CRICOS Number 00213J Australian Health Protection Committee Disaster Health Strategic Leadership...

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Australian Health Protection Committee

Disaster Health Strategic Leadership Program

Prof. Gerry FitzGerald

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Session 1: Principles of Disaster Health

Management• Definitions• Epidemiology and trends• Impact • Conceptual Frameworks• Principles and approaches of disaster health

management • Infrastructure Protection and business continuity

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Principles of disaster health management

• The objective of this session is to develop a common language and understanding of the principles and practice of disaster management.

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Definitions危机 (Crisis) = 危 (Danger) + 机

(opportunity)

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Emergency Management Australia “DISASTER”

“A serious disruption to community life

which threatens or causes death or injury in that community, and

damage to property which is

beyond the day-to-day capacity of the prescribed statutory authorities

and which

requires special mobilisation and organisation of resources other

than those normally available to those authorities.”

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What is a disaster?

• Everyday use “I had a disaster of a day”

• Dictionary definition“A sudden calamitous event producing great material damage, loss and distress”

The commonalities and ideas are more important than strict wording.

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A little perspective

• Each day over 20,000 Australians are treated at hospital Emergency Departments and over 8,000 are transported by ambulance.

“We have never had an event with 20,000 casualties in Australia.

Except every day!”

• So what is different in disasters?

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Is this a disaster?

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Or this?

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Is this a disaster?

• How many died?• How much damage was done?

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Terminology

Cat

astr

ophe

Health needs

Factors influencing health needsNature of the eventScope Location

Factors influencing resource levelsSocioeconomic statusCulture and attitudesTime of day

The mismatch between resources and health needs.

Resources

Em

erge

ncy

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What is a disaster?

• Disasters are relative:• To the nature of the event• To the resources available• To the location • To the time of day

For example:• A motor vehicle crash in a small rural town• Involvement of high profile people

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The “Event” Focus.

• Not all disasters are events.

But what about! • Pandemics: have special characteristics• The silent disasters (HIV/AIDS, TB, malaria,

poverty)• Heatwave: the biggest killer in Australia.

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CRED: Trends in disasters

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CRED: Trends, events and casualties

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Source: CRED

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Are disasters increasing?

• Improved reporting CNN as first responder

• Increased population and density 3m people now live in the

vicinity of Vesuvius

• Cities in high risk areas. 64 of the largest cities in the

world are in seismic zones or flood plains.

• Global warming Increased storm activity

• Increased technology Mass transport Chemical industrialisation Transport of dangerous goods

• Economic stress Urban slums in dangerous

environments

• Armed conflict Terrorism

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TYPES OF DISASTER

• All disasters are related to specific hazards and the hazards may be categorised.

(1) Natural

(2) Mixed (Natural + Man-made)

(3) Man-made

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CRED Categorisation of Natural Disasters

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Mixed: Natural + human caused

• Drought• Desertification• Floods• Erosion• Landslides/mudslides• Fire• Health-related• Infectious disease• Genetic • Other

How does human activity contribute?

(Guidelines for evaluation and research in the Utstein Style)

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Man-made (Human caused)

• Technological• Release of substances (chemicals, biological, nuclear)• Transport• Structural failure• Explosions• Fire• Environmental interference• Other

• Conflict• Armed conflict

• Conventional war• Armed conflict/civil conflict• Complex human emergency• Terrorism• Other

• Unarmed conflict (sanctions, embargos)

(Guidelines for evaluation and research in the Utstein Style)

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COST OF DISASTERS

• Human Costs• Deaths• Injuries and illness• Loss and grief

• Economic Costs• Actual costs• Intangible costs

• Environmental costs• Social costs

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Health impacts

• For every death• How many ICU admissions?• How many hospital admissions and surgical

procedures?• How many ED attendances?• How many injured requiring medical care?• How many do not require medical care (initially at

least?)

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Mapping the consequences and the impact

• Need to analyse the impact of particular events on human health in order to appropriately manage the secondary consequences.

• Understand the complexity of relevant relationships in order to better target interventions.

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Mapping the impact

TimelinessAssociation

Immediate Mid-term Long term

Direct e.g. drowning

Indirect e.g. Poverty related malnutrition

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Australia’s quarterly GDP growth

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Figure 3: Impact of disasters on development. Source:(Asian Disaster Reduction Center, 2005)

Impact of disasters on economic development

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Environmental impact:• Land degradation• Damage to historical artefacts• Loss of species (e.g. consider impact of bird

flu on big cats, loss of livestock during flood)• Pollution of water and water sources (e.g. oil

spills, chemical spills from factories, waterborne diseases, epidemics)

• Pollution in air (e.g. ash from volcano)

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Social impact• Civil disruption and conflict• Loss of sustainable social infrastructure• Loss of community support and cohesion• Uncertainty • Family stress and changes to work• Dependants may no longer be

able to attend school

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DISASTER HEALTH:PRINCIPLES AND APPROACHES

• A different paradigm• A prepared resilient community• Familiarity: a response based on normal activities• Risk based• All hazards• All agencies• Comprehensive PPRR approach

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A different paradigm: The greatest good for the greatest number

“ALL FOR ONE” to “ONE FOR ALL”

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A prepared resilient community

• Individual and community self-help is often the most effective and decisive immediate relief. Assistance that arrives in the first 24 hours to 48 hours is the most effective.

• Affected communities turn first to local agencies for advice, assistance and support.

• Local government and organisations provide the basis for organising self-help. Bhuj, Gujarat State, India

25 January 2001

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FAMILIARITY: Responses based on normal activities

• The response to major events should be

consistent with normal arrangements

wherever possible to avoid confusion

and lack of knowledge.

• This is not the time to learn

something different

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RISK MANAGEMENT Approach

• A structured and logical approach to the identification and management of risks will assist communities to minimise the likelihood or impact of disasters.

• A focus on risks reduces the likelihood of “fighting the last war – not the next”.

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Integrated ALL AGENCIES approach

• All agencies likely to be involved in a disaster, work together in planning and response and in recovery.• Common rules• Role clarity• Multidisciplinary approaches• Communication strategies

EMA – Australian Emergency

Manuals Series. “PLAYS WELL WITH OTHERS”

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ALL HAZARDS Approach

• Different hazards cause similar problems.

• Standardise response arrangements to enable familiarity and immediate

response. This allows the response to commence before all the

information is available.

• Identify hazard-specific measures that complement standardised

responses.

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COMPREHENSIVEApproach

• Prevention & mitigation• Preparedness, surveillance & planning• Response & relief• Recovery, rehabilitation & re-development

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The planning framework

It is critical to know of and understand the existence and hierarchy of plans• International plans and standards: in particular

WHO plans and standards• National disaster plan• National plans for health in major incidents

including special plans, e.g. pandemic plan• Local and organisational plans

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Session 1: Principles of Disaster Health

Management

Acknowledgements:

A/Prof Peter Aitken, JCUAdjunct Prof Mike Tarrant