MEDICAL APPROACH FOR

INDUATRIAL DISASTER

MANAGEMENT

DR. S. K. HALDAR

DY DIRECTOR GENERAL

DGFASLI, GOI

MUMBAI

WHAT IS A DISASTER ?

A disaster is a catastrophic situation in

which the day-to-day patterns of life are,

suddenly disrupted and people are plunged suddenly disrupted and people are plunged

into helplessness and suffering and, as a

result, need protection, clothing, shelter,

medical and social care and other necessities

of life.

Chemical Emergency :

Chemical emergency in any industry can be

described as Disaster. Management of

disaster is a task which tests the disaster is a task which tests the

resourcefulness of people who handling

it.

Some Catastrophic Accidents :

• Mississarega Railway chlorine transport accident in Canada, 1979

• Bhopal Methyl Isocyanate disaster in India, Dec., 1984Dec., 1984

• Explosion in gasoline tank in Maxico city, 1984

• Carnobyl nuclear power plant accident in Ukrain, 1986

• The Basle fire accident of a chemical storage, 1986

Atomic Explosion

Fire

Case Study in a Fertilizer Industry

A.Raw Material Quant. State Temp.

1. Ammonia 30,000 MT Liq. -33 deg.C

2. Sulphur 60,000MT Loose open in Solid

B. Intermediate

1. Sulphuric Acid 40,000MT Liq.1. Sulphuric Acid 40,000MT Liq.

2. Phosphoric Acid 4,000MT Liq.

C. Finished Product

Diammonium Phosphate

Causes of Investigation:

In the Year 2000

1. Excess flow of Ammonia from the tank

2. Fire of Sulpher2. Fire of Sulpher

Results :

Fatal & Non-fatal injuries

Recommendation :

Medical Aspects of Emergency prepardness should be incorporated.

PRE-DISASTER PLANNING :

Preparedness : It covers all actions taken with a

view to organizing and facilitating timely

and effective rescue, relief and

rehabilitation.rehabilitation.

Prevention : It means the formulation and

implementation of long term policies and

measures to mitigate the impact.

Factories (Amended) Act, 1987

Chapter IV-A, Section-41-A, Sub-section-(4):

Every occupier shall, with the approval of Chief

Inspector, draw up an on-site emergency plan and

detailed disaster control measures for his factory anddetailed disaster control measures for his factory and

make known to the workers employed therein and to

the general public living in the vicinity of the factory

the safety measures required to be taken in the event of

the accident taking place.

Indian National Disaster Guidelines

Activation of Medical First Response (MFRs)

will be carried out by an inbuilt triggering will be carried out by an inbuilt triggering

mechanism for prompt emergency medical

response at the site, during evacuation and

treatment of casualties at the hospitals.

OCCUPATIONAL HEALTH

SERVICE SCHEME :

A well established and functioning

enterprise level occupational health service

scheme (OHS) forms the basis of Major

Accident Hazard Control Scheme. An Accident Hazard Control Scheme. An

occupational health programme aims to

promote and maintain the highest possible

level of health of the employees.

THE RELIEF MEASURES OF A MAJOR

ACCIDENT :

ITS MEDICAL PREPARDNESS PLAN -

1. On-site Plan : Organization at the site

of disasterof disaster

2. Transportation :

3. Off-site Plan :

TRIAGE & RECEPTION UNIT

QUICK SHELTERS FOR ACCOMMODATION

ON-SITE PLAN

Ideally at least one full-time Doctor along with para

medical staff should be available at all the times at the

factory medical centre (Trauma Team).

It should have a large consultation room, one store room,

treatment room, a waiting room, a store room, and toilets.

Adequate number of beds should be provided.

It should have an illuminated board with prominent red-It should have an illuminated board with prominent red-

cross in white background for easy identification

It should be easily accessible by good roads.

An ambulance with a driver & helper should be readily

available at all times.

It should work round the clock on all days in a week.

Should be away from dispersion modules

IN ADDITION TO ROUTINE MED. EQUIP., THE

FOLLOWINGS ARE REQUIRED :

1. First aid kits

2. Sterile burns dressing

3. Stretchers

4. Suction apparatus

5. Specific antidotes

6. Oxygen cylinders and masks

7. Eye wash bottles with sterile normal saline

8. IV drip stands & fluids and infusion sets

9. All equipments for emergency cut down, tracheostomy,

orthopaedic first aid, CPR etc.

10. Well-stocked medical store with equipments & medicine

FOR READY REFERENCE,

HAZARD DATA AND DISASTER

PLAN MANUAL WITH

SPECIFIC INSTRUCTIONS

SHOULD BE AVAILABLE IN

THE MEDICAL CENTRE

ACTION PLAN1. Employee should be trained in first aid & be available at short

notice to take part in the rescue operation

2. Periodical mock drill should be conducted so that each one knows

his exact role & responsibility.

3. Liaison with nearby reference hospital

4. All employees should have had their blood grouped and routine

immunization carried out

5. A mutual-aid-scheme should be worked out in case of a industrial 5. A mutual-aid-scheme should be worked out in case of a industrial

complexes.

6. A system of “TRIAGE” is to be adopted to classify the patients into

different groups depending upon the severity of the injury &

urgency of transportation.

i. Category-I (Red tag) :

ii. Category- II (Blue tag) :

iii. Category- III (yellow tag) :

iv. Category- IV (Green tag) :

v. Category- X (Black tag) :

FUNCTION : APPROPRIATE EMERGENCY FIRST AID

TREATMENT AT THE EARLIEST :

1. To reduce delay time or reaction time : quick removal of the casualties

from disaster site.

2. Prevention of respiratory failure & administration of oxygen

3. Control of bleeding

4. Replacement of suitable fluid for loss of blood

5. Treatment of shock

6. Administration of suitable pain killers

7. Supportive treatment of for cardiac, respiratory & other system

8. Splinting & immobilisation in case of fractures

9. To keep the body warm with blankets & to protect open wounds with

suitable sterile dressing.

10. Moral support to the injured

11. Maintenance of medical records

12. Dead body if any, is to be identified & dealt in the appropriate manner

13. Distribution to the injured to referral centre

TRIAGE SYSTEM

The process of triage is used, to sort out

patients into categories of priority for

care and transport, based on the care and transport, based on the

severity of injuries and medical

emergencies. The sorting of patients

begins as soon as trained personnel

reach the site or sees the sick and

injured persons.

TRANSPORTATION

1. Ambulances

i. Having equipments to restore vital organs

ii. Having no equipments to restore vital organs

2. Every vehicle available that can be used as a carrier of

the injured should be utilized.

FIRST RESPONDER CRITICAL CARE AMBULANCE

INTERIOR OF AMBULANCE

REAR LIGHT

PUBLIC ADDRESS SYSTEM

ROOF TOP AIR CONDITIONING

AMPLE STORAGE SPACE

STRETCHER-CUM-TROLLEY

ATTENDANT SEAT

FOOT OPERATED - DRINKING

WATER

FOOT OPERATED - WASHING

WATER

ELECTRONIC GAS MANIFOLD

GAS MANIFOLD REGULATORS

STORAGE FOR JUMBO CYLINDERS

TROLLEY FOR JUMBO CYLINDERS

MOTORBIKE AMBULANCE

VENTILATION , OXYGEN INHALATION & SUCTION DEVICE

PATIENT MONITOR

DEFIBRILLATOR WITH DATA

TRANSMISSION

EMERGENCY BAG WITH VENTILATOR, SUCTION &

OXYGEN INHALATION

MASS CASUALTY OXYGEN

DELIVERY SYSTEM

MOUTH TO MOUTH RESPIRATION

SPLINT APPLICATION

VACUUM STRETCHER

AIR LIFITING BY RESCUE STRETCHER

OFF-SITE PLAN

1. Crash Team :

2. Mobilization of hospital emergency plan to creat

maximal admission

3. Peak load volume :

4. Premature discharge of lying-in patients

5. Increasing the bed capacity with equipments & facilities5. Increasing the bed capacity with equipments & facilities

6. Classification of casualties again :

i. Very serious (fatal & immediately fatal with

disturbance to vital organs) :sent to ICU

ii. Serious ( life threatening injuries which can be saved

with immediate medical attention) : sent to emer. ward

iii. Less serious (minor injury): sent home after first aid

INTERNAL VIEW OF THE SURGICAL

UNIT OF HOSPITAL

THE “3in1” FOLDABLE OPERATING THEATRE ON ITS WAY TO IRAQ WITH A C-130 HERCULES

SYSTEM FOR INDIVIDUAL DECONTAMINATION

(SHOWER)

MEDICAL RESPONSE FROM NON-MEDICAL ORG.

1. Police

2. Civil defence

3. Fire Brigade

4. Transport division4. Transport division

5. N.G.O.

LASTLY, IT IS ALWAYS KEPT IN MIND THAT

THE MEDICAL MANAGEMENT FOLLOWS “

ALL OR NONE” LAW AND THEREFORE,

PLANNING AND DEVELOPMENT TO GET THE

BEST MEDICAL RESPONSE WILL REQUIRE BEST MEDICAL RESPONSE WILL REQUIRE

DEVELOPMENT OF ALL COMPONENTS OF

THE EMERGENCY MEDICAL MANAGEMENT

OTHERWISE IT MAY CAUSE INCREASE IN THE

DELAY TIME FACTOR.