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ROLE OF PHYSIOTHERAPY IN DISASTER MANAGEMENT

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ROLE OF PHYSIOTHERAPY IN DISASTER MANAGEMENT

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ROLE OF PHYSIOTHERAPY IN DISASTER MANAGEMENT

  1. 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
  2. 2. P a g e | 2 Dr. Nithin Ravindran Nair (PT) • 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
  3. 3. P a g e | 3 Dr. Nithin Ravindran Nair (PT) 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
  4. 4. P a g e | 4 Dr. Nithin Ravindran Nair (PT) 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
  5. 5. P a g e | 5 Dr. Nithin Ravindran Nair (PT) 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
  6. 6. P a g e | 6 Dr. Nithin Ravindran Nair (PT) 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
  7. 7. P a g e | 7 Dr. Nithin Ravindran Nair (PT) • 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
  8. 8. P a g e | 8 Dr. Nithin Ravindran Nair (PT) 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. 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. 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
  11. 11. P a g e | 11 Dr. Nithin Ravindran Nair (PT) 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.
  12. 12. P a g e | 12 Dr. Nithin Ravindran Nair (PT) 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
  13. 13. P a g e | 13 Dr. Nithin Ravindran Nair (PT) 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)

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