costs that are locked up in inventories on account of

obsolescence, interest, physical deterioration, transportation, and taxes. The
inventory carrying costs amount to roughly about 25%.

Procurement costs – are those costs, which are incurred for buying materials
including cost on tendering, inspection costs, placing supply orders etc.

Reorder level – is the stock level at which a fresh order needs to be placed. Economic order
quantity of items is quantity of items to be procured to minimise
costs on inventory carrying and procurement. EOQ is applicable when
requirement of items does not vary and lead times are constant. This is an idealistic situation,
which may not be achievable. However, EOQ provides us an insight into material management.
Inventory control attempts to reduce financial investment in inventories, minimise idle time,
avoid losses due to obsolescence, and improve quality.

Certain statistical methods are used to control inventory stocks. Inventory control
techniques are most useful in decisions of certainty, however, statistical methods
can also be applied for events with decision uncertainty, like, disasters. Decisions
in uncertain conditions, especially, in disasters require the use of frequency
distribution tables where the values can be determined in terms of means, range,
and standard deviation.

Decisions under uncertainty and risk require further advanced techniques in

inventory control, which are beyond the scope of the current text. However, students are
advised to read literature and statistical books to gain detailed insight in concepts of material
management.

SECTION - II

9. Describe the control of communicable diseases as a vital aspect of community health

management.
Answer- Control of Communicable Diseases - Disease situations are often associated with
communicable diseases. Whenever there is a disaster, whether an earthquake or a cyclone,
there is a possibility of an outbreak of epidemic. Therefore, it is important to know about these
communicable diseases, and the factors that make them potentially dangerous in disaster
situations. The textbooks of medicine classify the communicable diseases depending upon
their causative pathogenic agent such as bacteria, virus, or parasite. However,
in disaster management, it will be more appropriate to classify them according
to their mode of transmission. This will help you have a better and clearer vision of the situation.

Diseases transmitted by contact -

Scabies
Trachoma
Conjunctivitis

Diseases transmitted by vectors

Malaria
Yellow Fever
Meningitis
Plague

Diseases transmitted through faecal matter

Non-specific diarrhoea
Cholera
Typhoid
Amoebas
Hepatitis

Diseases transmitted through the air

Acute respiratory infection
Tuberculosis
Measles
Meningitis

Sexually transmitted diseases

Gonorrhoea
Syphilis
AIDS

Factors influencing the impact of communicable diseases in disasters are:

Presence of a new pathogenic agent
Increase in susceptibility of the population to diseases. This depends on the immunity of the
population and individuals. Malnourished children and vulnerable group are particularly
susceptible to infections. Increased transmission due to overcrowded and poor sanitation and
hazardous living conditions in the camps. Insufficient water quantities deteriorate hygienic
conditions.

Deterioration of health services enable disease transmission at all levels,e.g., vaccinations not
given, deterioration of vector control programmes, etc. Thus, the risks of communicable
diseases increase in disaster situation, as the means of disease control are inadequate. All
these factors contribute to the spread of communicable diseases resulting in increased
morbidity and mortality. Some of the safety measures that can be taken up are as follows:

Predictability
Once the determinants and distribution of diseases are known, suitable intervention strategies
and methods can be chalked out. This can go in taking preparatory measures to counter such
diseases.

Hygiene and sanitation

Maintaining a clean and hygienic environment can help in intercepting the spread of
communicable diseases.Garbage control, vector control, proper and adequate disposal system
for wastes- solid and liquid, and use of insecticides will lessen the intensity and spread of such
diseases.

Community health education

Community can be educated on the signs and symptoms, determinants, and methods to deal
with communicable diseases.Equally, they can be taught to take nutritional diet, which can
enhance their health and immunity. They can be educated on taking care of the vulnerable.
Educating on taking immunisation and hygiene and sanitation measures, will enable the
community to check the spread of such diseases.

Besides, training can be imparted to disaster workers and other staff, at different
levels, in the preparedness and response measures.
10. Write short notes in about 200 words on each of the following:
a. Medical and health response to floods
Answer- Response - Today, there is undoubtedly an improvement in the preparedness and
response system to fire. According to Noji, this is due to increased fire related information,
awareness, education and training; sophisticated fire-fighting devices and gadgets; enforcement
and adherence to building codes; installation of safety devices in offices and buildings; and safe
storage of combustible items/materials. Medical and health response has to take cognisance of
these aspects to minimise the impact of fire disasters on human lives.

A contingency plan has to be prepared entailing immediate medical treatment

and rehabilitation of the burn victims. The medical and administrative staff should be well versed
in operating and implementing it. Training in contingency plan should be imparted to the key
medical, paramedical, and administrative staff. Medical practitioners should be trained in
rendering effective triage, which will enable proper diagnosis and treatment of the burn patients.

Medical team should be fully equipped in terms of resources, ambulances, logistics, and
personnel, to immediately respond on the very receipt of information/warning. Response should
be based on the principles of trigger mechanism.Equipments for resuscitation, fluid therapy,
oxygen, etc. should be kept ready. Trauma units/isolation wards should be kept ready with
adequate number of beds, and facility of plastic surgery.

A fleet of fire brigades should be maintained across the city. They should be fully equipped, and
kept ready to respond at any time. Effective coordination, communication, and transportation is
necessary between disaster site and hospital/medical centres. Occupational safety and health
of the medical team has to be ensured.

Psychologists and mental health experts should be provided to render advice

and counselling to the psychologically affected. Medical team should coordinate and fully utilise
the help from other agencies, such as the NGOs, volunteers, engineers, scientists, and
community.
For the response plan to be effective, we need to have epidemiological studies
of the impact and post impact phase of fire disasters. Epidemiological studies are necessary to
identify the different causes of deaths and injuries owing to fire. According to Noji, data
pertaining to the circumstances of fire, factors causing deaths, and the relation between the
types of fire and resulting number of casualties, is required to be collected. He further stresses
the need to address to safety requirements and actions for the vulnerable group. To develop
effective preventive measures, it is necessary to know people’s behaviour associated with fire
response. It is essential that we put in effort towards a proper system of medical response
based on surveillance, security, and safety operations.

We also need to integrate the efforts of the local bodies, NGOs, volunteers, and community with
the medical efforts. Focus should be on community awareness and training. The community
should be made aware of the do’s and don’ts of fire disasters. Equally, they should be trained
through simulation exercises, and drills in safety actions, and evacuation plans. Training in first
aid to treat burn injuries can also be given. They can be made aware of the safety devices, such
as, smoke detectors, fire sprinklers, and fire doors, to be installed in their houses. This will not
only reduce the public health impact of fire, but will also lessen the adverse social and economic
implications.

b. Application of GIS in health response

Answer- The public health sector is a very complex and controversial field. Professionals who
are interested in this domain should have critical understanding as regards the correlation
amongst factors that affect health. In recent years, the work of health professionals is constantly
becoming more and more effective owing to the use of both various information technology
services and software. There are much more problems and challenges in relation to the public
health sector than Dr. Snow faced in 1854 when he introduced mapping in medical research.
Recently, the use of GIS and spatial representation of various health issues make professionals
arrive at conclusions in a faster and better way in the field of both public health and decision-
making.

The use of these systems has a wide impact on the public health and lots of studies are based
on them. Prediction as well as simulation models rely on these systems. Additionally, risk
assessment models in relation to the contamination of drinking water in London are based on
them. Aside from this, other researches that focus on Hepatitis c and intravenous drug use have
been displayed with the aid of GIS.

Besides, GIS can contribute to public health in many ways due to the fact that they can provide
information on many issues and support correctly the decision making process. They can
provide information regarding the distribution of health services. Thus, any growing disparities
might be eliminated. Also, policy-makers would make right decisions. Health professionals can
easily identify the difficulties and disparities regarding the accessibility to health services; and
so, they are able to cope with the current situation. Generally, the planning of health and social
care is of major importance since it is a fundamental issue. At the dawn of the 21st century, in
the midst of remodeling the entire health care system, the use of new approaches relating to
health issues may become useful tools for the providers of these services. The use of GIS so as
public health issues to be solved has grown exponentially. Those systems have been vital to
both the assessment and treatment of health problems that relate to different areas of land.

As it was mentioned above, epidemiology was one of the fields, in which maps was firstly used
on health research. It is essential we be able to understand a disease and how it spreads
through human-to-human transmission.

A Geographic Information System can play an important role as regards the surveillance,
management and analysis of diseases. There seem to be important tools for analysis and
visualization of epidemiological data. Furthermore, trends and correlations would be difficult to
be understood with traditional ways of processing and imaging of these data. Public health
services, diseases, and any information regarding health can be displayed on a map and
correlated amongst many pieces of information such as environmental data, elements of health
concern and social information.

Thus, it is created a means of monitoring and management of both diseases and health
programs. It is necessary we be able to understand, monitor and emphasize on the reasons that
may be correlated to the development of a disease. Some of these factors could be the
environment, conduct and the socioeconomic level of an area. Should the “source” of a disease
is identifiable and its development and transmission are known, health administrators will able to
deal effectively with pandemic outbreaks. A GIS is a tool with great potential that might also
contribute to the assessment of environmental risks and people’s exposure to them.