Trainer’s Handbook Disaster Management Dr Satish Modh Ratan Sharda PREFACE Our country has faced a series of great disasters in last couple of decades and suffered huge losses. This is largely because we hardly take disasters into account in our planning nor do we take preventive measures to reduce the sufferings of our fellow citizens. We have seasonal disasters, which occur with routine regularity and ferocity every year. Some of the disasters like floods, cyclones and earthquake repeat themselves with tiring regularity but no norms are set, let alone implemented in areas like housing etc. More lives are lost due to ignorance and carelessness than the magnitude of disaster. We don’t have a stable continent, neither wellconstructed homes. On the top of it all, we have dense population! All these factors unfold tragedy far bigger than these disasters warrant. Proper disaster preparedness can reduce a great amount of distress and hardship to large number of people and prevent economic losses. We have heard and read of many heart warming and inspiring stories of swayamsevaks going out of their way to act courageously in a manner which even they would not have imagined that they could undertake. in normal circumstances. These stories always inspire us as we admire the uncommon courage of those who have nothing but compassion for the society driving them. Our swayamsevaks, untrained in athletics climb ropes to rescue stranded citizens, help doctors without having any first aid training and manage relief supplies, better than trained supply chain managers. But, we also realize that these disasters can be handled better if we were better trained and had knowledge of some basic skills required to run a well managed relief work. Keeping above view in mind a three day National level Workshop (Abhyas Varg) of select senior karyakartas of RSS was conducted at Mumbai from 25th April to 27th April 2003. Some of the topics covered were: 1. A case study of a disaster 2. Sharing of disaster relief experience 3. Introduction to search and rescue operation through Civil Defence 4. Psychological Rehabilitation 5. First Aid Training, Disaster Medicines 6. Medical Relief Operations 7. Interaction and co-ordination with government at local level 8. Training and exposure to emergency communication systems 9. Relief Camp Management, Sanitation, Nutrition 10.Logistics, Supplies, storage and distribution management 11.Preparing a local disaster plan At the end of the Abhyas Varg a comprehensive training plan was discussed. It was felt that there should be two types of camps:   Special Skill Camps: These camps should be organised for select group of people who volunteer to perform specialized tasks. General Subjects: There are certain areas of disaster preparedness which do not require special skill sets. A good exposure to such topics can make disaster management more effective and efficient. Ma. Bhayyaji Joshi, Sah Sarkaryavah of RSS, pointed out that any training programme should cover two aspects   one concerning those who are in the disaster zone and second for those who may be outside the disaster zone. We have tried to cover most of the points which were discussed during the three day camp. Please, remember this book only draws broad picture and guidelines for disaster management and does not purport to be all encompassing guide to disaster management. NGOs in each region facing different kinds of disaster situations need to flesh out the training progamme in greater detail and depth, and adopt it to their specific region with their own knowledge sharing. This is only a beginning to a structure approach to Disaster Management. We hope that this small training guide will be of some help in organising workshops on this subject. Volunteers in the field are welcome to send their suggestions and share new experiences to enrich this programme further. Dr Satish Modh Ratan Sharda INTRODUCTION Ma. Bhayyaji Joshi, Sah Sarkaryavah We are coming to the end of a three day Abhyas Varg on Disaster Preparedness. This is not the end but the beginning of a new phase of training on disaster preparedness of our swayamsevaks. This was appropriately called an Abhyas Varg because all of us assembled here are not novice in the area of disaster relief work. The time has come to share our experiences and evolve a methodology to give our swayamsevaks adequate exposure in disaster preparedness and planning. We have already introduced this subject as an optional subject in our third year Shiksha Varg at Nagpur two years back. A need was felt to discuss our preparedness strategies comprehensively. The Varg organised with the help of Dr Satish Modh and Ratan Sharda has been able to fulfill our expectations to a large extent. There was a time when we used to say that we do not need any special training in our shakha. Our system of working, our shakha, is sufficient to create a motivated group of swayamsevaks who can handle any situation. Our swayamsevaks have demonstrated this ability time and again. They have performed tasks, which look too difficult in normal circumstances. Our swayamsevaks have been at the forefront of many a rescue and relief operations, whether disasters are natural or man made. We have been carrying out this work spontaneously, without any structured training. We have done relief and rescue operations at various disaster sites, and because of that, the expectations from the society have also increased. I feel that if our swayamsevaks are exposed to certain skills involved in disaster relief, we can meet the heightened expectations from Sangh even better. During the course of presentations we have seen that some of the registered bodies (NGOs) are well equipped to carry out the relief work. We also seen through the experience of Kutchh Yuvak Sangh, how good documentation facilitates the flow of relief funds in right channels where it is needed. We saw, how we can bring together a large pool of NGOs and private companies to carry out various tasks including back office operations. We realized that good work alone may not be sufficient. There is, also, a need to audit the accounts at regular intervals and prepare a progress report so that other NGOs and organizations, who do not have adequate man power and want to extend a helping hand, can trust us. We know that every relief worker wants to be on the frontline. But, relief work also involves lot of back room activities, co-ordination and job of facilitating various processes. People are required for the job of carrying out survey of disaster areas. There is a need for observers whose sole focus would be taking care of those in the field and making sure that their needs are fulfilled, that they take adequate rest. Those not in the field may feel that these observers are just sitting in the office and not doing much. This is not so. In a disaster situation we should be prepared to take up all kinds of assignments, each being essential in its own right. During disaster relief, voluntary organizations and the administration have different roles to play. Victims have different expectations from society and the government about taking care of their losses. Generally, they have very heavy expectations from the government. Voluntary organizations have a supplementary role vis-à-vis the government in relief and rescue operations. They cannot face big disasters on their own. Many a times volunteers feel dejected and overwhelmed when they are unable to help the victims in complex situations. Administration has a great responsibility and it has great capabilities too. While carrying out disaster relief activities, we should take care of the feelings of the victims as much as that of their physical well being. People working in disaster zone should have high mental resilience and great compassion for doing social work. They should have empathy in their heart. Voluntary organizations have an inherent edge over government machinery in this respect. One must be aware of distortions and depravity in the society even in work related to disaster relief. There is too much of noise by political workers about doing relief work. Some business houses, too, try to get extra mileage in the media. Then, there are instances where some voluntary organizations provide relief only to a certain section of society based on caste or religious affiliations. This kind of behaviour creates problems in carrying out relief work. We know that Sangh is devoid of such distortions. This is possible only because of continuous training at Sangh shakhas. Param Pujya Guruji once said that during disasters one should not get bogged down by extraneous considerations. Only thing that matters is the humanitarian view. One has to rise above religion, caste and other divisive considerations. This is the way Sangh swayamsevaks work during disasters. This attitude develops slowly, as one attends shakha regularly and gets involved in social work. Sangh is an institution of man-making. The process is highly scientific and time tested now. Every swayamsevak, when he takes oath (pratigya), says that he will do this work all his life. He is committed to the society’s welfare and development. Hardly anybody joins Sangh after reading about its philosophy in a book. It is a slow process where the love for members of the society finds an expression in Sangh work. People join Sangh because of its various activities and programmes which are conducted on daily basis but carry on for life due to sheer compassion for society. It creates an atmosphere of growth and commitment in the minds of Sangh karyakarta. Sangh was born because of compassion and heartfelt desire to serve the society. Dr. Hedgewar created a group of dedicated people and sent them to various parts of the country to bring together people to serve the motherland. Every swayamsevak feels the pain of the society, works actively and performs his duty. Swayamsevaks understand very well that they exist because of the nation and their fate is linked to the destiny of the nation. They don’t sit and cry in face of an adversity - they act. While serving the society we should keep our ears open. This keeps us in touch with the reality. We should also observe and understand the reality. This is better than just listening. Eyes strengthen the resolve that was made when we listened. This continuous process of thinking, dutiful action and association with society makes a swayamsevak responsible to the society. We are firmly believe that this type of approach alone can change the society. (Excerpts from address the delivered by Mananeeya Bhayyaji Joshi, Sah Sar Karyavah, on April 25-27, 2003 at “Aapda Niyojan and Prabandhan: Abhyas Varg” at Mumbai) CHAPTER 1 Disaster Preparedness Readiness for disaster is important at every level of the emergency management system. And it is equally important for public at large. An emergency management system can be built by     Planning co-ordination of State and Non Government Organisations Making resources available for facilities and equipment Giving training to disaster assistance volunteers and Sharing preparedness information with citizens What makes a disaster? Disasters are the combination of a number of factors: Vulnerability, Capacity, Hazards and Risks. Most commonly agreed definitions of disasters contemplate at least one of these elements. Many of them also explicitly include an element of “capacity to cope with the situation” as well as vulnerability. Most of the losses related to disaster situations are disproportionately high among the vulnerable sections of the society. Complex emergencies When a number of hazards (i.e. natural and/or technological) are combined with social, economic and political factors, complex situations arise. Usually, complex emergencies present humanitarian workers with the challenges of forced migration, violent conflict, high levels of vulnerability and low levels coping capacities pf the local populace. Furthermore the situation may be exacerbated by limited access to the people affected by disasters and poor security. WHEN DISASTER STRIKES The damage caused by natural disasters and manmade events such as earthquakes, flooding, and terrorism can affect all elements of society and government. These events:   Severely restrict or overwhelm our response resources, communications, transportation, and utilities. Leave many individuals and neighborhoods cut off from outside world and its support. It takes time for emergency response agencies to set up and prepare for an organized response. Damaged roads and disrupted communications systems may restrict their access to critically affected areas. Thus, for the initial period immediately following a disaster often up to 3 days or longer, individuals, households, and neighborhoods may need to rely on their own resources for food, water, first aid and shelter. Individual preparedness, planning, survival skills, and mutual aid within neighborhoods and worksites during this initial period are essential measures in coping with the aftermath of a disaster. There should be       Participation from people involved with local emergency services Hospitals Business and Industry Elected officials Media Anyone who has a stake in mitigation, response, recovery DISASTER PREPAREDNESS Disaster preparedness is the result of a wide range of activities and resources that are conducted in the hope of preventing and mitigating disasters, or better responding to them in case they present themselves. A working definition proposed by the UNDMTP “Disaster Preparedness Module” is: “Disaster preparedness minimises the adverse effects of a hazard through effective precautionary actions, rehabilitation and recovery to ensure the timely, appropriate and effective organisation and delivery of relief and assistance following a disaster.” Another definition is “Measures to ensure the readiness and ability of a society to forecast and take precautionary measures in advance of an imminent threat, and to respond to and cope with the effects of a disaster by organising and facilitating timely and effective rescue, relief and appropriate post-disaster assistance.” UNICEF defines Disaster Preparedness as “a continuous planning process, which ensures a constant state of readiness." In 1998, UNICEF came up with the following definition: “Disaster preparedness is a planning process not merely the development of a fixed plan. To be prepared is to be in a constant state of readiness”. It is important to take precautionary measures to reduce damage. It is an integral part of personal preparedness. There are several relatively simple measures that individuals can take to alleviate many home and workplace hazards. Some of the hazards include:     Gas line ruptures from water heaters or ranges displaced by shaking, water, or wind. Damage from falling books, dishes, or other cabinet contents. Risk of injury or electric shock from displaced appliances and office equipment. Fire from faulty wiring, overloaded plugs, frayed electrical cords. It is very important to be properly informed on the probable impacts of likely events, including the potential for terrorist activity. The more information the citizens have, the better they will be able to plan adequately and respond reasonably. Regardless of the event or the amount of warning offered, there are safety precautions that people can take to reduce or prevent injury. An assessment should be done to estimate the effects of hazards on the community. Risk Analysis is employed to                Develop planning priorities, Develop hazard maps, Educate personnel, officials and the public, Develop realistic plans and resource management strategies, Prepare mitigation programs. Evacuation Planning Factors Information to public/ means to inform the public Evacuation routes Transportation resources and routes to support mass (number?) evacuations including traffic control Special resource/equipment and/or supplies requirements-nearest hospital Travel time to hospital – ability to receive helicopters? Validation An important aspect to see that plan works as anticipated Conduct tabletop and full-scale exercises Training an essential component Steps in finding the risk factor of a hazard in your area: 1. Identify hazards: Prepare probability of occurrence ratings: 0 1 2 3 not possible possible, but probably won’t happen probable, but not very likely possible and likely to happen 2. Response Management Difficulty Rating 0 1 2 3 Absolutely no problem, routine Can be managed with local resources Would require assistance from local community Would require considerable external support Risk Factor (for each hazard) = Probability Rating plus Response Management Difficulty MISSION The mission of any disaster preparedness plan will be to “reduce the loss of life and property from natural and technological hazards by preparing a comprehensive, risk based emergency management plan of mitigation, preparedness, response and recovery. STEPS IN DISASTER MANAGEMENT The different phases of a disaster cycle can be represented using the following figure: DISASTER MANAGEMENT CYCLE The immediate aftermath of the disaster is response phase, which includes rescue of victims and provision of relief. The most crucial period for rescue is the first 24 hours and for relief, the first 72 hours. In almost all cases, response phase does not exceed one week. During rehabilitation phase the affected people are provided with alternate temporary dwellings and the normal commercial activity picks up slowly. Except for massive disasters, the rehabilitation phase does not last for more than six months. The reconstruction and recovery represent restoration of pre-disaster situation and may take upto five years. Mitigation phase is also, generally, initiated during or after reconstruction and recovery. During this time, vulnerability of the community is reduced by better buildings, communication systems and health facilities. During preparedness phase the community takes actions in anticipation to cope with a possible disaster that may occur in future. These actions may include mock-drills, information dissemination and measures to overcome problems. In a nutshell, disaster management involves following steps: 1. Response Time-sensitive actions to save lives and property, reducing the possibility of secondary damage, and speedy recovery operations:     Mobilizing emergency response personnel and equipment (may be affected themselves) Conduct search and rescue Alerting the public Evacuation 2. Recovery Actions that conditions:      can restore the community to pre-emergency Long-term Medical Assistance (travel time to nearest hospital) Reconstruction Rehabilitation Crisis Counselling and Public Information Programs Hazard Reduction Programs 3. Mitigation Actions that can prevent, alleviate suffering, or diminish the potential effects of a disaster situation:     Zoning Public education Budget allocations Earthquake resistant construction 4. Preparedness Actions that enhance disaster response capabilities:      Disaster plans Training Drills and exercises Prepare a checklist of Do’s and Don’t’s for all the personnel on how to react to an actual event. What should happen and when? Who would take the lead? Efficient communication and proper coordination is the key to effective response. Government should involve the corporate sector in prioritising disaster management issues. Focus should shift from Response to Mitigation. Citizen groups should provide essential intellectual and capital input for development of disaster-resistant communities. They should also advocate and promote disaster-resistant (sustainable development) plans and practices with government. PUBLIC PREPAREDNESS Society based preparedness planning allows us to prepare for and respond to anticipated disruptions and potential hazards following a disaster. As individuals, we can prepare our homes and families to cope during that critical period. Through pre-event planning, neighborhoods can also work together to help reduce injuries, loss of lives, and property damage. Neighborhood preparedness will enhance the ability of individuals and neighborhoods to reduce their emergency needs and to manage their existing resources until professional assistance becomes available. Home and Worksite preparedness Protecting yourself during a disaster requires planning. There are measures that they should take to prevent or minimize the damage caused by most hazards. These measures can be taken long before a disaster occurs, during the time of the disaster, and after the disaster has occurred. Personal safety measures vary depending on:    The type of event. The time available to respond to a warning. Location during the event (i.e., inside, outside, driving). Preparedness is the key to survival in a disaster. Individuals, families, and residents of a building can take steps that will help minimize structural and non-structural hazards, facilitate escape, and help people survive during the period immediately following the event. An emergency plan can mean the difference between life and death in a disaster. For example:       How will you escape from your home? Where will you meet family members? What route will you take out of your neighborhood if evacuation becomes necessary? Do you have an alternate route in case your primary route is blocked or otherwise impassable? What will you take with you? Where will you go? What will you need to take inside a shelter? Do you have those items (or enough of those items)? Home and worksite preparedness includes individual preparations, such as:       Assembling a disaster supply kit. Developing a disaster plan. Developing a safe room in a secure area of the home (in case you are asked to stay indoors during a disaster, e.g. nuclear disaster). Raise utilities (in case of flood risk). Anchor such furniture as bookshelves, hutches, and grandfather clocks to the wall. Secure appliances and office equipment in place with industrialstrength Velcro.  Locate and label shutoffs for gas, electricity, and water before disasters occur. After a disaster, shut off the utilities as needed to prevent fires and other risks. Creating a Family Disaster Plan     Plan how your family will stay in contact if separated by disaster. Choose an out-of-state friend as a "check-in contact" for everyone to call. Post emergency telephone numbers by every phone. Show responsible family members how and when to shut off water, gas, and electricity at main switches. Meet with your neighbors. Plan how the neighborhood could work together after a disaster. Know your neighbors' skills (medical, technical). Disaster supplies list included in the appendix of this book is fairly complete, and but people can determine the supplies that they will need for evacuation, those that they will need to shelter in place, and those that they will need for both.   Evacuation-only supplies, and supplies (e.g., prescription medications) that are required for evacuation and shelter in place should be stored where they can be accessed quickly in case of evacuation. Shelter-in-place-only supplies (e.g., 3 days of water for each family member for a cyclone or earthquake) should be stored in an accessible location within the home or workplace. Studies of behavior following disasters have shown that groups working together during the disaster period perform more effectively if there has been prior planning for disaster response. These studies show that organized grassroots efforts may be more successful if they are woven into the social and political fabric of the locality, neighborhood associations, schools, workplaces, places of worship, and other existing organizations. Effective response, therefore, requires comprehensive planning and coordination of all who will be involved - Local government, volunteer groups, private businesses, schools, and community organizations. With training and information, individuals and citizen groups can be prepared to serve as a crucial resource capable of performing many of the emergency functions needed in the immediate post-disaster period. Preparedness ensures that if disaster occurs, people are ready to get through it safely, and respond to it effectively. Whether you are an individual citizen, a volunteer group or a government agency, preparedness means figuring out what you will do if essential services breakdown, developing a plan for contingencies, and practicing the plan. Emergency preparedness is crucial for coming out from disasters with least damage. Just the knowledge of what to do, may help save lives. Citizen preparedness will be less effective if the society isn't prepared. Representatives of all NGOs have a role in organizing their organization’s activities before an emergency or disaster. One should take a lead in organizing meetings of such representatives and work out a disaster preparedness plan. The plan would:     Assign responsibility to organizations and individuals for carrying out specific actions at projected times and places in an emergency that exceeds the capability or routine responsibility of any one organization. Set forth lines of command and control structure and organizational relationships, and shows how all actions will be coordinated. Describe how people and property will be protected in emergencies and disasters. Identify personnel, equipment, facilities, supplies, and other resources available-within the locality for response and recovery operations. A Local Disaster Management Cell (LDMC) concept was formulated during the workshop organized in Mumbai in 2003 based on the experience of several rescue jobs done by Sangh swayamsevaks during various disasters. RSS swayamsevaks recognize it most likely that citizens would be on their own during the early stages of a catastrophic disaster. Accordingly, the workshop reached a conclusion that some basic training in disaster survival and rescue skills would improve the ability of swayamsevaks and other citizens to survive until responders or other assistance could arrive. Further, it confirmed the need for training civilians to meet immediate post-disaster needs. The concept also draws its inspiration from Kutchch Yuvak Sangh which did splendid work during Gujarat earthquake. Local Disaster Management Cell can respond after a disaster by:      Locating and turning off utilities, if safe to do so. Extinguishing small fires. Treating life-threatening injuries until professional assistance can be obtained. Conducting light search and rescue operations. Helping disaster survivors cope with their emotional stress. Local Disaster Management Cell (LDMC) in a Disaster Setting will respond in the period immediately after a disaster when response resources are overwhelmed or delayed. LDMC would assume many functions which would be similar to those of service personnel following a disaster when emergency services are overwhelmed or delayed. No matter which function NGOs are assigned to, effective LDMC require teamwork. LDMC will also do liaison with the Fire Department and other government agencies through its team leader who should also co-ordinate other activities such as: Rescue Operations, Planning, Logistics, and Administration.     Operations should include two response teams: Search and Rescue and Medical Relief. Planning Team should plan for manpower, fund collection, equipment and resources for relief work. Logistics Team should take care of relief supply distribution. Administration Team should co-ordinate fund collection, relief supplies and documentation. MEDICAL INFRASTRUCTURE PREPAREDNESS Hospitals are the flagships of the health-care system, no matter where you are. Hospitals set the example for the other aspects of health care. If the hospitals are not prepared, how can we expect any other part of the health-care system to be prepared? We must be prepared, for surely, once it is said, "It will not happen to us," it surely will. After a major disaster there are, always, more victims than rescuers. There are limited resources and time is critical. The recent earthquake has brought forward a whole lot of issues surrounding disaster management Experts believe that hospitals should have a contingency plan for any unforeseen natural or man-made disaster but most admit that they don’t have any concrete disaster management plan. The problem can be looked at from following perspective: 1) A comprehensive review of the problems encountered by hospitals during disasters and mass-casualty incidents 2) Estimating the patient population encountered by a community-level hospital following an earthquake in a densely populated area 3) An analysis of disaster plans for the emergency departments of public hospitals; and 4) The factor of additional stress placed upon health professionals during a disaster must be considered in the mobilization of medical personnel Each point highlights a different, but important aspect of what happens or could happen to a hospital during a disaster or mass-casualty situation. Hospitals and their staffs are also vulnerable to both disasters and the events that precipitate them. Generally, a hospital should take following steps: 1. Form a Disaster Management Committee, the structure of which should be truly comprehensive, involving the hospital management, hospital staff, social organisations of the area etc. It may comprise of the following: a) Representative of the Medical Officers b) Hospital Administrator c) Representative of para-medical/nursing staff d) Representative of hygiene related employees e) Representatives of social organisations f) Representative of other small hospital/nursing homes of the area 2. Decide the type and kind of the medical and other related services that shall be required during calamity. For example in the context of an earthquake, we can list the nature/type of medical services. a) There can be bone fracture, hence the requirement of orthopedic services b) There may be need for surgery for removal of limbs trapped in the debris, to save life hence the requirement of specialized or general surgery. c) Pregnant ladies may require urgent surgeries, hence the requirement of gynecologists’ services. d) There can be psychological disorders, hence the requirements of psychiatric and yoga centres. A comprehensive list can be prepared after a good degree of thoughts and deliberations for each type of calamity. To accomplish the above tasks, one has to take care of other related services also, such as: a) Making arrangements for make shift tent-hospital b) Arrangements for different types of life saving and other drugs c) Arranging for food, water, clothes, sanitary material, etc. d) Transportation arrangements The hospital will not be able to contribute much in the abovementioned related services. Here, then, is a role of voluntary organisations. They should come forward to arrange for the above. 3. For each medical service enlisted as above, decide the resources – both human as well as material. For each medical service, the sequence of steps can be as under: a) Form a team which may comprise of one doctor, one nurse and one midwife. The number of teams will depend on the strength of hospital. b) Prepare the list of equipments to be taken to the place of casualty. c) List of medicines which are likely to be needed. d) Any other thing relevant in that particular situation 4. Having decided upon the resources - human and material - next activity would be to organise them and keep them in order. Take following steps: a) Decide the structure and hierarchy of the team - who is what? Who is the team leader? Who is next in command? In deciding it, merit should be the only criterion. b) Describe the duties and responsibilities. Leave no room for confusion. Everybody in the team from top to the bottom is supposed to know what to do, how to do and when to do. 5) Design a training programme, both classroom as well as field - for each category of the staff in the team. The team leader should be taught lessons on the leadership and organisation. Training should generate team spirit among the team members. 6) Organise mock drills, if possible, say once in six months. keep the Disaster Management Team on the alert all the methodology and the situation for the team to be activated mock drill needs detailed deliberations and it can not be here. This is to time. The as part of described 7) Remain in touch with different social organisations, which can be of great help in mobilising resources at the time of crisis. It will also lessen the problem of co-ordination which is not uncommon (and can play havoc) on such occasions. 8) Last but not the least, give due importance to the work of disaster management by making budgetary provisions. A small part of your budget accumulated over the years and its proper utilisation will play miracles in tackling the calamity. No matter whether the healthcare institutions are situated inside or outside a natural disaster-prone area or not, it is always important for them to have some basic planning and preparedness in place to address calamities. Disasters like the Gujarat earthquake really test the capabilities of hospitals in the affected area. It is, but natural, that there may be lack of enough medicines and medical staff to attend to the enormous number of casualties and injured. Even then, with a proper planning in place one can address the situation in a better way and avoid utter chaos. It is also important for the healthcare institutions across the country to send in their relief personnel to assist the doctors and paramedical staff who may be attending to the injured in the affected area. It is a fact that most of the hospitals in India don’t have a contingency plan for addressing natural calamities or man-made disasters. Although talks have been going on for many years regarding the implementation of disaster management plan, nothing visibly concrete on the ground has been done in this direction. During disasters like the one at Gujarat, this topic takes the center stage and the media provides a lot of coverage about the topic. But once the dust settles down, everybody forgets about it. In India, it should be made mandatory for all the hospitals to have a disaster management plan. CHAPTER 2 Disaster Management Training TRAINING OVERVIEW AND OBJECTIVES The purpose of disaster management training is to provide the private citizens with the basic skills that they will need to respond to their locality’s immediate needs in the aftermath of a disaster, when emergency services are not available on call. By working together, citizens can assist in saving lives and protecting property using the basic techniques learned. The citizens who undergo training should be able to: 1. Identify the types of hazards that are most likely to affect their homes and communities. 2. Take steps to prepare themselves for a disaster. 3. Identify and reduce potential fire hazards in their homes or workplaces. 4. Apply techniques for opening airways, controlling bleeding, and treating for shock. 5. Select and set up a treatment area. Employ basic treatments for various wounds, and apply splints to suspected fractures and sprains. 6. Identify planning and size up requirements for potential search and rescue situations. 7. Work as a team to apply safe techniques for debris removal and victim extrication during search and rescue operations. 8. Know the post-disaster emotional environment and the steps that rescuers can take to relieve their own stress, and/or those of survivors. Some of the topics of disaster training are dealt in greater detail here for the benefit of the trainers. EFFECTS OF DISASTERS Disasters can be natural, manmade, and/or technological. Regardless of the event, disasters have several key elements in common:    They are relatively unexpected, with little or no warning or opportunity to prepare. Available personnel and emergency services may be overwhelmed initially by demands for their services. Lives, health, and the environment are endangered. In the immediate aftermath of a disaster, demand for help and redressal will be greater than rescue volunteers or services personnel can provide. In these instances, voluntary organizations become a vital link in the emergency service chain. Possible Effects Damage to transportation can:      Cause inaccurate damage assessment. Prevent ambulances from reaching victims. Prevent police from reaching areas of civil unrest. Prevent fire departments from getting to the fires. Interrupt the flow of needed supplies. Damage to structures can:   Prevent damaged hospitals from receiving patients. Increase the risk of damage from falling debris. Disrupted communication can:   Prevent victims from calling for help. Hamper coordination of services. Damage to utilities can:      Cause loss of service. Increase risk of fire and electrical shock. Cause loss of contact between victims and service providers. Cause an inadequate water supply for firefighting. Increase the risk to public health (if there is extensive damage to the water supply or if it becomes contaminated). Damage to fuel supplies can:   Increase the risk of fire or explosion from ruptured fuel lines. Pose a risk of asphyxiation from natural gas leaks in confined areas. Each instance of damage to the infrastructure may severely restrict the abilities of police, fire, and emergency medical services in that disaster. Because emergency services personnel are likely to have inadequate resources to meet the public's needs, those resources must be applied according to the highest-priority need.    Police will address incidences of grave public safety. Firefighters will suppress major fires. Service personnel will handle life-threatening injuries. Lower-priority needs will have to be met in other ways. While conducting training, organizers should also focus on various types of disasters e.g. drought, heat wave, riots, accidents, water logging. Some of the disasters are such that they occur regularly and we have sufficient prior information about them. We should prepare for them and try to organize help accordingly. RESPONSE WITHIN 24 HOURS If you are in the disaster zone: First 24 hours are very crucial in any disaster. There is a need to list tasks in the order of priorities. I. Assessment: If you are in the disaster zone you must look at yourself, around yourself and assess the damage. If you find yourself in good shape, thank God and get involved in relief work. The first task will be Situation Assessment - to find out the extent of damage to life and property and try to communicate by whatever means possible. II. Rescue Operation: Try to rescue as many victims as possible. People should also be told about some precautions to be taken while handling dead bodies. First Aid and Medical Relief: One must try to save as many lives as possible during first few hours of rescue work. Every delay is fatal to somebody. III. Co-ordination Team (Samanvay Toli): There are many tasks to be co-ordinated at this stage e.g. getting necessary equipment (boats in flood relief or earth moving equipment in earthquake), team formation to look after each area of activity. At this time one should also start co-ordinating with local government, local hospitals, other NGOs. A group should also focus on providing food supplies to victims and site selection for relief camps to provide temporary shelter. It is very important to create a communication bridge between all the teams working so that the situation can be handled efficiently and effectively. One should set up a temporary office and assign people to it to co-ordinate all the activities. IV. Security: Once initial set up is in order, we should concentrate on providing security for belongings of victims and at the relief camp sites. We should remember that there are people in the society who try to take advantage of such situations. V. Organising relief supplies, their storage and distribution: There should be a clear assessment of needs of the disaster zone and victims. One should also have fair assessment of conditions of approach road and conditions of other infrastructure facilities. There is a tendency to send lot of unnecessary supplies to disaster areas in a surge of emotion. Volunteers who are incharge of this operation should be clear in their mind about what they need and what they don’t need. VI. Interaction: There is, then, a need to start interaction with other agencies working in the area. There should not be duplication of work. One should also see that all the agencies are not concentrating in only one area and leaving many areas unattended. Response when you are outside disaster zone: I. II. III. IV. V. VI. VII. Assessment: If you are outside the disaster area, you must try to get the best picture of disaster zone. Send a survey team if possible. Immediate Medical Relief: Send well equipped ambulances for medical aid on the spot and other transport to bring other patients to outside disaster area for help and temporary hospitals, if possible. Send ready to eat and prepared food items, drinking water. Collection of funds for relief: To buy immediate relief supply kits. Support and Co-ordination: Those outside disaster area can organise relief equipment, special medical aid and co-ordinate with other agencies. They can send relief camp material and other relief supplies. They can also co-ordinate with bigger hospitals and transfer serious patients to big towns nearby. Relief camp management: Outside volunteers are in a better frame of mind to run relief camps and organise supply of relief materials in collaboration with people in the disaster area. Office Support: They can provide help in long term rehabilitation, documentation and auditing of relief funds received. ORGANISING LOCAL DISASTER MANAGEMENT CELLS Since independence we have been coping with disasters through a method of trial and error. We have overcome many challenges. The life force of our country is the mutual affection of our people. We rise as one in the event of any disaster. The relationship underlining the volunteers should be one of affection. It will be built through person to person, heart-toheart talk and informal interaction. Lack of such a relationship would impact the quality of work during a disaster. People rushing to help, even if motivated by a great urge to help others, can actually cause infrastructural and law and order problem at the disaster sites. If there is no record of people reaching disaster site, criminals and anti-social elements can take advantage of the situation. The numbers may be there but there is no interconnectedness in those numbers. Every person reaching disaster site has an individually driven purpose, but there is no collective purpose. It is important to take other like minded people along, appreciating their work in disaster situations and forming teams or co-coordinating with other NGOs. It is also important to understand the working of government officers and agencies and take their help and guidance in carrying out relief work. The LDMC program can harness the power of every individual through education, training, and volunteer service to make communities safer, stronger, and better prepared to respond to the threats of terrorism, crime, public health issues, and various kinds of disasters. If available, emergency services personnel are the best trained and equipped to handle emergencies. However, following a catastrophic disaster, you and the community may be on your own for a period of time because of the size of the area affected, lost communications, and unusable roads. Their training should cover basic skills required in a disaster when emergency services are not available. With training and practice and by working as a team, one will be able to do the greatest good for the greatest number after a disaster, while protecting oneself from becoming a victim. The Local Disaster Management Cell should also work out plans with local government agencies, Civil Defence wardens of the areas, arranging training with them, creating detailed plan of the area, identifying the areas for setting up relief camps, escape routes and vehicles like cheap rafts, implements, first aid kits etc. The LDMCs can provide an effective first-response capability. Acting as individuals first, then later as members of teams, trained LDMC volunteers can fan out within their assigned areas, extinguishing small fires, turning off natural gas inlets to damaged homes, performing light search and rescue, and rendering basic medical treatment. Trained volunteers also offer an important potential workforce to service organizations in nonhazardous functions such as shelter support, crowd control, and evacuation. Local Disaster Management Cell checklist will help guide you in the setup of your LDMC as well as emergency preparedness at home. The issues to be considered while forming an LDMC are:       Leadership - Team leader and Group leaders Membership – Roster, Phone list, Skills inventory Communications – Meetings, Notifications, Telephone tree, Newsletter, Amateur radio, Runners Resources and Locations – Personnel, Equipment, Supplies, Response kits Area Surveys - Evacuation plans, Staging area/command post (The staging area is a centralized contact point which makes it possible to communicate damage assessments and allocate volunteer resources more effectively), Medical treatment area, Specific hazard areas, Area maps Response Plan - Response criteria, Drills and exercises, Training First Aid, CPR LDMC members who encounter no serious problem in their immediate area can report to their staging area, where they take on assigned roles based on overall area needs. Members who find themselves in a heavily affected location send runners to staging areas to get help from available resources. Ham and radio links also may be used to increase communication capabilities and coordination. ORGANISING DISASTER ASSISTANCE VOLUNTEERS (DAVs) What is a Disaster Assistance Volunteer (DAV)? A Disaster Assistance Volunteer is one who is willing to perform disaster response and recovery activities, usually at temporary work sites located in disaster areas. Once activated or deployed DAVs will be assigned to disaster location, depending upon the requirement. DAVs should be highly motivated individuals ready to help people. They need to be able to do quality work with minimal supervision, under pressure and in a hectic work environment. The work day of a volunteer may be exhausting and stressful, but would also be challenging and rewarding. DAVs are a critical resource in the disaster preparedness and mitigation process. They will perform key programmes, technical and administrative functions during disasters. Without this work force, the ability to assist State and local governments in recovering from the effects of disasters would be significantly less effective. DAVs must be free to travel from two to six weeks, or more, at a stretch, usually with as little as a day or two of notice. General volunteers may be required to work for upto four weeks depending on the nature of disaster. Specialist DAVs may be required to work for a longer period till the rehabilitation work is on. Who can be a DAV? There is a role for everyone - young people, older adults, men and women, people who are fully fit, people of average health or even people with disabilities. Everyone can learn new skills and make his or her own unique contribution. All education and training programs should be provided free of charge. Equipment training, wherever required, should be provided. If a DAV is injured in any way whilst on rescue and relief work full insurance coverage should be provided. Specialist DAVs Other than general volunteers, following type of specialists may be required: Contract Specialists Contract Specialist will perform the work of acquiring specialists for disaster assistance materials and equipment on contract or outright purchase to be used at disaster sites. They will be required to be on call and will be used on an intermittent basis to provide acquisition support during declared disasters. Contract Specialists will be responsible for processing a variety of Procurement actions and closing out contracts. They must have experience in soliciting, evaluating, negotiating, administering and awarding contracts and simplified acquisitions. Finance Specialist Finance DAVs should have experience in management and development of large budgets and in financial systems and analysis. They must be available for travel, sometimes on short notice, for anywhere from 3 -4 or more weeks at a time. Technical Specialist DAVs will also be required to operate equipments round the clock, help in constructing relief camps and provide software support for logistic help in distribution of relief materials. There is an example of an Israeli technical expert on logistics who conducted the whole relief operation from his laptop sitting in an airport during Somalian disaster. Medical and Paramedical Specialist DAVs are required to reach disaster sites immediately to provide medical help to victims and save as many lives as possible within first 24 hours. There is always a shortage of paramedical volunteers at the site of disasters to give support in identifying medicines and for monitoring patients. Journalists Disaster management also requires trained public relations officers to direct the flow of information and control exaggerated reporting or spreading panic by over enthusiastic and emotional reporters. Volunteers who have experience in journalism, broadcasting, or public relations may also become specialist DAVs. All the stories related to disasters should be cleared by this group for contents and visuals. Disasters have to be treated like a national emergency. Training All DAVs must be given at least one week’s training course on disaster management and emergency care with case studies and actual site visits. Training sessions should be conducted periodically throughout the year with a refresher course of one day every year. Recommended Equipment for Volunteers: The following equipment and supplies are recommended as a minimum supply reserve for all LDMC teams. The equipment and supplies should be maintained at or near the team staging area. A register of these supplies should be maintained giving details about the Equipment/Supply, Date Obtained, Quantity and Date Checked. 1. Nylon/canvas bags with shoulder strap 2. Water (two bottles per Search and Rescue team), Water purification tablets 3. Dehydrated foods 4. Work gloves, Examination gloves 5. Goggles, Dust masks 6. Flashlight or miner's lamp, Batteries and extra bulbs, Secondary flashlight or light sticks 7. Utility knife 8. Note pads, Markers: Thin-point, Thick-point, Pens 9. Duct tape, Masking tape (2-inch), Scissors 10.First aid pouch containing:  4 x 4 gauze dressings (6)  Abdominal pads (4)  Triangular bandages (4)  Band-Aids  Roller bandage SEARCH AND RESCUE Our experience from previous disasters shows that immediately after almost every disaster, the first response to trapped victims is by spontaneous, untrained, and well-intentioned persons who rush to the site of a disaster in an attempt to rescue the victims. During the earthquake in Mexico City, spontaneous efforts saved 800 lives but cost the lives of more than 100 people. Mexico City example is not isolated, but is part of a larger pattern of behavior in emergencies, ranging from accidental drowning in which the would-be rescuer also drowns, to the massive influx of volunteers following major disasters. More often than not, these spontaneous rescue efforts result in serious injuries and compounded problems. Therefore, however well meaning they may be, rescue efforts should be planned and practised in advance. All those involved in search and rescue must understand their limitations, and also realize that their safety is paramount, even above that of the victims. Light search and rescue operations includes:     Identifying and sizing up the requirements for potential search and rescue operations Using the most common techniques for searching a structure. Using safe techniques for debris removal and victim extrication. Protecting rescuers during search and rescue. Following factors deeply influence any search and rescue operations:       Type of event Intensity/severity/duration Occupancy affected Current/forecast weather conditions Time of day and week Other factors that may affect search and rescue operations Search and Rescue Operations involve Size-up. Search involves locating victims and documenting location. Rescue involves procedures and methods to extricate victims. Search and rescue consists of three separate operations:    Size-up meaning assessing the situation and determining a safe action plan. Search involves locating victims and documenting their location. Rescue involves the procedures and methods required to extricate the victims. The decision to attempt a rescue should be based on two factors:   The risks involved to the rescuer The overall goal of doing the greatest good for the greatest number of people Goals of search and rescue operations are to:   Rescue the greatest number of people in the shortest amount of time. Rescue lightly trapped victims first. The most important person in a rescue attempt is the rescuer. Effective search and rescue operations hinge on:    Effective sizeup. Rescuer safety. Victim safety. Steps involved in Search and Rescue Sizeup: The facts of the situation must guide the search and rescue efforts. Therefore, steps are: 1. 2. 3. 4. 5. 6. 7. 8. 9. Gather Facts Assess Damage Consider Probabilities Assess Your Situation Establish Priorities Make Decisions Develop Plans of Action Take Action Evaluate Progress STEP 1: GATHER FACTS When gathering facts, one needs to consider:  The time of the event and day of the week - At night, more people will be in their homes, so the greatest need for search and rescue will be in residential areas. Conversely, during the day, people will be at work, so the need will be in commercial buildings. Some emergency services are not available, or not available in the same numbers during the evenings or on weekends. Search and rescue     operations may also be affected by where people are located in their homes and the amount of daylight available. The type of structure - The purpose for which the structure was designed may indicate the likely number of victims, and their location. Construction type - Some types of construction are more susceptible to damage than others. Weather - Severe weather will have an effect on victims and rescuers alike and will certainly hamper rescue efforts. Forecasts of severe weather should be considered as a limiting factor on the time period during which search and rescue can occur. Hazards - Knowledge of other potential hazards in the general and immediate areas is important to search and rescue efforts. Time lost trying to locate and shut off utilities, for example, can have a big impact in terms of loss of life. There is a need for accurate fact gathering before attempting to assess damage. By this point in the size-up, rescuers should have a good idea of whether the incident was caused by terrorism. One should never initiate search and rescue operations if they suspect that:   A biological, chemical, or radiological weapon has been used. There may be secondary explosive devices inside the building. If a possible terrorist related situation exists, rescuers should leave the area immediately. STEP 2: ASSESS AND COMMUNICATE DAMAGE The type of damage influences rescue mission, i.e.:    If damage is light (superficial or cosmetic damage, broken or cracked plaster, minor damage to the interior contents). The mission is to locate, triage, and prioritize removal of victims. If damage is moderate (visible signs of damage, decorative work damaged or fallen, many visible cracks in plaster, major damage to interior content, building is on its foundation). The mission is to locate, stabilize, and immediately evacuate victims to a safe area while minimizing the number of rescuers inside the structure. If damage is heavy (partial or total collapse, tilting, obvious structural instability, building off its foundation, heavy smoke or fire, hazardous materials inside, gas leaks, rising or moving water). The mission is to secure the building perimeter and warn others of the danger in entering the building. One must not enter a building with heavy damage under any circumstances. STEP 3: CONSIDER PROBABILITIES Because the rescuers will be working in such close proximity to the dangerous situation, considering what will probably happen and what could happen are of critical importance, one should identify potentially life-threatening hazards with an eye toward details like:    How stable the situation really is. Even within a structure that appears from the outside to have only minimal or moderate damage, nonstructural damage or instability inside the structure can pose real danger to the rescue team. Are chemicals, paints, or other potentially hazardous materials stored within the structure? How are they stored? Where are they? The answers could make a huge difference in how we approach the search. What else could go wrong. Based on the information gathered during steps 1 and 2 of the sizeup, rescue team members should take a few moments to play "What if?" to try to identify additional risks that they may face. What if the electricity fails during the search? What if a wall that appears stable shifts and collapses? Applying "Murphy's Law" to the situation could save the team's lives. What it all means for the search and rescue. Based on the probabilities, rescue team members should think about what they can do to reduce the risks associated with the probabilities that they have identified. Is a spotter necessary to look for movement that could indicate a possible collapse and warn the rescue team? Is some remedial action required to stabilize nonstructural hazards before beginning the search? Search and rescue teams must remember that their own safety is the first priority. STEP 4: ASSESS YOUR SITUATION Sizeup is a building process, with each step building upon the previous steps until the decision is made to begin the search and rescue operation (or that the situation is unsafe). Assessing resources is extremely important to search and rescue operations. Rescue teams should assess their situation to determine:    Whether the situation is safe enough to continue. The risks that rescuers will face if they continue. What resources will be needed to conduct the operation safely (and what resources are available). Planning Questions Personnel     Who lives and/or works in the area? During which hours are these people most likely to be available? What skills or hobbies do they have that might be useful in search and rescue operations? What might be the most effective means of mobilizing their efforts? Equipment  What equipment is available locally that might be useful for search and rescue?    Where is it located? How can it be accessed? On which structures (or types of structures) might it be most effective? Tools  What tools are available that might be useful for lifting, moving, or cutting disaster debris? Search and rescue resources include:    Personnel - Who lives and/or works in the area? When are they likely to be available? Do they have skills that might be useful in search and rescue operations? How can their efforts be mobilized? Tools - What tools are available that might be useful for lifting, moving, or cutting debris? Equipment - What equipment is available that might be useful for search and rescue? Where is it located? How can it be accessed? On which types of structures might it be most effective? Considering each of these questions will facilitate better action planning. STEP 5: ESTABLISH PRIORITIES After evaluating the situation, their next step is to determine what should be done and in what order. Safety is always the first priority and will dictate some of their other priorities. For example, removing or mitigating known hazards must be completed before teams begin to search. One should think through the situation logically to determine how they should approach the operation. STEP 6: MAKE DECISIONS At this point rescue teams will make decisions about where to deploy their resources for maximum good, while maintaining an adequate margin of safety. These priorities are based on (in order):     The safety of rescue team members. Life safety for victims and others. Protection of the environment. Protection of property. STEP 7: DEVELOP PLANS OF ACTION The rescue team leader will decide specifically how the team will conduct its operation, considering the highest priority tasks first. Action plans do not need to be written since the situation is probably complex enough. But a simple written plan will:  Help focus the operation on established priorities and decisions.   Provide documentation to be given to responding agencies when they arrive. Provide documentation that can be used, if necessary, after the incident. It is always useful to keep a notebook for jotting notes. These notes should also reflect any new information that comes in. STEP 8: TAKE ACTION Conducting rescue operations includes:    Creating a safe rescue environment by lifting objects out of the way, using tools to move objects, and removing debris. Triaging or stabilizing victims. Removing victims when required by the Sizeup. STEP 9: EVALUATE PROGRESS Evaluating progress is the most critical issue, not only in terms of evaluating whether the plan works, but also from a safety standpoint. Also, sizeup is ongoing process and that information gained during step 9 needs to be fed back into the decision making process for possible revision of priorities and updated action planning. Safety Considerations Regardless of the severity of structural damage, rescuer’s safety must be the primary concern. Two most frequent causes of rescuer’s’ deaths are:   Disorientation. Secondary collapse. Rescuers must follow these guidelines during all search and rescue operations:     Use a buddy system. Always work in pairs, with a third person acting as a runner. Be alert for hazards (e.g., power lines, natural gas leaks, hazardous materials, sharp objects, overhead objects that could fall, etc.). As a caution, one should not attempt to search an area where water is present. Use safety equipment. Wearing gloves and a helmet will protect a rescuer's hands and head. Also, primary cause of rescuer problems after working in a structural collapse is breathing dust, so a dust mask is essential. However, dust masks will not filter very fine particles, nor will they filter chemicals or biological agents. If the use of chemical or biological agents is suspected, the team must evacuate to an upwind location and notify first responders. Have backup teams available to allow rotating of teams, prevent fatigue, and ensure help if a team gets into trouble. Have teams drink fluids and eat to keep themselves fresh. Rescue team members should ask questions when talking with rescued individuals, including:       How many people live (or work) in the building? Where would they be at this time? What is the building layout? What have you seen or heard? Has anyone come out? What are the normal exit routes from the building? FIRST AID TRAINING When someone is injured or becomes ill, there is a critical period – before you can get medical help – that is of the utmost importance to the victim. What you do, or what you don’t do, in that interval can mean the difference between life and death. First Steps in First Aid: 1. When you approach a seriously injured person, think of the ABCs. A is for Airway. Make sure that the victim’s airway is not blocked. B is for Breathing. Make sure that the person is breathing. C is for Circulation. Make sure that the person has a pulse. 2. Check for bleeding. Act fast if the victim is bleeding severely. Every second counts. 3. Although most injured persons can be safely moved, it is vitally important not to move a person with serious neck or back injuries – unless you have to save him from further danger. 4. Keep the patient lying down and quiet. If he has vomited – and there is no danger that his neck is broken – turn him on his side to prevent choking. 5. Have someone call for medical assistance while you apply first aid. The person who summons help should explain the nature of the emergency and ask what should be done pending the arrival of the ambulance. 6. Reassure the victim, and try to remain calm yourself. Your calmness can allay his fear and panic. 7. Don’t give fluids to an unconscious or semiconscious person; fluids may enter his wind pipe and cause suffocation. Don’t try to arouse a person by slapping or shaking. 8. Rescuers should not put anything on wounds other than purified water. The use of other solutions (e.g., hydrogen peroxide) on wounds must be the decision of trained medical personnel. SANITATION TRAINING Primary public health measures include:   Maintaining proper hygiene. Maintaining proper sanitation.  Purifying water (if necessary). MAINTAINING HYGIENE Some steps that volunteers can take to maintain hygiene are to:     Wash hands frequently using soap and water. Hand washing should be thorough (at least 12 to 15 seconds) with an antibacterial scrub if possible. Wear latex gloves at all times. Change or disinfect gloves after examining and/or treating each patient. As explained earlier, under field conditions, volunteers can use rubber gloves that are sterilized between treating victims using bleach and water (1 part bleach to 10 parts water). Keep dressings sterile. Do not remove the over-wrap from dressings and bandages until use. After opening, use the entire dressing or bandage, if possible. Avoid contact with body fluids. Wash areas thoroughly that come in contact with body fluids with soap and water or diluted bleach as soon as possible. MAINTAINING SANITATION Volunteers can maintain sanitary conditions by:    Controlling the disposal of bacterial sources (e.g., latex gloves, dressings, etc.). Putting waste products in plastic bags, tying off the bags, and marking them as medical waste. Keep medical waste separate from other trash, and dispose it off as hazardous waste. Burying human waste. CONDUCTING MEDICAL RELIEF OPERATIONS As a preparedness measure, It is important to create a database of doctors, paramedics, hospitals, Red Cross, ambulance services, blood donors etc., trained first aid volunteers, how to set up temporary dispensary or hospital and how to resource the material for such a set up. There are four major functions of disaster medical operations:     Triage: The initial assessment and sorting of victims for treatment based on the severity of their injuries. Treatment: The area in which disaster medical services are provided to victims. Transport: The movement of victims from the triage area to the treatment area. Morgue: The temporary holding area for victims who have died as a result of their injuries. Following steps will help in conducting a good medical help operation: Step 1: Stop, Look, Listen, and Think. Before you start, stop and size up the situation by looking around and listening. Think about your safety, capability, and limitations, and decide if you will approach the situation and how. Step 2: Begin by calling out, "Help is here. If you can walk, come to the sound of my voice." If there are survivors who are ambulatory, instruct them to remain at a designated location, and continue with the operation. (If rescuers need assistance and there are ambulatory survivors, then these survivors should be asked to provide assistance.) These persons may also provide useful information about the location of the victims. Step 3: Start where you stand, and follow a systematic route. Start with the closest victims and work outward in a systematic fashion. Step 4: Evaluate each victim and tag them "I" (immediate), "D" (delayed), or DEAD. Remember to evaluate the walking wounded. Step 5: Treat I victims immediately. Initiate airway management, bleeding control, and/or treatment for shock for Category I victims. Step 6: Document, if possible, for triage results, for information on the victims' locations and a quick record of the number of casualties by degree of severity. ESTABLISHING TREATMENT AREAS Time is critical during a disaster. Therefore, it is important to select a site and set up a treatment area as soon as injured victims are confirmed. Treatment area is the location where the most advanced medical care possible will be given to victims. The site selected should be:     In a safe area, free of hazards and debris. Close to the hazard zone(s). Accessible by transportation vehicles helicopters, etc.). Expandable. (ambulances, trucks, Treatment area must be protected and clearly delineated using a ground cover or tarp, and that signs should identify the subdivisions of the area. Patients in the treatment area should be positioned in a head-to-toe configuration, with two to three feet between victims. A clearly marked treatment area will help in transporting victims to the correct location.    "I" for Immediate care. "D" for Delayed care. "DEAD" for the morgue. "I" and "D" divisions should be relatively close to each other to allow:    Verbal communication between volunteers in the two areas. Shared access to medical supplies (which should be cached in a central location). Easy transfer of patients whose status has changed. There is a need for thorough documentation of victims in the treatment area, including:       Available identifying information. Description (age, sex, body build, height, weight). Clothing. Injuries. Treatment. Transfer location. DISASTER PSYCHOLOGY Disaster Psychology deals with the psychological impact of a disaster on victims and rescue workers, and how to provide ‘psychological’ first aid. The topics in trauma management training should cover the critical role of psychiatrists and psychologists in trauma management, identifying and understanding the difference between chronic, serious problem and a milder form of depression or shock, creating databank of such relief workers, material resources like books, CDs etc. The event of a disaster has multifold effects on the mind and nature of the human beings getting affected by the disaster. The psychosocial impacts on the human mind are related to the following factors of the disaster:  Type of disaster and its aggressiveness, intensity, duration, etc affect the mind differently. The case of disaster due to fire shall have different effects on the mind than the case of an earthquake or flood;  Nature of exposure to the disaster and distance from the disaster: Exposure to the disaster may be direct or indirect, may involve irreversible or reversible damages, etc, each having varied effects;  Duration of exposure: Number of casualties (both injuries and deaths, especially to children);  Loss of infrastructure/ property/ belongings/ regional settings/ neighborhood;  Loss of sense of safety After the occurrence of the disaster, generally, an atmosphere of destruction, devastation and damage prevails. There is loss of life, property and infrastructure. People find themselves in a helpless situation of shock which demands a lot of work to return back to their normalcy. In such conditions, there are various factors which affect the psycho-social part of the human mind thereby affecting his/her response and reaction to the situation. The post disaster situational factors, which affect the mind are as follows:  Immediate environment which includes the smell, the sights of destruction and death, the weather, the devastation and general atmosphere of helplessness among all;  Separation of the families due to death, injuries or loss;  Availability of assistance and social support;  Management of the situation including the leadership assumed in the community or the social workers thereby directing the relief works and all methods and attempts to return to normal conditions;  Reactions of other people like laborers, social workers, researchers, health inspectors, officials etc;  Communication about the probable proposed ‘development’ to ensure basic needs and opportunities;  Type and intensity of media coverage;  Religious and cultural issues, rituals. VICARIOUS TRAUMA Vicarious trauma is the process of change in the rescuer resulting from empathic engagement with survivors. It is an ‘occupational hazard’ for rescue volunteers. Volunteers should be warned against over identifying with the survivors. They should not take on the survivors' feelings as their own because it will compound their own stress and affect overall effectiveness. They should be alert to signs of disaster trauma in themselves, as well as in disaster victims, so that they can take steps to alleviate stress. Possible Psychological Symptoms:            Irritability, anger Self-blame, blaming others Isolation, withdrawal Fear of recurrence Feeling stunned, numb, or overwhelmed Feeling helpless Mood swings Sadness, depression, grief Denial Concentration, memory problems Relationship conflicts/marital discord Possible Physiological Symptoms:         Loss of appetite Headaches, chest pain Diarrhea, stomach pain, nausea Hyperactivity Increase in alcohol or drug consumption Nightmares Inability to sleep Fatigue, low energy There are steps that NGOs can take to reduce the stress on rescue workers before, during, and after an incident: 1. Provide pre-disaster stress management training to all probable volunteers. 2. Brief them before the effort begins on what they can expect to see and what they can expect in terms of emotional response in the survivors and themselves. 3. Share the workload and emotional load. It can help defuse pent-up emotions. 4. Encourage rescuers to rest and re-group so that they can avoid becoming overtired. 5. Direct rescuers to take breaks away from the incident area, to get relief from the stress of the effort. 6. Encourage rescuers to eat properly and maintain fluid intake throughout the operation. Explain that they should drink water or other electrolyte replacing fluids, and avoid drinks with caffeine or refined sugar. 7. Rotate teams for breaks or new duties (i.e., from high-stress to low-stress jobs). Team members can talk with each other about their experiences. This is very important for their psychological health. During the relief operations NGOs may invite a mental health professional trained in Critical Incident Stress Management (CISM) to conduct a Critical Incident Stress Debriefing (CISD). CISD is a formal group process held between 1 to 3 days after the event and is designed to help emergency services personnel and volunteers cope with a traumatic event. Participation in CISD should be voluntary. CISD has seven phases:        Introductions and a description of the process, including assurance of confidentiality Review of the factual material about the incident Sharing of initial thoughts/feelings about the incident Sharing of emotional reactions to the incident Review of the symptoms of stress experienced by the participants Instruction about normal stress reactions Closing and further needs assessment Volunteers should spend some time thinking about other ways to reduce stress personally. They can take the following preventive steps in their everyday lives:        Get enough sleep. Exercise. Eat a balanced diet. Balance work, play, and rest. Allow oneself to receive as well as give. identity is broader than that of a helper. Connect with others. Use spiritual means. Remember that your Experienced volunteers find these steps helpful in controlling their stress levels, but that, in some cases, it might be necessary to seek help from mental health professionals. WORKING WITH SURVIVORS' TRAUMA With the occurrence of a disaster the human mind, passes through four stages. They are can be classified in the following categories:  Heroic- this state of mind in the human comes just after the disaster to attempt at saving the lives of the affected with great amount of involvement and feelings. Personal preferences, schedules or priorities take backseat and the need for social help drives the mind.  Honeymoon- a sense of relief and satisfaction (short-lived) that the disaster is over and the destruction and damage shall no more be there. A sense of rebuilding and making a new world prevails.  Disillusionment- a sense of frustrations when the work of recovery and relief often fails to reach up to the expectations of the affected and fails to bring back normalcy.  Reconstruction/recovery- the phase of work, labor and involvement to build up the damaged and restore the loss. Volunteers should expect that survivors will show psychological effects from the disaster and that they should expect that some of the psychological warfare will be directed toward them. Traumatic Crisis A crisis is an event that is experienced or witnessed in which people's ability to cope is overwhelmed:     Actual or potential death or injury to self or others. Serious injury. Destruction of their homes, neighborhood, or valued possessions. Loss of contact with family members or close friends. Traumatic Stress related to disasters Dr. Harish Shetty has worked extensively in this area over years. The following views and opinions reflect his experience in this field as a professional. The mental disorder due to emotions of extreme fear or trauma due to the disaster situation is the traumatic stress in a person. The common reactions found in traumatic stress are as follows:  Emotional reactions like- fear and anxiety, sadness and depression, anger;  Physical problems like- sleep disorders, gastro-intestinal problems);  Difficulty in concentrating or thinking clearly;  Family difficulties (abuse);  Substance abuse. With the accumulation of expectations and frustrations, often these stress related symptoms aggravate. There rises a need to seek professional help when- the unpleasant symptoms remain more than four to six weeks, when it becomes difficult to function effectively on jobs, or at home or school and when an individual feels concerned about his/her emotions and behaviors. When traumatic stress overcomes individuals, different people react differently. There are individual differences in response to traumatic stress. The differences are in terms of severity, symptoms, timings, limitations of coping skills, and delayed reactions. Post-traumatic stress is another common feature observed in the affected populace of a disaster. The experiences range in the following manner:  Re-experiencing the stress with nightmares, flashbacks, intrusive memories;  A tendency of avoidance of people, places, topics, activities related to original stress;  Hyper arousal including exaggerated startled responses, sleeping difficulties, etc;  Overall impairment of functioning. The traumatic events are more stressful in the following cases:       Many people die in the event; The disaster is absolutely unexpected; The crisis situation has a long duration; The cause is unknown; They are poignant/meaningful; The impact is over a large area. Traumatic stress may affect:    Cognitive functioning - those who have suffered traumatic stress may act irrationally, have difficulty making decisions; or may act in ways that are out of character of them normally. They may have difficulty sharing or retrieving memories. Physical health - traumatic stress can cause a range of physical symptoms from exhaustion to heat problems. Interpersonal relationships - those who survive traumatic stress may undergo temporary or long-term personality changes that make interpersonal relationships difficult. Coping with stress Traumatic events can be less stressful due to certain factors. Effective preparation of pre-disaster mitigation measures and preparedness leads to reduced stress. Training of the people in both pre and post disaster scenario of how to cope up with situations and how to prepare and expect situations helps to shape up the psychology and reduce stress too. Teamwork, cooperation and healthy social work can be an answer to most of the traumatic stress. The presence of a community feeling, togetherness and unity to stand up in a situation of crisis and the sense of culture and tradition are also strong factors that help in reducing traumatic stress. Understanding an individual's ways of coping with the stress in such positions of crisis is crucial. The most effective way of coping is his/her talking with the family members, friends, elders. In terms of psychological first aid, one needs to take care of oneself, rest, relax, eat well, involve and maintain personal and family time. One should also maintain a routine schedule of work and follow it. In dire cases one should seek help from medical and / psychiatric professionals. Disaster stress may revive memories of prior trauma, as well as possibly intensify pre-existing social, economic, spiritual, psychological, or medical problems. Trauma management is crucial and rescue workers as well as family members should prepare themselves to handle trauma hit members in the family. Strength and type of personal reaction vary because of:      The person's prior experience with the same or a similar event. The emotional effect of multiple events can be cumulative, leading to greater stress reactions. The intensity of the disruption in the survivors' lives. The more the survivors' lives are disrupted, the greater their psychological and physiological reactions may become. The meaning of the event to the individual. The more catastrophic the victim perceives the event to be to him or her personally, the more intense will be his or her stress reaction. The emotional well-being of the individual and the resources (especially social) that he or she has to cope. People who have had other recent traumas may not cope well with additional stresses. The length of time that has elapsed between the event's occurrence and the present. The reality of the event takes time to "sink in”. Volunteers should not take the survivors' on the surface attitudes personally. Rescuers may expect to see a range of responses that will vary from person to person, but the responses they see will be part of the psychological impact of the event and probably will not relate to anything that they have or have not done. They should provide support by:    Listening to them talk about their feelings and their physical needs. Victims often need to talk about what they've been through and they want someone to listen to them. Empathizing. Show by your responses that you hear their concerns. Victims want to know that someone else shares their feelings of pain and grief. Help survivors connect to natural support systems, such as family, friends, or religious teachers. Survivors that show evidence of being suicidal, psychotic, or unable to take care of themselves should be referred to mental health professionals for support. When providing support, volunteers should avoid saying the following phrases. (On the surface, these phrases are meant to comfort the survivors, but they do not show an understanding of the person's feelings.)       "I understand." In most situations we cannot understand unless we have had the same experience. "Don't feel bad." The survivor has a right to feel bad and will need time to feel differently. "You're strong/You'll get through this." Many survivors do not feel strong and question if they will recover from the loss. "Don't cry." It is Ok to cry. "It's God's will." Giving religious meaning to an event to a person you do not know may insult or anger the person. "It could be worse" or "At least you still have ..." It is up to the individual to decide whether things could be worse. These types of responses could elicit a strong negative response or distance the survivor from you. It is ok to apologize if the survivor reacts negatively to something that you said. Managing the Death Scene One unpleasant task that volunteers may face is managing the family members at the scene of the death of a loved one. You may use following guidelines:     Cover the body; treat it with respect. Wrap mutilated bodies tightly. Have one family member look at the body and decide if the rest of the family should see it. Allow family members to hold or spend time with the deceased. Stay close by, but don't watch - try to distance yourself emotionally. Let the family grieve. Don't try to comfort them out of a need to alleviate your own discomfort. Informing Family of a Death In some cases, the family may not know of the death of their loved one, and you may be called upon to tell them. In this situation:  Separate the family members from others in a quiet, private place.  Have the person(s) sit down, if possible.  Make eye contact and use a calm, kind voice.  Use the words to tell the family members about the death, like, "I'm sorry, but your family member has died. I am so sorry." Children and Disaster There are three groups of children who need different ways of trauma management:    Preschoolers - Under 6 years School going - 6- 12 years Pre-adolescents and Adolescents - 12- 8 years Ms. Bhavana Jhaveri spent over four months in quake-hit Bachau, using play therapy for children in relief camps. Play is to a child what work is to an adult—it is what they do. Play comes naturally to children. It is through play that children learn about their world and the things in it. Play allows children the chance to explore their environment, to learn how it works and how they relate to it. Through the manipulation of toys more than words, the child can show more adequately how he/she feels about him/herself and the significant persons and events in his/her life. Hence, the concept of play therapy. Most children under the age of ten have not yet developed the abstract reasoning skills and verbal abilities to sit in the counselor’s office and be articulate about their thoughts, feelings, and behaviours. For older children, play may be the outlet through which they convey emotions that they are either unwilling to share verbally or do not have the sufficient vocabulary to express. Modes of Play Therapy With the use of small toys and characters children can recreate a portion of their world in a sand-tray, box or on a table. Suggested toys and characters are people, animals, buildings, cars, soldiers, houses, trees, hedges, gates, boats, etc. It might be helpful to separate the props by type to aid the child’s choice of mixing toys. Combining water with this activity can be especially effective. However, children above eight or ten years of age may see this as “child’s play” or use it as a simple escape measure, thus limiting the effective communication of feelings. Games such as checkers, board games, and playing cards allow an older child (ten and above) a more complex avenue for expression that is beyond his younger peers. By participating with or watching a child play a game, it is possible to observe its responses to perceived threats (being jumped in checkers), aggression (how determined they are to win) and how they respond to actual loss (losing the game). A child probably approaches a game in quite the same manner that they approach life: willingness to compete or standout, willing to take a risk to win or lose, desire to be in control, refusal to engage, demonstration of foresight and planning, responses to loss or victory. Games can also be a simple way to break the ice and make introductions. Use of Art Play therapy can also include art therapy where a child uses clay, paint, and other art media to create images that explore their feelings, dreams, memories or ideas. Individuals suffering from depression, those facing loss, coping with trauma, dealing with addiction, recovering from sexual abuse, or seeking means to overcome anxiety have often found relief, courage, and strengthening insight through art therapy. Creativity can provide a means of expression for that which has no words, or is not yet fully understood. Although no permanent record will be created, the blackboard offers familiarity and a quickly reusable surface to a school-going child. Further, several children can work at once on either individual projects or in the creation of a mural. This is a simple tool if a child or group of children need to be briefly separated from adults, e.g. during a disaster relief organisation’s meeting. Not only does this leave the adults free to attend to other more pressing demands, but it also protects the children from hearing about serious problems facing their community. The primary advantage of using clay is that children can express feelings in three dimensions. Figures can be made and moved. Buildings can be constructed and destroyed. By allowing children to create a representation of their world, whether real or fanciful, the chance to gain a better understanding of their needs is presented. As with other media, the process is as important as the product. Story-telling A child may share important and insightful information with an adult through story-telling. The various kinds of story-telling can be arranged in oorder of appropriateness for children by age group. Story-telling is a good way to incorporate stress relief into a programme for children. By weaving a tale about disasters, focusing on one’s own experiences or on those of the children, one can communicate trust and security about frightening issues. RELIEF SUPPLY MANAGEMENT Training on relief supply management should include:       Setting up of a proper back office for managing supplies Analysing the survey reports and deciding the kind of supplies required and communication of these requirements to relief workers or agencies Maintaining records Identifying the possible storage points in an area (accessibility, safety etc.) Identifying and directing areas where relief material may not reach due to their remoteness Keeping care of expiry related information about medicines An Example: SUMA - A Relief Supply Management System What is SUMA? The flood of relief supplies that arrive in the aftermath of large-scale disasters, often, poses serious logistic and management problems for organizations engaged in relief work. SUMA is a tool for the management of humanitarian relief supplies, from the time pledges are made by donors, to their entry into the disaster area and their storage and distribution. SUMA - SUpply MAnagement system can keep authorities and donors informed of exactly what has been received. It quickly identifies and assigns priority to those supplies that are urgently needed by the disaster- affected population; offers a tool for inventory control on warehousing and distribution of supplies. SUMA began as a PAHO/WHO technical cooperation project in Latin America and the Caribbean in 1990. The objective of SUMA was to build a capacity in the countries to deal effectively with information on incoming relief supplies. Some 2100 officers in more than 30 countries in the Americas and in other regions of the world have received training. SUMA has been implemented in a variety of both natural and complex emergencies in this region. HOW DOES SUMA WORK? Information on supplies is collected at different points of entry such as an airport, seaport, or border. The SUMA team assigns a priority to each item based on how it meets the needs of the disaster victims. Items are classified by category, subcategory, and item. Other SUMA teams work at warehouses and distribution hubs, managing information on the distribution of items from central to peripheral points. Information gathered in the field is forwarded in an electronic format to the central level, where the emergency is being managed. Standard or customized reports can be easily generated for disaster coordinators, assisting them to monitor pledges from donors and identify gaps or duplications. Who operates SUMA? In the immediate aftermath of large-scale disasters, local trained health professionals may sort through incoming medical supplies. PAHO/WHO also provides logistical and technical support in mobilizing SUMA teams from nearby countries. SUMA teams are self-sufficient and have received specialized training, which includes:  Sorting and identification of supplies  software operation  use of the SUMA labeling system  operational aspects of relief (radio and satellite communications, use of generators, etc.) The SUMA team members assist affected countries in large-scale international disasters. SUMA is now the accepted standard in Latin America and the Caribbean for relief supply management, and is being increasingly requested for disaster management outside the region of the Americas. Experienced SUMA team members provide training locally, in neighboring countries, and are being called on to train potential SUMA teams outside of this region. One of the most important features of SUMA is its flexibility. It can be used in many different emergency situations, large or small scale, and in natural as well as complex emergency situations. The development and modification of the software is based on constant feedback from national team members who have used it in a variety of disaster situations and training sessions. The SUMA software is copyrighted by the Pan American Health Organization, but distributed free of charge in English, Spanish and French. For information on technical requirements or to obtain the software and training manuals, please contact: SUMA Project, Pan American Health Organization 525 Twenty Third Street, N.W. Washington, DC 20037 Fax: (202) 775-4578 e-mail: suma@paho.org CHAPTER 3 Training for Rehabilitation Humanitarian issues, like meeting fundamental human needs for survival and emotional recovery, dominate only the emergency period. Rehabilitation is a long haul effort and requires lot of stamina. We need to understand the issues like difference between temporary and permanent shelter, identifying the kind of people who will be interested in such a long run work, resourcing right kind of people and materials for a particular disaster and area. There are little appreciated and understood issues like co-ordination with government departments and critical importance of proper project reports to get right funding to complete such a work. The goal of appropriate disaster rehabilitation is to support the positive qualities of the affected society while working as an agent of positive change in regard to its disaster-prone elements. One of the most widely held myths regarding earthquakes, cyclones, floods, and other natural disasters is that they are ‘great equalizers’. They bring to mind the wrath and power of an untamed nature that hits men and women, young and old, rich and poor alike. In fact, natural disasters are not great equalizers. There is sufficient evidence by now to demonstrate that they affect populations selectively. The poor are the most vulnerable, the least prepared and the hardest hit. Among them, the most seriously threatened by mortality and morbidity are often those already known to be at greatest risk in normal times: women, children, older people. A major natural disaster not only directly damages or destroys part of the economy and service infrastructure but also affects other areas outside the disaster zone as funds, supplies, and personnel are diverted, albeit unwisely, for the recovery effort. If a society is to return to normal the economic systems damaged by a disaster, physical facilities and distribution networks must be restored as quickly as possible. In the succeeding phases, the issues are essentially economic. They deal with housing, reconstruction, agricultural recovery, restoration of jobs, small businesses, and governmental services. The development issues most overlooked during rehabilitation are: 1. The need to facilitate cooperative action. It has been frequently shown that if a society is to develop socially or economically, it must attain a degree of sophistication in conducting cooperative activities. Many outfits overlook this connection, and some of their programs reduce the possibility of cooperative action in future programs. 2. Participation in decision making. An NGO that offers a predetermined plan or one prepared without the full participation of the disaster victims misses the opportunity to increase the people's ability to make choices and to help them attain self- confidence in decision making. For example, housing planned in the aftermath of Kutchch earthquake had toilets with 12 liter flushing system, where, getting even a bucket of water every day would be taken as a luxury! 3. Dependency relationships. The degree of dependency on institutions or resources beyond the control of a low-income population is a major contributor to social and economic underdevelopment. The dependency relationship may involve leadership, money, or materials. Generally, dependency relationships are one-sided or highly loaded in favor of the provider. 4. Fostering unrealistic expectations. Many relief programs have led to unrealistic expectations on the part of the recipients. For example, the provision of free housing for a relatively small number of people following the Andhra Pradesh cyclone or Orissa cyclone created the expectation that everyone who had lost a house would soon be receiving a pucca (brick and cement) house from either the government or a relief agency. In fact, it was impossible for the government to provide housing of this type for even one-tenth of the total number of affected families. Hindrances for normalization Many a times, disaster relief operations can create a second round of aftershock or disaster within the community. E.g. humanitarian aid after a disaster can, in fact, be harmful to the beneficiary. Rehabilitation volunteers have no understanding of the resources existing within a society that can cope with the disasters. Nor do they have an understanding of the role these coping mechanisms play. This is due to the their lack of familiarity with the social and anthropological background of the locality and their desire to respond to short-term needs which overshadows the long-term implications of their actions. Therefore, every NGO must learn to identify the coping mechanisms that exist in the society and how they relate to outside help. They must learn utilize these built-in disaster response systems and to encourage a collective response. Failure to do this can:  Undermine the authority and prestige of local leaders  Become a disincentive to self-help  Undermine the confidence in local agencies whose resources are limited as compared to outside agencies. Most experienced relief agencies are fully aware of their foremost responsibility to do avoid inflicting such harm. Unfortunately, however, examples of the detrimental effects of ill-conceived assistance on painfully achieved progress are still all too common. Such as: 1. Immediately following a disaster, large amounts of food and essential items are brought in. A distribution system is set up by Government agencies and NGOs, which operates through local working groups or committees. The relief packets are then given away to the disaster victims. In the meantime, because the relief packet distribution system is divorced from the normal distribution system, local merchants are stuck with the items that they have, and would be of use to the victims. 2. There is also obstruction to normalisation due to the loss of some opportunities to resolve basic problems. The can lead to introducing new problems that must be overcome to attain predisaster development objectives within the affected locality. 3. Relief and reconstruction programs compete with development programs for available funds, with the likelihood that relief programs would take precedence. Rehabilitation Approaches: The Ad hoc Approach: NGOs provide aid in as many different sectors (e.g. health, housing) as possible. The problem is that the activities are not tied together and, thus, do not complement or supplement each other. The Single Sector Approach: In this approach, an NGO focuses all of its efforts and resources in one sector, for example, housing. It may, however, conduct a variety of projects and use a number of different methods to make provision for building materials and making housing loans and grants available. In this way various activities are complementary and may be designed so that each contributes to the overall goals. The Integrated Recovery Approach: A variety of projects and activities may be conducted in different sectors, but they are planned, balanced, and integrated in such a way that each is complementary to and builds upon the other activities. If conducted properly, integrated recovery programs afford an NGO the best vehicle to introduce change and to have a long-term impact on a small locality. Opportunity for Change After Disaster The record of success for building a model society after a disaster has been low. This does not mean that opportunities for modest change are not present. Rather, it means that a subtle approach, patience, and a long-term commitment on the part of the government and NGOs is required. There are three broadly recognized ways by which change can occur: Invisible change: Making improvements without outwardly affecting appearance or performance. For example, improving traditional building techniques to enable housing to better withstand the forces of earthquakes. Substitute method: For example, the provision of a new type of seed, one that is stronger or resists various pests, but that requires no basic change in normal cropping patterns, can be substituted following a disaster where crops have been affected. Building block method: An organization can introduce changes slowly by first working to re-establish a semblance of normalcy, and then introducing limited innovations. Rehabilitation: From Shelter to Housing In some of the most severe disasters the single greatest loss (after human suffering) is that of housing. The reconstruction of the damaged or destroyed houses is one of the largest costs in the disaster recovery process. Relief and reconstruction operations should be conducted within the context of development. The process through which a family obtains disaster assistance may be more important than the actual aid received. The people can do it and they know how. The people consistently prefer private and informal solutions over public and formal ones, even when the latter may, objectively, be more adequate. When properly executed, rehabilitation can provide a strong stimulus to recovery and a base for positive changes. The following is a description of an approach to the reconstruction of housing, based on experiences gained from Latur, Maharashtra and Kutchch, Gujarat. The objectives of the program should be:       To help the disaster victims repair or rebuild safe houses at a cost they can afford To improve the building skills of local carpenters, masons, and other building tradesmen so that they can continue to build safe houses To lower the overall disaster vulnerability of housing in the community To stimulate economic recovery as well as physical reconstruction To stimulate the development of small enterprises in the housing sector, helping to reduce building costs and to provide a basis for improving the standard of housing throughout the project area To establish a basis for vulnerability reduction areas outside the disaster-affected zone. Generally in a shelter-to-housing program, a variety of post-disaster shelter and housing services are offered by NGOs to low-income disaster victims. Many affected people from high income groups are simply left out the loop. After some time many families from low income group move to the pucca houses but families belonging to pre-disaster high income group continue to remain in temporary shelters. There is a need to offer them programs where they can rebuild their houses. In this program, building materials may be sold to them at a subsidized price. The housing program should be designed so that every family is able to move on to the long-term recovery phase. The reconstruction program should also involve victims in the repair and rebuilding of their housing to increase the sense of participation in the process. The families participating in the program should be encouraged to help each other. The following are the series of activities required during the housing rehabilitation program and the sequence in which they are carried out. Disaster Assessment: The assessment determines the needs in the project area and the resources that are available in the area. Rehabilitation Planning: The planning process sets out a framework that will guide the project during the initial stages of implementation. As the project proceeds, plans may be revised or changed. Materials’ Acquisition: The materials that are necessary to help people rebuild or repair houses are identified and acquired during this phase. Public Awareness: As the program commences, an extensive program to inform the public regarding how they can participate in the program is carried out. Construction Training: The principal element of the program is training in methods of improved disaster-resistant construction. Participation: NGOs should help victims to participate more effectively in the rehabilitation programmes. Special attention is given to organizing groups of families to help each other build as a means of reducing costs and speeding up the construction. Materials Distribution: Material Distribution activity has five components: Material acquisition: The sources are usually either from commercial supplies, on-site production of building materials, or recovery from salvaged material. Logistics: It consists of the equipment, procedures, and control for moving the materials from the source of acquisition to the point of distribution. Materials distribution: It consist of direct sales to the beneficiary, grantsin-aid, or materials-for-work. Credit: In some cases it may be necessary to provide loans to families to enable them to purchase building materials. CHAPTER 4 A Training Plan The training should cover both the aspects, one concerning those who are in the disaster zone and the other for those who may be outside the disaster zone. There should be two types of training: Special Skill Training: These trainings should be organised for select group of people who volunteer to perform specific tasks. Subjects for these trainings could be:       Managing Office - includes auditing techniques, report preparation, documentation. Civil Defence - includes relief and rescue techniques, handling fire extinguishers etc. First Aid and Disaster Medicine Communication - including Ham Radio operation Trauma Management - Psychological rehabilitation Rehabilitation - includes shelter, work, educational and cultural facilities General Subjects: There are certain areas of disaster preparedness which do not require special skill training but a good exposure to certain ideas which make such management much easier and efficient. These areas are:        Work to be done in first 24 hours - preparedness Knowledge of Local government, co-ordination with local government and local hospitals Problems in doing relief work and their solutions Relief camp management, sanitation, nutrition A continuous Survey of Local areas and data bank of NGOs and other community leaders and co-ordination with them General aspects of rehabilitation General psychological aspects of handling disaster victims Specialized skills: 1. First Aid Resources required – Orthopedic specialist, general practitioner doctor First Aid related charts, First aid training book Possible topics – Bandaging of various kind, putting splinters on fractures, taking care of unconscious person, artificial respiration etc. Information about medicines for common disaster related medical problems 2. Office management 3. 4. 5. 6. 7. Resources required – Experienced volunteers of NGOs, Accounts and Finance manager, Company secretary, experienced office secretary to train on correspondence Possible topics – Importance of maintaining all records and proper filing, simple account keeping, making project reports, highlighting letter writing skills for governmental correspondence, understanding the fact that co-ordination (samanvay) with different agencies is a long term exercise and not one time instant effort Search and Rescue Operations Resources required – People trained in Civil defense, local warden of Civil defense cell Possible topics – training for light search and rescue operations for various disasters, general first aid, making local area disaster management plan, getting certification for civil defense courses Disaster Assistance Volunteer (DAV) Training Resources required – experienced volunteer in the field, relevant documentary films, books, films, world wide and Indian data Possible subjects - creating team spirit, understanding skills of individual volunteers, allocating different jobs to persons depending upon their skills and leading with example, giving trainees class room case study exercises to simulate relief measures and other disaster management related issues Communication systems Resources required – Ham radio operator, wireless expert Possible topics – setting up of a ham radio set, understanding wireless protocols, using satellite telephones, legal issues involved in using ham radios Psychological counseling Resources required – Psychiatrist, Psychologist, Counselor Possible topics - Mental make up of a disaster victim, recognizing signs of mental sickness, various phases of a psychologically upset victim, differentiating between a mildly upset victim and a serious patient requiring immediate counseling, recognizing the difference between problems of adults, women and children and treating them accordingly Rehabilitation – related to building permanent and temporary shelters, short/long term employment. Resources required – Structural engineer, architect, town planner, civil contractor, NGOs, persons in government, like deputy collector etc. Possible topics – designing temporary and permanent structures depending upon geography and type of disaster, working out long term strategy for rehabilitation and building of a new village, township or houses, other issues in rehabilitation like immediate and long term employment, governments’ key role in rehabilitation an dealing with the concerned departments General skills: 1. Co-ordination with government agencies Resources required – working or retired senior government officials specially in HRD, Home ministry, PWD etc. Possible topics – Understanding the psychology of government officers and dealing with them accordingly, getting to know government 2. 3. 4. 5. 6. 7. policies on various disaster or relief related programs and how to utilize them for relief related activities, art of correspondence and follow ups with government departments and officers Setting up relief camps Resources - Red Cross officials, Working or retired NCC officers or Army officers, Civil defense officials Possible topics – setting up of temporary relief camps, resources required, possible sources of getting the required materials, hygiene related issues, first aid camp, keeping local hospital, nursing home and doctors’ lists and information, organizing medical personnel at short notice Surveying the disaster areas Resources required – experienced volunteers in the field Possible topics – Keeping maps of an area handy, mapping of a disaster area, making right kind of survey forms, skills of collecting information from victims, communication skills, getting over language problems Co-ordination with other NGOs Resource required - People working with NGOs Possible topics – Understanding the psychology of other voluntary agencies and their workers, understanding the working of NGOs, absorbing and appreciating their style of working and their issues, skills of taking them along, building close rapport with NGOs, synergizing with like minded people and multiplying the results Rehabilitation – general Resources required – Experienced volunteers, vocational guidance experts, engineers, specialized architectural books Possible topics – temporary rehabilitation, giving a long term vision of rehabilitation exercise, difficulties of sustaining such a work over a long period and possible solutions to overcome such difficulties, precautions in fund raising and other relief materials Nutrition and hygiene Resources required – Civil defense volunteer, Red Cross volunteers, Nutritionists, Nurses, Doctors Possible subjects – cardinal rules of hygiene and nutrition, using available resources to provide nutritious food to victims, importance of hygiene, steps to control out-break of some water borne diseases, simple chemicals, materials to make water potable Introduction to Disaster Psychology and rehabilitation Resources required – psychiatrist, psychologist Possible topics – general mental make up of disaster victims, providing relief to them, recognizing a seriously upset victim and arranging for his/her help, general counseling, using local idiom to take care of disturbed people Preparing for Disaster Management Workshop: 1. Identifying Resource persons 2. Collecting resource materials like exhibition, CDs, statistical data, books and other information 3. Identify groups for training workshops who may be interested in this kind of work 4. Identifying NGOs who conduct or can help you conduct the programme 5. Updating information about disaster management related subjects Appendix I Disaster Preparedness Case Study Description This is a fictional case study arising from an amalgamation of a number of natural disasters. Participants can be asked to work in groups to review a disaster response operation, which suffers typical problems, and find examples of where the operation was not done well. Recommendations are made for the future. CASE: THE DISASTER A major cyclone strikes a coastal of 300,000 inhabitants. For eight hours major sustained winds of 300 km/hr hit the region mixed with heavy rains. Rivers and tributaries clog causing massive flooding. In some cases the water rises 3 meters in less than one hour. About 1,000 people are killed, three times that are injured and tens of thousands are left homeless. The worst hit are the poor villagers whose houses were built using wood and bamboo and were not Pakka houses. Many buildings were also damaged near the beach. The intense flooding causes dams to burst. Drainage ditches that handle "normal" rains cannot cope with this intense storm. Housing built on hillsides or without minimum standards are washed away by water or blown away by wind. There were early warning systems and evacuation plans ready but not implemented due to Sab Chalta Hai attitude. Many may have died because they did not know the storm was coming or simply went in the wrong direction once it hit. The basic infrastructure of the region breaks down. Sanitation becomes an immediate problem. Those that can, climb onto roofs or trees. Many head for high points in and around the city and villages but are soon isolated on these newly formed islands. Those who do make it to high ground are forced to set up crude shelters, toilets and washing facilities on limited space. There is no clean drinking water and people are beginning to drink the polluted water that surrounds them. Snake and other animal bites rise as these animals seek the same high ground being occupied by humans. The elderly and infants are severely affected. Some drowned and others die of exposure to the elements. The survivors lack the physical capacities to protect themselves, to establish makeshift shelters or mobilize themselves sufficiently for food and water. The nation responds generously. Government facilitates preparation of food packages to be dropped in the disaster region. Soon thousands of tons of food - from powdered milk to Rotis/Puris pile up at the local airport and warehouses. However, the storm has neutralized the ground transportation systems as bridges collapse and roads disappear under water. The government has limited airlift and boat capacity for this type of disaster. The military, Government Ministries, and the NGOs are deployed to manage the crisis. However their standards and operating procedures vary widely. Arguments soon develop as to which agency should take the lead, who will coordinate transportation/rescue efforts and who should be responsible for communications. The media criticizes both the Central and State governments for not responding rapidly and meeting human needs. Dozens of foreign rescue teams arrive, although most do not speak the local language. These relief volunteers become bottlenecked at the capital or the main airport. The Municipal authorities are being inundated with requests from the media, Central Government, local and international agencies with lists of their needs. There is no coherent or authoritative list of what resources are available and what is needed. Aid workers who do find their way to the flooded area often show up with inappropriate equipment. There are vehicles without proper equipment, incompatible radio systems, boats without boatmen. Relief workers, military, municipal workers and volunteers are victims of the disaster themselves; many suffering from post traumatic stress. They lack experience and specific guidance from the government. Friction of a serious nature occurs between the NGOs and Central Government over funding, standards, responsibility and accountability. The quantity and quality of services (from the size and spacing of temporary shelters, to the number of latrines and water points, to what kind and how much food is needed and how it should be prepared and distributed) lead to serious discrepancies of agreement. Camps are established at the periphery of the flood on high ground for those who are lucky to make it to these locations. Some camps are 'five star' while others have truly miserable conditions. There is a feeling that certain ethnic groups are getting second rate care. There is no coordination on how to rescue trapped on the "islands" inside the flood area. Feelings of competition among aid providers (especially international providers) and feelings of resentment among the affected population grow rapidly. Some families have received airy family tents which are modern, spacious, water proof, fully ventilated, high enough to walk upright in and with built in ground sheets. Others have received only the UN standard 5m x 5m plastic sheeting, while some have been coping with torn sheets of packing plastic nailed to bamboo sticks. Meanwhile children are becoming ill with gastro-intestinal diseases, mosquitoes abound and dense areas of sheltered accommodation are beginning to resemble muddy swamps. Local political leaders are incensed by the perceived injustice of the shelter distribution. Few have experience of how to manage the thousands of tons of food and domestic items that have been sent to the region. Inappropriate clothing items, unsolicited as is much of the aid, clog the system. Even much needed items such as water purification tablets sit in warehouses. The overflowing warehouse of the government is ransacked by an unruly crowd who can see mattresses, water containers and food parcels which have not been distributed. In the surrounding countryside the people seem to be little better off. Flooding and wind damage was less but basic transportation infrastructure still was destroyed. Trees and bushes have been cut down to make shelters. Their primary concern is for basic foodstuffs and hygiene items as the roads have been cut off for a week now. Urban areas have been taking priority because of the numbers involved, putting the populations in rural areas at risk of malnutrition and disease. Water in many areas is contaminated, though it was initially clean and potable. Excrement lies everywhere. Odors of death and filth merge. As floodwater recedes reconstruction is happening haphazardly. Some people clear their properties and start collecting bricks, roofing materials or timber, according to their means. Others just sink deeper into depression and inaction, lacking materials, land and guidance. Notes for Instructor: 1. Preparation Photocopy enough case study exercise sheets for each participant. 2. Exercise Read the case study. The instructor should give the participants instructions, which they have in writing in their background document. As an individual, write down three things that went well in the case's response and three things that didn't. With your group, brainstorm on the above issues and develop the following:    Five specific examples where the disaster response were not good List three major planning and coordination issues and explain how the could have been avoided. Make 5 recommendations for a future Emergency Preparedness Plan based on lessons learned from this disaster. Note that the group presentations might be fairly similar, and to avoid tiresome and unproductive repetition, several approaches can be taken:     Ask only a couple of groups to make a presentation, and encourage others to add things from their work that were missed Ask each group to present one of the questions, again asking the other groups to fill in issues that were missed Assign a different optional question to each group Start with the first group presenting their entire work, and ask subsequent groups to only add things that were not mentioned  Alternative for time saving: Divide room into six, or four groups and have the groups present to each other rather than in plenary. Facilitators divide up and pose optional discussion questions in each small group. Results are reported in plenary. 3. Try to Identify following issues during discussion:                      Disaster Preparedness and Planning Issues Mitigation and Risk reduction issues. Site Selection and Planning Initial Assessment Relief and Rescue Operations Disaster Planning Issue Sanitation General Nutrition Support to the Population Analysis of Relief Operation Assessment, sensitivity to specific needs and vulnerabilities Handling the Media Inappropriate equipment Incompatible radio systems Code of Conduct, Principles of co-ordination and co-operation Respect for role of local communities and authorities The need for resources for assessment The human resource and capacity training of each sector Feelings of competition among aid providers Feelings of resentment among the affected population Resource Management Appendix II Disaster Supply & Evacuation Kits DISASTER SUPPLY KIT When creating a Disaster Supply Kit, keep in mind the following:    The number and ages of people for whom the kit is being prepared. The space available for storing and transporting the Kit. Any special health problem associated with the disaster. The Kit can be of two types:   For relief supplies: This kit is prepared for the use of disaster affected people. This Kit should be prepared according to the need of the victims. For Evacuation: There are occasions when you have advance warning about the impending disaster. In such cases one must prepare the Evacuation Kit for use while away from home. Place the supplies you are apt to need for an evacuation in an easy-to-carry container. There are six basic supplies which one should stock at home: water, first aid, clothing and bedding, emergency supplies and special items. The items that are needed for evacuation should be stored in an easy to carry container. Some suggestions are:       Store the Evacuation Kit in a convenient place. Keep items in airtight plastic bags. Change stored water supply every three months so it stays fresh. Change stored food items every six months. Review the Kit once in a year. Replace batteries, update clothes etc. Update your medical supplies based on your health. WATER Water should be stored in plastic containers such as soft drink bottles. Avoid using containers that will decompose or break, such as milk cartons or glass bottles. A normally active person needs to drink at least two Liters of water each day. Hot environments and intense physical activity can double that requirement. Children, nursing mothers, and ill people will need more.  Store 4 Liters of water per person per day (2 Liters for drinking, 2 Liters for food preparation/sanitation.)  Keep at least a 3-day supply of water for each person in your household. How to Purify Water If you have questions about the quality of the water, purify it before drinking.    Boiling: Boiling is the safest method to purify water. You can heat water to a rolling boil for 10 minutes. To improve taste, pour from one clean container to another several times. Purification Tablets: Use commercial purification tablets to purify the water. Usually one tablet is enough for one liter of water. Bleach Purification: You can also use household liquid chlorine bleach if it is pure, unscented, 5.25% sodium hypochlorite. For one liter, add 2 drops if the water is clear, 4 drops if the water is cloudy. After adding bleach, shake or stir the water container and let it stand 30 minutes before drinking. FOOD Store at least a 3-day supply of nonperishable food. Select foods that require no refrigeration, preparation, or cooking and little or no water. Select food items that are compact and lightweight. Include a selection of the following foods in your disaster supply kit:       Ready-to-eat food, fruits, and vegetables Canned juices, milk, soup (if powdered, store extra water) Staples: sugar, salt, pepper High-energy foods: peanuts, biscuits Foods for infants, elderly persons, or persons on special diets Comfort/stress foods: cookies, hard candy, sweetened cereals, instant coffee, tea bags KITCHEN ITEMS        Paper cups, plates, and plastic utensils All-purpose knife Household liquid bleach to treat drinking water Sugar, salt, pepper Aluminum foil and plastic wrap Re-sealing plastic bags If food must be cooked then a small vessel, spoon, small cooking stove and a can of cooking fuel SANITATION/HEALTH KIT Wrap the following brand new items in the new hand towel, tie it with string and place inside a sealed plastic bag.       1 1 1 1 1 1 hand towel washcloth hair comb, regular size (not pocket) nail file or nail clipper bath-size bar of soap in wrapper toothbrush in sealed package       1 large tube of toothpaste Feminine supplies Plastic garbage bags Plastic bucket with tight lid Disinfectant Household chlorine bleach FIRST AID MEDICINE KIT Where possible, purchase tablets in bottles of 100 or more. Medicine samples should not be used in these kits. The total quantity required for a situation could be in multiples of the bottles available.  Rolled Bandages -- for first aid applications. Sterile Gauze Pads (4x4) 50 nos.  Adhesive Tape 6 Rolls, 1/2" or I" x 10yds. or more  Triple Antibiotic Topical Ointment 4 Tubes (10 gm tubes) e.g. Neosporin Ointment  Aspirin 325 mg (5 gm) tablets  Ferrous Sulfate Tablets 500 nos. of 325 mg  Children's Multivitamins with Iron Chewable Tablets 500 nos.  Adult Multivitamins with Iron Tablets 500 Tablets  Children's Acetaminophen Chewable Tablets 300 Tablets of 80mg.  Acetaminophen for Adults -- pain reliever  Antacid -- for treatment of upset stomach / heartburn  Mebendazole or Thiabendazole -- for intestinal worm infection  Sulfamethoxazole/Trimethoprim -- antibacterial for adults and children  Tetmosol Soap --for treatment of scabies for adults and children  Oral Rehydration Salts -- to combat dehydration for adults and children  Promethazine -- for treatment of nausea  Metronidazole -- for treatment of intestinal amebiasis (amebic dysentery)  Chlorhexidine -- antiseptic for adults and children  Tolnaftate 1% Antifungal Cream -- for skin infections for adults and children CLOTHING AND BEDDING Include at least one complete change of clothing and footwear per person. The following kits are recommended following a natural disaster.     One complete change of clothing Sturdy shoes Rain gear Bedding Pack with 2 flat double-bed sheets, 2 pillow cases, 2 pillows or inflatable rubber pillows, Blankets SEWING KIT Sewing kits foster interdependence rather than dependence. Women can make clothing in their own size and in the style of their culture. Cottage industries often grow out of the sewing classes where women use these kits to practice valuable income-generating skills.  3 yards of cotton or cotton-blend solid-color or print fabric (3 uncut yards of fabric is required to be practically usable)  1 pair of sewing scissors  1 package of needles  1 spool of thread  6 matching buttons FOR BABY Kits with the basic supplies every baby needs. Please be sure that all items are fresh and new. Bundle the items inside one of the receiving blankets and secure it with diaper pins.        6 2 2 2 2 1 2 cloth diapers shirts baby wash cloths gowns diaper pins sweater receiving blankets SCHOOL KIT After a disaster young children should be kept busy with their studies and activities. School kits may be the only educational resources available in such a situation. Teacher's knowledge and student’s own notes are the only things available. They would have difficulty learning without the basic tools in this kit, which is designed for a variety of ages. Prepare a 12"x14" (finished size) cloth bag with handles and a closer (Velcro, snap, or button) and place the following items in the bag.         1 blunt scissors 2 pads of 8 ½ " x 11" ruled paper 1 30-centimeter ruler 1 pencil sharpener 6 unsharpened pencils with erasers 1 eraser, 2 ½" 12 sheets of construction paper 1 box of 8 crayons TOOLS AND SUPPLIES      Generators Tarps Tents Cots Flashlight, Battery-operated radio and extra batteries  Match box in a waterproof container PREPARING EVACUATION KIT IN CASE OF WARNING You can cope best by preparing for disaster before it strikes. One way to prepare is by assembling a Disaster Evacuation Kit. After disaster strikes, you won't have time to shop or search for supplies. If you've gathered following supplies in advance, you and your family can endure an evacuation or home confinement.            Store 4 Liters of water per person per day (2 Liters for drinking, 2 Liters for food preparation/sanitation.) High-energy foods like peanuts, biscuits and Comfort/stress foods like cookies, hard candy, sweetened cereals, instant coffee, tea bags. Sanitation Kit, First Aid Kit All-purpose knife Flashlight, Battery-operated radio and extra batteries Clothing and Bedding Personal identification, cash (including change) or traveler's checks, and a credit card Copies of important documents: birth certificates, marriage certificate, driver's license, passport, wills, deeds, inventory of household goods, insurance papers, immunizations records, bank and credit card account numbers, stocks and bonds. Be sure to store these in a watertight container. Emergency contact list and phone numbers Map of the area and phone numbers of places you could go An extra set of car keys and house keys Appendix III Questionnaire on Disaster Preparedness Ask yourself how prepared you are in the event of a disaster. This is a step towards getting yourself ready to meet eventualities which might save your family’s life and your own in the event of disasters. Also you may be able to help your community to come out better from disasters. After going through this questionnaire explore resources listed above for preparedness in event of disasters as mentioned. Preparedness for your Family  Do you think that your family is relatively well-prepared for a disaster such as an earthquake, tornado, cyclones, winter storm, fire, flood and other such incidents?  Can you list the actual cash value of every item in your home? You may be asked to prepare such a list after a fire, cyclone or flood. Obviously, a wise choice is to make that list (called a household inventory) well before a disaster occurs. A household inventory can provide you with some excellent information for deciding how much insurance to purchase as well.  Have you discussed disaster preparedness with your family? Each family member needs to know how to phone for help, escape out of the house, and seek safe shelter in the house. Each family member needs to know how to be safe when they are out of the home (at work, school, play). Each family member needs to know how the family plans to reunite if it becomes impossible to return home.  Do you have an out-of-area phone contact? Believe it or not, long distance phone calls are often easier to make immediately following a disaster than are local phone calls. Does everyone in your family know how and whom to call up to inform about one’s safety.  Do all members of your family know how to call for help or know numbers like that of the Police, Fire, Ambulance, responsible friend/relative, etc. near the phone? Do your kids know what sort of information they will need to give over the phone (i.e., the address of the home, their last name, etc.)?  Do they know how to turn off all utilities (gas, electricity, water, etc.)? For a variety of reasons, it may be necessary to turn off the utilities in your home.  Do they know where the circuit breaker box or main switch is?  Do you know where your family records are? A great place to keep your valuable papers (marriage certificate, birth certificates, passports, insurance papers, household inventory, etc.) is in a safe deposit box.  Is the home earthquake safe - no unsecured heavy objects (mirrors, bookshelves, etc.), the water heater bolted to the wall? If there is a water tank on the top of the house, then how much water should be stored in earthquake prone zones?  Do you have a Family Disaster Supply Kit? Your supply kit should have all thing that will help it survive for 72 hours. This will include food and water of course, but also medicines, blankets, flashlights, etc. Even if you don't put together an actual kit (although we would encourage you to do so), think about having at least enough food, water and medicine at home with you to last 72 hours.  Are you trained in First-Aid ( during last 3 years)? Basic first-aid, for example how to stop bleeding by applying pressure, can be crucial, even life saving knowledge. First-aid courses are often offered by local hospitals and charitable hospital for nominal charges.  Are you and your family members updated on CPR (Cardio Pulmonary Resuscitation) It is a simple technique that has saved many folks who would have, otherwise, been choking, drowning, smoke inhalation, or heart attack victims. When you think about a few hours of training saving a loved one's life, isn't it worth it? Preparedness of your neighborhood  Do you believe that the neighborhood you live in is relatively wellprepared for a disaster?  Do you know about your Neighborhood/ Panchayat/District, Disaster Management Plan?  Is there any source of community Information system that you know of? Are you aware of any source of information to prepare yourself for disasters?  Has your District/State Authority worked with local hospitals, nursing homes, day care centers, shopping malls, schools, etc. to make sure they have a plan for an emergency? Preparedness for Fire at home or at Workplace  Do you know about fire extinguishers? How do you make sure it is fully charged (they can lose their charge over time)? There are three basic classes of fires. All fire extinguishers are labeled using standard symbols for the classes of fires they can put out. A red slash through any of the symbols tells you the extinguisher cannot be used on that class of fire. A missing symbol tells you only that the extinguisher has not been tested for a given class of fire. Class A: Ordinary combustibles such as wood, cloth, paper, rubber and many plastics. Class B: Flammable liquids such as gasoline, oil, grease, tar, oilbased paint, lacquer, and flammable gas. Class C: Energized electrical equipment - including wiring, fuse boxes, circuit breakers, machinery, and appliances Many household fire extinguishers are "multipurpose" A-B-C models, labeled for use on all three classes of fire. If you are faced with a Class A fire and don't have an extinguisher with an "A" symbol, don't hesitate to use one with the "B:C" symbol. But, it is very dangerous to use water or an extinguisher labeled only for Class A fires on a Class B or Class C fire.  Do you know how to use the fire extinguisher? Using a fire extinguisher is not so straightforward and the time to learn how to operate one is not during a fire. Follow the four-step PASS procedure. Pull the pin: This unlocks the operating lever and allows you to discharge the extinguisher. Aim low: Point the extinguisher nozzle (or hose) at the base of the fire. Squeeze the lever above the handle: This discharges the extinguishing agent. (Some extinguishers have a button instead of a lever.) Sweep from side-to-side: Moving carefully toward the fire, keep the extinguisher aimed at the base of the fire and sweep back and forth until the flames appear to be out. Preparedness at School/Workplace  Do you know about disaster plans at your workplace, at your children's school? Few of us spend 100 percent of our time at home, so we need to know about the disaster plans at the other places we (and our loved ones) spend time. Be sure that you know about the plan and also that it is a sound plan. View publication stats