THE ROLE OF EPIDEMIOLOGY AFTER DISASTERS

THE ROLE OF EPIDEMIOLOGY AFTER DISASTERS

Objectives

By the end of this lecture, participants will be able:

·         To list three uses of epidemiologic methods in emergency situations.

·         To describe the operational aspects of conducting epidemiologic activities post-disaster; and

·         To describe three constraints in applying epidemiologic methods to emergency situations.

Disaster Defined

“ a serious disruption of the functioning of a society, causing widespread human, material, or environmental losses which exceed the ability of the affected society to cope using its own resources” – UNITED NATIONS DISASTER         

 “ a disaster is the result of a vast ecological breakdown in the relation between humans and their environment, a serious and sudden event on such a scale that the sticken community needs extraordinary efforts to cope with it, often with outside help or international aid.

TYPES OF DISASTERS

1.     Natural: interrupts the normal function of a community, people maybe injured or killed or may loose their homes and possesions the impact is so great that the affected community often must depend on outside help in order to cope with the result.

Natural forces that can cause widespread human suffering include Earthquakes, tornadoes, hurricanes, floods, volcanic eruptions, wilderness fires and extreme hot or cold.

Earthquakes: buildings and the objects inside them can fall injuring those who live or work there.

The large the numbers of people who are suddenly ill or injured can exceed the capacity of the local health care system for them.

 Hospitals may be damaged, roads blocked and personnel may be unable to perform their duties.

Floods: drowning

Wildfires: can cause burns and illness from smoke inhalation.

2.     Technological disaster: is an event caused by a malfunction of technological structure or some human error in controlling or handling the technology. The effects of disaster may be long lasting and can endure for years. However, symptoms may appear gradually and impacts may not be seen immediately.

All types of disaster is an event caused by a malfunction of technological disasters tend to be even more difficult for the following reasons:

2.1  The threat cannot be anticipated: a technological disaster is sudden unexpected and unpredictable.

2.2   People are responsible: victims of technological disasters tend to feel anger toward people who are responsible for accidents that may have prevented.

2.3   Community breakdowns and conflicts may result: technological disaster can create disputes within communities

                      Example : FURUSHIMA DAICHII NUCLEAR POWER STATION IN JAPAN

                  Effects: Stressful, especially because they are unpredictable, individual, families                                   and communities are affected, results include  income loss, loss of job.

3.    Man- made disaster

Example:

Arson: criminal intent of setting a fire with intent to cause damage.

Civil Disorder: broad term that is typically used by law enforcement to describe forms of diturbance like low minimum wage to racial segregation.

Terrorism: use of violence for the purpose of creating fear.

War: conflict between relatively large groups of people, which involves Physical force inflicted by the use of weapons.

EFFECTS OF DISASTER

         

·         Interrupts the normal function of the community

·         Affected population cannot cope

·         Need for external assitance

AIMS OF DISASTER RESPONSE

The overall aims of disaster response are:

·         To ensure the survival of the maximum possible number of victims, keeping them in the best possible health in the circumtances.

·         To re establish self-sufficiency and essential services as quickly as possible for all population groups.

·         To repair or replace damaged infrastructure and regenerate viable economic activities.

·         In situations of civil war or intetional conflict.

·         In cases involving population displacements( due to any type of disaster).

DISASTER RESPONSE ACTIVITIES

1.    WARNING: refers to information concerning the nature of the danger and imminent disaster threats.

Must be rapidly disseminated to government officials, institutions and the population at large in the areas at immediate risk so that appropriate actions may be taken, namely either to evacuate or secure property and prevent further damage. The warning could be disseminated via radio, television, the written press, telephone system and cell phone.

2.    EVACUATION AND MIGRATION: relocation of a population from zones at risk of an imminent disaster to a safer location.

Primary concern is the protection of life of the community and immediate treatment of those who may be injured.

Evacuation is most commonly associated with tropical storms but is also a frequent requirement with technological or industrial hazards. For evacuation to work there must be:

􀂃 A timely and accurate warning system,

􀂃 Clear identification of escape routes,

􀂃 An established policy that requires everyone to evacuate when an order is given,

􀂃 A public education programme to make the community aware of the plan.

3.    SEARCH AND RESCUE ( SAR ): the process of identifying the location of disaster victims that may be trapped or isolated and bringing them to safety and medical attention.

In the aftermath of tropical storms and floods, SAR usually includes locating stranded flood victims, who may be threatened by rising water, and either bringing them to safety or providing them with food and first aid until they can be evacuated or returned to their homes.

In the aftermath of earthquakes, SAR normally focuses on locating people who are trapped and/ or   injured in collapsed buildings.

4.    POST-DISASTER ASSESSMENT: To provide a clear, concise picture of the post-disaster situation, to identify relief needs and to develop strategies for recovery.

 It determines options for humanitarian assistance, how best to utilize existing resources, or to develop requests for further assistance.

5.    RESPONSE AND RELIEF: Occurred response and relief have to take place immediately; there can be no delays. It is therefore important to have contingency plans in place. Relief is the provision on a humanitarian basis of material aid and emergency medical care necessary to save and preserve human lives.

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It also enables families to meet their basic needs for medical and health care, shelter, clothing, water, and food (including the means to prepare food). Relief supplies or services are typically provided, free of charge, in the days and weeks immediately following a sudden disaster. In the case of deteriorating slow-onset emergency situations and population displacements (refugees, internally and externally displaced people), emergency relief may be needed for extended periods.

6.    LOGISTICS AND SUPPLY: The delivery of emergency relief will require logistical facilities and capacity. A well-organized supply service is crucial for handling the procurement or receipt, storage, and dispatch of relief supplies for distribution to disaster victims.

7.    COMMUNICATION AND INFORMATION MANAGEMENT: All of the above activities are dependent on communication.

There are two aspects to communications in disasters.

One is the equipment that is essential for information flow, such as radios, telephones and their supporting systems of repeaters, satellites, and transmission lines.

The other is information management: the protocol of knowing who communicates what information to whom, what priority is given to it, and how it is disseminated and interpreted.

8.    SURVIVOR RESPONSE COPING: In the rush to plan and execute a relief operation it is easy to overlook the real needs and resources of the survivors. The assessment must take into account existing social coping mechanisms that negate the need to bring in outside assistance.

On the other hand, disaster survivors may have new and special needs for social services to help adjust to the trauma and disruption caused by the disaster. Participation in the disaster response process by individuals to community organizations is critical to healthy recovery. Through these appropriate coping mechanisms will be most successfully developed.

9.    SECURITY: Security is not always a priority issue after a sudden onset of disasters. It is typically handled by civil defence or police departments.

However, the protection of the human rights and safety of displaced populations and refugees can be of paramount importance requiring international monitoring.

10.  EMERGENCY OPERATIONS MANAGEMENT: None of the above activities can be implemented without some degree of emergency operations management. Policies and procedures for management requirements need to be established well in advance of the disaster.

11.  REHABILITATION: Rehabilitation consists of actions taken in the aftermath of a disaster to enable basic services to resume functioning, assist victims’ self-help efforts to repair dwellings and community facilities, and to facilitate the revival of economic activities (including agriculture).

Rehabilitation focuses on enabling the affected populations (families and local communities) to resume more-or-less normal (pre-disaster) patterns of life. It may be considered as a transitional phase between (i) immediate relief and (ii) more major, long-term reconstruction and the pursuit of ongoing development.

12.  RECONSTRUCTION: Reconstruction is the permanent construction or replacement of severely damaged physical structures, the full restoration of all services and local infrastructure, and the revitalization of the economy (including agriculture).

Reconstruction must be fully integrated into ongoing longterm development plans, taking account of future disaster risks. It must also consider the possibilities of reducing those risks by the incorporation of appropriate mitigation measures. Damaged structures and services may not necessarily be restored in their previous form or locations. It may include the replacement of any temporary arrangements established as a part of the emergency response or rehabilitation. Under conditions of conflict, however, rehabilitation and reconstruction may not be feasible. For obvious reasons of safety and security, activities in rehabilitation and reconstruction may need to wait until peace allows them.

13.  RECOVERY: As the emergency is brought under control, the affected population is capable of undertaking a growing number of activities aimed at restoring their lives and the infrastructure that supports them. There is no distinct point at which immediate relief changes into recovery and then into longterm sustainable development. There will be many opportunities during the recovery period to enhance prevention and increase preparedness, thus reducing vulnerability. Ideally, there should be a smooth transition from recovery to on-going development.

Recovery activities are classified as short-term and long-term. During response, emergency action was taken to restore vital functions while carrying out protective measures against further damage or injury.

a Short-term recovery is immediate and tends to overlap with response. The authorities restore interrupted utility services, clear roads, and either fix or demolish severely damaged buildings.

Additionally, there may be a need to provide food and shelter for those displaced by the disaster. Although called short-term, some of these activities may last for weeks

b Long-term recovery may involve some of the same activities, but itmay continue for a number of months, sometimes years, depending on the severity and extent of the damage sustained. For example, it

may include the complete redevelopment of damaged areas. The goal is for the community to return to a state that is even better than before the emergency. This is an ideal time to implement new mitigation measures so that the community is better prepared to deal with future threats and does not leave

itself vulnerable to the same setbacks as before. Helping the community to take new mitigation steps is one of the most important roles during the recovery phase.

The Recovery Plan

The recovery process should be understood clearly and it is important to have a general plan for recovery which should be appended to emergency operation plans.

The primary purpose of the plan is to spell out the major steps for managing successful recovery. For each step you will also designate key partners and their roles and steps to mobilize them. The plan should have at least the following seven steps:

1 Gathering basic information

2 Organizing recovery

3 Mobilizing resources for recovery

4 Administering recovery

5 Regulating recovery

6 Coordinating recovery activities

7 Evaluating recovery

For the majority of disasters, local communities are able to provide the assistance needed for recovery. However, for a major disaster, it may be necessary to obtain assistance from the government and other sources. Therefore, preparations must be made to request outside aid if a major disaster occurs. This will mean informing and convincing decision makers, especially those outside the affected area. Documenting the effects of the disaster is the best way to carry this out. Documentation involves providing evidence of what happened. Photographs of the damage provide irrefutable evidence. Take pictures of

the damage, the repair work, and completed restorations. .

There can be a good documentation if the following five simple steps are followed:

1 Take pictures of damages and repairs. More is better than too little. Private citizens may have excellent shots to supplement your own.

2 Take notes on damages and repairs. Again, more is better than too

little. If there is too much to write at one time, dictate your notes into a tape recorder for later transcription.

3 Clip and file newspaper reports and stories. If you can get video footage from the television stations, do that also.

4 Record all expenditures carefully and keep all receipts and invoices.

5 Make sure anyone acting on behalf of the jurisdiction does the same.

Modern and traditional responses to disasters

The responses to disasters may employ a mix of approaches from traditional to modern with these approaches moving back and forth depending on the nature of disaster in term of their scope. The scope of disasters has influenced responses in the following ways:

􀂃 Humanitarian (aid to relieve pain and suffering),

􀂃 Remittance (Cash sent to victims),

􀂃 Relief assistance (food, medication, tents),

􀂃 Networking (contacting organizations),

Modern methods of disaster response

New technologies can be very useful and powerful tool in disaster response, namely:

1 Cell phones: cell phones as warning devices can be very useful. Short messages can be sent to recipients warning of imminent threat of tropical storms, wind storms or any severe weather likely to cause damage.

2 Spatial information – use of satellite imagery. The emergency management community is keenly aware of the potential of mapping technologies such as geographic information systems (GIS), remote

sensing (satellite imagery), and global positioning systems (GPS) in support of emergency response operations. Increasingly, geographic technologies are being utilized for hazard mitigation as well as response efforts. These range from damage assessments mapping the event and affected areas to search and rescue, risk assessment, risk perception (Hodgson and Palm, 1992), and risk communication (Hodgson and Cutter 2001). There is more information on the role of technology for managing disasters in Unit 8.

3 Social media and social networking – social media and social networking can be used as a tool to emergency response communications. Text messaging such as Twitter and the social networking system such as Face book can be used as a channel of communication in disaster response.

Examples of suggested applications of social media and social networking include:

􀂊 Use blogs to rapidly publicize the need for assistance grants.

􀂊 Create geo-tagged photo groups to document damage.

􀂊 Publicize volunteers willing to share recovery-relevant expertise.

􀂊 Use map-based mashups (combinations of data in webpages) to display relevant local information.

􀂊 Immediately share “lessons learned.”

􀂊 Integrate volunteer directories with social networks to simplify information sharing.

􀂊 Distribute weather information via methods that support geographic targeting.

􀂊 Encourage sharing of resource information among corporations that will most likely be involved in recovery work.

􀂊 Use the assistance application process as basis for voluntary sharing of information among affected populations.

Emergency Support Functions

• Emergency Support Functions
• ESF # 8
• Health and Medical Response Lead Partners

 Emergency Support Functions

Emergency Support Functions (ESFs) is the grouping of governmental and certain private sector capabilities into an organizational structure to provide support, resources, program implementation, and services that are most likely needed to save lives, protect property and the environment, restore essential services and critical infrrastructure, and help victims and communities return to normal following domestic incidents.

Emergency Support  Functions

• ESF1    Transportation
• ESF2    Communications
• ESF3    Public Works and Engineering
• ESF4    Firefighting
• ESF5    Emergency Management
• ESF6    Mass Care, Housing, and Human Services
• ESF7    Resources Support
• ESF8    Public Health and Medical Services
• ESF9    Urban Search and Rescue
• ESF10  Oil and Hazardous Materials Response
• ESF11  Agriculture and Natural Resources
• ESF12  Energy
• ESF13  Public Safety and Security
• ESF14  Long-term Community Recovery and Mitigation
• ESF15  External Affairs

There are 15 ESFs, and HHS is the primary agency responsible for ESF 8- Public Health and Medical Services.  ESF 8 is coordinated by the Secretary of HHS principally through the Assistant Secretary for Preparedness and Response (ASPR). ESF 8 resources can be activated through the Stafford Act or the Public Health Service Act.                                                                                                                                                                         

ESF 8 – Public Health and Medical Services provides the mechanism for coordinated Federal assistance to supplement State, Tribal, and local resources in response to an emergency.

ESF 8 – Public Health and Medical Services

ESF 8 – Public Health and Medical Services provides the mechanism for coordinated Federal assistance to supplement State, Tribal, and local resources in response to the following:

• Public health and medical care needs
• Veterinary and/or animal health issues in coordination with the U.S. Department of Agriculture (USDA)
• Potential or actual incidents of national significance
• A developing potential health and medical situation

ESF #8 involves supplemental assistance to State,Tribal, and jurisdictional governments in identifying and meeting the public health and medical needs of victims of major disasters or public health and medical emergencies.This support is categorized in the following functional areas:

• Assessment of public health/medical needs
• Public health surveillance
• Medical care personnel
• Medical equipment and supplies
• Patient movement
• Hospital care
• Outpatient services
• Victim decontamination
• Safety and security of human drugs, biologics, medical devices, veterinary drugs, etc.
• Blood products and services
• Food safety and security
• Agriculture feed safety and security
• Worker health and safety
• All hazard consultation and technical assistance and support
• Mental health and substance abuse care
• Public health and medical information
• Vector control
• Potable water/wastewater and solid waste disposal, and other environmental health issues
• Victim identification/mortuary services
• Veterinary services.
• Federal public health and medical assistance consists of medical materiel, personnel, and technical assistance.  

Health and Medical Response Lead Partners

HHS leads and coordinates the overall health and medical response to national-level incidents through coordination, along with the following.

• Department of Agriculture
• Department of Transportation
• Department of Defense
• Department of Veterans Affairs
• Department of State
• Agency for International Development
• Department of Energy
• Environmental Protection Agency
• Department of Homeland Security
• General Services Administration
• Department of Interior
• U.S. Postal Service
• Department of Justice
• American Red Cross
• Department of Labor

THE INCIDENT COMMEND SYSTEM

The Incident Command System (ICS) is "a systematic tool used for the command, control, and coordination of emergency response" according to the United States Federal Highway Administration.A more detailed definition of an ICS according to the United States Center for Excellence in Disaster Management & Humanitarian Assistance is "a set of personnel, policies, procedures, facilities, and equipment, integrated into a common organizational structure designed to improve emergency response operations of all types and complexities. ICS is a subcomponent of the National Incident Management System (NIMS), as released by the U.S. Department of Homeland Security in 2004.

National Incident Management System (NIMS),

Weaknesses in incident management were often due to:

• Lack of accountability, including unclear chains of command and supervision.
• Poor communication due to both inefficient uses of available communications systems and conflicting codes and terminology.
• Lack of an orderly, systematic planning process.
• No predefined methods to integrate inter-agency requirements into the management structure and planning process effectively.
• Freelancing by individuals with specialized skills during an incident without coordination with other first responders
• Lack of knowledge with common terminology during an incident.

An ICS is based upon a flexible, scalable response organization providing a common framework within which people can work together effectively. These people may be drawn from multiple agencies that do not routinely work together, and ICS is designed to give standard response and operation procedures to reduce the problems and potential for miscommunication on such incidents. ICS has been summarized as a "first-on-scene" structure, where the first responder of a scene has charge of the scene until the incident has been declared resolved, a more qualified responder arrives on scene and receives command, or the Incident Commander appoints another individual Incident Commander.

 ICS includes procedures to select and form temporary management hierarchies to control funds, personnel, facilities, equipment, and communications.

HISTORICAL CONTEXT

The ICS concept was originally developed in 1968 at a Phoenix AZ meeting of Fire Chiefs. Originally the program was established to follow the management structure of the US Navy and it was mainly for fire fighting of wildfires in California and Arizona. During the 1970s, ICS was fully developed during massive wildfire suppression efforts in California and following a series of catastrophic wildfires in California's urban interface. Property damage ran into the millions, and many people died or were injured. Studies determined that response problems often related to communication and management deficiencies rather than lack of resources or failure of tactics. ICS fell under California's Standardized Emergency Management System or SEMS. ICS became a national model for command structures at a fire, crime scene or major incident. The ICS System was used in New York at the first terrorist attempt on the twin towers in the 1990s. In 2003, SEMS went national with the passage of Homeland Security Presidential Directive 5 (HSPD5) mandating all federal, state, and local agencies use NIMS or the National Incident Management System to manage emergencies in order to receive federal funding. The Superfund Amendment and Re-authorization Act title III mandated that all first responders to a hazardous waste or hazmat emergency would be trained in accordance with 29 CFR 1910.120(q). This standard recognizes the OSHA ICS program. The National Incident Management System (NIMS) came about as a direct result of the terrorist attack on the twin towers in New York on September 11, 2001.

ILOILO CITY, Aug 3 (PIA) -- The use of the Incident Command System (ICS) in the Philippines as a tool for on-scene disaster response and management in consonance with the country’s disaster risk reduction and management law is underway.

The use of the ICS mechanism is also within the framework of the Association of Southeast Asian Nations-United States (ASEAN-US) Cooperation on Disaster Management Program which was adopted during the first ASEAN Committee on Disaster Management Meeting (ACDM) in Brunei in 2003.

As the country adopts the ICS system, SSupt. Joseph B. Bacareza, head of the Health and Emergency Management Division (HEMD) of the Bureau of Fire Protection and member of the ICS National Cadre, said at the ongoing ICS Basic/Intermediate Training Course here that trainings have already been held for the National Disaster Risk Reduction and Management Council, some Regional Disaster Risk Reduction and Management Councils as well as the national offices of some national government agencies.

These agencies include the Department of Foreign Affairs (DFA), Bureau of Fire Protection (BFP), Department of Tourism (DOT) and Armed Forces of the Philippines (AFP).

Bacareza, who is the lead trainor in the course, said trainings have also started at the level of local government units (LGUs) with the cities of Olongapo and Bacolod and the town of Surallah, South Cotabato as pilot areas. Similar trainings will also be held for other LGUs, added Bacareza, who is a medical doctor by profession.

ICS is a standard, on-scene, all-hazard incident management concept that can be used by all disaster risk reduction and management councils or emergency management and response agencies and can be used for routine incidents as well as major disasters such as typhoons, floods, disease outbreaks, hostage-taking, and even planned events such as fiestas and concerts.

Activated at first response, ICS allows users to adopt an integrated organizational structure to match the complexities and demands of single or multiple incidents without being hindered by agency or jurisdictional boundaries.

In her message at the opening of the three-day training from August 2 to 4, Office of Civil Defense (OCD) Regional Director and RDRRMC chairperson Rosario T. Cabrera said ICS could also address some persistent issues and problems arising at on-scene level such as who is in-charge, especially when the incident involves multi-agency participation and multi-jurisdictional, too many responders, too many people reporting to one supervisor, unclear lines of authority, no check-in procedures for responders, and unclear incident objectives.

Cabrera said the on-scene disaster management tool has proven to be an effective disaster response mechanism at the scene level and has been used by the United States and adopted by a number of countries.

Members of the RDRRMC Committee on Disaster Response participated at the training at Amigo Terrage Hotel. The training was designed to enhance the understanding of participants of ICS as a disaster response tool and the role of the system within the broader framework of the Philippine Disaster Risk Reduction and Management System.

The NDRRMC chaired by defense secretary Voltaire T. Gazmin has issued a memorandum circular earlier this year on the implementing guidelines on the use of ICS in disaster response and management in the country. (JCM/JSC-PIA6).

INCIDENT COMMAND SYSTEM

THREE PURPOSES:

·         ICS helps responders and others

·         ICS helps achieve objectives of response

·         ICS helps with effecient use resources.

BASIC ICS STRUCTURE

Integrated communications

The use of a common communications plan is essential for ensuring that responders can communicate with one another during an incident. Communication equipment, procedures, and systems must operate across jurisdictions (interoperably). Developing an integrated voice and data communications system, including equipment, systems, and protocols, must occur prior to an incident.

Effective ICS communications include three elements:

• Modes: The "hardware" systems that transfer information.
• Planning: Planning for the use of all available communications resources.
• Networks: The procedures and processes for transferring information internally and externally.

COMPOSITION

Incident commander

• Single incident commander - Most incidents involve a single incident commander. In these incidents, a single person commands the incident response and is the decision-making final authority.
• Unified command - A Unified Command involves two or more individuals sharing the authority normally held by a single incident commander. Unified Command is used on larger incidents usually when multiple agencies or multiple jurisdictions are involved. A Unified Command typically includes a command representative from major involved agencies and/or jurisdictions with one from that group to act as the spokesman, though not designated as an Incident Commander. A Unified Command acts as a single entity. It is important to note, that in Unified Command the command representatives will appoint a single Operations Section Chief.^[8]

• Area command - During multiple-incident situations, an Area Command may be established to provide for Incident Commanders at separate locations. Generally, an Area Commander will be assigned - a single person - and the Area Command will operate as a logistical and administrative support. Area Commands usually do not include an Operations function.

Command staff

• Safety officer - The Safety Officer monitors safety conditions and develops measures for assuring the safety of all assigned personnel.
• Public information officer - The Public Information Officer (PIO or IO) serves as the conduit for information to and from internal and external stakeholders, including the media or other organizations seeking information directly from the incident or event. While less often discussed, the Public Information Officer is also responsible for ensuring that an incident's command staff are kept apprised as to what is being said or reported about an incident. This allows public questions to be addressed, rumors to be managed, and ensures that other such public relations issues are not overlooked.
• Liaison Officer - A Liaison serves as the primary contact for supporting agencies assisting at an incident.

General staff

• Operations Section Chief - The Operations Section Chief is tasked with directing all actions to meet the incident objectives.
• Planning Section Chief - The Planning Section Chief is tasked with the collection and display of incident information, primarily consisting of the status of all resources and overall status of the incident.
• Finance/Administration Section Chief - The Finance/Admin. Section Chief is tasked with tracking incident related costs, personnel records, requisitions, and administrating procurement contracts required by Logistics.
• Logistics Section Chief - The Logistics Section Chief is tasked with providing all resources, services, and support required by the incident.

200-Level ICS

At the ICS 200 level, the function of Information and Intelligence is added to the standard ICS staff as an option. This role is unique in ICS as it can be arranged in multiple ways based on the judgement of the Incident Commander and needs of the incident. The three possible arrangements are:

• Information & Intelligence Officer, a position on the command staff.
• Information & Intelligence Section, a section headed by an Information & Intelligence Section Chief, a General Staff position.
• Information & Intelligence Branch, headed by an Information & Intelligence Branch Director, this branch is a part of the Planning Section.

400-Level ICS

At the ICS 400 level, the focus is on large, complex incidents. Topics covered include the characteristics of incident complexity, the approaches to dividing an incident into manageable components, the establishment of an "Area Command", and the MultiAgency Coordination System (MACS).

DESIGN

Personnel

ICS is organized by levels, with the supervisor of each level holding a unique title (e.g. only a person in charge of a Section is labeled "Chief"; a "Director" is exclusively the person in charge of a Branch). Levels (supervising person's title) are:

·         Incident Commander

·         Command Staff Member (Officer)- Command Staff

·         Section (Chief)- General Staff

·         Branch (Director)

·         Division (Supervisor) - A Division is a unit arranged by geography, along jurisdictional lines if necessary, and not based on the makeup of the resources within the Division.

·         Group (Supervisor) - A Group is a unit arranged for a purpose, along agency lines if necessary, or based on the makeup of the resources within the Group.

·         Unit, Team, or Force (Leader) - Such as "Communications Unit," "Medical Strike Team," or a "Reconnaissance Task Force." A Strike Team is composed of same resources (four ambulances, for instance) while a Task Force is composed of different types of resources (one ambulance, two fire trucks, and a police car, for instance).

·         Individual Resource. This is the smallest level within ICS and usually refers to a single person or piece of equipment. It can refer to a piece of equipment and operator, and less often to multiple people working together.

Facilities

ICS uses a standard set of facility nomenclature. ICS facilities include: Pre-Designated Incident Facilities: Response operations can form a complex structure that must be held together by response personnel working at different and often widely separate incident facilities. These facilities can include:

• Incident Command Post (ICP): The ICP is the location where the Incident Commander operates during response operations. There is only one ICP for each incident or event, but it may change locations during the event. Every incident or event must have some form of an Incident Command Post. The ICP may be located in a vehicle, trailer, tent, or within a building. The ICP will be positioned outside of the present and potential hazard zone but close enough to the incident to maintain command. The ICP will be designated by the name of the incident, e.g., Trail Creek ICP.

• Staging Area: Can be a location at or near an incident scene where tactical response resources are stored while they await assignment. Resources in staging area are under the control status. Staging Areas should be located close enough to the incident for a timely response, but far enough away to be out of the immediate impact zone. There may be more than one Staging Area at an incident. Staging Areas can be collocated with the ICP, Bases, Camps, Helibases, or Helispots.

• A Base is the location from which primary logistics and administrative functions are coordinated and administered. The Base may be collocated with the Incident Command Post. There is only one Base per incident, and it is designated by the incident name. The Base is established and managed by the Logistics Section. The resources in the Base are always out-of-service.

• Camps: Locations, often temporary, within the general incident area that are equipped and staffed to provide sleeping, food, water, sanitation, and other services to response personnel that are too far away to use base facilities. Other resources may also be kept at a camp to support incident operations if a Base is not accessible to all resources. Camps are designated by geographic location or number. Multiple Camps may be used, but not all incidents will have Camps.

• A Helibase is the location from which helicopter-centered air operations are conducted. Helibases are generally used on a more long-term basis and include such services as fueling and maintenance. The Helibase is usually designated by the name of the incident, e.g. Trail Creek Helibase.

• Helispots are more temporary locations at the incident, where helicopters can safely land and take off. Multiple Helispots may be used.

Each facility has unique location, space, equipment, materials, and supplies requirements that are often difficult to address, particularly at the outset of response operations. For this reason, responders should identify, pre-designate and pre-plan the layout of these facilities, whenever possible.

On large or multi-level incidents, higher-level support facilities may be activated. These could include:

• Joint Information Center (JIC): A JIC is the facility whereby an incident, agency, or jurisdiction can support media representatives. Often co-located - even permanently designated - in a community or state EOC the JIC provides the location for interface between the media and the PIO. Most often the JIC also provides both space and technical assets (Internet, telephone, power) necessary for the media to perform their duties. A JIC very often becomes the "face" of an incident as it is where press releases are made available as well as where many broadcast media outlets interview incident staff. It is not uncommon for a permanently established JIC to have a window overlooking an EOC and/or a dedicated background showing agency logos or other symbols for televised interviews. The National Response Coordination Center (NRCC) at FEMA has both, for example, allowing televised interviews to show action in the NRCC behind the interviewer/interviewee while an illuminated "Department of Homeland Security" sign, prominently placed on the far wall of the NRCC, is thus visible during such interviews.

• Joint Operations Center (JOC): A JOC is usually pre-established, often operated 24/7/365, and allows multiple agencies to have a dedicated facility for assigning staff to interface and interact with their counterparts from other agencies. Although frequently called something other than a JOC, many locations and jurisdictions have such centers, often where Federal, state, and/or local agencies (often law enforcement) meet to exchange strategic information and develop and implement tactical plans. Large mass gathering events, such as a presidential inauguration, will also utilize JOC-type facilities although they are often not identified as such or their existence even publicized.

• Multiple Agency Coordination Center (MACC): The MACC is a central command and control facility responsible for the strategic, or "big picture" of a disaster. A MACC is often used when multiple incidents are occurring in one area or are particularly complex for various reasons such as when scarce resources must be allocated across multiple requests. Personnel within the MACC use Multi-agency Coordination to guide their operations. The MACC coordinates activities between multiple agencies and incidents and does not normally directly control field assets, but makes strategic decisions and leaves tactical decisions to individual agencies. The common functions of all MACC's is to collect, gather and analyze data; make decisions that protect life and property, maintain continuity of the government or corporation, within the scope of applicable laws; and disseminate those decisions to all concerned agencies and individuals. While often similar to an Emergency Operations Center (EOC), the MACC is a separate entity with a defined area or mission and lifespan whereas an EOC is a permanently established facility and operation for a political jurisdiction or agency. EOCs often, but not always, follow the general ICS principles but may utilize other structures or management (such as an Emergency Support Function [ESF] or hybrid ESF/ICS model)schemas. For many jurisdictions the EOC is where elected officials will be located during an emergency and, like a MACC, supports but does not command an incident.

Equipment

ICS uses a standard set of equipment nomenclature. ICS equipment include:

• Tanker - This is an aircraft that carries fuel (Fuel Tanker) or water (Water Tanker).
• Tender - Like a tanker, but a ground vehicle, also carrying fuel (Fuel Tender), water (Water Tender), or even fire fighting foam (Foam Tender).

Type and kind

The "type" of resource describes the size or capability of a resource. For instance, a 50 kW (for a generator) or a 3-ton (for a truck). Types are designed to be categorized as "Type 1" through "Type 5" formally, but in live incidents more specific information may be used.

The "kind" of resource describes what the resource is. For instance, generator or a truck. The "type" of resource describes a performance capability for a kind of resource for instance,

In both type and kind, the objective must be included in the resource request. This is done to widen the potential resource response. As an example, a resource request for a small aircraft for aerial reconnaissance of a search and rescue scene may be satisfied by a National Guard OH-58 Kiowa helicopter (Type & Kind: Rotary-wing aircraft, Type II/III) or by a Civil Air Patrol Cessna 182 (Type & Kind: Fixed-wing aircraft, Type I). In this example, requesting only a fixed-wing or a rotary-wing, or requesting by type may prevent the other resource's availability from being known.

Command transfer

A role of responsibility can be transferred during an incident for several reasons: As the incident grows a more qualified person is required to take over as Incident Commander to handle the ever-growing needs of the incident, or in reverse where as an incident reduces in size command can be passed down to a less qualified person (but still qualified to run the now-smaller incident) to free up highly qualified resources for other tasks or incidents. Other reasons to transfer command include jurisdictional change if the incident moves locations or area of responsibility, or normal turnover of personnel due to extended incidents. The transfer of command process always includes a transfer of command briefing, which may be oral, written, or a combination of both.

ROLE OF EPIDEMIOLOGY IN EMERGENCIES

·         Role extends beyond understanding how diseases are contracted and spread.

·         Epidemiology can provide the evidence base for making decisions.

·         Epidemiologic methods can be used to measure and describe the adverse health effects of disasters.

Epidemiology

•          The study of the distribution & determinants of health related events in human populations and the application of the study to the control of health problems

Disaster Epidemiologist: measure and describe the adverse health effects of natural and human-caused disasters and the factors that contribute to those effects, with the overall objective of assessing the needs of disaster-affected populations, matching available resources to needs, preventing further adverse effects, evaluating program effectiveness,and planning for contingencies. Disaster epidemiology evolved as a result of the increasing realization that epidemiologic methods can be used in studying the effects that disasters have on the health of populations.

Study designs in epidemiology

•          Observational study

–         Descriptive study: Description of the occurrence of a disease in a population

•          Usually described in person, place & time

–         Analytical study: Analyses relationships between health status & other variables

•          Case control study

•          Cohort study

•          Experimental study or intervention study

Disaster epidemiology

•          Use of epidemiology in disaster situations

•          Epidemiologic methods can be used to measure & describe the adverse effects of natural and man made disasters

Types of studies in disaster epidemiology

•          Surveillance

–         Ongoing systematic collection, collation & analysis of data & the timely transmission of information to those who need to know for action to be taken

•          Public Health impact evaluation

•          Natural history evaluation

•          Analytic studies of risk factors

Types of studies in disaster epidemiology 2

•          Clinical investigation

•          Population based study

•          Study of the psychological effects of disasters

Historical development of disaster epidemiology

•          1950- Early review of role of epidemiology during disasters

•          Late 1960 Civil war in Nigeria: Practical application of epidemiology in disaster management

•          Early 1970 Establishment of Center for Research on Epidemiology of Disasters

Historical development of disaster epidemiology 2

•          1976 Earthquake in Guatemala important epidemiologic studies carried out

•          1980 Eruption of Mount St Helena was a major milestone in shaping governments response to disasters

Applications of epidemiology in disasters

·         During the past 20 years, disaster epidemiology has emerged as an area of special interest.

·         The applications of epidemiologic methods in disaster situations have been reviewed in a number of reports and periodic updates on the “ state of the art” appear every few years.

·         The role of epidemiology in disaster situations has included a broad range of activities.

1.     Rapid assessment of health needs

2.     Surveillance and action-oriented infromation systems

3.     Disease- control strategies for well-defined problems

4.     Assessment of the use and distribution of health services

5.     Etiologic research on morbidity and mortality owing to disasters

6.     Development of long-term epidemiologic studies of the affected populations.

·         Health decisions made during emergencies are often based on insufficient, nonexisting,or even false information, which results in inappropriate, insufficient or unnecessary health aid; waste of health resources; or counter effective measures.

Example:

Large amounts of useless drugs and other consumable supplies are frequently sent to a disaster site. After the 1976 earthquake in Guatemala, 100 tons of unsorted medicines were airlifted to the country from foreign donors. Of these supplies, 90% were of no value because they consisted of medications that had expired, that were already opened, or for which the labels were written in foreign languages.

A similar situation occured after the 1988 Armenian earthquake, when international relief operations sent at least 5000 tons of drugs and consumable medical supplies. Because of the difficulties with identification and sorting only 30% of the drugs were immediately usable by the health workers in Armenia; 11 % were useless, and 8% had expired. Ultimately , 20% of all the drugs provided by international aid had to be destroyed.

Because these relief operations were often conducted under the watchful eye of the media, medical relief efforts were often pejoratively called “ the second disaster”.

·         The critical component of any disaster response is the early conduct of a proper damage assessment to identify urgent needs and to determine relief priorities for an affected population.

·         Dissaster assessment provides relief managers objective information about the effects of the disaster on a population, generated on the basis of rapidly conducted field investigations.

RAPID NEEDS ASSESSMENT

Objective: to assess

·         The presence of ongoing hazards

·         Nature and magnitude of disaster

·         Major medical and public health problems of the affected community

·         Availability of resources in affected community

·         Community need for external assistance

·         Augmentation of existing public health surveillance to monitor the ongoing impact

During the past several years , various efforts were made to develop rapid and valid epidemiologic assessment techniques. Guha- sapir has developed useful indicators for needs assessment after earthquakes. ( “ quick and dirty”  surveys ).

These indicators have been simple, easy to use quickly, and operationally feasible.

The purpose of this assessment is to estimate the following factors:

1.     Overall magnitude of the effect of the disaster ( geographical extent, number of affected persons, and estimated duration)

2.     Effect on health ( number of casualties)

3.     Integrity of health services delivery systems

4.     Specific health care needs of survivors

5.     Disruption of other service sectors ( power, water, sanitation ) that are relevant to public health

6.     Extent of response to the disaster by local authorities

Information collected during the rapid assessment should be used to plan and implement immediate responses.

·         The emphasis of these assessments is to gather a small amount of relevant information quickly (usually 2 to 4 days after a sudden-impact disaster).

·         This “ quick and dirty” approach requires a multidisciplinary team (e.g., an epidemiologist, statistician, engineer, and health planner) and relies on visual inspection, interviews with key personnel, and surveys.

The health effects of a disaster can be measured by a series of indicators that permit objective assessment and are used to guide relief efforts:

1.     Such indicators include mortality, morbidity, the number of damaged houses, homeless persons, and nonfunctioning hospitals; and the status of community lifelines (e.g., water, electricity, gas, sewage disposal ).

Because everyone in the disaster area will feel needs and experience loss, the challenge of the early assessment is to decide for which needs and affected areas early intervention will prevent the greatest loss of life or severe morbidity.

SURVEILLANCE

·         The ultimate goal of disaster epidemiology is to prevent or reduce the adverse health consequence of the disaster itself, as well as optimize the decision- making process associated with management of the relief effort.

·         These epidemiologic objectives can be simply defined as the surveillance cycle, that is the collection of data, analysis of data, and response data.

·         The surveillance cycle must turn many times: immediately, with rapid, quick, and dirty assessments of the problems using the most rudimentary data collection techniques, then with short-term  assessments involving the establishments of simple but reliable sources of data, and subsequently, with ongoing surveillance to identify continuing problems and monitor the response to the interventions chosen.

·         Field surveillance methods vary greatly by disaster setting and the personnel and time available. As described previously, early field surveys must be simple and address the essential basic questions requiring immediate answers that will directly prevent loss of life or injury.

·         Surveillance must be sensitive to monitor the impact of relief on the health problems of the population, to determine wether the effort is having a tangible impact on the population or if new strategies are needed

·         Finally, It is important to link the information is clearly an essential requirement for determining appropriate relief supplies, equipment, and personnel needed to respond effectively to a catastrophic event.

An organized approach to data collection in disaster situations can greatly improve decision making and can predict a variety of options that disater managers need to face.

The availability of questionnaires prepared before the disaster that can be adapted and modified quickly will assist in an effecient data collection operation.

Therefore, standardized procedures for collecting data in disasters need to be developed which can then be linked to operational decisions and action.

The success of epidemic investigation of a disaster can be measured directly by how rapidly data collected and analyzed can identify prevention strategies and how effectively these strategies can be implemented by decision makers to direct relief and decrease ongoing morbidity.

USE OF EPIDEMIOLOGY AFTER A DISASTER

·         Generally , epidemiologic studies of natural disasters, including the studies of the preimpact and impact phases, are conducted during the postimpact phase.

Example:

Glass and coworkers have emphasized the need for such post disaster epidemiologic follow- up studies to identify risk factors for death and injury that can then serve as the basis for planning strategies to prevent or reduce impact-related morbidity and mortality in future disasters.

Specific interventions: early warning, preparation, and evacuation procedures, and life saving actions) can then be suggested to mitigate the negative consequences of disasters for high-risk populations( the aged, people living alone, and people dependent on life support systems.)

·         Subsequent evaluation of the effectiveness of these prevention measures can then lead to the development of actions that are even more effective in preventing morbidity and mortality directly atrributable to disasters.

Example:

Calculations of death rates can be used to evaluate the effectiveness of prevention measures aimed at mitigating the effects of disasters, such as assessing the adequacy of warning and evacuation in an area hit by flash floods determining the safety of different types of building constructions in an area where a strong earthquake has occured.

·         Epidemiologist have employed a great variety of data collection methods and strategies to study the postdisaster health effects of major disaters involving acute events, such as earthquakes and tropical cyclones.

·         Primarily using descriptive epidemiology, they have collected large amounts of epidemiologic data through case studies of new and previous disasters.

Example:

Some of the few analytic  epidemiologic studies conducted include risk factors for morbidity and moratality in Guatemala, italy, Armenia, the Philippines and Puerto Rico. Such analytic studies have usually been of a case-control design. For example why did some people die while their neighbors, family, members, or others survive?

Isolated case studies of the relationship between death or injuries and the type of traditional housing structures have provided clear indications regarding simple measures to be implemented in order to reduce human losses.

More analytic studies such as these are needed to test conventional warnings and public safety advisories.

·         PRACTICAL, APPLIED, OPERATIONAL RESEARCH can also be useful in planning medical and public health responses to future disasters as well as in providing information useful for individual patient care. Ideally, the results of such retrospective epidemiologic studies would be used in formulating predictive indices that would allow emergency managers to assess the public health impact of a subsequent disaster from a few essential elements (indicators) and thus develop an appropriate relief response.

Example:

Attack rates for various types of illness or conditions in survivors could be calculated and the indices derived from these calculations could be used in determining what kinds of supplies, equipment, and personnel are most urgently needed.

·         During the post impact phase , information is also needed on the complicated process of long-term rehabilitation and health services reconstruction.

·         After a disaster, epidemiologic methods can be used to evaluate the effectiveness of health intervention programs. Such evaluations in which what actually happened is compared with what was intended should be an integral part of the entire relief operation.

·         In assessing disaster management, the evaluator would be looking at the “ actual “ results versus the “intended” results on two levels- the overall outcome of disaster management efforts and the impact of each discrete category of relief efforts ( provision of food and shelter, delivery of medical care, managementcommunications).

Example:

Studies of the role of effectiveness of outside medical and rescue volunteers following disasters should help settle the controversy regarding their usefulness and provide public health authorities and emergency managers with guidlines and criteria for constructively using such volunteers. Unfortunately there are are no quantifiable measures of volunteer effectiveness and no agreed- on methodology for evaluating the assistance that is provided by external sources.

PRE-IMPACT PHASE

·         Conducting hazard & vulnerability analyses of the population

              Hazard analysis: Collecting & assessing data on the nature, causes, frequency, distribution and                      effects of past events in order to make predictions about future events

               Vulnerability analysis: analysis of a population risk when a hazard of a given magnitude occurs

·         Modeling/ Simulating disaster scenarios

·         Conducting drills

·         Designing emergency protocols

·         Assessing level of Emergency preparedness

·         Assessing flexibility of surveillance systems

·         Training health & safety personnel

·         Educating defined population at risk

IMPACT PHASE

•          Conducting disaster damage assessment

•          Conducting rapid field investigations

•          Identifying urgent needs & matching resources

•          Prioritizing relief efforts

•          Conducting disaster surveillance

•          Conducting epidemic investigations

POST-IMPACT PHASE

·         Conducting post disaster epidemiologic follow up studies

·         Identifying risk factors for death & injury

·         Planning strategies to reduce impact-related morbidity & mortality

·         Developing specific interventions based on the nature of the disaster

·         Evaluating effectiveness of interventions

·         Conducting descriptive & analytical studies

·         Planning medical & public health responses to future disasters

·         Conducting long term follow-up of rehabilitation & reconstruction activities

Challenges to applying epidemiologic methods

•          Extent of physical destruction

•          Public fear

•          Social disruption

•          Lack of infrastructure for data collection

•          Time urgency for results

•          Movement of populations

•          Lack of local support or expertise

Challenges for selecting study designs

•          Cross sectional: Studies of frequencies of deaths, illnesses, injuries and adverse health effects

–         Limited by absence of population counts

•          Analytical study: Case control study is the best study to determine risk factors & study interactions among multiple factors

–         Limited by definition of specific outcomes & issues of selecting cases & controls

Challenges for the Epidemiologist

        . Function in rapidly changing physical and social conditions

        . Collect information within frist few hours to days after disaster

        . Data must be objective and accurate

Conclusion

•          Epidemiology can provide much needed information on which a rational, effective & flexible policy for the management of disaster is based

•          Epidemiology provides the tools for rapid & effective problem solving during public health emergencies like natural & man made disasters

      .     Sound epidemiologic knowledge of the morbidity and mortality caused by disasters is essential when determining what relief supplies, equipment, and personnel are needed to respond effectively in emergency situations. All disasters are unique because each affected region of the world has different social, economic, and baseline health conditions. Some similarities exist, however, among the health effects of different types of disasters, that if recognized, can ensure that the limited health and medical resources of the affected community are well managed.

http://www.phe.gov/preparedness/support/esf8/pages/default.aspx

https://edis.ifas.ufl.edu/fy1230

http://wiki.answers.com/Q/What_are_the_effects_of_man-made_disasters_on_environment

http://www.bt.cdc.gov/preparedness/

http://www.pia.gov.ph/news/index.php?article=901343977941

http://en.wikipedia.org/wiki/Incident_Command_System