Combat Engineering Handout "Disaster Management" April 2022 PDF

COMBAT ENGINEERING HANDOUT “DISASTER MANAGEMENT” APRIL 2022  2 RESTRICTED TABLE OF CONTENTS Chapter Contents Page No...

COMBAT ENGINEERING HANDOUT “DISASTER MANAGEMENT” APRIL 2022  2 RESTRICTED TABLE OF CONTENTS Chapter Contents Page No Theory of Disaster Management 1. Introduction to Disaster 5 2. Hazard Types and Assessment 16 3. Disaster Preparation and Planning Strategy 26 4. Disaster Prevention and Mitigation 32 Establishment of Control Headquarters 5. Establishment of Control Headquarter 35 MFR 6. Emergency Medical Services 45 7. Rights of Patient 48 8. Anatomical References 49 9. Assessment and Procedures 51 10. Basic Life Support and Cardiopulmonary Resuscitation 58 CSSR 11. Intro To CSSR 66 12. CSSR op Safety 70 13. Construction Material, Structure and Damage Type 74 RESTRICTED  3 RESTRICTED 14. Searching and Location 84 15. INSARAG Marking System 101 16. Tools, Equipment and Accessories 108 17. Lifting And Stabilities Loads 114 18. Pre-Hospital Treatment 121 FRMR 19. Intro to FRMR 127 20. Flood Recovery Process 138 21. Pre-Flood Preparation 142 RESTRICTED  4 RESTRICTED THEORY OF DISASTER MANAGEMENT RESTRICTED  5 RESTRICTED Chapter – 1 INTRODUCTION TO DISASTER 1. Disaster is a sudden adverse or unfortunate extreme event which causes great damage to human beings as well as plants and animals. Disasters occur rapidly, instantaneously an indiscriminately. These extreme events either natural or man induced which exceed the tolerable magnitude within or beyond certain time limits, make adjustment difficult, results in catastrophic losses of property, income and life is paralyzed. These events which occur aggravate natural environmental processes to cause disasters to human society such as sudden tectonic movements leading to earth quake and volcanic eruptions, continued dry conditions leading to prolonged droughts, floods, atmospheric disturbances, collision of celestial bodies, etc. (Joshi, 2008). 2. Disasters have always co-existed with civilizations. With technological advancement, development initiatives resulted in the creation of a lot of infrastructure and permanent assets. Gradually material development detached man from nature on one hand, and increased vulnerability of human population, on the other. The progressive increase in loss of life, property and deleterious effect on environment due to disasters moved the international community to look at disaster management in a new perspective, which transcends international barriers, anticipates possible threats and enables tackling of disasters from the pre-stage. The last decade (1900-1999) was observed by the international community as the international decade for natural disaster reduction', a decade dedicated to promoting solutions to reduce risks from natural hazards. The international dimension of disasters was realized and a protocol sought to be established so that when it comes to suffering of humanity, help from the international community flow in right earnest. 3. Almost every day, newspapers, radio and television channels carry reports on disaster striking several parts of the world. But what is a disaster? The term disaster owes its origin to the French word "Desastre" which is a combination of two words 'des' meaning bad and astre' meaning star (Bad or Evil star). The United Nations defined disasters as "A serious disruption of functioning of a community or all society causing RESTRICTED  6 RESTRICTED widespread human, material, economic and environmental losses which exceed the ability of the affected community/ society to cope using its own resources' (UNDP, nd). 4. A disaster is a result from the combination of hazard, vulnerability and insufficient capacity or measures to reduce the potential chances of risk. A disaster happens when a hazard impacts on the vulnerable population and causes damage, casualties and disruption. Figure 1 gives better illustration of what a disaster is. Any hazard - flood, earth quakes or cyclone which is a triggering event along with greater vulnerability (inadequate access to resources, sick and old people, lack of awareness etc.) would lead to disaster causing greater loss to life and property. For example; an earth quakes in an uninhabited desert cannot be considered a disaster, no matter how strong the intensities produced. An earth quake is disastrous only when it affects people, their properties and activities. Thus, disaster occurs only when hazards and vulnerability meet. But it is also to be noted that with greater capacity of the individual/community and environment to face these disasters, the impact of a hazard reduces. Therefore, we need to understand the three major components namely hazard, vulnerability and capacity along with other terminologies with suitable examples to have a basic understanding of disaster management. 5. Important Terminologies a. Hazard b. Risk c. Vulnerability d. Capacity e. Critical Facility f. Exposure g. Mitigation h. Preparedness i. Climate Change j. Prevention k. Response RESTRICTED  7 RESTRICTED l. Recovery m. Relief n. Reconstruction o. Rehabilitation p. Disaster 6. Hazard. A dangerous phenomenon, substance, human activity or condition that may cause loss of life, injury or other health impacts, property damage, loss of livelihoods and services, social and economic disruption, or environmental damage. Hazard is a threat. It’s a future source of danger. It has the potential to cause harm to:- a. People in the shape of Death, injury, disease and stress b. Human activity in the shape of Economic and educational loss c. Property as Damage and economic loss d. Environment as Loss of flora and fauna and increased pollution 7. Exposure. Elements present in the hazard zones that are thereby subj to potential threat i.e. a. People b. Property c. Infrastructure d. Natural /Artificial resources 8. Vulnerability. The characteristics and circumstances of a community, system or asset that make it susceptible to the damaging effects of a hazard. It is a condition or sets of conditions that reduces people’s ability to prepare for, withstand or respond to a hazard e.g RESTRICTED  8 RESTRICTED 9. Critical Facilities. The primary physical structures, technical facilities and systems which are socially, economically or operationally essential to the functioning of a society or community, both in routine circumstances and in the extreme circumstances of an emergency e.g. a. Hospitals b. Factories c. Industries d. Vocational training Institutes 10. Capacity. The combination of all the strengths, attributes and resources available within a community, society or organization that can be used to achieve agreed goals. Capacity enhancement depends on a. Responsive and responsible govt b. Strong community org c. Local knowledge and practice d. Adequate food and Income sources e. Family and community support in crisis 11. Risk. The probability that a community’s structure or geographic area is to be damaged or disrupted by the impact of a particular hazard, on account of their nature, RESTRICTED  9 RESTRICTED construction, and proximity to a hazardous area. Following elements serve as an example at risk a. Persons, b. Buildings c. Crops or other such like societal components exposed to known hazard, which are likely to be adversely affected by the impact of the hazard 12. Preparedness. The knowledge and capacities developed by the governments, professional response and recovery organizations, communities and individuals to effectively anticipate, respond and recover from the impacts of likely, imminent or current hazard events or conditions 13. Mitigation. Measures taken prior to the impact of a disaster to minimize its effects (sometimes referred to as structural and non-structural measures). It is the lessening or limiting the adverse impacts of the hazards and related disasters RESTRICTED  10 RESTRICTED 14. Prevention. The complete avoidance of adverse impacts of hazards and related disasters 15. Climate Change Adaptation. It refers to actions taken to limit the negative impact of climate change on human systems. It can be defined as initiatives and measures to reduce the vulnerability of natural and human systems against actual or expected climate change effects. It includes actions taken to limit the impacts of both the slow trends associated with climate change, such as sea level rise or less predictable rainfall, and adaptation to increased frequency and magnitude of climatic hazards. RESTRICTED  11 RESTRICTED 16. Response. The provision of emergency services and public assistance during or immediately after a disaster in order to save lives, reduce health impacts, ensure public safety and meet the basic needs of the people affected. 17. Relief. Measures that are required in search and rescue of survivors, as well to meet the basic needs for shelter, water, food & health care. 18. Recovery. The restoration and improvements where appropriate, of facilities, livelihoods and living conditions of disaster affected communities, including efforts to reduce disaster risk factors. 19. Rehabilitation. Restoration of an entity to its normal or near normal functional conditions after the occurrence of a disaster. It includes: - a. Re-establish essential services b. Revive key economic and social activities 20. Reconstruction. Permanent measures to repair or replace damaged dwellings and infrastructure and to set the economy back on course 21. Development. Sustained efforts intended to improve or maintain the social and economic well-being of a community RESTRICTED  12 RESTRICTED 22. Classification of Disaster. Disasters are classified on the basis of their causes, scale and speed of on set. a. Causes (1) Natural (2) Manmade b. Scale (1) Major (2) Minor b. Speed of Onset (1) Sudden (2) Slow 23. Types of Hazards a. Biological/Environmental Hazard b. Hydro Meteorological Hazard c. Geological Hazard d. Technological Hazard e. Complex Hazard Disaster Preparedness Response/relief Mitigation Rehabilitation Prevention Reconstruction RESTRICTED  13 RESTRICTED Disaster Management Cycle 24. The Disaster management cycle illustrates the ongoing process by which governments, businesses, and civil society plan for and reduce the impact of disasters, react during and immediately following a disaster, and take steps to recover after a disaster has occurred. Appropriate actions at all points in the cycle lead to greater preparedness, better warnings, reduced vulnerability or the prevention of disasters during the next iteration cycle. The complete disaster management cycle includes the shaping of public policies and plans that either modify the causes of disasters or mitigate their effects on people, property, and infrastructure. The mitigation and preparedness phases occur as disaster management improvements are made in anticipation of a disaster event. 25. Developmental considerations play a key role in contributing to the mitigation and preparation of a community to effectively confront a disaster. As a disaster occurs, disaster management actors become involved in the immediate response and recovery RESTRICTED  14 RESTRICTED phases. The disaster management phases do not always, or even generally, occur in isolation or in this precise order. Often phases of the cycle overlap and the length of each phase greatly depends on the severity of the disaster. One of the main goals of disaster management is the promotion of sustainable livelihoods & their protection and recovery during disasters and emergencies. Where this goal is achieved, people have a greater capacity to deal with disasters and their recovery is more rapid and long lasting. In a development-oriented disaster management approach, the objectives are to reduce hazards, prevent disasters, and prepare for emergencies. Therefore, developmental considerations are strongly represented in the mitigation and preparedness phases of the disaster management cycle. 26. DM and DRM. Over the past decade, a notable attempt to shift away from post- disaster response, relief and rehabilitation efforts as the only options available to manage disaster. A new focus on changing the conditions that lead to disaster can reduce the potential post-disaster loss of life and property damage. 27. Disaster Risk Management. This disaster risk management approach addresses each element of risk: hazard severity and frequency, elements at risk (e.g., population, critical infrastructure) and vulnerability. It promotes sustainable development by reducing disaster susceptibility. Preparedness and mitigation actions have been RESTRICTED  15 RESTRICTED recognized as important strategies for reducing disaster risks. Adaptation of this process is used widely in business, engineering and other disciplines. A process that identifies: a. Risks b. Vulnerabilities c. Priorities d. Treatments 28. Disaster Risk Management is different to earlier approaches because it: - a. Works on risks that cause disasters not just disaster themselves b. Gives greater emphasis to prevention and mitigation c. Involves a much wider group of participants d. Aims to integrate risk prevention into sustainable development “Disaster Risk Management is not a new business, it is a new way of doing business, building on current knowledge and experience to produce a more effective result” Disaster Crunch Model RESTRICTED  16 RESTRICTED Chapter - 2 HAZARD TYPES AND ASSESSMENT Types of Hazards 1. Hydro Meteorological Hazards a. Tropical Cyclones b. Floods c. Storm Surges d. Drought e. Tornado f. Extreme Temperature g. Lightening h. Avalanches 2. Geological Hazards a. Earth quakes b. Volcano c. Tsunami d. Landslide e. Ground subsidence f. Glacial lake outburst 3. Biological/Environmental Hazards a. Pandemic/Epidemic in humans b. Pandemic/Epidemic in plants c. Pandemic/Epidemic in animals d. Pollution e. Pest Infestation (Locusts) f. Wildfire 4. Technological Hazards a. Transport accidents RESTRICTED  17 RESTRICTED b. Industrial explosions and fires c. Accidental release of toxic chemicals d. Nuclear accidents 5. Complex Hazards a. Terrorism b. Civil unrest c. Violation Earthquake 6. Magnitude. It is measurement of energy released from the earth quake. It is measured in Richter Scale. 7. Intensity. It is measurement of ground shaking at different places. It is measured in Modified Mercalli Intensity (MMI). RESTRICTED  18 RESTRICTED 8. General and Long-Term Forecast. It can be deducted in the regions where earth quakes will occur based on the study of regional seismicity and the outline of seismic zones. Specific and short-term prediction is still not feasible despite all research. Here the primary hazard is the earth quakes and secondary hazards are: - a. Building collapse RESTRICTED  19 RESTRICTED b. Dam failure c. Fire d. Hazardous material spill interruption of power/ water supply/ communication/ transportation/ waste disposal e. Landslide f. Soil liquefaction g. Tsunami (tidal wave) 9. Rate of Onset Earth quakes is rapid onset which can’t be predicted and there is always less time for evacuation. 10. Parameters of Severity a. Depends upon the magnitude scale b. Depend upon the amount of energy release at the epicenter c. Distance away from the epicenter d. The size of an area affected by the earth quakes e. Intensity/Severity of the shaking at a location f. Local soil Condition RESTRICTED  20 RESTRICTED Flood Hazard 11. Rate of Onset. Flooding is slow as well as rapid onset but its occurrence can be predicted. 12. Parameters of Severity a. Area flooded (sq.km) b. Depth and height of flooding c. Velocity of water flow d. Amount of mud deposited or held in suspension e. Duration of inundation 13. Mechanism of Destruction. It occurs due to inundation of ground and flow of water Currents of moving or turbulent water carry along debris which is destructive and injurious. Structures are damaged. Mud, oil and other pollutants carried by the water is deposited and ruins crops and building contents. Flooding destroys sewerage systems, pollutes water supplies and may spread diseases. Flood causes saturation of soils and may cause landslides or ground failure. RESTRICTED  21 RESTRICTED 14. Types of Flooding a. River Floods b. Flash Floods c. Urban Floods d. Storm Surges e. GLOF 15. Contributing Factors to Flooding a. Saturated ground b. Deposition of silt c. Deforestation d. Building of impermeable concrete and other surfaces in river basins (Urbanization) e. Clogged drains and canals 16. Secondary Hazards with Flood a. Epidemics b. Snake bite c. Electric Shocks d. Power Outage e. Communication infrastructure failure f. Dam failure g. Diseases in animals and humans Cyclone Hazard 17. Rate Of Onset Rapid onset but can be predicted accurately now with the help of remote sensing technologies. 18. Parameters of Severity a. Heavy and forceful winds b. Thunderstorm c. Cloud Bursting RESTRICTED  22 RESTRICTED d. Heavy and sudden rise of flood water 19. Types. The difference between a hurricane, typhoon and cyclone is basically in location. a. Hurricane. North Atlantic Ocean, Northeast Pacific Ocean east of the International Dateline (western hemisphere) and the south Pacific Ocean. b. Typhoon. Northwest Pacific Ocean. Japan, China, Taiwan and the Philippines. c. Tropical Cyclone. Indian Ocean, Southern Pacific Ocean and Northern Australia. Drought Hazard 20. Rate Of Onset. It is a very slow onset in nature. It is creeping hazard. We can predict its occurrence. 21. Parameters of Severity a. Rainfall level b. Rainfall deficit (mm) c. Period of drought d. Extent of loss of soil cover e. Extent of desert climatic zone RESTRICTED  23 RESTRICTED 22. Mechanism of Destruction Followings are causes and contributing factors of drought: - a. Lack of water affects health of crops, trees, livestock, and humans. b. Land becomes subject to erosion and flooding. c. Effects are gradual but if not checked, crops and trees and livestock die, people lose livelihood. d. Forced to move, and may starve if aid is not provided. Land Slide Hazard 23. Rate Of Onset. Land sliding is slow and rapid onset. Sometimes its occurrence is predictable. 24. Parameters of Severity a. Volume of material dislodged (m3), b. Area buried or affected, c. Velocity (cm/day), d. Boulder sizes 25. Mechanism of Destruction. Landslides destroy structures, roads, pipes and cables. Gradual ground movement causes tilted, unusable buildings. Cracks in the ground split foundations and rupture buried utilities. Sudden slope failures can take the ground out from under settlements. Rockfalls cause destruction from fragmentation of exposed rock faces into boulders that roll down and collide into structures and settlements. Debris flows in softer soils, slurry material, man-made spoil heaps and soils with high water content flow like a liquid, filling valleys, burying settlements, blocking rivers (possibly causing floods) and blocking roads. Hazard Assessment Process 26. Hazard Matrix. The Hazard Matrix (or Table) helps us to systematize information regarding the properties of the community ‘s hazard exposure. It is a useful guide when conducting hazard assessment workshop with community members. Discussion can then continue to take up hazard intensity (potential destructive force, adverse effects) and extent (geographical coverage, range of impact). Such discussion flows to the next RESTRICTED  24 RESTRICTED step in the Participatory Risk Assessment—the Vulnerability Assessment. Probability of occurrence of a hazard of a certain level of severity, within a specific period of time, in a given area. HAZARD MATRIX FOR FLOOD AND EARTH QUAKES 27. Hazard Map It is drawn to locate the probable area covered by a hazard ‘s impact and the elements at risk historical profile or time line: can make us understand RESTRICTED  25 RESTRICTED how hazards have changed over time; which hazards have happened in the past; or the start of particular hazard occurrence. 28. Seasonal Calendar. It visualizes the time, frequency and duration of common hazards. 29. Some Guidelines In Hazard Assessment a. Take action to translate scientific data into practical information. b. Integrate local knowledge with scientific and technical information. c. Approach knowledgeable sources/people. d. Understand the various intensities of the same hazard. e. Look out for secondary hazards. f. Be on the lookout for new or emerging hazards. g. Be aware of local threats: the increasing number of small scales, localized hazards which do not hit the headlines or appear in disaster statistics. Cumulatively, these can present a more serious problem than a catastrophic event. For example, in densely populated shanty towns, regular fires, floods, landslides, and epidemics are increasingly common events. h. Bring available maps to facilitate drawing of hazard maps. Specifying the nature and behavior of the hazard is specifically important in designing. early warning system, especially at the local and community. RESTRICTED  26 RESTRICTED Chapter - 3 DISASTER PREPARATION AND PLANNING STRATEGY 1. Disaster management is how we deal with the human, material, economic or environmental impacts of said disaster, it is the process of how we “prepare for, respond to and learn from the effects of major failures”. Though often caused by nature, disasters can have human origins. According to the International Federation of Red Cross & Red Crescent Societies a disaster occurs when a hazard impacts on vulnerable people. The combination of hazards, vulnerability and inability to reduce the potential negative consequences of risk results in disaster. (Vulnerability+ Hazard ) / Capacity = Disaster 2. Natural disasters and armed conflict have marked human existence throughout history and have always caused peaks in mortality and morbidity. This article examines the advances in the humanitarian response to public health over the past fifty years and the challenges currently faced in managing natural disasters and armed conflict. 3. Aspects of Disaster Management. The International Federation of Red Cross & Red Crescent Societies defines disaster management as the organization and management of resources and responsibilities for dealing with all the humanitarian aspects of emergencies, in particular preparedness, response and recovery in order to lessen the impact of disasters. 4. Disaster Preparedness. “The knowledge and capacities developed by governments, professional response and recovery organizations, communities and individuals to effectively anticipate, respond to, and recover from, the impacts of likely, imminent or current hazard events or conditions". 5. According to ICRC (International Committee of Red Cross), Disaster Preparedness refers to measures taken to prepare for and reduce the effects of disasters, be they natural or man-made. This is achieved through research and planning in order to try to predict areas or regions that may be at risk of disaster and where possible prevent these from occurring and/or reduce the impact those disasters RESTRICTED  27 RESTRICTED on the vulnerable populations that may be affected so they can effectively cope. Disaster preparedness activities embedded with risk reduction measures can prevent disaster situations and also result in saving maximum lives and livelihoods during any disaster situation, enabling the affected population to get back to normalcy within a short time period. Minimization of loss of life and damage to property through facilitation of effective disaster response and rehabilitation services when required. Preparedness is the main way of reducing the impact of disasters. Community-based preparedness and management should be a high priority in physical therapy practice management. 6. The Disaster Paradigm a. D – Detection b. I – Incident Command c. S – Safety & Security d. A – Assess Hazards e. S – Support f. T – Triage & Treatment g. E – Evacuation h. R – Recovery 7. How Do We Plan for Disaster? The structure of disaster and emergency management in Pakistan, centered on the National Disaster Management Commission (NMDC), was established immediately after the disastrous Kashmir earth quake in 2005 and has been operational since 2007. As Fig 2 below illustrates, the institutions begin at the national level and extend to the Union Council levels for the implementation of disaster policies. The commission is the highest policy and decision making-body for disaster risk management. It also Disaster Management in Pakistan 10 oversees the integration of disaster risk management issues into sectorial development plans and manages the implementation of this policy through National Disaster Management Authority (NDMA), chaired by the Prime Minister. Since disaster risk is a multi-sectorial activity that requires timely response, the NDMA was established to serve as focal point and coordinating body to facilitate the RESTRICTED  28 RESTRICTED implementation of disaster related mitigation strategies. It directly communicates with all stakeholders, including ministries, departments and other agencies which are likely to participate in disaster risk management. The provincial government has the authority to form the Provincial Disaster Management Authority (PDMA) which is chaired by the Chief Minister. The authority lays down the provincial/regional disaster risk management policy and develops the provincial disaster risk management plans in accordance with guidelines laid down by the national commission. It also reviews the implementation of the provincial plans and oversees the provision of funds for risk reduction and preparedness measures. Further, it coordinates and provides technical assistance to local authorities for carrying out their function. A District Disaster Management Authority (DDMA) can be established by Provincial governments in the hazard prone areas on a priority basis. This authority is headed by Nazem (district chief) of the district. The authority formulates disaster risk management plans and coordinates their implementation. It also prepares guidelines for local stakeholders on disaster risk reduction. In the event of a disaster, it organizes emergency response through district emergency operation center and maintains linkages with PDMA and relevant departments. Authorities at the town and Tehsil levels serve as the frontline organizations of disaster risk reduction and response, interfacing directly with communities. Tehsil and town Nazism lead the risk and response operations with the help of Tehsils and town officers in consultation with DDMA. Other key players include extension workers, police officers, fire services, community organizations, traditional leaders and NGOs. The Union Council is the lowest tier in the governance system, but has important roles in allocating resources for local development works. Union councils are expected to advocate for the communities with the district councils and disaster management authorities. The Figure 5.1 in the article describes the institutional mechanism of Pakistan. The relationship among the different levels is important starting from national to union council level. Disaster Management in Pakistan in number of situations in the aftermath of October 08 earth quakes gave NDMA some favorable opportunities to promote disaster management in Pakistan. These include: a. Heightened awareness among highest level decision-makers, officials, media and civil society about disaster risks and vulnerabilities. RESTRICTED  29 RESTRICTED b. Enhanced commitment of donors and the UN for establishing institutional arrangements and developing capacity on disaster risk management, iii) approval of the National Disaster Management Ordinance 2006, establishment of NDMC, and the NDMA, and iv) commitment of the NDMA leadership. Figure 2 Disaster Management Institutional Mechanism of Pakistan 8. Flood Warning System. Most flood forecasting is still based on traditional methods and indicative variables: worldwide, flood forecasts and predictions based on forecasted rainfall and run-off models are in general not yet good enough for warning purposes. The major trend is towards improvement of predictability of forecasts through research and development of new hazard modelling, and, of effectiveness of warnings. RESTRICTED  30 RESTRICTED A number of approaches are being adopted, including worldwide efforts to operationalize combined models through coupling of meteorological with hydrological models, but developed countries (and others such as China) are making better progress in combining rainfall forecast with numerical run-off models to generate operational and effective flood warming. An ongoing trend that is gathering momentum and is expected to make significant improvement in flood forecasting, is the movement towards incorporation of satellite rainfall estimates and the use of infrared and radar information in combination with existing systems to improve rainfall prediction. Radar alternatives are also being assessed in the USA for use in deriving real-time non-contact measurements of changing river profiles, such as river depth, velocity and discharge to improve flood forecasting. The technological foundation for developing new generation flood early warning systems include: rainfall radar, stable and low-cost observation systems for rainfall and other climate variables, satellite communication, mobile telephony, broadband and other communication systems, broadcasting and information dissemination systems (e.g., satellite and internet broadcasting), and computers and software that allow use of geographical information systems (GIS) and other emerging applications. Regarding effectiveness of warnings, an approach that is likely to become a future trend in enhancing the utility of flood warnings is reawakening public awareness and preparedness for flood, including early warning, through strategies based on the social marketing approach. However, in several developing countries, the concern is more fundamental: how to develop the basic infrastructure for flood forecasting. 9. Preparation and Planning Strategy a. Drought. No province of Pakistan is without experience of prolonged drought or crop-failure due to lack of rain. In Pakistan, deforestation and uncontrolled grazing by cattle herds have played a contributory role over the years. By their nature droughts are creeping disasters, unlike the sudden earth quakes or rapid floods. Counter measures against them have to be taken first in the realm of agriculture, soil management, etc. However, if the worst happens and a part of the country becomes drought- stricken then the “creeping’ disaster will have arrived. A system of food RESTRICTED  31 RESTRICTED security is being established which should make it possible to hold national stocks for disaster use and not simply for market adjustments. Trailers, containers and water-trucks and water-purification chemicals must also be provided for drought conditions b. Epidemics. Apart from periodic or seasonal outbreaks, natural disasters, floods and earth quakes in particular, increase the risk of epidemics such as Cholera, Typhoid, etc. Floods also give rise to the danger of extensive malaria transmission, and seem to increase the number of cases of diarrhea, diphtheria. c. Avalanche. Floods and earth quakes in the kind of physical damage they cause, avalanches, (landslides caused by earth quakes or by heavy rains when they are usually associated with floods), may be considered in the context of these destructive phenomena, and have not been treated here separately. Avalanches occur mainly in the northern regions of Pakistan. The months of April, May and June form the particular danger period, when mountain snow is melting. In some cases, the avalanches result in heavy losses to forest and wildlife. The Indus River above Tarbela derives its perennial flows by draining a vast area covered by glaciers of Karakorum Ranges. d. Tsunami. This is the Japanese name for a wave caused by a sudden change at the bottom of the sea due to seismic tremors. The earth quakes which shook the Mekran coast in November 1945, also caused a seismic sea wave, which affected most of the Pakistan coast on the Arabian Sea. An enormous wave of 40 feet reportedly hit the town of Pasni on the Mekran coast, resulting in serious loss of life and property. Severe destruction was also reported from Ormara and from a number of villages situated along the coastal strip. Even Karachi, though 275 miles from the epicenter, was hit by a seismic wave causing damage in Karachi harbour and along the coast. RESTRICTED  32 RESTRICTED CHAPTER 4 DISASTER PREVENTION AND MITIGATION 1. Introduction. Except for tropical cyclones and hurricanes, the geographical position of Pakistan makes it subject to most natural hazards. Floods in the broad heart land of the country, earth quakes in its large seismic belt areas, avalanches and landslides in the north, periodic droughts and even Tsunami (tidal waves) in its south western coastal areas. 2. Prevention. The complete avoidance of adverse impacts of hazards and related disasters 3. Mitigation. The lessening or limitation of adverse of adverse impact of a hazard and related disasters. Measures taken prior to the impact of a disaster to minimize its effects (sometimes referred to as structural and non-structural measures). a. Structural Mitigation. Construction projects which reduce economic and social impacts. b. Non – Structural Mitigation. Policies and practices which raise awareness of hazards or encourage developments to reduce the impact of disasters. 4. What All Is Covered in Mitigation? a. Reviewing of building codes. b. Vulnerability analysis updates. c. Zoning and land use management and planning. d. Reviewing of building use regulations and safety codes. e. Implementing preventive health measures. f. Educating business and public on simple measures they can take to reduce loss or injury. 5. Priority Actions a. Ensure that disaster risk reduction is a national and a local priority with a strong institutional basis for implementation. b. Identify, assess and monitor disaster risks and enhance early warning. RESTRICTED  33 RESTRICTED c. Use knowledge, innovation and education to build a culture of safety and resilience at all levels. d. Reduce the underlying risk factors/ causes. e. Strengthen disaster preparedness for effective response at all level. 6. Tools to Prevent or Mitigate Disasters a. Hazard management and vulnerability reduction. b. Economic diversification. c. Political intervention and commitment. d. Public awareness. 7. Mitigation Strategies a. Hazard identification and vulnerability analysis. b. Mitigation measures (1) Mainstreaming DRR in development. (2) Economic diversification. (3) Developing disaster resistant economic activities. 8. Relationship of Disasters to Development a. Disasters are now recognized as one of the major contributors to underdevelopment, and underdevelopment is one of the major contributors to disaster It has also been recognized that if disaster response is mishandled, many years of progress can be wiped out and the chances for further progress set back. b. Disasters can put development at risk and make it unsustainable. Hence, effective disaster risk reduction contributes to sustainable development. c. It has also been recognized that if disaster response is mishandled, many years of progress can be wiped out and the chances for further progress set back. d. Disasters can put development at risk and make it unsustainable. Hence, effective disaster risk reduction contributes to sustainable development. e. It is extremely important that disaster managers be aware of the impact of disasters and the role that development programs can play in mitigating disasters and reducing vulnerability. RESTRICTED  34 RESTRICTED 9. Conclusion. Disaster, may it be natural or manmade is very unlikely to prevent, however with good DM policies it can be mitigated RESTRICTED  35 RESTRICTED CHAPTER - 5 ESTABLISHMENT OF CONTROL HEADQUARTERS 1. Introduction a. Control HEAD QUARTERS plays a pivotal role. It must incl all stake holders; Ministries representatives, Liaison Officers, Chief Secretary etc b. Control HEAD QUARTERS - Plans branch and Operations branch c. Synergize and articulate unified effort against disaster d. Mapping of disaster relief area 2. Scope of Activities – Con HEAD QUARTERS a. Planning and coordination with all stakeholders to steer a coherent response. b. Threat forecasting and evidence-based decision making. c. Support response team activities. d. Coordinate Media Campaigns. 3. Tiers of Response a. National level. b. Provincial level - Provincial Disaster Control Centre (PDCC). c. District level - District Disaster Control Centre (DDCC). d. Tehsil Level - Field Disaster Control Centre (FDCC). 4. Con HEAD QUARTERS Reps - Provincial Level. a. Provincial Disaster Coordinator. b. Secretary, ministry of health KPK. c. Secretary establishment and administration department. d. DG PDMA. e. Rep of ministry info and broadcasting. f. Representative of ISPR. g. Administration Division Health Officers RESTRICTED  36 RESTRICTED 5. Functions of PDCC. The provincial disaster control centre (PDCC) shall have to perform following functions: - a. Act as focal point for inter district, inter-ministerial, inter department and inter agency coordination for COVID-19 threat response. b. To review provincial and national COVID spread sit with the help of threat forecasting by relevant organization and real time data by the field teams. c. Monitor state of COVID outbreak and response measures at provincial level to generate daily sit report incl the effects of damages, determine level of risk, stock level of supply, logistics, gr infrastructure and existing resources. d. Harness appropriate use of IT depicting real time sit with ref to COVID spread. e. To issue regular provincial warning and advisories on various aspects of COVID outbreak. f. In coordination with PDMA, maintenance a real time state of essential eqpt and sup along with oversight of ongoing procurement, production and need assessment. g. To ensure media awareness campaign through ministry of info and broadcasting and ISPR. h. In coordination with all stake holders, prep and compile req of fin and resources for eff response against COVID and forward recommendation to concerned depts. i. To avoid duplication of effort and perform any other assigned task. 6. Resp of PDCC Appointment Responsibility Provincial Disaster Establish of Con Overall prevailing threat sit Coordinator RESTRICTED  37 RESTRICTED No of hospital and their capacity/ Resource mapping, No of Secy Health reported cases and vuln areas DG PDMA Need based assessment & proc of resources Dir Ops and plans Mandate and Functions Stat analysis GSO-1 Plans Damage assessment Predictive/ forecast modelling Sitrep and sit update charts Force emp and req of addl GSO-1 Coord resources. Dir Logistics Assessment of vuln areas. Resource distribution Dir MoI&B Media coverage of govt actions Dir ISPR Media coverage of AF efforts Establish of complaint desk Complaint and info charts vis-à- OIC Complaints vis actions taken Complaint inventory 7. Con HEAD QUARTERS Reps – DDCC and FDCC District Disaster Control Centre Appointment Responsibility Establishment of Control HEAD QUARTERS, overall District Coordinator prevailing threat sit Deputy commissioner Assessment of vuln areas and Resource distribution District police officer Law and order sit. Measures taken District health officer No of hospitals and their capacity/ resource mapping, no RESTRICTED  38 RESTRICTED of reported cases and vuln areas Daily situation report and situation update charts / G2-Plans/ Coordinator Operational management Field Disaster Control Centre Establish of Control HEAD QUARTERS, overall Field Coordinator prevailing threat sit Assistant commissioner Assessment of vuln areas, Recourse distribution Superintend of police Law and order sit. Measures taken MS Hospital No of reported cases vis-à-vis hospital capacity GSO-2 Plans/ Coordinator Daily Sitrep and sit update charts / Op management 8. Organogram 9. Mandate a. Focal point for Tehsil effort b. Reviewing / monitoring regional sit c. Evidence based decision making RESTRICTED  39 RESTRICTED d. Maintain real time record of essential eqpt and resources e. Ensure media awareness campaign 10. Chart / Updating Req a. Prevailing Sit (COVID cases, age wise) b. Situation Report c. Vaccination Update d. Mapping, Low / High threat areas etc e. Oxygenated Beds 11. Mapping RESTRICTED  40 RESTRICTED 12. Status of Isolation Wards in Tehsil NSR Suspected Isolation Bed Ser Hospital Cases Currently Capacity Admitted 1 Qazi Hussain Ahmad Shaheed 70 10 RESTRICTED  41 RESTRICTED Hospital (QHASH) 2 Distt HEAD QUARTERS Hospital 50 4 (DHEAD QUARTERSH) 3 Sehatmand zindagi centre 20 - Nowhera 4 Total 140 14 13. Quarantine Centre in Tehsil Currently Name of Quarantine Capacity of Ser Present structure individuals Individuals 1 GPGC Nowshera 80 0 2 GGHS Khair Abad 40 0 3 GHSS No1 NSR Cantt 25 0 4 GHSS Kheshgi 40 0 Total 185 0 14. Tracing and Tracking of Personnel Returned from Abroad Total to People Date be Cleared Suspected Pending Contacted traced RESTRICTED  42 RESTRICTED From 25/3/2021 Till 1700 1430 1430 0 270 05/05/2021 15. Covid Patient Flow Path 16. Role of Police in COVID a. Implementation of govt’s policies at grass root level b. To keep the busiest places like markets, bus terminals, parks and Marriage halls closed c. To maintain smart lock down (restricted mov of citizens in ident hotspots) d. Performing security duties at Quarantine centre e. Deployment in Covid-19 ICUs at hospital (DHEAD QUARTERS, Qazi Hussain Ahmed med complex, Ziarat Kaka Sahib Hospital, CMH) f. Provision of security to the Dr and paramedic staff 17. Military Setup – Mandate a. Establish of field teams RESTRICTED  43 RESTRICTED b. Establish of quarantine centres c. Asst to civil govt in implementation of law and order d. Ensure smooth distribution of resources through coordination with civil administration department e. Send feedback and info in coordination with focal media personnel to higher HEAD QUARTERS 18. Resource Aval Chart Resource Strength Police Station 4 Manpower 1250 Vehicles 10 19. Media Cell a. Role (1) Responding to media inquiries (2) Maintenance of media kit (3) Effectively and timely passage of info to PDCC and DDCC (4) Org seminars on monthly basis (5) Mass awareness programs RESTRICTED  44 RESTRICTED b. Organogram OIC Media Cell Operations Planning Administration Wing Wing Wing Advertising Area Head Section LO Officer Officer Journalist Publisher Acct Awareness HR Management Officer 20. Working Mechanism. a. Follow the guidelines/ policies of PDCC b. Collection of info/stats by field reporters c. Broadcasting updates after every 24 hours d. Weekly press conf RESTRICTED  45 RESTRICTED Chapter - 6 The Emergency Medical Services (EMS) System and Medical First Responder (MFR) 1. Introduction. Emergency medical responders are people who are specially trained to provide out-of-hospital care in medical emergencies. There are many different types of emergency medical responders, each with different levels of training, ranging from first aid and basic life support. Emergency medical responders have a very limited scope of practice and have the least amount of comprehensive education, clinical experience or clinical skills of emergency medical services personnel. The EMR program is not intended to replace the roles of emergency medical technicians or paramedics and their wide range of specialties. Emergency medical responders typically assist in rural regions providing basic life support where pre- hospital health professionals are not available due to limited resources or infrastructure. "Emergency medical responder" is a broad term, used either to describe a certain EMERGENCY MEDICAL SERVICE, or generally to describe those who respond to medical emergencies. Broadly used, a first responder is the first medically trained RESTRICTED  46 RESTRICTED personnel who comes in contact with a patient. This could be a passerby, citizen volunteer, or fire department, police, military person or emergency medical services personnel. 2. Emergency Medical Services. The Emergency Medical Services (EMS) System is a network of resources linked together for the purpose of providing emergency care and transport to victims of sudden illness or injury 3. Medical First Responder. The first person on the scene of an incident with emergency medical care skills, typically trained to the most basic EMS level. 4. Duties of MFR a. Protect your safety and the safety of your crew, the patient and bystanders b. Gain access to the patient c. Assess the patient to identify life threatening problem d. Alert additional EMS resources e. Provide care based on assessment findings f. Assist other EMS personnel g. Participate in record-keeping and data collection as received h. Act as liaison with other public safety workers i. Perform patient packaging and preparation for movement and transport 5. An EMR usually does not transport patients to the hospital. EMTs have more advanced skills, are able to administer additional emergency medications, and are trained in the transport, stabilization, and ongoing assessment of patients 6. A first responder is a person with specialized training who is among the first to arrive and provide assistance at the scene of an emergency, such as an accident, natural disaster, or terrorism. First responders typically include law enforcement officers, paramedics, EMT's and firefighters 7. An emergency medical technician (EMT) is a medical professional who gives emergency care to people outside of or on the way to the hospital. They can give basic RESTRICTED  47 RESTRICTED medical and first-aid care until a person can get help at a hospital or other medical facility 8. The basic difference between EMTs and paramedics lies in their level of education and the kind of procedures they are allowed to perform. While EMTs can administer CPR, glucose, and oxygen, paramedics can perform more complex procedures such as inserting IV lines, administering drugs, and applying pacemakers 9. EMTs are trained to give Basic Life Support (BLS) treatments, so they are able to Perform CPR and use an AED. Bandage wounds. Stabilize head and neck injuries RESTRICTED  48 RESTRICTED Chapter - 7 RIGHTS OF PATIENT 1. Abandonment. Discontinuing emergency medical care without making sure that another health care professional with equal or better training has taken over 2. Negligence. Failure to provide the expected standard of care, causing injury or death of the patient 3. Rights of Patient. A patient's bill of rights is a list of guarantees for those receiving medical care. It may take the form of a law or a non-binding declaration. a. To solicit and receive pre-hospital care b. Confidentiality regarding personal information and condition. c. To pursue legal recourse for acts of negligence, abandonment, and/or violations of confidentiality. d. To denounce and demand restitution for improper care and/or any violation of privacy. e. In some situations, the patient has the right to refuse care. 4. Consent. There are three different types of consents: - a. Implied Consent. Consent assumed on the part of an unconscious, confused or seriously injured patient or, for a minor patient that cannot make decisions. b. Express Consent. Permission obtained from every responsive, competent adult patient before providing emergency care. c. Involuntary Consent. Consent granted on the authority of court order. 5. Incident. An event caused by a natural phenomenon or human activity that requires the intervention of emergency service personnel to prevent or mitigate loss of life and damage to property and the environment. RESTRICTED  49 RESTRICTED Chapter - 8 Anatomical References 1. Normal Anatomical Position. Patient standing erect with arms down at the sides, palms facing forward. “Right” and “left” refers to the patient’s right and left 2. Conventional References a. Anatomical Planes (1) Medial Plane (2) Frontal plane (3) Transverse plane b. Positional terms (1) Prone (2) Supine (3) Lateral c. Extremities and Subdivisions (1) Proximal (2) Distal d. Body Regions (1) Head (2) Neck (3) Trunk (4) Upper limbs (5) Lower limbs e. Body Cavities (1) Cranial RESTRICTED  50 RESTRICTED (2) Thoracic (3) Abdominal (4) Pelvic (5) Spinal f. Abdominal Quadrants (1) Right upper quadrant (2) Left upper quadrant (3) Right lower quadrant (4) Right lower quadrant g. Body Systems (1) Nervous system (2) Respiratory system (3) Circulatory (4) Digestive (5) Urinary system (6) Reproductive (7) Musculoskeletal (8) Endocrine (9) Skin RESTRICTED  51 RESTRICTED Chapter - 9 Assessment and Procedure 1. Initial Assessment. A process used to identify and treat conditions posing an immediate threat to the patient’s life 2. Arrival at the Scene a. Ensure your own personal safety. b. Ensure patient safety. c. Establish a general impression of the scene and begin initial assessment of the patient. d. Identify and treat life-threatening conditions. e. Stabilize and continue to monitor the patient. 3. Identify Yourself a. State your name and organization. b. Identify yourself as a medical first responder. c. Ask the patient if you may help him/her (obtain consent) 4. Immediate Sources of Information a. The scene itself (observe, plan, react) b. Patient (if responsive) c. Relatives or bystanders d. The mechanism of injury (forces that caused the injury) e. Any remarkable deformity or obvious injury f. Any sign or characteristics of certain types of injury or illness 5. Steps Of Initial Assessment a. Form a general impression b. Check for responsiveness (AVPU) (1) Alert (2) Verbal RESTRICTED  52 RESTRICTED (3) Pain (4) Unresponsive c. Ensure adequate airway (1) Responsive (2) Unresponsive d. Verify breathing (1) look, listen, feel (2) Adequate (3) Inadequate e. Assess circulation (1) Responsive patient (2) Unresponsive patient (3) Control serious external bleeding (4) Begin CPR if pulse is absent f. For patient status update, Inform responding EMS units of your findings (1) If patient has life threatening condition (2) If more resources needed (3) If patient is stable with minor injuries 6. Physical Examination. The main purpose of the physical exam is to reveal any injury or medical problem that could be a threat to patient survival if left untreated a. Principles (1) Inspection (looking) (2) Palpation (feeling) (3) Auscultation (listening) b. Examine from head to toe (1) Head (2) Neck (3) Chest RESTRICTED  53 RESTRICTED (4) Abdomen (5) Pelvis (6) Upper Limb (7) Lower Limb (8) Back c. Vital signs (1) Pulse rate (2) Blood pressure (3) Respiratory rate (4) Skin (5) Pupils d. Breathing (1) Rate (2) Frequency (3) Depth (4) Smooth/ Noisy e. Pulse (1) Rate (2) Rhythm (3) Strength (4) Site f. Skin (1) Temperature (2) Capillary refill (3) Colour (a) Redness (b) Paleness (c) Blueness (d) Yellowness RESTRICTED  54 RESTRICTED (e) Black and blue mottling g. Pupils (1) Pupillary reaction h. Blood pressure (1) Normal values (2) Factors influencing blood pressure (3) Methods of taking BP 7. Patient History a. Signs and symptoms b. Allergies c. Medication d. Past history e. Last meal f. Events 8. Ongoing Assessment. Complete the following every 5 minutes for unstable patients and every 15 minutes for stable patients: - a. Re - Assess LOC (alert, verbal, painful, unresponsive). b. Re - Assess and correct any airway problems. c. Re - Assess breathing for rate and quality. Ventilate as needed. d. Re - Assess pulse rate and quality. e. Re - Assess skin temperature, colour and condition. f. Repeat any part of physical exam that may be needed. g. Reassess your interventions (treatment) to check effectiveness. h. Continue to calm and reassure the patient. 9. Hand - Off Report a. Patient age and sex b. Chief complaint c. Level of consciousness RESTRICTED  55 RESTRICTED d. Airway status e. Breathing status f. Circulation status g. Patient history h. Treatment given 10. Infectious Diseases and Precautions a. Modes of Transmission (1) Direct contact (a) Body fluid (b) Open wounds or body tissues (c) Contact with mucous membranes (2) Indirect contact (a) Air borne through sneezing, coughing, breathing (b) Contaminated instruments 11. Diseases of Concern a. Hepatitis (A, B, C, D, E) b. HIV (AIDS) c. TB d. Cholera e. Typhoid f. Dengue g. Common cold h. Sexually transmitted diseases i. Nausea j. Yellowish coloration of the skin and sclera of the eyes k. Headache, chest or abdominal pain l. Coughing or shortness of breath RESTRICTED  56 RESTRICTED m. Diarrhea n. Fatigue o. Weight loss 12. Signs and Symptoms a. Nausea b. Yellowish coloration of the skin and sclera of the eyes c. Headache, chest or abdominal pain d. Coughing or shortness of breath e. Diarrhea f. Fatigue g. Weight loss 13. Body Substance Isolation (BSI). A strict form of infection control based on the premise that blood and other bodily fluids are infectious. 14. BSI Precautions a. Hand washing b. Cleaning equipment (1) Cleaning (2) Disinfection (3) Sterilization c. Using personal protective equipment (1) Latex gloves (2) Mask (3) Gown (4) Goggles 15. Immunization a. Tetanus b. Hepatitis A, B c. Measles d. Mumps RESTRICTED  57 RESTRICTED e. Rubella f. Polio g. Influenza 16. Reporting Exposures. Report any suspected exposure to blood or bodily fluids to your supervisor as soon as possible. Include in your report the date and time of the exposure, the type and the number of bodily fluids involved, and details of the incident. RESTRICTED  58 RESTRICTED Chapter - 10 BASIC LIFE SUPPORT (BLS) AND CARDIOPULMONARY RESUSCITATION (CPR) 1. Anatomy and Function of Heart and Lungs a. Cardiovascular system (1) Heart (2) Arteries (3) Capillaries (4) Veins b. Respiratory system (1) Airway (2) Alveoli (3) Musculoskeletal system (4) Arteries, capillaries and veins 2. Death. Neither consciousness nor spontaneous respiration is possible in the absence of functional brain. a. Clinical death (reversible) b. Biological death (irreversible), exceptions e.g., cold water drowning c. Signs of death a. Lividity b. Rigor mortis c. Decomposition d. Others 3. Artificial Ventilation a. Opening of Airways RESTRICTED  59 RESTRICTED (1) Head tilt and chin lift (2) Jaw thrust b. Artificial ventilation (1) Mouth to mask (2) Mouth to barrier device (3) Mouth to mouth 4. Heart Attack a. Factors that cannot be changed: - (1) Family history (2) Sex (3) Ethnic background (4) Age b. Risk factors that can be changed: - (1) Smoking (2) High blood pressure (3) High cholesterol (4) Physical activity c. Contributing factors: - (1) Obesity (2) Diabetes (3) Express stress 5. Cardiopulmonary Resuscitation (CPR) a. Preparation steps for CPR: - (1) Establish Un-Responsiveness (2) Activate EMS (3) Perform CAB (a) Compression (b) Airway RESTRICTED  60 RESTRICTED (c) Breathing 6. Cardiopulmonary Resuscitation (CPR) a. Steps: - (1) Position the patient (2) Expose patient’s chest (3) Get in position (4) Locate compression site (5) Position your hands (6) Position your shoulder (7) Start compressions b. Adult (9yrs +) CPR protocol: - (1) Compression depth: at least 2 inches (5 cm) (2) Compression rate: at least 100 per minute (3) Each ventilation: 1 second (4) Pulse location: carotid artery (5) One-rescuer cycle: 30 compressions, 2 breaths (6) Two-rescuer cycle: 30 compressions, 2 breaths (7) 5 cycles (about 2 minutes) c. Child (1-8yrs) CPR protocol: - (1) Compression depth: at least 1/3 anterior-posterior diameter or about 2 inches (5 cm) (2) Compression rate: at least 100 per minute (3) Each ventilation: 1 second (4) One-rescuer cycle: 30 compressions, 2 breaths (5) Two-rescuer cycle: 15 compressions, 2 breaths (6) 5 cycles (about 2 minutes) d. Infant (1yr old and under) CPR protocol: - (1) Compression depth: at least 1/3 anterior-posterior diameter or about 1.5 inches (4cm) RESTRICTED  61 RESTRICTED (2) Compression rate: at least 100 per minute (3) Each ventilation: 1 second (4) Pulse Location: Brachial artery (5) One-rescuer cycle: 30 compressions, 2 breaths (6) Two-rescuer cycle: 15 compressions, 2 breaths (7) 5 cycles (about 2 minutes) e. Signs of successful CPR: - (1) Have someone feel for a pulse during compressions (2) The chest should rise and fall with each ventilation (3) The pupils may begin to react normally (4) Patient’s skin colour may improve (5) Patient may attempt to move and try to swallow (6) Heartbeat may return 7. When not to CPR a. Obvious mortal wounds b. Rigor mortis c. Decomposition d. Lividity e. Stillbirth 8. Complications of CPR a. Fracture of the sternum and ribs b. Pneumothorax c. Hemothorax d. Cuts and bruises to the lungs e. Lacerations to the liver 9. Common Mistakes in CPR a. Patient not on hard surface b. Patient not in horizontal position RESTRICTED  62 RESTRICTED c. Improper head tilt and jaw thrust d. Incomplete seal around patients’ mouth or nose e. Nostrils not pinched properly during mouth-to-mouth breathing f. Improperly placed hands g. Improper depth of compressions h. Improper compression ventilation ratio 10. Foreign Body Airway Obstruction (FBAO) a. Causes of airway obstruction: (1) Tongue (2) Epiglottis (3) Foreign bodies (4) Tissue damage (5) Illness b. Recognizing FBAO (1) Stridor (2) Stops breathing (3) Cyanosis (4) Loss of consciousness c. Types of FBAO (1) Partial (2) Complete 11. Management of FBAO in Adults and Children a. Responsive (patient standing or sitting): (1) Take BSI precautions (2) Determine whether obstruction partial or complete (3) Encourage the pt. to cough if partial obstruction (4) Get into position (5) Position your hands RESTRICTED  63 RESTRICTED (6) Perform abdominal thrusts (7) Repeat thrusts (8) Activate EMS and begin CPR if Pt become unresponsive before airway clearance b. Unresponsive (patient lying down): (1) Position the patient supine (2) Assess responsiveness (3) Get into position and begin CPR (4) After 30 compressions open airways (5) Attempt to give proper ventilation (6) Continue CPR if 2 attempts fail to achieve chest rise c. Responsive (patient standing or sitting): (1) Determine if partial or complete obstruction (2) Get into position (3) Position your hands (4) Perform a chest thrust (5) Repeat thrusts if fail to expel foreign body (6) Activate EMS and start CPR if patient become unresponsive before airway clearance 12. Managing FBAO in Infants a. Conscious infant: (1) Verify complete obstruction (2) Position the infant (3) Deliver 5 back blows (4) Deliver 5 chest thrusts (5) Repeat until successful (6) Perform CPR if infant become unresponsive RESTRICTED  64 RESTRICTED b. Unconscious infant: (1) Establish unresponsiveness (2) Begin CPR (3) Open airway, after 30 compressions (4) Attempt to give ventilation (5) Start CPR after two failed attempts to ventilate (6) Repeat CPR cycles until foreign body expels 13. Oxygen Therapy a. Indications: (1) Heart failure/ heart attack (2) Respiratory deficiency (3) Bleeding (4) Head injury (5) Poisoning RESTRICTED  65 RESTRICTED COLLAPSED STRUCTURE SEARCH & RESCUE (CSSR) RESTRICTED  66 RESTRICTED Chapter - 11 Introduction to CSSR 1. Lesson Objectives a. Upon completing this lesson, you will be able to: b. Define a collapsed structure search and rescue operation. c. Describe the structure of a CSSR squad and the positions within it d. List five phases of a CSSR operation. e. List the six stages of the Operations phase. f. List the five steps of the initial assessment. g. Describe how a CSSR squad fits into the Incident Command system. h. Name the four levels in the scope of operations as they pertain to CSSR. 2. Collapsed Structure Search and Rescue. According to the National Fire Protection Act (NFPA 1670) CSSR is an operation to conduct safe and effective search and rescue operations at collapsed structure incidents involving the collapse or failure of reinforced and unreinforced masonry, concrete and heavy timber construction etc. 3. CSSR Squad. An active component of an emergency response system whose purpose is to search for, locate, gain access to, stabilise and extricate trapped victims from a collapsed structure. 4. CSSR Squad Organisation Squad Leader Rescue Rescue Rescue Rescue Rescue Specialist Specialist Specialist Specialist Specialist (L) (L) – Squad members rotate positions as Logistics Person RESTRICTED  67 RESTRICTED 5. Operation phases 1. Preparation Stages 3.1 Safety and security Steps 3.2 Initial Assessment 2. Activation and Mobilisation 3.2.1 Compile information 3.2.2 Command Post 3.2.3 Operational objectives 3. OPERATIONS 3.2.4 Assign tasks 3.2.5 Reassess and adjust 3.3 Search and locate 4. Deactivation and 3.4 Gain access to patient Demobilisation 3.5 Stabilise the patient 3.6 Extricate the patient 5. Post- Operational Activities 6. CSSR Response 7 days Survival Rate (%) Buried Highly (trapped specialised Increased training/ more equipment beneath and equipped structural teams elements) 2 days 5% Estimated Time Elapsed CSSR Team scope of Trapped First in void 15% response action 8 hours spaces teams Trapped, Community beneath 30% response non-structural groups elements 4 hours 50% Improvised rescues Injured victims, by neighbors and not trapped passers-by near the collapse site Victim Status Type of Response RESTRICTED  68 RESTRICTED 7. Incident Command System. A flexible system for managing people and resources. Incident Commander Information Officer Safety Officer Liaison Officer Finance/ Operations Planning Logistics Administration Section Section Section Section 8. Scope of Operation RESTRICTED  69 RESTRICTED Affected region City or area Scene Work Site RESTRICTED  70 RESTRICTED Chapter - 12 CSSR OPERATION SAFETY 1. Safety in CSSR Operation a. CSSR op are the most complex and difficult activities that first responders team face in the line of duty. b. After the Mexico City earthquake in 1985 almost as many rescuers were killed as there were victims of the actual earthquake. 2. Unsafe Actions and Conditions a. Unsafe Actions b. Unsafe Conditions 3. Course Safety Rules a. Practice areas b. PPE c. Hygiene d. Safety Officer e. Group safety f. Safety Zone g. Rotations h. Safety Marking i. Violations 4. Course Safety Rules a. Whistle signals (1) Stop : — (2) Evacuate : (3) Continue : — b. Safety Zone c. Fire extinguishers d. Drinking water e. Maintenance RESTRICTED  71 RESTRICTED f. Rotations g. Smoking and drinking h. Weather conditions i. Safety markings j. Team safety k. Safety violations l. Miscellaneous 5. CSSR Msn Phs a. Prep b. Activation and mob c. Ops d. Deactivation and demobilisation e. Post-mission activities 6. Safety Considerations a. The CSSR team leader is responsibility for the safety of his team members b. However, SAFETY is everybody’s responsibility 7. Prep phase a. Cultivate a positive attitude b. Safe procedures and protocols c. Maintenance of equipment d. Training of personnel e. Training f. Well informed 8. Activation and Mob phase a. Establish safety procedures b. Safety in briefings c. Ensure PPE d. Ensure safety RESTRICTED  72 RESTRICTED 9. Operational Phase a. Correctly identify the risks b. Include following in daily briefings (1) Alert and alarm signals (2) Escape routes (3) Designate safety officer (4) Use of identity signs (5) Med facility location and transport 10. Safety Guidelines on Work Site a. including safety standards in work b. Monitor ops c. Accounting of personnel d. Personal rotations e. Monitor personnel for fatigue 11. Post Mission Activity a. Including all info in msn report including lessons learned b. Hold post msn evaluation session c. Document how to improve specific safety procedures d. Treatment of PTSD e. Replace worn-out material 12. Safety Officer a. The Safety Officer has the auth to alter, suspend or terminate activities involving an imminent hazard to persons b. The safety officer or lookout works from a safe and clear visual access just outside of the direct work area c. The person must not become involved with actual hands-on job d. To do so would possibly limit his ability to continue being an observer capable of identifying hazards RESTRICTED  73 RESTRICTED 13. Safety Officer Category a. Overall b. Site-specific c. Special Hazards 14. Safety Briefing Components a. Chain of Comd b. Identifying the Safety Officer c. Safety Plan (LCES) d. Comm Plan 15. Safety Plan a. L — Lookouts b. C — Comm c. E — Escape routes d. S — Safe zones 16. Safety Briefing Components a. Medical Plan b. Rehabilitation Plan c. Specific hazards d. General safety message RESTRICTED  74 RESTRICTED CHAPTER – 13 CONST MATERIALS, STRUCTURE AND DAMAGE TYPE 1. Construction Materials a. Natural material processed by man and used in the construction of buildings, which consist of structural and non-structural elements b. Classified by composition (1) Stones (a) Marble (b) Granite (c) Slate Marble Granite RESTRICTED  75 RESTRICTED Slate (2) Organic materials a) Wood b) Plywood c) Paper d) Particle board Wood Plywood RESTRICTED  76 RESTRICTED Paper Particle board (3) Metals (a) Iron (b) Steel (c) Aluminium Iron Aluminium (4) Conglomerates (a) Concrete (b) Plaster RESTRICTED  77 RESTRICTED (c) Adobe (d) Clay Concrete Plaster Adobe Clay RESTRICTED  78 RESTRICTED (5) Ceramics (a) Tiles Tiles (6) Glass (a) Window (b) Glass block Windows Glass block (7) Plastics (a) Polyurethane (b) Thermosetting adhesive (c) Duct Tape RESTRICTED  79 RESTRICTED Polyurethane Thermosetting Adhesive c. Classified by use: - (1) Structural load bearing element (2) Decorative element (a) Façade (b) Veneer RESTRICTED  80 RESTRICTED Façade Veneer (3) Non-structural walls ad partition (4) Covering element (roofing) Non-structural walls and partition 2. Tension. Force that acts to elongate or stretch a material RESTRICTED  81 RESTRICTED 3. Compression Force. Force that acts to crush or compress a material 4. Shear Forces. Forces acting in opposite direction, parallel direction and on different and on different planes so that they cut or break a material 5. Methods Of Construction a. Unframed Structures. Structure in which the weight of the floors and roof are supported by the bearing walls. RESTRICTED  82 RESTRICTED b. Framed Structures. Structures that are erected by constructing a structural steel or reinforced concrete skeleton made of horizontal beams and vertical columns. Unframed Structure Framed Structure 6. Structural Types a. Lt frame b. Hy wall c. Hy floor d. Pre-cast concrete 7. Characteristics of a Structure a. General b. Architecture c. Structural elements d. Non-structural elements 8. Damage Types to a Building. It can be classified as two types: - a. Structural. Affecting structural (load-bearing) elements b. Non-Structural. Affecting non-structural and decorative elements RESTRICTED  83 RESTRICTED 9. Basic Collapse Patterns a. Cantilever b. Pancake c. Lean to V shape Cantilever Pancake Lean to V Shape RESTRICTED  84 RESTRICTED CHAPTER - 14 SEARCHING AND LOCATION 1. Definition. A set of tech and procedures whose purpose is to obtain a response or indication of the presence of live victims in a void space within a collapsed structure. 2. The survival rate is: - 100 91 81 90 Survival Rate (%) 80 70 60 50 36.7 33.7 40 30 19 20 10 7.4 0 0.5 24 48 72 96 120 Time Elapsed (Hours) 3. Search Squad Squad Leader Rescuer 1 Rescuer 2 Rescuer 3 Rescuer 4 Rescuer 5 a. Squad Leader RESTRICTED  85 RESTRICTED (1) Responsible for developing the search plan, drawing diagrams, documentation and making recommendation to the Incident Commander. (2) Performs the duties of the Safety Officers and is responsible for monitoring security during the search op. b. Basic Equipment for Search (1) PPE (2) Personal supplies (for 12 hours) (3) Drinking water (4) Food (5) Proper clothing (6) Marking supplies (a) Paint (b) Chalk (c) Flags (d) Cones (e) Markers (7) Communication devices (8) Warning and alert devices (a) Megaphone (b) Whistle (c) Hammer (d) Flags (9) Recce & Vision Devices RESTRICTED  86 RESTRICTED (a) Binoculars (b) Photo camera (c) Flashlight (10) Radio Equipment (a) Radio equipment to communicate with team members and Command Post. (b) Portable radios (walkie-talkie) (11) Additional Material (a) Search diagrams, pencils, color pens, clipboards (b) Technical search equipment, specialized or improvised (c) Hazardous gas detector 4. Steps to Search and Location a. Compile and analyze information b. Secure the scene c. Inspect and evaluate the structure d. Rescue surface victims e. Make markings on the structure f. Create a diagram g. Select search area h. Select search method i. Conduct search and place INSARAG markings on structure and diagram j. Analyze results and re-evaluate k. Pre-hospital treatment l. Confirm potential victim location RESTRICTED  87 RESTRICTED 50% Victims Trapped on surface 35% victims lightly trapped 15% victims trapped in void spaces 50% victims on surface