Disaster Preparedness - 1 PDF

C H A N G E R E D U C E A C T I O N E N E R G Y F U T U R E “We want the tiles to turn green, just like our FUTURE.” Dr. Connie Gan [email protected] Lecturer in Planetary Health School of Medicine and Dentistry_Public Health Centre for Excellence of Elimination Violence Against W...

C H A N G E R E D U C E A C T I O N E N E R G Y F U T U R E “We want the tiles to turn green, just like our FUTURE.” Dr. Connie Gan [email protected] Lecturer in Planetary Health School of Medicine and Dentistry_Public Health Centre for Excellence of Elimination Violence Against Women (CEVAW) Learning outcomes 01 02 03 Outline the direct List potential Outline activities and indirect impacts environmental hospitals should of disasters on hazards in the event undertake to ensure population health of a disaster preparedness for disaster Can you name a disaster event? Tsunamis Hurricanes Type of disaster based on its ORIGIN Natural: Tectonic / geological hazards (earthquakes, volcanos, tsunami) Mass-movement hazards (Debris movements, rock falls, debris flows/mudslides, avalanches, land subsidence. Hydrologic hazards (Floods, desertification, landslides) Meteorological (cyclones, tornados, ice storms, hail rain, extreme temperature, sandstorm, El Niño and La Niña ) Climatological (drought, wildfires, glacial lake outburst) Biological (human epidemics, animal/plant epidemics) Other (meteorites, soil salination, animal attacks) Man-made based on origin Technological/unitentional Transportation (accident), industrial, infrastructure (e.g. dam burst), Food shortage, structural fires and failures, Intentional, civil, and political hazards (e.g. war, terrorism, stampede) Type of disaster based on its TIME Rapid onset: storms, earthquakes, fires, and other natural hazards; also industrial accidents, including explosions, and some toxic exposures; Slow onset: drought, desertification, sea level rise, coastal erosion, loss of eco-system services, some toxic exposures. Lives lost Disaster consequences Direct Indirect Tangible Intangible Fatalities Loss of livelihoods/income Cost of building Cultural impacts Injuries potential repair/replacement Stress Cost of repair or replacement of Input/output losses of Response costs Mental illness damaged or destroyed public businesses Loss of inventory or Loss of community character and private structures (buildings, Loss of community population possessions Poor morale schools, bridges, roads, etc.) Loss of community character Loss of wages Consequences of a damaged Loss of possessions Relocation Loss of critical services due to costs/temporary housing Loss of organization or business losses Loss of tax revenue environment agriculture and livestock Reductions in business/personal Loss of trained or technical Increased health risks Loss of business spending ("ripple effects") Loss staff Sentimental value inventory/facilities/ of institutional/tacit knowledge Environmental losses equipment/information Mental illness/psychosocial (aesthetic value) Loss of usable land Community impacts Bereavement/emotional response and cleanup costs loss incurred Loss of historical documents or records Public health impacts of disasters Health-Related Issues Common to All Disasters Disasters, whether natural or man-made, often lead to a range of health-related problems that affect communities. Injuries and trauma Infectious diseases Mental health mental stress Chronic disease management Malnutrition difficulty in accesing food Understanding these common health issues is crucial for effective disaster preparedness and response, enabling healthcare systems and relief efforts to address the most pressing needs of affected populations. limited resources  E.g., NCDs in disaster settings Diabetes is most commonly studied NCD EMRO region with predominant focus among published studies Reported association between stress and increased incidence of diabetes as well as impaired fasting glucose Food insecurity in these settings contributes to challenges with diabetes management given lack of availability of meals Malnutrition also a determinant for diabetes among children exposed in utero Additional challenges for diabetes care include lack of access to medications and diagnostics, limited access to clinical sites for care and lack of patient understanding on disease management Disease complications are a common cause for presentation, including but not limited to, being the lead cause for limb amputation surpassing those consequences after event due to trauma some examples Being female, unmarried, having less education, additional comorbidities, and having refugee status confers worse outcomes for DM Reliance on established tertiary care for diabetes management contributes to worse outcomes during crisis given reduced access to care Ngaruiya, C., Bernstein, R., Leff, R. et al. Systematic review on chronic non-communicable disease in disaster settings. BMC Public Health 22, 1234 (2022). https://doi.org/10.1186/s12889-022-13399-z E.g., Post-disaster Infectious disease outbreaks high level association with disaster Correlation plots for the Pearson’s chi squared test residuals for each catagories in less a, region against disaster (X- Asia squared = 101.81, df = 28, P-value ≤ 0.05), b, disease against disaster (X-squared = 31.49, df = 12, P-value ≤ 0.05) and c, disease transmission against disaster (X- squared = 47.31, df = 16, P-value ≤ 0.05). Positive residuals are blue, suggesting a positive association between the corresponding row and column and negative residuals are red, suggesting a negative association. Charnley, G.E.C., Kelman, I., Gaythorpe, K.A.M. et al. Traits and risk factors of post-disaster infectious disease outbreaks: a systematic review. Sci Rep 11, 5616 (2021). https://doi.org/10.1038/s41598-021-85146-0 crowd - risk of infectious disease measles higher health impact Food shortages may arise due to the reduction of food availability, disruption of distribution. Food distribution is often a major or urgent need.  Case study of Storms and Flooding in Urban Areas leads to secondary hazards long-term recovery issue Lane, K., Charles-Guzman, K., Wheeler, K., Abid, Z., Graber, N., & Matte, T. (2013). Health effects of coastal storms and flooding in urban areas: a review and vulnerability assessment. Journal of environmental and public health, 2013.  water supply impact Diseases-related interruption of services flooding impact erosion, threaten health system Leaderships & Financing Essential governance medical products Service delivery & technologies HIS Health workforce  Essential medical products & technologies Service delivery Financing Hurricane Maria increased cost of food IV bag shortage Puerto Rico  Essential medical products & technologies Leaderships & governance Financing Heat Waves Power shortage lose power challenge non-essential services Melbourne  Health workforce Service delivery Essential medical products & technologies Leaderships & governance Flood flood impact on hospitals 7 Hospitals paralysed Penang  HIS Service delivery Essential medical products & technologies Health workforce storm impact on central Mozambique damage, routes inaccessible 19 2005 Hurricane Katrina Over 100 healthcare sites affected with at least 7 completely destroyed 2009 Flooding in QLD Ambulances forced to bypass Caboolture and RBWH hospitals due to flooding 2019-2020 Australian bushfires Five regional hospitals in NSW had to relocate their patients Health services that didn’t burn down were rendered nearly non-functional by water scarcity and the extreme heat  2019-2020 Australian Bushfires Air filtration system in Canberra Hospital unable to deal with levels of smoke Unhealthy levels inside the buildings Medical equipment such as pathology, MRI and CT machines failed due to smoke and the heat Sterilised equipment in the hospital was also contaminated Staff affected by smoke 2018 – 2020 Stanthorpe droughts and fires Increased presentations of gastro due to poor quality drinking water During bushfires – hospitals were left without power for more than 24 hours Roads leading into and out of hospitals were cut off due to fires Smoke caused poor air quality Fire impact - more frequent and intense Cascading effects disrupt supply chain >1,460 health facilities are affected, of which 432 fully damaged recover and rebuild key to prepare  Health Infrastructures are ill-prepared “… adaptation activity is much lower, with only 57% of health systems, 22% of hospitals, and 20% of health centres having developed a plan to address future health-care service delivery needs resulting from climate change.” (Lancet, 2018) lower activity blue - increase preparedness blue Climate related events, such as severe storms and flooding, might compromise electricity and water supplies, interrupt supply chains, disable transportation links, and disrupt communications and IT networks, which reduce the capacity to provide medical care. (Lancet, 2017) 25 25 5 key health related issues to be included in the post- disaster early assessment: 2. the affected population, 3. Availability of safe 1. Endemic and epidemic diseases that arelocation, common including number,in the size, and density of affected water and adequate sanitation facilities areas settlements 2. Living 1. conditions of the affected population including number, size, location, and density of settlements. safe water and sanitation 3. Availability of safe water and adequate sanitation facilities. 4. Underlying nutritional status and immunisation coverage among the population 5. Degree of access to healthcare to effective case management. Disaster Management Cycles There are many models: 4 main elements/stages Response focus on saving lives Recovery return to near normal Mitigation Preparedness phases Response Assess the needs Reduce the suffering Limit the spread and the consequences of the disaster needs after earthquake Activities during response Emergency Operation Search & Rescue In the aftermath of Merapi Volcano Eruptions (Pyroclastic Cloud), Indonesia (2019) First Aid Evacuation Relief Services Assessment – planning implementation Develop foundation for rehabilitation and recovery  Rapid Assessment Purpose: Identify requirements, local capabilities, avoid unnecessary and harmful assistance. not want hazards how evacuate Available Services Victims Needs Noji, E. K. (Ed.). (1996). The public health consequences of disasters. Oxford University Press. Changing needs/priorities Earthquake mass casulaty to mental health and other needs on different needs Changing needs/priorities Floods put into shelter different needs 2. Recovery support community 46 Functions of Recovery can take months/years Aspects Notes Economic Economic recovery includes renewal and growth of the micro economy (within the affected area) and the macro economy. Environment Restoration and regeneration of biodiversity (species and plants) and ecosystems; natural resources; environmental infrastructure; culturally significant sites and heritage structures; and management of environment health, waste, contamination and pollution and hazardous materials. Human and social Physical health and emotional, psychological, spiritual, cultural and social well-being; public safety and education; and administering relevant financial assistance measures. Roads and transport Reconstruction projects and activities for road and transport systems. Building Building industry supply chain; the repair and restoration 3. Preparedness 52 Early preparedness – Sand bagging (Cyclone Debbie, 2017) sand bagging Key components of Healthcare Disaster Preparedness Risk assessment and hazard vulnerability analysis Emergency operations planning Staff training and drills Resource management and stockpiling support other partners Communication systems and protocols Coordination with external agencies and community partners mass casualty 4. Mitigation 48  Building Blocks of Health Systems Access Coverage Improved health (level and equity) Responsive Social and Financial Risk Protection Quality Improved efficiency Safety Source: World Health Organization. Everybody’s Business: Strengthening health systems to improve health outcomes – WHO’s Framework for Action. Geneva. WHO 2007. page 3 Helping the vulnerable Remain in your PPEs only wear one for shift mentsl stress, not sanitary cost cutting reduce impacts Source: CNN Philippines Mason DJ, Friese CR. Protecting health care workers against COVID-19—and being prepared for future pandemics. JAMA Health Forum Mar. 2020;1(3):e200353. https://doi.org/10.1001/jamahealthforum.2020.0353.  physical barrier Gan, C.C.R., Tseng, Y.-C., & Lee, K.-I. (2020). Acrylic window as physical barrier for Personal Protective Equipment (PPE) conservation. The American Journal of Emergency Medicine, 0(0). Available https://doi.org/10.1016/j.ajem.2020.04.044 Lin C-H, Gan CCR, Tseng Y-C, Lee K-I, Chen W-K, Lee F-Y. (2020). Protection effectiveness of a building- integrated COVID-19 sampling station that uses a sealed acrylic window as a physical barrier. Annals of Emergency Medicine [Internet] Available http://doi.org/10.1016/j.annemergmed.2020.05.010 43 low cost 44 “Use physical barriers to reduce exposure to the COVID-19 virus, such as glass or plastic windows.” Rational use of PPE for COVID19 Interim Guidance (WHO, Feb 2020) Waste: Reducing the use of PPEs for clinician who collect throat or nasopharyngeal swabs for each medical procedure. Water-resistant gown*1 Gloves*1 Disposal face shield*1 N95 Facemask*1 Haircap*1 Shoe covers*2 A reduction of 45-59% of waste per testing. Total tests performed by countries in Asia = 720,085 (OurWorldInData.org, 20th Mar 2020) Connie CR Gan, Kuan-I Lee (2020) COVID-19: Redesign Hospital Screening Area for PPE Conservation. https://www.greenhospitals.net/wp-content/uploads/2020/06/GGHH-Case-Study-COVID-19-Redesign-of- Hospital-Screening-Area-for-PPE-Conservation-Taichung-Tzu-Chi-Hospital-.pdf  Sr. Arcelita Sarnillo, SPC, hospital administrator of St. Paul’s Hospital Iloilo, believes there is a need to reduce their plastic waste to become better environmental stewards. “We thought we need to devise something that has to be sustainable so it can be economical on our part and less impact on the waste, on the environment.” reduce materials https://www.philstar.com/headlines/2020/08/15/2034986/earth-not-healing- medical-waste-piles-covid-19-cases-rise  Factoring climate risks into decision making Project on Climate Resilient and Environmentally Sustainable Health Care Facilities in three different ecological regions. border with India 2019-2023 disaster risk see diseases Gaur Hospital, Rautahat Karnali Academy of Health Sciences, Jumla Dhaulagiri Hospital, Baglung HEALTH ENVIRONMENT & CLIMATE ACTION Clean, Green and Climate Resilient Healthcare FOUNDATION Revisiting decisions and outcomes over time new information - adapt Collaborative, value-based approach 90% of the nursing staff joined 3-day training Health & Climate Research Vulnerability, Capacity & Adaptation Assessment Climate Resilient & Sustainable Tech & Infrastructure Energy Use Intensity [kWh/(m2.yr)] less reliant on electricity less energy  Building Blocks of Health Systems Access Coverage Improved health (level and equity) Responsive Social and Financial Risk Protection Quality Improved efficiency Safety building blocks Source: World Health Organization. Everybody’s Business: Strengthening health systems to improve health outcomes – WHO’s Framework for Action. Geneva. WHO 2007. page 3  WHO operational framework for building resilient health systems Source: World Health Organization. Operational framework for building climate resilient health systems. Geneva. WHO 2015. page 12 (WHO, 2020) 53  Thank You ! Dr Connie Gan School of Medicine and Dentistry [email protected] @connie_gan #FutureProofingHospitals #W_planetaryhealth