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Contingency planning for natural disasters

2011; Wiley; Volume: 6; Issue: 1 Linguagem: Inglês

10.1111/j.1751-2824.2011.01485.x

1751-2824

Menchu Martinez,

Disaster Response and Management

A disaster may be defined as an event – usually sudden and unexpected – that intensely alters the beings, objects and localities under its influence. It results in loss of lives and health in the local population, causes severe environmental damage and the destruction or loss of material goods resulting in a dramatic disruption of normal patterns of life. Such disruption – which may be local, national – gives rise to the need for immediate intervention and humanitarian aid. The definition adopted by the World Health Organization (WHO), terms a disaster as “The result of a vast ecological breakdown in the relations between man and his environment, a serious and sudden (or slow, as in drought) disruption on such a scale that the stricken community needs extraordinary efforts to cope with it, often with outside help or international aid”. Disasters may be caused by natural phenomena, human actions, or industrial accidents. A natural disaster is the effect of a natural hazard. Managing the blood system in disasters is one of the main challenges for any blood transfusion service exposed to natural hazards. The blood system may require a much larger amount of blood than usual and the ability to collect, test, process, and distribute blood may be impaired. Local population can be temporarily restricted or prevented from donating blood, or the use of the available inventory of blood products may require immediate replacement or resupply of the region’s blood inventory from another region. A sudden influx of donors may occur, requiring accelerated drawing of blood to meet an emergent need elsewhere. Natural Hazards can be classified into: Geological hazards (avalanches, earthquakes, volcanic eruptions) Hydrological hazards (floods, limnic eruptions, tsunamis) Meteorological hazards (blizzards, cyclonic storms, droughts; hailstorms, heat waves, tornados) Fires The factors that decide whether a natural hazard event turns into a disaster or not, can be summarized in the term vulnerability, which can be defined as the potential loss from a natural hazard event. A natural hazard will never result in a natural disaster in areas without vulnerability. This understanding is concentrated in the formulation: ‘disasters occur when hazards meet vulnerability’, e.g. a small earthquake in a poorly prepared country easily classifies as a disaster, whereas a much stronger earthquake in a well-prepared country does not. A disaster causes both direct and indirect losses. The physical destruction caused by a disaster is considered a direct loss, and includes the human victims, environmental degradation, building and urban spaces damage. Indirect losses are generally divided into social and economic effects. Social effects include the interruption of transportation, communications (including the mass media), and other public services. They can include the negative image that a country or region might acquire. Economic effects include the cost of reconstruction and rehabilitation, the impact of reduced production or consumption on trade and industry and the potential discouragement of foreign investment. A natural disaster leads to financial, environmental or human losses. They happen because we are not adequately prepared and can to a large extent be avoided. In order to assess and mitigate the vulnerability of the blood system a complete evaluation must be performed. Structural vulnerability assessment considers the determination of areas that might be affected by different types of hazards. (Structural elements that support the weight of the building, e.g., beams, columns, and load-bearing walls, are very important in an earthquake). In order to diminish nonstructural elements vulnerability, it is important to consider some architectural elements such as false ceiling made of tiles or plaster and windows. Secure gas tanks, oxygen tanks, and generators to the floor or walls; attach diagnostic equipment and centrifuges to counters walls or panels, and anchor heavy equipment with bolts or cables [1]. Store laboratory glassware in containers and keep a reasonable amount of space between them. Choose safe places for chemical and biological reagents to minimize the risk of contamination and fire; store supplies and tools in accessible safe places that allow for their rapid retrieval in emergencies. To assess organizational and administrative vulnerability it is important to establish an appropriate layout and connections between areas in the facility, identify and signpost evacuation routes, emergency exits, danger zones areas where there is risk of exposure to toxic substances, the location of alarms and fire extinguishers, and similar sites and determine administrative processes and routines to guarantee adequate operation under both normal and emergency conditions. The impact on the blood supply can be directly affected by the severity of the disaster. Blood usage may not be initially significant, but traumatic injuries may occur in coastline areas during a tsunami and in earthquakes, resulting in an acute need for trauma-related transfusions. Hospitals may temporarily suspend elective surgeries, followed by a spike in such surgeries once operations are back to normal. Blood collectors should make special preparations to ensure that operations can be quickly resumed. Blood collection schedules may be disrupted, depending on the severity of the disaster as it may have a negative effect on blood collections in the days before and after. On the other hand, due to the tragic nature and magnitude of a disaster many citizens may decide to donate blood, resulting in a donor surge. Contingency plans are devised by governments, including the establishment of a reference blood centre to coordinate operations in accordance to geopolitical conditions and a second blood centre with similar technical managerial capacity in the event that the reference centre fails to function. This national planning must organize the communications systems of the blood centres, transfusion services, and the reference centre, ensure that information is transmitted, about the need for blood and components, and organize the transportation to the affected areas; and plan blood collection in accordance with needs. Blood centres should prepare an Emergency Plan. Its major objectives are to ensure containment of damage or injury, loss of personnel and property, and continuity of the key operations of the organization. Is a plan devised for a specific situation when things could go wrong? All departments’ heads and workers must be aware of their duties in a state of disaster. All members of the Blood Center are responsible to assume promptly their jobs. This planning must consider the risk of disaster from natural causes, and should identify possible health scenarios and needs based on previous experiences, physical and organizational vulnerability of the blood services, vulnerability of the life lines that guarantee the operation (water and electricity supply, communications, and transportation), the organizational and institutional response capacity, and must identify the roles and duties of the key staff members. It must consider the mechanisms for coordination between the network of blood services and other related institutions such as health services, military hospitals, and customs houses. It is important to disseminate the emergency plan widely and to train the staff that plays an important role in its execution, conduct periodic simulations to test the viability of the plan, develop a budget for disaster preparedness and response activities; and institutionalize, through ministerial directives, the emergency plans for blood services. In times of severe shortages, when all efforts to increase the available supply of blood components have been exceeded, National Blood Services need to have a plan to determine the equitable allocation of blood components. Canadian Blood Services’ plans consider four phases of inventory availability: Green, Amber, Red and Recovery [2].Green Phase implies that normal blood component inventory levels exist and supply generally meets demand. Amber Phase implies that the national blood inventory is insufficient to continue with routine transfusion practices and hospitals will be required to implement specific measures, in order to reduce blood usage. Red Phase implies that blood inventory levels are insufficient to ensure that patients with non-elective indications for transfusion will receive the required transfusion. Recovery Phase implies that blood component inventories have begun to increase and are expected to be maintained at a level which would enable the return from Red to Amber and subsequently to Green Phase. The plan of the National Health Service UK is structured to provide a framework of actions for the NBS and hospitals at three phases [3] [4]. Green, normal circumstances where supply meets demand. Amber, reduced availability of blood for a short or prolonged period. Red, severe prolonged shortages. There are several critical actions that must be undertaken, among them: Evaluate the operational status of the blood centre, assessing the impact of the disaster on the facility, as well as any blood supply needs and provide this information to the authorities. Be on the lookout for fires, as they are the most common earthquake-related hazards. Fires can be caused by broken gas lines and damaged electrical lines. Notify staff, donors, customers, and vendors about the status of the facility after the disaster. Define functions for the different working areas, taking into account higher demand, and reduced capacity to provide services. Communicate with hospital customers in order to assess their operational status and blood product needs and confirm the number of units available for immediate release to the affected areas. Calculate fuel needs and ensure fuel supply for critical systems at the facility (e.g., generator), blood collection and transportation vehicles, and essential staff vehicles. Fuel for at least 3–5 days without assistance from routine fuel sources must be in place in tanks provided with fuel pumps with redundant power sources to operate the pumping mechanisms. Investigate alternate fuel sources to fulfil future needs. During extreme fuel shortages, consider the need to provide security to prevent theft. Trace all systems linked to the facility’s emergency power supply (e.g., generator) to ensure that all critical systems are connected. It is important to consider that all critical systems can be powered for at least 7–10 days without outside assistance. Note: make sure that systems critical to employee health and safety (toilets, water and waste removal) can run properly. Analyse all systems relying on water ensuring that the facility can conduct collections, processing, testing, storage, and delivery of blood products to hospitals. Ensure that the installation has sufficient water storage capacity (such as a cistern or on-site gravity feed water sources, e.g. water towers) to operate for at least 2 days independently of external supply. Identify the areas where a supply of water is vital and determine necessary rationing. If needed, contact local and regional providers to deliver water. Careful attention should be given to subsystems needed for the health and safety of staff, water for toilets and drinking water. Keep staff and board members informed about contact information and emergency procedures and regarding who is in charge of what during the emergency, As routine communication channels (i.e., land lines and cell phone) will fail or be overloaded, use local radio and TV stations to broadcast messages to staff and donors or use a private Web site hosted outside the affected area or text messaging and external e-mail accounts (e.g., gmail.com, yahoo.com) if the facility’s e-mail servers are offline. If restoration of services is extensive, develop a process to communicate with staff, board members, the public, and donor groups about progress. Maintain timely, accurate and consistent communication with the public and media. Key messages will be developed according to the blood shortage phase, but in all phases messaging will need to be honest and serious about the situation; reassuring as possible, considering the situation, regarding safety and supply issues, and providing an opportunity for audience education about the blood system and the ongoing need for blood. Prioritize and develop procedures for using suitable modes of communication such as landline phones, wireless (cell) phones, portable two-way radios (sometime called hand-held radios or walkie-talkies), voice over internet protocol (VOIP) phones, satellite phones, amateur (ham) radio and word of mouth (e.g. send messengers) and electronic communication (fax, e-mail through a local area network, e-mail through a wireless connection, text messaging, website). Verify that the blood centre is equipped with a depot of emergency supplies including food for 3 days, water, first aid supplies, cots and blankets, flashlights, and battery-powered radios and that mobile emergency kits are available in the blood centre vehicles. Verify possible transportation modes and routes identifying alternatives (road, water, air and rail). Contact local law enforcement and emergency organizations as their assistance may be needed to transport blood to hospitals in affected areas. Regarding staff, arrange alternative transportation for essential employees, as routine routes may not be available (e.g., because of fuel shortages or road damage). Assist essential employees in developing a family support plan to ensure that their needs are met while they are on duty (e.g., care for children or elderly family members). Provide sufficient food, water, and restroom facilities for essential employees while they are on duty and make sleeping arrangements if they are unable to return home after their shift. Put in place the emergency notification protocol with staff who are operating a blood drive outside the facility and with distribution personnel who deliver blood products to hospitals. Consider the following: Ensure that all automated computer systems are adjusted for facility closure. Notify second and third shift employees and contractors (e.g. cleaning services) about the status of the facility. Consider using law enforcement or private security firms to secure evacuated facilities. Consider the need to secure any special equipment (i.e., irradiators) and to notify local management authorities and national regulatory agencies. Consider the impact of evacuation and utility interruptions on the facility, supplies, and blood products (both stored and in process). Areas to consider include IT, storage systems, security systems, monitoring systems, and any timed systems, such as refrigerators/freezers, door locks, lights, and sprinklers [5]. Put in place the plan for an alternative blood centre operations site (management team), along with the required staff and volunteers and the required resources to ensure contact with customers, vendors, and local emergency authorities until you can reoccupy the blood centre. On 27th February 2010, a devastating 8·8 Richter earthquake struck Chile. The earthquake cause massive surface destruction, and it also triggered a tsunami and numerous and severe aftershocks (often exceeding a magnitude of 6·0). The earthquake’s epicentre was very close to Chile’s second largest city Concepción. The chaos after this natural disaster was dramatic considering that all basic services were damaged. Looting and arson incidents occurring in its immediate aftermath in Concepción. The authorities needed several weeks to determine and evaluate the damages. At the Concepción Blood Center, water, electricity and fuel were not available for many days. After the disaster the board organized emergency activities to maintain different work areas. Some staff members were in charge of obtaining fuel, water and food; others had e.g., the responsibility of calibrating laboratory equipment. Fortunately the Blood Center had a 7 days blood stock able to respond regional demands. It is important to apply the lessons learned and mistakes made during this earthquake, such as in improving the tsunami warning system, ensuring sufficient backup power and establishing emergency communication systems, and designating strategic locations for crucial human resources and supply stocks around the country. Applying lessons regarding standards for some types of construction. And more generally, the looting and arson is a potent reminder of the potentially explosive socio-economic tensions inherent in an unequal society and under-employment among the poor. The disaster has led to some lessons for our blood centres: Communication within the blood centre is critical but also communication with customers ordering blood products. Breakdowns occur if protocols are not in place prior to the situation: policies and procedures need to be in place. In the face of chaos, there is a powerful tendency to skip normal procedures and take drastic measures. It is imperative to do exactly the opposite. Disaster management requires strict lines of authority. It is necessary to have an overall inventory management within the country, a unified approach to communication among blood facilities and adequate transportation of blood and blood components. It is important to ensure that facilities maintain inventories to be prepared for disasters at all times in all locations. A 7-day supply of the combined inventory of both blood collectors and hospitals is recommended. None.