ROLE OF PHYSIOTHERAPY IN DISASTER MANAGEMENT

1. P a g e | 1 Dr. Nithin Ravindran Nair (PT)
DISASTER MANAGEMENT
Disaster has been defined by the UN as a serious disruption of the functioning of a
community or a society involving widespread human, material, economic or
environmental losses and impacts, which exceeds the ability of the affected
community or society to cope using its own resources.
Hazard: It is a dangerous phenomenon or a physical condition that has the potential
to cause fatalities, injuries, property damage, loss of livelihoods and services, social
and economic disruption, or environmental damage.
Risk: Likelihood × Consequences (Therefore by decreasing either likelihood or
consequences incurred we may reduce the probable risk)
Vulnerability: The extent to which a community, structure, service, and/or
geographical area is likely to be damaged or disrupted by the impact of particular
hazard, depending on their nature, construction and proximity to a disaster-prone
area.
TYPES OF DISASTER
1) Depending upon its nature of occurring
• Natural Disaster: Result of natural phenomena
Further classified on the basis of origin.
• Anthropogenic Disaster: Result of man’s interaction with artificial
environment
Further classified on the basis of origin.
Natural Disaster
Geophysical
Earthquake
Tsunamis
Hydrological
Avalanches
Floods
Climatological
Drought
Wildfires
Biological
Disease epidemic
Plagues
Meterorological
Cyclones
Storms

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• Hybrid Disaster: Arises from linkage of man-made and natural events
2) Depending on the basis of onset
• Sudden onset
• Creeping onset
Sudden onset Creeping onset
Rapid onset: Little or no warning Slow onset
Damaging effects sustained
within hours or days
Effects can persist for months
Geological and Climatic Hazards:
Earthquake, volcanic eruptions
Environmental Hazards:
Drought, Famines
CAUSES OF DISASTER
• Geological or Climatic Changes
• Poverty
• Population Growth
• Rapid Urbanization
• Transitions in Cultural Practices
• Environmental Degradation
• Lack of Awareness and Information
• War and Civil Strife
• Technology
Man-made
Disaster
Chemical
Explosions
Gas leakage
Mechanical
Accidents
Collapse of
building
Nuclear
Warfare
Radiations
Biological
Disease epidemic
Communicable
Disease
Warfare
Terrorism
Civil unrest

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EFFECTS / IMPACT OF DISASTER
STAGES OF DISASTERS: Divided into 5 chronological stages
Inter Disaster Stage Disaster training and education program
Warning Stage Early warning and mobilization
Impact Stage Crucial stage – Lasts from minutes to days or weeks
Emergency Stage Begins during impact stage until threat have passed
Rehabilitation Stage Restores the community to pre-disaster conditions.
CATEGORIES OF DISASTERS
LEVEL 1
▪ Multiple casualty incident
▪ Local resources adequate
▪ Area is capable of handling (no outside support
needed)
LEVEL 2
▪ Multiple casualty incident
▪ Local resources not adequate
▪ Region wide support (mutual aids and resources)
required.
LEVEL 3
▪ A mass casualty event
▪ Local and regional resources inadequate
▪ National and International support may be required.
THE INDIAN SENARIO
Asia-Pacific Region: 60% of major natural disasters. India: 2.4% of world’s land area,
7th
largest country of the world with 15% of the world’s population.
EFFECTS
Physical
Infrastructural
Damage
Economical
Agricultural
Damage
Psycological
PTSD
Health
Injuries
Morbidity
Social
Telecommunication
Loss
Poverty
Emotional
Mortality
Cultural
Disruption - SOL,
Lifestyle
Environmental
Damage to inland
and coastal
environment

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India manifests many natural disasters like floods, cyclones, landslides, earthquakes
etc. due to vast variations of geographical terrain and climatic conditions, changing
demographics and socioeconomic conditions, unplanned urbanization and
development within high risk zones, environmental degradation, epidemics and
pandemics.
On 23rd
Dec 2005, the Government of India enacted the Disaster Management Act
which envisaged the creation of – NDMA (National Disaster Management Authority)
– Headed by PMO, SDMA (State Disaster Management Authority) – Headed by
respective CMs
NDMA pledges to built a safer and disaster resilient India by a holistic, proactive,
technology driven and sustainable development strategy.
GOALS OF DISASTER MANAGEMENT
Disaster management can be defined as the organization and management of the
resources and responsibilities for dealing with all humanitarian aspects of
emergencies, in particular – preparedness, response and recovery in order to lessen
the impact of disasters OR It is a systematic process that aim to reduce the negative
impact or consequences of adverse events.
LEVELS OF PREVENTION
Level of
prevention
Primordial Primary Secondary Tertiary
Target
Population
General
Population
Susceptible Asymptomatic Symptomatic
Goals Decreased Risk
Reduce Disease
Incidence
Reduce
Prevalence
Reduce
Complications
Examples
Remedial
measures
against
overcrowded
buildings in
earthquake
prone zone.
Vaccination,
Immunization
Staying alert to
possible
displacements of
populations,
providing basic
amenities to the
refugees.
Rehabilitation
programs
including
vocational
rehabilitation

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CONTEMPORARY DISASTER MANAGEMENT (A FOUR LEVEL APPROACH)
MITIGATION:
• Mitigation refers to all actions taken before a disaster to reduce its impacts on
nation or community.
• Mitigation = Prevention + Preparedness
• Four vital tools that could be used to prevent or mitigate disaster
o Hazard management and vulnerability reduction
o Economic diversification
o Political intervention and commitment
o Public awareness
PREPAREDNESS
RESPONSE
RECOVERY
MITIGATION
DISASTER
IMPACT
REDUCES/ELIMINATE
CONSEQUENCES OF HAZARD –
BEFORE AN EMERGENCY
RETURN TO NORMAL – AFTER
THE EVENT
ACTION TO ELIMINATE IMPACT
OF DISASTER – AFTER THE
EVENT
DEVELOPS PLANS FOR WHAT
TO DO, WHERE TO GO, WHO TO
CALL – BEFORE AN EVENT

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PREPAREDNESS:
• Preparedness refers to pre – disaster activities that are undertaken within the
context of disaster risk management and are based on sound risk analysis.
• It includes –
o Emergency exercises / training
o Emergency communication systems
o Emergency personnel or contact lists
o Warning systems
o Evacuation plans and training
o Mutual aid agreements
o Public information / education
o Disaster drills / Mock tests: Well planned, organized and coordinated. It
can be scheduled periodic or unannounced.
RESPONSE:
• Disaster response is the sum total of actions taken by people and institutions
in the face of disaster.
• The focus is on meeting the basic needs of people until more permanent and
sustainable solutions can be found.
• Main Goal – Promotion of sustainable livelihood and their protection so as to
enhance the capacity of the affected to deal with disasters and promote a
rapid and long-lasting recovery.
• Aims –
o Survival of maximum number of victims
o To re-establish self-sufficiency and essential services
o Repair or replace damaged infrastructure
o Regenerate viable economic activities
o Protect and assist the civilian population during civil or international
conflicts in compliance with national and international conventions.
• Disaster response activities –
• Warning – evacuate or secure property
• Evacuation and migration
• Search and rescue
• Post disaster assessment – relief needs
• Relief – material aid and emergency medical care
• Logistics and supply

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• Communication and information management
• Survivor response and coping – new and special needs
• Security – rights and safety
• Emergency operations management – Policies and procedures
• Rehabilitation – resume functioning
• Reconstruction – permanent construction
• Revitalization of the economy
RECOVERY:
• Return the community to normal.
• Types –
o Short term recovery – Restore interrupted utility services, clear roads,
temporary housing, public information, health and safety education,
provide food and shelter (those displaced by disaster) – few weeks
o Long term recovery – Complete re-development of damaged areas of
the community – months / years
• Steps to recovery –
o Gathering basic information
o Organizing recovery
o Mobilizing resources for recovery
o Administering recovery
o Regulating recovery
o Co-ordinating recovery
o Evaluating recovery

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TRIAGE
• The word Triage is of French origin which means selection or categorization
• Triage consists of rapidly classifying the injured on the basis of severity and
likelihood of their survival with prompt medical intervention.
• Aim of Triage –
o To identify priority cases
o To organize, streamline case management
o To minimize complications, and save limbs and organs
o To utilize resources effectively
• Components
o Personnel: Responsible, knowledgeable, critical thinking, physical
assessment skills – Physician, surgeon, nurses, physiotherapist,
auxiliary staff.
o Space requirement: Large enough to hold supplies, equipment and
patients. It should be easily accessible.
o Equipment and supplies: Tailor made for specific triage treatment
protocol, should even include diagnostic assessment tools.
o Communication and information: Direct link between incoming
ambulances and emergency vehicles, closed circuit TV monitoring,
computerized information storage, important phone numbers.
o Documentation: Patients complaints, history, objective assessment,
vital findings. Acuity rating – life threatening, urgent, semi – urgent,
referral.
SORTING
• Based on Priority
Priority Description Treatment plan
ONE Needing immediate resuscitation
After emergency treatment shifted
to ICU
TWO Immediate Surgical treatment Transferred immediately to OT
THREE
Needing first aid and possible
surgery
Give first aid and admit
FOUR Needing only first aid Discharge after first aid

9. P a g e | 9 Dr. Nithin Ravindran Nair (PT)
• Based on Colour code
Colour code Time (prompt medical care within…)
Red Second
yellow Minute
Green An hour
Blue Hours
White Day
Black Dead
• Canadian Triage and Acuity Scale (CTAS)
Level
Time to physician
assessment
Level 1 (Resuscitation) Immediate
Level 2 (Emergent) < 15 minutes
Level 3 (Urgent) < 30 minutes
Level 4 (Less urgent) < 1 hour
Level 5 (Non – urgent) < 2 hours

10. P a g e | 10 Dr. Nithin Ravindran Nair (PT)
ROLE OF PHYSIOTHERAPY IN DISASTER MANAGEMENT
INTRODUCTION: Physiotherapists are well placed and have ideal qualifications and
training to optimize health and function in vulnerable populations thereby
increasing their adaptability in adverse conditions during disaster.
Physiotherapist can be a valuable asset not just in rehabilitation but also in
mitigation and response stage too.
VICTIM EVACUATION TECHNIQUES: Required to evacuate injured person from an
emergency scene to a location of safety.
Types of Lifts, Carries and Drags:
o Tied – Hands Crawl
o One Person Arm Carry
o One Person Pack Strap Carry
o Fireman’s Carry ONE PERSON
o Ankle Pull/Drag
o Clothes Drag
o Shoulder Pull
o Blanket Drag
o Two Person Carry
o Chair Carry
o Two Handed Seat Carry TWO PERSONS
o Four Handed Seat Carry
o Human Crutch
o Three Person Carry
o Improvised Stretcher THREE OR MORE PERSONS
o Blanket Stretcher
CARDIOPULMONARY RESUSCITATION (CPR)
2010 AHA guidelines for CPR: Consists of these main parts
o Chest compressions
o Airway
o Breathing
o Defibrillation

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INITIAL STEPS:
✓ Verify scene (make sure scene is safe)
✓ Tap the victim’s shoulder and shout “are you all right?’
✓ Check to see if the victim is breathing – if not – activate emergency response
and ask to get AED
✓ Check carotid pulse for 10 sec (count 1:1000….)
✓ Begin cycle of 30 chest compression (push hard and fast – rate of at least 100
compressions per minute + allow the chest to recoil after each compression
✓ It is followed by 2 rescue breaths (ratio – 30:2) – ensure head tilt chin lift + nose
pinch
✓ Complete 5 cycles
✓ Defibrillation (AED) –
o Step 1 – Power ON
o Step 2 – Attach AED pads – over upper right sternal border and other
lateral to left nipple
o Step 3 – Clear the victim and analyze the rhythm
o Step 4 – If AED advices a shock, press the shock button
o Step 5 – If no shock is needed, and immediately after shock delivery
resume CPR immediately
PHYSIOTHERAPISTS ROLE IN MEDICAL CENTER
IN CASE OF SCI (Tertiary care)
o Reassure person with SCI and their family (Give them hope)
o Tell them importance of breathing exercises
o Encourage to stay active and use UL actively
o Passive ROM of LL, ankle mobility to prevent DVT
o Learn to handle LL with active use of UL
o Educate caregivers about 2 hourly change in position to prevent bed sores
o Guide for long sitting and high sitting
o Teach bed side transfers, level transfers – posteroanterior, lateral, pivot
transfers, wheelchair transfers.
o Learn to proper wheelchairs – indoors, outdoors and over gentle slope.
o Guidance about architectural modifications and design – house and work place.

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o Physiotherapists emphasizes on functional training, bed and mat activities,
wheelchair activities, self-care activities, ambulation, orthosis, travel, aids for
communication, guidance for bowel and bladder care.
IN CASE OF AMPUTATION (Tertiary care)
o Quick assessment of the injury
o Motor and sensory status
o Plan a preoperative program – breathing exercise, strengthening all innervated
musculature.
o Edema management – elevation, bandaging
o Proper positioning – to prevent contractures
o Discuss with surgeon and prosthetist about the nature of prosthesis
o Teach bandaging techniques to patient, family or caregivers
o Counselling
o Gait training
o Desensitization
ROLE OF PHYSIOTHERAPIST DURING EACH STAGES OF DISASTER MANAGEMENT
STAGES ROLE
Mitigation Public awareness
Preparedness
Planning and coordination, Advocacy, Stock piling and supplies,
Training
Response Acute rehabilitation, Holistic education, Psychological support
Recovery Scaling up rehabilitation services, Advocating for reconstruction

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REFERENCES:
❖ Disaster Management for Health Care Professionals – Joshi Sonopant (1st
ed)
❖ Textbook of Prevention Practice and Community Physiotherapy – Dr. Bharati
Vijay Bellare (1st
ed)
❖ The Role of Physiotherapists in Disaster Management – WCPT Report
❖ BLS for Health Care Providers – American Heart Association
❖ Emergency Department Triage Revisited – Fitzgerald et. al, Emergency Medical
Journal, 2010
❖ Preventive and Social Medicine – K. Park (25th
ed)