“43 X ayo" Sal apf ARTIFICIAL RESPIRATION Definition: Artificial respiration (artificial ventilation)It is the act of simulating respiration for a person who is not breathing or not making sufficient respiratory effort on his or her own. This is breathing induced by some manipulative techniques when natural respiration has ceased or is faltering. Such techniques, if applied quickly and properly, can prevent some deaths from drowning, choking, strangulation, suffocation, carbon monoxide poisoning, and electric shock. Resuscitation by inducing artificial respiration consists chiefly of two actions: (J) Establishing and maintaining an open air passage from the upper respiratory tract (mouth, throat, and pharynx) to the lungs and (2) Exchanging air and carbon dioxide in the terminal air sacs of the lungs (alveoli) while the heart is still functioning. To be successful such efforts must be started as soon as possible and continued until the victim is again breathing. METHODS FOR ARTIFICIAL RESPIRATION 1. Manual method (emergency method): eg-mouth to mouth breathing, mouth to nose breathing, mouth to mask. 2. Mechanical method: this method is used when artificial respiration is required for longer period.eg-drinker and shaw tank, mechanical ventilator(ventilator, tracheal isitubation, cricothyrotomy, tracheostomy) Manual method (emergency method) 1, Mouth to Mouth (Kiss of Life): The rescuer makes a seal between his or her mouth and the person’s mouth. The rescuer blows air into the person. The amount of oxygen delivered to a vietim during mouth-to-mouth resuscitation is about 16% (compared to 21% in normal fresh air). * place victim on back, loosen shirt around neck Open his mouth and using finger to remove debris (blood, knocked teeth) Open the airway ging head-tilt, chin-lift technique or jaw thrust ‘Take deep breath and blow in to his mouth by sealing mouth around the patient’s own, Observe for rise of the chest as air gets into lungs, repeat a second breath. Breathe should bbe delivered over one second, [2. Mouth to Mask: Seal the mask against the person’s face by placing four fingers of one hand across the top of the mask and the thumb f the other hand along the bottom edge of the mask Using your fingers on the bottom of the mask, open the airway using head tilt or chin lift Press firmly around the edges of the mask and ventilate by delivering over one second as you watch the person’s chest rise. . Mouth to Nose:It is the rescuer’s choice to use this method because there may be vomit in the mouth or injuries. With the head tilted back, close the mouth by pushing on the chin. Seal your mouth around the person’s nose and breathe into it. Open the person’s mouth between breathes to let out air. Mechanical method This is the use of a machine called Ventilator to fully or partially provide artificial respiration (ventilation) Methods that were popular particularly in the early 20th century but were later supplanted by more effective techniques included. 1. Drinker’s method- In this method the patient is placed in an air-tight chamber, the head remaining outside. 2. Bragg Paul’s method 3. Tank respirator However these method have been replaced by more advanced method like the 4. Mechanical Ventilator: (Refer to the note on Mechanical Ventilation)SINS Copy Diseshe (ayy MECHANICAL VENTILATION (MV) Mechanical ventilation can be defined as the technique through which air is moved toward and from the lungs through an external device connected directly to the patient. It is a supportive treatment and not curative. A mechanical ventilator is an instrument (@evice) that replaces or assists in spontaneous breathing. Indications for MV Mechanical order to resolve over time. mon specific medical indications for mechanical ventilation include: Ae ‘ Surgical procedures especially under general anesthesia ~ Acute lung injury, including acite respiratory distress syndrome (ARDS), trauma, or Pneumonia ary hemorrfiage 5 Apnea with respiratory arrest ¢ Hypoxemia (ALS), Guillain-Barré syndrome, myasthenia gravis, etc. |\ Newborn premature infants with neonatal respiratory distress syndrome Clinical Indices of the Need for MV Inadequate Ventilation + Respiratory rate: RR > 30 breaths/min (Normal 10-20) + Tidal Volume; VT < 5 mi/kg (Normal 5-7) + Vital Capacity; VC < 15 mi/kg (Normal 65-75mi/kg) + Partial pressure of carbon dioxide; PaCO2 > 60 mmig (normal 35-45mmHg) + Respiratory rate/Tidal volume (RR/VT > 100) + Dead space ventilation/tidal volume; VD/VT ratio > 0.6 (Normal < 0.3) + Paradoxical ling, Inadequate Gas Exchange + Partial pressure of oxygen; PaO2 < 60 mmHg on Fi02 > = 0.6. ROUTES USED FOR MV Non-invasive Mechanical Ventilation Noninvasive mechanical ventilation involves use of a machine that delivers oxygen and removes carbon dioxide through an external device (such as a face mask). This type ofdifficulty ventilation is most commonly used for patients with mit to moder : breathing due to an ce on ned mentoring nthe hospital to ensure the difficulty does not worsen. breathing ificuty does not wterace available, each wit its own particular benefits and drawbacks: « total face masks (enclose mouth, nose eyes) =fulface masks (enclose mouth and nose) tee s Paced tween ip arden pace by psa cei ttlows or plugs (Inserted into nostrils 4 “Rea (eovers the whole head/all or part of the neck — no contact with face). Invasive Mechanical Ventilation lungs). The endotracheal tube is connected to a machine a amount of oxygen and volume of air, along with a set number of breaths per minute. These are adjusted according to a patient's levels oxygen and carbon dioxide levels. Patients with an acute iliness who require invasive mechanical be monitored in an intensive care unit.” ventilation should Invasive mechanical ventilation is required for patients who are critically ill and have low blood levels of oxygen (hypoxemia) or high e Ih i ‘and may provoke aniety. Patients who are receiving mechanical venti on or ek, oon Senin hoa Semele penn prechintormphsb bre the stomach to provide nutrition. The: ae ‘or mouth into a. Tracheal intubation is often performed for mechanical ventilation of mouth (orotrachoal mnubaton) ind advanced (oasotrechea!itubation or tubes son) into the with inflatable cuffs are used for trachea. In most cases, : for usually given to provide tolerance of the tube. Other disadvantages of ion include damage to the mucosal lining of the naso tracheal b. Supraglottic oa eemnowie. he by airway — a supraglottic airway (SGA) i : seated above and outside the trachea, 2s on altemative conan intubation. Most devices work via masks or cuffs that inflate to cole thetrachea for oxygen delivery. Newer devices feature esophageal ports for suctioning or ports for tube exchange to allow intubation. Supraglottic differ primarily from tracheal intubation in that they do not prevent aspiration. ‘After the introduction of the laryngeal mask airway (LMA) in 1998, supraglottic airway devices have become mainstream in both elective and emergency ‘Qnesthesia. There are many types of SGAs available including the esophageal- tracheal combitube (ETC), laryngeal tube (LT), and the obsolete esophageal ¢. Cricothyrotomy — Patients requiring emergency airway management, in whom tracheal intubation has been unsuccessful, may require an airway inserted ‘through a surgical opening in the cricothyroid membrane. This is similar to a tracheostomy but a cri access. STAGES/PHASES OF MECHANICAL VENTILATION @ ‘There are four stages of mechanical ventilation. There is the trigger phase, theinhalation has js the brief moment when the peony poe Te pegun The exrtory phase the passive exhalation of air from the patient. TYPES OF MECHANICAL VENTILATION : ‘The two main types of | ventitation through passive exhalation. b. Negative Pressure Ventilation (NPV) ‘There are several types of NPVs, including: > ron lung, also known as a tank ventilator, Drinker and shaw tank or Emerson tank - Cuirass ventilator, also known as a chest shell, turtle shell or tortoise shell ~exovent jacket ventilator, also known as a poncho or raincoat ventilator -Pulmotor. {ron lung ‘The iron lung, also known as the tank ventilator, Drinker tank or Emerson tank, was the ventilator The cuirass ventilator, also known as the chest shell, turtle shell or tortoise shell, is a more compact variation of the iron lung, which only encloses the patient's torso, and is- satel around ther ack nd wales, andl doprenrzec i eget DY a OTIS Er Portable vant. The exovent isa modem device similar tothe cuiras ventilator, but developed in 2020, in response to the COVID-19 pandemic. Jacket ventilator The jacket ventilator, also known as a poncho or raincoat ventilator, is a lighter version of the iron lung or the cuirass ventilator, constructed of an airtight material (such as Baste or rubber) arranged over Rabi metal or plagie fenne, oF werecn, en depressurized and repressurized by a portable ventilator. Pulmotor The Pulmotor is a device developed in the early 1900s which was the forerunner of modem mechanical ventilators. It used pressure from a tank of compressed oxygen to sah ee pels ire apo 7 meee 4 positive and negative air pressure. Although portable, and able to be used by lay persons and non-medical emergency responders, some medical personnel criticized it as dangerous (in part due to the risks of barotrauma or vomiting). ‘TYPES OF VENTILATORS 1) Manual ‘There are manual ventilators such as bag valve masks and anesthesia bags that require the users to hold the ventilator to the face orto an arificial okway and maintain beats ith their hands. (Sinnaala aaa een renee 2 Ta 2) Mechanical: Mechanical ventilators are ventilators not requiring operator effort and are typically com pneumatic-controlled. typically reeure power by a battery or a wall outlet (DC or AC) though some ventilatorsCommon positive-pressure mechanical ventilators include: work on a pneumatic system not requiring power. \ 1. Transport ventilators--These ventilators are smal and more rugged, and can be ventitators—These ventilators are larger and usually run on AC power (though virtually all contain a battery to facilitate intra-facility transport and as a back-up in the event of a power failure). This style of ventilator often provides greater control of a wide variety of ventilation parameters (such as jroo Aseria poalry = dr diate aeeheaas, salen ance: amend visual feedback of each breath. Pic shows ICU ventilator 3. Neonatal ventilators (bubble CPAP)—Designed with the preterm neonate in mind, these are a specialized subset of ICU ventilators that are designed to deliver the smaller, more precise volumes and pressures required to ventilate these patients.4. Positive airway pressure ventilators (PAP) — These ventilators are specifically designed for non-invasive ventilation. This includes ventilators for use at home for treatment of chronic conditions such as sleep apnea or COPD Nursing Management of Patient On Mechanical Ventilator 1. Monitor ventilator settings and modes: 2. Suction appropriately ‘ 3. Assess pain and sedation needs (Two scales that help you evaluate your patient's sedation level are the Richmond Agitation Sedation Scale and the Ramsay Sedation Scale.) 4. Prevent infection 5. Meet the patient's nutritional needs 6. Nutritional support 7. Positioning, eye and oral care 8. Wean the patient from the ventilator appropriately 9. Educate the patient and family WEANING FROM MECHANICAL VENTILATION ‘Since ventilation itself, when not required can be life threatening so should be discontinued at the earliest. There are two components of weaning - discontinuation of ventilation and removal of the airway. Weaning should be attempted when the following conditions are fulfilled: * Patient is alert andShallow Breathing index (RSBI) Measured after 1 minute of spontaneous breathing with ventilator rate set to 0 and pressure support set to 0. The respiratory frequency to tidal volume (f / VT) ratio is currently regarded as the most reliable predictor of weanability. A ratio of 105 best differentiates between successful and unsuccessful attempts at weaning (less than 105 predicts successful weaning) Complications of Mechanical Ventilation + Ventilator-induced lung injury + Volutrauma . + Barotrauma (damage to pulmonary system due to alveolar rupture from excessive airway pressures and/or overdistention of alveoli) Atelectasis ooee Oxygen toxicity Nosocomial infection e.g Ventilator-associated pneumonia Cardiovascular effects. 4UNIT 25 INTERNATIONAL AGENCIES Structure 25.0 Objectives 25.1. Introductions 25.2 International Ayencies including United Nations: Role and Importance in Disaster Mitigation 25.3. Important International Agencies in Disaster Mitigation 254. Financial and Logistical Assistance in Disaster Situations 25.5 Interaction and Coordination with Governmental and Non-Governmental Organisations: Government's Policy for International Assistance 25.6 Let us Sum Up 25.7 Key Words 25.8 References and Further Readings 25.9 Answers to Check Your Progress Exercives, 25.0 OBJECTIVES ‘fier studying this unit you will be able 10; discuss the role of International Agencies in Disaster Mitigation; describe the important International Agencies in Disaster Mitigat explain the mechanism of financial assistance by international bodies; and understand Government's Policy for international assistance 25.1 INTRODUCTION “Red Cross” is the first organized trans-national or international effort to provide relief to those affected by war— a manmade disaster. With the experience gained {in attending to the Austrian and French victims of the Battle of Solferino in 1859, J.H.Dunant, a Swiss Philanthropist and Humanitarian, founded the Intemational Committee of Red Cross in 1863 in Geneva when delegates from 14 countries ‘adopted the Geneva Convention. Dunant received the Nobel Peace Prize in 1901 and the Intemational Committee of Red Cross was honoured thrice with the Nobel Peace Prize (1917, 1944 and 1963). It shared the. 1963 Nobel with the League of Red Cross and Red Crescent Societies”, also headquartered in Geneva. Both the organisations complement cach other. While the International Committee deals mainly with war like situations, the League provides relief after ‘natural and manmade disasters and helps the development of national Red Cross Societies. This background of intemational assistance since the 19" century has provided a txeat deal of experience and precedent on which other disaster assistance ‘programmes developed. Thus today. there isa reasonably clear understanding, by both donors and recipients, of what is involved in disaster assistance yenerally. Also, the increasing interdependence of nations tends to give disaster assistance a respectable image and makes it an acceptable part of international relations. It is agreed that all disaster assistance programmes have their difficulties. However, the fact remains that the overall concept of international disaster assista ‘eutiently recognised by most nations as being valid, practicable and pr u eeUNITED NATIONS: ROLE AND IMPORTANCE IN DISASTER MITIGATION The increasing population and infrastructural growth worldwide has resulted in worsening the effects of disastrous events (natural and manmade), The fast development of communications and the visual impact of television images has upgraded the awareness and sensitivity worldwide irrespective of the location where the disaster occurred. The world witnessed a few terrible disasters which took unprecedented toll of life and property and their effects are still being felt decades after their occurrence. The Bangladesh Cyclone (1970), the Bhopal Gas Leak (1984) and the Chernobyl Nuclear Power Plant Disaster (1986) made the United Nations (UN) to take cognizance of the situation leading to the 1989 Resolution of the UN General Assembly that set forth an international framework of action at national and international levels and also provided an international structure with scientific, technical and financial support. The most important follow up was the launching of the International Decade for Natural Disaster Reduction (1990-2000) which is better known by its initials IDNDR. A mid-way review of IDNDR was taken by the UN Conference on Natural Disaster Reduction at Yokohoma (Japan) in 1994 when the Yokohoma Strategy was’ adopted. In Tine with the thinking within the UN, major international funding agencies increasingly recognise the benefits of funding disaster related projects. However, a critical fact to be recognised here is that it must be the prerogative of @ stricken or potential recipient country to decide whether or not it needs international disaster assistance. International agencies provide assistance at various stages as follows : 1) Pre-Disaster Assistance Pre-disaster assistance from international sources takes on a variety of forms. @Assistance in prevention/mitigation 4) Assistance in building a system of dams. aimed to prevent flooding, b) Development of monitoring and warning systems. (ii) Assistance in Preparedness ) Provision of assistance in the formulation of plans at national and regional levels: ») Provision of assistance in establishing and developing disaster ‘management structures or key points; for instance, the establishment of a national disaster management centre, office ot section, Provision of systems and facilities in the form of warning systems, communication systems, emergency operations centres; emergency broadcasting systems, Stockpiling of emergency items, such as generators, chain saws, jovels, water purification plank. cooking equipment, shelter materials, medical equipment. ,2) Assistance in Response Operations International Agencies ‘As with pre-disaster circumstances, assistance in response operations can also take various forms, like; Monitoring and warning of potential disaster impact. b) Post impact survey for instance, aerial photographic or visual reconnaissance, ©) Provision of emergency assistance teams; for instance medical teams, other specialist teams. 4) Provision of emergency: equipment and supplies: for instance communications, power generator, clothing, shelter materials, food transport and medical supplies, ©) Provision of specialist personnel; for instance, to install and operate water purification plant. f) Temporary provision of major response capabilities for instance, helicopter capability for various emergency roles (including survey and assessment and food distribution, shipping capability for movement of heavy/bulky supplies, offroad vehicle capability. 3) Assistance in Recovery Programmes The post-disaster recovery process usually consists of a series of distinct but inter-related prgorammes, for instance, covering infrastructure, medical and health system, education facilities, and so on. International assistance may therefore be directed towards a specific recovery programme, or comprise some form of contribution to overall recovery. Therefore, they may take the form of. a) Financial grants or credits b) Building Materials c) Technical Equipment 4) Agriculture rehabilitation ¢) Extended feeding programmes f) Specialists or specialist teams 8) Food for work 4) Assistance in Future Development In many cases, international assistance in post-disaster recovery may develop ‘or merge into long-term development programmes, for instance, development of transport systems. jing of dams and embankments. Pre-disaster assistance and assistance in future development tend to be of a routine nature and can be processed in a routine manner. Assistance in response operations and recovery programmes usually has a high degree of urgency, which necessitates quick processing. In some circumstances, problems can arise locally. For example. the affected community may become totally or over-dependent on aid. In such a case, cfiginal and traditional customs of combating disaster have been eroded. In these circumstances self-coping mechanisms of rehabilitation have to be strengthened. i. 33iid injection of aid jally food items can upset a local economy. This ani ice when focal” markets and rural production ae particularly applies when local : i interdependent. Such a situation adds considerably to the problem in immediate post-impact conditions. Over supply of aid is another well known problem area which can particularly apply to severe and widely publicised disasters. The Maharashtra Earthquake (1993), the Andhra Cyclone (1996) and the Gujarat earthquake (2001) are ‘good examples of over supply of aid by international agencies. It may result in aid of unsuitable varieties being showered on a stricken people with little or no regard for its usability or the amount of aid already received. ‘The work of intemational agencies depends very significantly on the understanding between the agencies and recipient nations. Most of the miajor problems in international assistance can be avoided if a few basic factors are recognised. Assistance agencies need to exercise a sensitive approach and practice. ‘When assistance is needed, the recipient nation is usually in some form of post-impact shock. In such a situation, the recipient may have difficulty in identifying assistance needs. The desirable concept is one of a mutual relationship throughout the whole [Process of preparedness, response and recovery. In this way, when assistance needs to be applied, it is merely one phase of an ongoing dialogue, rather than aa sudden shock response to an already traumatised recipient country. ‘Check Your Progress 1 Note: i) Use the space given below for your answers, ii) Check your answers with those given at the end of the unit, 1) Describe different stages at which International Agencies provide assistance for disaster mitigation. oe ——_— —_ -— AA eee —_ ee 2) Mention any four forms of assistance in recovery programmes provi International Agencies. Rea ——_—_—- ° w- 25.3 IMPORTANT INTERNATIONAL AGENCIES IN DISASTER MITIGATION There are four major categories of International agencies. active in disaster mitigation. ‘Category I: Core Agencies of the U.N. Department of Humanitarian Affairs (UN-DHA), Office of Disaster Relief Coordinator, Geneva. The agency assists in disaster assessments and relief Natural Disaster Reduction ((IDNDR) and now houses the secretariat for its ‘successor programme viz., the International Strategy for Disaster Reduction (ISDR). FAO-Food and Agriculture Organisation \t offers technical advice on the reduction of vulnerability and monitors and advises in food production. It is headquartered in Rome. United Nations Centre for Human Settlements (UNCHS), Nairobi It advises on settlement planning that will reduce risk and on post-disaster reconstruction. ‘UNDP: ‘The United Nations Development Programme (UNDP) with headquarters in New York incorporates disaster mitigation in developmental planning and also provides financial aid for technical assistance for disaster management. It offers administrative support to resident coordinator -and advises on flood loss prevention, mitigation and management through agencies such 2s UN Economic and Social Commission for Asia and the Pacific (UN-ESCAP, Bangkok). UNDP has sanctioned the project to the Ministry of Agriculture (Govt. of India) on ~Strengthening Disaster Management capacity’ for the country. UNESCO: relationship with the UN Centre for Human Settlements (UNCHS) (Habitat) and has its own publications programme.dren's Emergency Fund) attends to the The UNICEF (United Nations Chil we i ime of disaster. It collabo it ildren including that at the time of a wih ot Orgnizaon (WHO) and World Food Programme (Wry, eee! propamees including improvement of water supply. sanitation ang — nes, it is now entering, into Besides running its own publications program rn ee preperednes, planning and mitigation work in alliance with other agencies. : ited Nations International Emergency Network through a diedatew > oma places members of the world-wide disaster management community in direct communication with each other and provides them instantaneously with both background and operational disaster related information. The UNHCR (United Nations High Commissioner for Refugees) assists refugees through camps, financial grants and other assistance. The WFP or World Food Programme provides targeted food aid, sometimes linked to ‘food for work’ programme for construction of flood protection structures and coordinates pre and post disaster emergency food aid. It also rans its own publications programme. The WHO or World Health Organisation provides assistance in post-disaster -Fapid response. It promotes ‘health cities’ programmes and is supportive of disaster mitigation measures. It also has its own publications programme. ‘The WMO or World Meteorological Organisation provides technical guidance, training and coordination to the national weather services to. upgrade their forecasting capabilities for the weather and climate related disasters. Category III: Major International Agencies (outside the UN System) The Asian Development Bank located in Manila finances projects in Asia and the Pacific. It is committed to ensuring disaster mitigation which is included in Programming of its projects. It publishes mitigation handbooks. Publishing programme and advisory work is being done as part of technical assistance. The Asian Disaster Preparedness Centre in Bangkok provides traini information services for countries in the Asia and the Pacific region oo fre Policies and develop capabilities in all areas of disaster management, The European Community Humanitarian Office is newly founded, but active i the development. of disaster’ mitigation strategies. Its parent body ‘the Commission of European Communities organises funding of, mitigation structures such as cyclone shelters in Bangladesh, ‘The International Institute for Environment and Development (IED) of USA promotes and disseminates results of research on the development of tenements and squatter settlements in urban area, social factors which cause or aggravate natural disasters and interventions that can limit their impact on the poorest sectors of society. It provides technical assistance to national and international agencies. Organisation for Economics Cooperation & Development (OECD) of Europe has issued guidelines, through’ its Development Assistance Committee, to aid agencies on disaster mitigation. The World Bank (IBRD-Interational Bank for Reconstruction and Development) offers loans for structural adjustment and projects. It plays agaiaiytic role 1m the development OF mitigation strategies, It tunds large-scale food control and water management projects, as well ws running, its publication programme The Bank has recently funded the Maharashtra Earthquake ‘elbititation programme in India by providing loan, The International Federation of Red cross and Red crescent Societies PRS) assist programmes of the national Red-cross societies of various countries. In India, they assist and work with the Indian Red Cross Society. IFRS also publish 4 World Disaster Report’ from its Geneva office. Category IV; National Bodies Assisting Overseas ODA ~ Overseas Development Administration (UK) operates a disaster response unit and undertakes advice and studies in disaster mitigation. It finances consultancy and construction work for post-disaster and pré-disaster preparedness. It also has its own publications propramme, O¥DA ~ Office of Foreign Disaster Assistance (USA) holds regional seminars on mitigation strategies, It also offers consultancy and issues publications. NCDM/India - The, National Centre for Disaster Management (NCDM) : established by Government of India at the Indian Institute of Public Administration in New Delhi. provides training, research and consultancy in different areas of disaster manayement in India and to countries in the South Asian region. = 25.4 FINANCIAL AND LOGISTIC ASSISTANCE IN DISASTER SITUATIONS Logistics have been described as the procurement and delivery of the right supplies in the right order in good condition at the riyht place at the right time. Obviously, logistics play a crucial role in disaster mitigation. International assistance usually boosts the a bility of much-needed relief commodities provided liaison between the stricken country and international donors has ensured the preclusion of unnecessary relief items. Mf, however, good liaison is not maintained, inappropriate and often unusable items may be received. This can be a Serious liability, since the in-country supply system may become choked and valuable local resources may have to be Meployed to sort usable commodities from non-usable one. It is, therefore, normally the responsibility of potential recipients 1o. ensure that inappropriate supplies (e.g, unacceptable foodstuffs or clothes) are made known to donors. International relief input usually places additional demands on the in-country logistic system, This may be a crucial sector if major ports, airfields roads and railways have had their capacity reduced by disaster effects. Extra demands may also be placed on fuel and food stocks by visiting aircraft and various relief teams, jernational assistance activities, whilst contributing many’ invaluable benefits also, impose logistic complications. Any such complications need to the minimised through prior planning and preparedness arrangements. "ry and the international assistance In the interests of both the stricken county | don meetin agency, it is important that no undue delays ar by delays from customs or other formalities. International Financial aid in disaster situations is released via four main channels 1) The United Nations contribute funds for disaster situations which are released on request from the stricken country, This assistance is channeled through the appropriate UN agency such as, UNHCR or UNWFP or UNICEF or UNDP. 2) Developed nations usually have some funds set aside for disaster situations in the under-developed world. The amount they release is determined by a variety of functors like the magnitude of the tragedy, the relations between the ‘two countries, etc. 3). International bodies like the European Union have also been assisting t disaster-affected countries. . 4) Countries may have ‘bi-lateral agreements among themselves that may include the clause that if either country is stricken by a disaster, the other will help with the required form of assistance - monetary or otherwise. Major disasters impose a tremendous strain on a country's financial and other resources, In such a situation it is almost impossible for it to cope on its own without finaricial aid from international agencies. In such a scenario, when aid starts flowing from various quarters, it becomes very essential to keep track of the amounts coming in and to ensure that they are utilised in an appropriate ‘manner. 25.5 INTERNACTION AND COORDINATION WITH GOVERNMENTAL AND NON-GOVERNMENTAL ORGANISAITONS; GOVERNMENT’S POLICY FOR INTERNATIONAL ASSISTANCE All international agencies require clearance from the national government. ‘The international agencies operate at different levels. They usually have a branch head office in the national capital and some branches at state levels. The head office regulates the flow of funds; receives orders and instructions from the agency headquarters and passes them on to the branch offices. It also liaises with the national government and finalises operational details. Non-Governmental Organisations usually work in close conjunction with the international agencies. The agencies normally work through NGOs. They finance the specific project and the NGOs do the ground work. This way, the country gets the financial aid of the international agency and the agency, in working through local organisation (s), gets a true picture of the events and is able to utilise its resources more effectively. Alternativély, the agencies might fund and carry out a programme on its own ‘after first getting clearance from the governmental. Sometimes, these agencies simply fund the government programmes in part or as a whole,the policy of Government of India with regard to external assistance for relief in the wake of disasters is not to issue a formal appeal, either directly or through any national or international agency, to request relief assistance from abroad. However, any assistance donated on a voluntary basis is accepted and acknowledged as a token of international solidarity. If the assistance is in cash, it is to be sent to the Prime Minister’s National Relief Fund. If it is in kind, it should preferably be routed through the Indian National Red Cross. __ Check Your Progress 2 Note: i) Use the space given below for your answers. ii) Check your answers with those given atthe end of the unit. 1) List the core agencies of the U.N. working for disasters mitigation. fii ie a openly DN ee ee a ee atte eee tne ee atcitorotoh ek eaten eon Ee 2) IBRD stands for: a) International Bank for Rural Development b). International Bureau for Reconstruction and Development ) International Bank for Reconstruction and Development. 4) International Bank for Reconstruction Development. 3) Mention the salient features of Government's Policy for intemational assistance in the event of disaster.caster Management Teof Various Agencies ST Tg OL 25.6 LET US SUM UP it becomes very difficult for the country to When a major disaster strikes, ‘ it rehabilitation on its own. In manage the rescue and relief work and consequen ° such a situation, the assistance of international agencies is required, particularly in developing countries. With the increasing recognition of the importance of disaster related matters, more and more agencies are now providing aid in this field. There are four major types of international agencies active in disaster management. They interact with the national and state/governments and get an idea of the amount of money and type of material that are required immediately. Many of the international agencies work in close conjunction with the Non- Governmental Organisations (NGOs). a arm ee 25.7 KEY WORDS Self-coping : Tobe able to manage by itself Infrastructural : Collective term for fixed installations including roads, communications, bridges. etc. Reconnaissance + Process of surveying or inspection or gathering information ‘Transnational : Across nations Traumatised : Upset, shocked 25.8 REFERENCES AND FURTHER READINGS Carter, W.N. (1991), Disaster Managemem; A Disaster Manager's Handbook, Asian Development Bank, Manila. The Institution of Civil Engineers (1995), Mega Cities: Reducing Vulnerability to Natural Disasters, Thomas Telford, London. 25.9 ANSWERS TO CHECK YOUR PROGRESS EXERCISES ‘Check Your Progress 1 1) Your answer should include the following points: © Pre-disaster stage ‘© Response Operations stage © Recovery Programmes stage ‘© Future Development stage 2) Your answer should include the following points: © Financial grants or credits; Building Materials; Technical Equipment; Agriculture Rehabilitation, Food for Work. Check Your Progress 2 1) Your answer should include following points: © _UN-DHA, UN-FAO, UNESCO, UNDP i\ —— 2) Your answer should include the following points: e International Bank for Reconstruction and Development. 3) Your answer should include the following points: © Government of India’s Policy is not to ask for external assistance e Ifaid comes voluntarily, it is accepted as token of international solidarity © Cash aid goes to PM’s National Relief Fund and material aid should be routed through Indian Red Cross International Agencies(toed S/ Al Cpy? ABCDEF OF RESUSCITATION Definition: Resuscitation is the process of correcting physiological disorders (such as lack of breathing or heartbeat) in an acutely il patient. It is also the action or process of reviving someone from unconsciousness or apparent death. It is an important part of intensive care medicine, trauma surgery and emergency medicine. Well known examples are cardiopulmonary resuscitation and mouth-to-mouth resuscitation. Recommended for Resuscitation They include but not limited underlisted: ‘© Oxygen mask with reservoir bag * Pocket Mask and one way valve ‘+ Automated External Defibrillator (AED) with electrodes and razor * Syringe and needles * Oxygen cylinder (of suitable size to deliver high flow 02 for a minimum of 30 Drugs: Epinephrine/Adrenaline, Amiodarone, Naloxone, Atropine | Self-inflating bag with reservoir (BVM) ~ Adult/Child Oropharyngeal (Guedel) airways/Nasopharyngeal airways ‘STEPS FOR RAPID PATIENT ASSESSMENT ‘The ABCDEF approach is the most recognized tool for rapid patient assessment, it allows us to recognize life-threatening conditions early and a systematic method that focuses on identifying problems and implementing critical interventions in a timely manner. AIRWAY (A) The aim of the airway assessment is to establish the patency of the airway and assess the risk of deterioration in the patient's ability to protect their airways. The patient's airway can be clear (if the patient is talking), partially obstructed (if air entry is diminished and often noisy) or completely obstructed (if there are no breath ‘sounds at the mouth or nose) Causes of Airway Obstruction 1. Patient's tongue 2. Foreign 3. Vomit, blood and secretions 4. Local swelling‘Ansenang ‘the Airway . Observe patient for signs of airway obstruction: such as paradoxical chest and abdominal movements. This refers to a state whereby the chest and abdomen rise and fall alternatively and vigorously to attempt to overcome the obstruction. 2 Look to identify whether skin colour is blue or mottled. 3. Listen for signs of airway obstruction: certain sounds will assist you in localising the level of the obstruction (Smith 2003). For example, noises such as snoring, expiratory wheezing, or gurgling may indicate a sign of a partially obstructed airway. 4. Listen and feel for airway obstruction: If the breath sounds are quiet, then air entry should be confirmed by placing your face or hand in front of the patient's mouth and nose to determine airflow, by observing the chest and abdomen for symmetrical chest expansion, or listening for breath sounds with a stethoscope. Treatment of airway obstruction Airway opening can be achieved through: 1. Head tilt, chin lift, or jaw thrust if a neck injury is suspected 2. Simple adjuncts (an accessory or auxiliary agent or measure), such as: naso- pharyngeal airway, oropharyngeal airways, laryngeal mask airway. 3. Suctioning of Mucus. 4. Administration of supplementary oxygen 5. Heimlich maneuver in case of choking. BREATHING (B) Breathing function should only be assessed and managed after the airway has been judged as adequate. Assessment of breathing is designed to detect signs of respiratory distress or inadequate ventilation. The following steps can be used to assess breathing: Assessing Breathing 1. Feel for air movement around the patient's nose/mouth and look for chest expansion 2 Look Fur the peaeral sigue.ct mapiratrsy distress Such 68 siveeting. the effort The the number of breaths that a patient takes over one minute through the rise and fall of the chest. A high respiratory rate is a marker of illness or an early warning sign that the patient may be deteriorating. 4. Assess the depth of each breath the patient takes, the rhythm of breathing and whether chest movement is equal on both sides. 5. Measure patient's peripheral oxygen saturation using pulse oximeter applied to the end of the patient's finger. oye patish Thoracic Society recommends a target oxygen saturation of between 94%-98%, with a minimum level of 88%. However, the pulse oximeter does not detect hypercapnia (carbon dioxide retention).SS \ 4 “4, test provides a valuable respiratory aseossr re the levels of oxygen, carbon dioxide in the blood and the . provides more in-depth information about the effectiveness of respiratory 7. Asses a ety using stethoscope to confi whether airs entering the ings, whether both lungs have equal air entry and whether there are any additional abnormal breath sounds such as wheezing and crackles. ‘Treatment of Breathing a oe rate oes regardless of the cause, expert help should be called immediately. 1. If the patient's breathing is compromised, position patient appropriately (usually in an upright position). % 2. Deliver oxygen at the appropriate rate (Ifthe patient is breathing, start with 2 : 3 6. Blood gas analysis: . If CPRis in progress, deliver 2 breaths per 30 compressions. CIRCULATION (Cc) The aim of assessing the circulatory system is to determine the effectiveness of the cardiac output. Cardiac output is the volume of blood ejected from the heart each minute. litres per minute via a 3. Monitor oxygen level via the pulse oximeter — aim for patient's usual reading or > 96% Assessing Circulation 1. Check pulse (carotid for adult/brachial for infants and neonates), then a 12 lead electrocardiogram (ECG) should be undertaken. : {f the patient is not breathing, give 15 litres per minute via a bag ~ valve ~ mask 2. Assess capillary refill time (CRT): a simple measure of peripheral circulation. The 4. Assess for any signs of external bleeding from wounds or drains. 5. Monitor blood pressure ‘Treatment of circulatory problemsThe specific treatment for circulation problems replacement, problems depends on the cause, however, fluid Testoration of tissue perfusion and hemorrhage control will usually be 1. Arrest bleeding 2. Create intravenous or intraosseous access 3. Commence blood/intravenous it (0) This assessment involves reviewing the patient's neurological status, and its assessment should only be undertaken once A, B and C above have been optimised, as these parameters can all affect the patient's neurological condition. Neurological Function 1. Level of consciousness: conduct a rapid assessment of the patient's level of consciousness using the AVPU system. A=Awake/Alert: observe if the patient can open his/her eyes, takes interest and level of consciousness. the patient who doesn't respond to voice should be shaken gently to try to elicit a response. If there is still no response, then painful stimuli should be applied. If the patient responds to painful stimuli, then the level of consciousness is assessed as ‘responds to pain’. Examples of central painful stimuli include the, pressure and stemal rub. 2 nepens paton’s Glasgow coma scale (20S) 3. Pupil reaction: examine the patient's pupils for size, shape and reaction to light. 4. Blood glucose levels: a blood glucose measurement should be taken to exclude hypostycaemia using a rapid finger prick bedside testing method, Fallow local protocols for management of hypoglycaemia ‘Treatment for Disability (Altered Conscious Level) Te raty ote eeeny deny, breathing and croultion to exclude hypoxia and 1. Check the patient's medicine chart for reversible medicine induced causes of an altered level of consciousness, administer the antidocte e.g Naloxone for Opioid overdose and remember to call for expert help. 2. Unconscious patients whose airways are not protected should be nursed in the recovery position. EXPOSURE (E) Assessing Exposure 1 tt may be necessary to expose the patient in order to conduct a thorough examination of the patient's body for abnormalities, checking the patient’s skin for the presence of rashes, swelling, bleeding or any excessive losses fromdrains, pain, tendemess, hypo/hyperthermia etc. Respect the patient's dignity at all times and minimize heat loss. 2. Look at the patient’s medical notes, medicine charts, observation charts and results from investigations for any additional evidence that can inform the assessment and ongoing plan of care for the patient. 3. Remember to document all the assessments, treatments and responses to treatment in the patient's clinical notes. Always seek help from more senior or experienced practitioners if the patient is continuing to deteriorate. FOLLOW-UP (F) After successful resuscitation, continued support is required and reassessment is needed. * Correct Acidosis: Establish normal renal function or administer sodium bicarbonate if’ blood gas analysis is available. Cardiac Support: inotropes may be required to maintain cardiac output and improve renal blood flow. Fluid Therapy- Fluids should be administered to maintain blood pressure and urine output. Minimise cerebral oedema: Position patient with head inclined upwards, hyperventilate to reduce PaCO2 and administer corticosteroids and/or mannitol if cerebral oedema is suspected. « Assess neurological function ¢ Monitor and maintain urinary output at 1-2mi/kg/hr. © Maintain body temperature. PICTURES SUMMARIZE THE STEPS/TOOLS FOR RESUSCITATIONEMSS17ABCDE chart EXAMINATION INTERVENTION saleway noises = potition of head + foreign body fluid, secretions oedema Jook-sten -feel approach respiratory rate and effort breath and added sounds. subcutaneous emphysema, symmetry of chest movement + tracheal deviation “Jugular vein distention sopanosis $00.- FICO. SG-X-ay- CF KG USG &* Xray GOAL Patent aleway Sufficient oxygenation ventilationS/n Spe Prepepeloeg, uy py y2y | oO | LIFE-THREATENING EMERGENCY | © Uetvectening emergency mecrs the tudden ond unexpected onset ofa | condition which threatens Ife, limb, or | ‘organ system and requires immediate | medical or sugical nfereniion bul no | Case later than fwertfour a) hous | ||| Sher onset } DLT eee L a — intro. | | CLASSIFICATION OF LIFE Not all emergencies are life-threatening, ||| “oncnot ifefrectering conatons Sie THREATENING EMERGENCIES emergencies when they ate known an modiected or rected and managed. | Thay can be clcsdlied Ile tree (3) | i * Medical i i * Surgical Knowing when you're in the midst of a real . maecological Life emergency, ‘andi whet 10 do In that event Treseceg mergencies empowers you to take the right action immediately Precious minutes can be wasted when you panic or are uncertain what would be the correct course of action. 4 DS. tonMedical Life Threatening Emergencies © Difficulty br. I CHeey, breathing, including asthma or © Anaphylaxis is a generalized immungiateel cSnation ‘of sudden onset, Beigsninercare oooue os £9. Severe allergic reaction with swelling , Animal bite/nsect sing | MEDICAL EMERGENCIES Cont. | | © Polsoning Any substance that can cause Injury liness or death when inroduced into the body. Eg. Inhaled poison, ingested ppolion, Absorbed polson, Injection. ‘@.Gardiac emergencies Myocardial infarction, Careiac tamponade, Cardiogenic shock, Pulmonary embolism, Sudden cardiac death © Bee sting reaction (with hives or swelling OF YOU Wn OTTER) ora Neurologic emergencies Stroke, Altere ‘Consciousness and Coma, Status Spllopicus Haemorhage, Spinal shock. Oe eo I 1 fee | } MEDICAL EMERGENCIES Cont. MEDICAL EMERGENCIES Cont. 2 Respbety emengeneg, | @ Unconsciousness or ee ee | . shear Gradereal ° responding Yo uivel medication) + heute purmoncry edema } + Respitatory distress e Shock is a condition characterized by decreased tissue perfusion and | impaired cellular metabolism |fracture or dsiocattion, especialy with visible bone). © Laceration or amputation of mb (e.g. finger) Tor COI L Peet ia Surgical Life Threatening Surgical Life Threatening Emergencies Emergencies cont.. © Mater kyor (e.5. ‘open chest wound with ‘otrauma Head injury. Chest injury ‘Abdominal injury ‘© Acute abdomen Abdominal pain is a symptom of mar eee types of tissue ifjuy end con arte trom gbdominal or pete engone red bse onbdorinal ‘emergency- Conditions ike I Ferorated ucer or dverticum, fesicuar oF ovarian torsion, ectopic pancreatitis, mesenteric +! Vascular inuey De as CEES CI ToL ——T iy I Tar Surgical Life Threatening Causes of Emergency And Life Emergencies cont.. i Threatening Conditions ‘Post op bleeding, Gi bleeding, Aortic dissection, Ruptured Pefopic Pregnancy, Ruptured organ or Vessel, Ml, Dehydration, Sepsis, Diabetes insipidus, Addisonian isis Trauma, Fracture, RTA. Le Ser) 1/21/20,a 2 TRIAGE SYSTEM | h f | “pation clad. acca to jency ||. condhignats urgency oft wee ane veal tent othe Wight ice at the | Right ime with the Rand ocr Provider. | | eo | ler IT-T = Cl a Toot OBJECTIVES OF TI TAGE SYSTEM TRIAGE SYSTEM oTo Identifying the patient, oTo Identifying the rlority of the Definition of Triage- atten s ne for Predies emergencong fansport from the hs cene, French vert en caved rom olrack the patient's progress rors eet er m through the triage prococe | oTo Identity additional hazards such, / Gs contamination. far va eTi TYPES OF TRIAGE 1. Simple triage 2. Advanced triage 3. Continuous integrated triage 4. Reverse triage 5. Under triage or over trlage TYPES OF TRIAGE cont.. 1. Simple tage. ls usually used in a scene of an accident or “mass-casvalty Incident" (MCI), In order to sort Patients Into those who need critical attention ‘and immediate transport to hospital and those with less setious injuries. TET x I TYPES OF TRIAGE Cont.. '3. Continuous Integrated triage- It is an approach to triage in mass casualty it combines three form of trlage with Progressive specificity to most rapidly Identity those patients in greatest need employs- a. Group triage b. Individual |||tlage c. Hospital tage. {ron of care while. balancing the needs of the Individual patients ‘against the available Tesources. Continuous integrated triage caSn oo TYPES OF TRIAGE Cont.. 4, Reverse trage- This process of trlage can be applied to discharging patients early TYPES OF TRIAGE Cont.. I 5. Under frlage- It Is the under estimating the | severly ofan liness or Injury. An example of when the medical system Is stressed, this would be categorizing as- ~wetvor} || + During a “surge” in demand; such as ‘ ea eon ee | immediate after a natural disaster, many + prlonty 3 (rninima) || hospital beds will be occupied by regular | non-critical patients, Lior 2 I ime I= | TYPES OF TRIAGE Cont.. + In order to accommodate a greater number of the new critical patients, the existing patients may be trlaged, and those who will not need immediate care can be discharged, Co TYPES OF TRIAGE Cont.. | 6. Over trlage- It is over estimating of the severity of illness or Injury. An example of this | would be categorizing as- { + Prlority 1 (minimal). + Prlority 2 (delayed). + Prlority 3 (minimal).>!LOT Cit Levels of Triage |.1. RED (Retuscttation)- Threat to tile ‘Time of exsestment Immediate Charactedties- ‘Obtructed alway | + +$p02< 80 Resprctory rate >35 of 23" Heart rate > 130 + Drsys<00 } - -0cs<8 1/2 Levels of Triage Cont.. I Example- || » Cardiac and respiratory arrest + Major trauma | + Active seizure * Shock | + Status asthmatics Doers eer) 2. Orange (Emergent) Pletal eat te + Characteristics- - Tveatened alway I + + $pO2: 80-89 R315 | Toot Levels of Triage Cont.. | | i