HEALTHCARE IN EMERGENCIES AND REHABILITATION

ASEAN Conference and Exposition on Disaster RiskManagement and Climate Change Adaptation

ACEDRMCCA 2018

Theme

Converging with the ASEAN Community in Managing Disaster Risks and Climate Change

for a Resilient Community

“,

Mindset

“A culture of awareness that preparation is not only possible, but also will greatly reduce the consequences from disasters in reduce the consequences from disasters in terms of human and economic loss.”

The goal of the health care system during an major incident is to:

- mitigate the loss of lives

- minimize the physical and psychological

consequences of the incident to the

greatest possible extent

Chain of actions that must be:

coordinated,

synchronized and synchronized and

harmonized in order to get the desired

outcome.

No element in this process is considered the weakest link as each link is as importantweakest link as each link is as importantas all the others.

What is involved?

Definition of Terms

Disaster

- a sudden overwhelming and unforeseen event

At the household level:At the household level:

major illness,

economic or social misfortune

death

At the community level:

a flood,

a fire,

a collapse of buildings in an

earthquake,

the destruction of livelihoods,

an epidemic or displacement through

conflict

Scope of a disaster

- common measure is the number of people

killed or affected

- no single measure of a disaster that can - no single measure of a disaster that can

capture the full scope of a disaster

- consider all affected and their losses both

in the immediate and the longer term

Classification of Disasters1. Disasters from forces in nature

1.1 hydrometeorological disasters,

1.2 geophysical disasters, 1.2 geophysical disasters,

1.3 biological disasters

2. Disasters with humans as a factor

Mudslides from deforestation

Famine

Desertification

3. Disasters directly caused by people

Conflict Conflict

Industrial events: explosions, hazardous

materials

Pollution

Transportation events

Disaster managementInvolves protecting populations and property

through:

1. the estimation of risks,

2. preparation, 2. preparation,

3. which will mitigate the consequences of

predictable hazards and

4. post-disaster reconstruction in a way that

will decrease vulnerabilities

In Disaster Management pertaining to public

health, our an important partners are:

Engineers,

Planners, Planners,

Elected leaders and

Community organizations

BASIC CONCEPTS

• CONTINUITY

• DISCUSSION/DIALOGUE

• METHODS/STRATEGIES

• PREVENTION OF SECOND DISASTERS

• Continuity of healthcare services during and after disasters.

• Discussion about the impact of disasters on • Discussion about the impact of disasters on the healthcare system, rehabilitation in post-disaster and preparedness measures.

• Methods and strategies handling healthcare in emergencies and rehabilitation

LEVELS

national, national,

regional and

local

ensure continuous service provisions

Possible measures to prevent secondary disasters which involves

Infectious diseases

Non-communicable disease emergencies Non-communicable disease emergencies

OB emergencies

Psychological distress

PLAN

‘Chance favours the prepared mind’

- Louis Pasteur -

c

‘All hazard’ approach

mapping of vulnerabilities

assessing of the shortfall in existing assessing of the shortfall in existing

resources

communities and organizations to prepare

“All-Hazard concept Disaster Plan”

the structure of the plan must be

adjusted for the management of most adjusted for the management of most

of the events, irrespective of the causes

3 Strategic Goals:

1. Introduction of disaster risk reduction into planning for sustaining development at planning for sustaining development at national and local levels

2. Development and strengthening of institutions, mechanisms and capacities to build resilience to hazards

3. Systematic incorporation of risk reduction approaches into the implementation of emergency preparedness, response and recovery programmes

Planning

1. strategic planning,

2. defining specific objectives,

3. strategic analysis of the environment, 3. strategic analysis of the environment, using prediction tools related to the type of crisis and hazard analysis, and

4. coordination of efforts and effective design of organizational structures.

Logical framework, or ‘log frame’ approach

- useful for planning and sequencing activities for - useful for planning and sequencing activities for

the management of relief/response activities.

Key Considerations:

1. Emphasis on the importance of

assessments as the basis for health

interventionsinterventions

2. Existing health services may be

inadequate to meet needs in an emergency

Cont., Key Considerations:

3. Prediction and warning

Available technologies include any one or

all of the following: all of the following:

1) Monitoring

2) Forecasting

3) Early warning

4) Scenario identification

Cont., Key Considerations:

4. Preparedness minimize the negative 4. Preparedness minimize the negative

impacts of structural and nonstructural

where prevention and mitigation fail.

Cont., Key Considerations:

5. Previous experiences may be used for

creating such plans

- as points of comparison by considering - as points of comparison by considering

the outcomes of the medical

interventions carried out during those

various events

Cont., Key Considerations:

6. There is a need to have good plans for

every part of the society, based on a risk

and vulnerability analysis that has been

done.

The plans are:

1) Resource inventory planning

2) Stockpiling planning

3) Logistical planning3) Logistical planning

4) Evacuation planning

5) Communication planning

6) Needs assessment planning

Response Phase

Initial Assessment

immediate first step after a disaster

Check for the Check for the

damages and their consequences,

future risks, and

the outbreak of new conditions.

For medical professionals, the choice of

treatment for and outcome of any medical

condition is directly related to the

mechanisms of injury: mechanisms of injury:

1. Physical trauma

2. Environmental injuries

3. Bioterrorism injuries

4. Transport injuries

5. Hazardous materials explosions injuries

Physical trauma:

Military combat injuries

Natural disaster traumatic injuries

Transport/Vehicular Crash Injuries

Environmental injuries: Environmental injuries:

Electrical, chemical, and thermal burns,

Hot and cold injuries

Radioactive injuries,

Toxic gas inhalations and exposures,

Based on the first assessment, the following points should be addressed for each victim:

1. The type of transportation from the scene.

2. The place where the victim must be 2. The place where the victim must be

transported to get proper care.

3. The estimated travel time which will not

compromise the victim’s life.

The first on-scene report is crucial, but its quality depends on the qualifications of the people preparing it and needs to be completed with thorough evaluations by the specialized teams.

Depending on the number of staff in the first team:

- provide information - provide information

- start building the first incident

command post on the scene and if

- initiate medical interventions with the

available resources in the field

First team staff members are supposed to be able to:

1. Apply basic triage criteria, prioritize and conduct primary emergency conduct primary emergency management/treatment.

2. Efficiently apply simplified diagnostic/therapeutic methods, with minimal supplies.

Con’t. First team staff members are supposed to be able to:

3. Maximize efficiency using or relocating

existing resources. existing resources.

4. Collaborate with other involved organizations

and integrate the medical activities with the

overall response.

The recent super Typhoon Haiyan was

the record breaking typhoon of 2013 in the Asia-Pacific.

FACTS:

8.1 on the 8 point Dvorak scale

314 km/hr winds with gusts of up to 370 km/hr

480 km wide coverage

STATISTICS:

Death toll = 6,300

Missing = 1,500

STATISTICS:

Affected = 16 million people 44 provinces of 9 regions

.

The study documented the existing Philippine EMS system in action according to what transpired during the acute phase of Typhoon Haiyan.Typhoon Haiyan.

•Adjusted Distribution of Cases according to Triage Category

Triage Category Number % Distribution

Male Female 0 to

<1 y/o

1to

<5y/o

5 to

18 y/o

19 to

65 y/o

>65 y/o

<1 y/o <5y/o 18 y/o 65 y/o

T1 cases(Red/emergent) 1,044 1,028 826 208 418 245 416

T2 cases (Yellow/urgent) 2,156 1,678 1,066 378 422 1,187 762

T3 cases

(Green/non-urgent)

7,382 4,673 2,056 3,152 2,378 3,439 1,241

T4 cases

(Black/ Blue/expectant)

520 712 0 0 125 852 0

RESULTS

Types of cases seen Number % Distribution

Table 41Adjusted Distribution of Cases according to Primary and Secondary Casualties

Types of cases seen Number % Distribution

Male Femal

e

0 to

<1 yo

1 to

<5yo

5 to

18 yo

19 to

65 yo

>65 yo

Primary Casualties (drowning, asphyxiation,

hypothermia, trauma) 5,375 6,752 1,777 4,059 3,630 1,716 1,337

Secondary casualties (hypertension, diabetes,

congenial and chronic diseases, or other

injuries sustained after the typhoon, etc) 8,815 6,581 747 1,208 2,932 7,049 3,075

• 44% of the injuries = directly related to

the typhoon

• 11% of patients = classified as T1 • 11% of patients = classified as T1

• 63% of patients = classified as T3

• Total Patients treated = 27,523

• Urgent Cases = 3,849 (14%)

Females (57%)

1- <5 y/o age group (30 %) 1- <5 y/o age group (30 %)

• Non-urgent cases = 23, 674 (86%)

Males (53%)

19-65 y/o age group (40%

RESULTS

Most common health problems encountered were:

soft tissue injuries - extremities

head head

symptoms of depression

infectious and pulmonary problems

Trauma and reports of depression

- teens, adults and elderly victims

Communicable diseases Communicable diseases

- infants and children

The least encountered problems:

1. childbirth1. childbirth

2. allergies

Hospital Admissions = 5,873 (21%)

Classification of casualties:

1. Primary casualties - 12,127 (44%)

<1 to 5 y/o age group (7,689)

2. Secondary casualties - 15,396 (56%)

Findings

• The EMS response was disorganized

• There were various levels of coordination.

• There was no documentation done by most field teams

• The triaging process was also not

standardized.

Documenting and Analyzing the Quality of Coordination and Response of Emergency Medical Services in Areas Acutely Affected by Typhoon Haiyan” by Gundran, Lam, Santamaria, Lopez & Tuazon

Lessons Learnt:

1. Need for a Philippine National EMS Registry

2. Need to improve the coordination and communication process for

government and non-government organizations with EMS

responders

3. Promotion of the importance of EMS training

RESPONSE PHASE

The main issue during the management of any event is the imbalance between the needed and the existing resources

Necessitates the optimal use of available resources, as well as relocation of other resources

Response Phase: may start early or late due to the sustainability of the infrastructure and logistics

Priorities: actions to save lives, and thus

start during the response stage

From the onset of any disaster or MI (Major Incident):

- all hospitals need to initiate a coordination

and command center, and command center,

- need of a direct communication and

coordination with the regional and

national level agencies to ensure their

support and help as necessary

The Hospital Command and Coordination

Center has the mandate to administer the Center has the mandate to administer the

whole action during a (MI) major incident

Hospital Command and Coordination Center has the responsibility for:

- the management of media,

- hospital information center, - hospital information center,

- maintenance of hospitals technical needs

eg. water, electric and IT (Information

Technology) support,

- management of deaths and

- the psychological support of victims and staff

The outcome of the medical intervention might be displayed in quantitative and qualitative parameters:

- immediate post-disaster and late - immediate post-disaster and late

mortality and morbidity

- the impairment of the quality of life

For a successful response to a Major Incident

there need to be structured and there need to be structured and

disciplined plans

GUIDE POSTS:

In the response phase, we use all knowledge collected from earlier phases to cope with a disaster disaster

Available plans built upon risk and vulnerability analysis and resource assessment etc. will now be brought into play.

GUIDE POSTS:

The immediate or delayed reaction which depends on the type of event depends on the type of event

- a chain of reaction in the society

concerned and among all authorities

involved in disaster management

Response Phase activities that may blend into one another:

1) Situation analysis.

2) Early damage assessment2) Early damage assessment

3) Crisis mapping.

4) Information, communication with stakeholders

5) Evacuation and shelters

6) Dispatching of resources

Special consideration should be made for vulnerable groups and those at home with the high need for medical instruments.

It includes: It includes:

1) Search and rescue.

2) Rubble and debris removal.

3) Logistics.

4) Delivery of relief supplies.

5) Prioritizing actions

Knowledge competencies needed at different Disaster Management Levels pertaining to Healthcare:

Basic levelBasic level

Advanced level

Master level

Basic Level Competencies:

To be familiar with the sequence of medical activities:

1. Initial call to emergency services to the

arrival of PHE (Pre-hospital Engagement)

on the scene,

2.Activities on the scene, transportation of

the victims to the secondary level, in-

hospital activities during MCI/disaster

Basic Level Skills:

1. BLS/ACLS ( Basic Life Support/Advanced

Support

2. ATLS (Advanced Trauma Life Support) 2. ATLS (Advanced Trauma Life Support)

3. ETC and ABC-T and other relative

national/international guidelines.

Advanced level:

Communication/informational technology

Command/decision-making process

Inter-agency and dispatch coordination Inter-agency and dispatch coordination

Media management

Security issues of medical service

Master level:

Cross-border cooperation

LegislationLegislation

Ethical issues of MCI/disaster.

Recovery, Recontruction and Rehabilitation Phasepplies. - 5) Prioritizing actions

Rehabilitation Phase

- most challenging phase of the disaster

cycle and covers a wide range of cycle and covers a wide range of

actions

Rehabilitation phase may include:

1. Spatial planning

2. Infrastructure

3. Communication. 3. Communication.

4. Water, hygiene, sanitation

5 Housing

Con’t., Rehabilitation phase includes:

6. Livelihoods.

7. Social security

8. Transport 8. Transport

9. Agriculture

10. Evaluation

Key Points:

The most demanding element is to review and evaluate the disaster management

- the relevant process to see whether it - the relevant process to see whether it

could have been managed better in

preparation for possible future disasters

In Summary

Disaster preparedness

Planning emergency health services

Mass casualty management

Emergency medical care

Intermediate events causing temporary displacement

Mass event with long-term major implications

Mass event of immediate, limited implication

Mass event long term displacement

Managing essential drug supplies

Post-emergency phase

SALAMAT PO!Terima Kasih

Sie Sie Ni

QUESTIONS?

Why we need the EMS Bill urgently?

The Philippines is a disaster prone country and it is a fact that its impact on life, property, livelihood and environment in any property, livelihood and environment in any country, among other things, depends on a competent and organized EMS delivery

2. International and national EMS studies

established that the patients seen and

given appropriate and standard pre-

hospital care at the onset of acute hospital care at the onset of acute

manifestations of their critical illness

(medical or trauma cases), have

increased survival rates.

3. There is a need to professionalize the

practice of Paramedicine to ensure the

quality of their training, to create a

competitive compensation for the country competitive compensation for the country

to stop losing talented individuals/EMT

professionals to other developed countries

Support:

EMS System Bill in the Congress/Senate

#supportFilipinoEMSlaw

CPR Ready Philippines

#CPRreadyPhilippines

HOPE ABOUNDS!

MABUHAY !!!

REFERENCES

• Handbook of Emergency and Disaster Management – Khorram-Manesh, Amir

• Public Health Guide for Emergencies – WHO• Public Health Guide for Emergencies – WHO