Disaster Management Plan Zakir Hussain Municipal Hospital, Nashik Prepared for Nashik Municipal Corporation By Colonel (Retd) P P Marathe and Colonel (Retd) V N Supanekar Disaster Management Plan of Zakir Hussain Municipal, Nashik Introduction Reference: 1. Scrutiny of Zakir Hussain Municipal Hospital, Nashik Road, conducted in December 2010. 2. Vulnerability Map of India. Appendices: A- Hazard, Vulnerability and Risk Analysis of Zakir Hussain Municipal Hospital. B- Feasibility Study of Management of Mass Casualty Incidents Occurring Outside the Hospital. C- Resource Management. D- Organisational Structure for Disaster Management. E- Roles and Responsibilities of Various Appointment-holders. F- Procedures during various Contingencies. G- Communication and Warning System. P- Sketch Showing Layout of Zakir Hussain Municipal Hospital. General 1. Hospitals are a soft and vulnerable targets for any disaster. These threats emanate from the changed environmental conditions, life styles, inability of the civic bodies to meet the demands of fast track development and geo-political conditions in our country. Hospitals are organised to meet the medical and health requirements of the society and the staff of any hospital is engaged in investigating ailments of the suffering population and treating them. They are neither geared up to face any hazards that threaten their own facility nor are sufficiently equipped to counter any security threats. 2. For hospitals to counter any threats of natural and man-made hazards the job charts of the staff have to be essentially reorganised and additional help needs to be offered by the government to enable the hospitals to prevent, mitigate and effectively respond to the hazards. Thus, some degree of organisational restructuring, bring greater awareness and equipping them to counter the threats is essential. 3. This DM Plan has been deduced based on general aspects of geology, climatology, geo- political situation, probability of accidents due to human errors or faulty procedures, organisational structures and socio-cultural as well as economic aspects. Characteristics of an Indian Hospital 4. A hospital provides medical services and facilities to a population that has ailments to be cured/ treated and the focus of the hospital staff and the patients is more on medical treatment rather than other forms of safety and security. Thus, a hospital in India is not competent to protect its staff and the inmates from other forms of threats. Their awareness about hazards is low and thus, this section of the society is highly vulnerable to any hazards. 5. The medical staff is engaged in technical activities related to investigation and treatment of ailments and has tremendous pressure of professional work. This is particularly so because of lack of sufficient staff. Thus the staff is engaged in their primary task of saving lives from ailments and is not available for responding to disasters. 6. The non-medical and administrative staff is similarly engaged and oriented towards fulfillment of their day-to-day requirements related to medical treatment and administration of the institutional and outdoor patients. They are not sufficiently trained to prevent, mitigate and respond to hazards/ disasters that are not in their normal course of duties. 7. A hospital has two responsibilities – firstly to prevent, mitigate and respond to internal threats arising from their own working and secondly to cater to extra load that they may have to bear in case of hazards/ disasters that may affect a large section of the population in the vicinity. 8. The hospital service has to work 24 hours without a break. Thus, hospital has to be in the state of operational efficiency round the clock and staff has to be accordingly managed to ensure efficiency and effectiveness at all times. Characteristics of Municipal Hospitals in India 9. The Municipal Hospitals in India draw their patients from that strata of the society which shows the following characteristics:- (a) Low income group with poor living standards. (b) Low awareness level regarding prevention, mitigation and response to disasters. (c) Bear low level of social sense towards cleanliness, hygiene and personal habits. (d) Education level is below normal – most inmates are illiterates or semi-literates. (e) Hails from vulnerable sections of the society in terms of acts of violence, habits of consumption of alcohol and consumption of untreated tobacco or the likes. (f) Poorly fed and hence have poor standard of sustenance. Their post disease nursing is of poor quality and ailments of recurrent and recovery is slow. They are compelled by their economic condition to resume work at the earliest and do not have concerns for full recovery. They also look for speedy symptomatic relief rather than long term cure. 10. Ratio between medical staff and nursing staff to the institutionalized patients is mostly adverse. 11. There is a lack of all specialties in the hospitals because of varying sizes. 12. There is a lack of modern equipment, adequate supply of expendable essential commodities for treating the patients and often the serviceability and maintenance of equipment is not done regularly. It takes a long time for any equipment to be repaired and made serviceable. 13. Cleanliness of the entire hospital is a suspect and unclean environment results in spread of infections within the hospitals and the medical and non-medical staff as well as the patients become highly vulnerable. 14. Many buildings are old, sub-standard and have structural deficiencies. Repairs and maintenance of the buildings is not carried out on priority. This results in creation of structural threats. 15. The policy of revenue generation through municipal properties needs to be reviewed in case of Hospital Buildings. These buildings should be stand alone and not combined with shopping complexes. 16. Space available is not efficiently managed many times. Many a time the space is inadequate and stop-gap/ make-shift arrangements result in obstructions to the flow of human mass from one section to the other section within the hospital. This causes delays in evacuation, salvaging or inflow for treatment of emergency cases and men or material. 17. Accountability systems are not established towards Disaster Management and no specific job definitions or job contents are listed for each office bearer – medical or non-medical – in this regard. Most work is done on assumption. Procedural flow-chart of actions is not known to the staff, except the aspect of medical treatment. Thus, the hospitals are not geared up to face any emergencies – natural or manmade. Hazards in Nashik 18. Nashik is an ancient place located astride Sahyadri Mountain ranges. River Godavari and some of its tributaries drain through Nashik. It is a growing industrial town and holds a great religious significance. Being an old city situated on the banks of Godavari River, the city has a typical old part along both banks of the river with building that are of considerable vintage. The streets in this part of the city are narrow and congested with traffic and economic activities. The modern areas of Nashik are well developed where the roads are broad and building construction is modern in outlook. However, the Municipal Rules have not yet taken into consideration the need for earthquake resistant designs and consideration towards the rock and soil structures and textures. The growth rate far outpaces the ability to cope up with the civic needs, particularly in the peripheral areas. Nashik faces the following Natural Hazards:- (a) Earthquakes: Nashik is in Seismic Zone 3 of India. Here, quakes of intensity measuring 7.0 on the Richter scale are possible. This may result into a large population getting affected. Old buildings may suffer total or partial collapse resulting into severe crush injuries and burying under the debris. (b) Floods: Godavari River is a major river that flows through Nashik. There are other minor tributaries of Godavari. During monsoons, the city does experience flood conditions affecting a large population. (c) Heavy Precipitation: Nashik receives moderate to heavy rainfall each year. The drainage system is not very efficient and water blockages resulting into accumulation and causing submergence is well on the cards. Precipitation may also result into building collapses. There is no possibility of major water logging because of natural slope in the ground. (d) Lightning Strike: The city being within the heavy monsoon region, the Cumuli-Nimbus cloud base is fairly low and probability of lightning strike is high. (e) Landslides: Nashik has hilly terrain around it. There are small villages and hamlets on the hill-slopes or at the bases. Landslides could occur due to natural phenomenon as well as human intervention.(resulting in to disruption of road communication) (f) Biological Threats: Nashik has approximate population of 11 Lac and it is increasing at a rapid pace due to industrialization. The old part of Nashik is unclean and densely populated. The hygiene and sanitation status as well as water filtration status is not adequate and hence the chances of the spread of contagious diseases are high. (g) Industrial and Chemical Disasters: Nashik is an upcoming industrial town. The safety and security status of industries is indifferent and variable. Chances of industrial accidents are fairly high. (h) Fire: The growing population has this common hazard. This is particularly predominant in slums. The dense layout of hutments in the slums and the flammable construction material used it spreads faster in surrounding areas hence affects larger population staying there. Incidents of fire during normal times and during festivities are on the rise. (i) Stampedes: narrow roads and lanes leading to river banks result in very high chances of stampedes during Kumbha Mela and other religious festivities are high. The past record also suggests the same. (j) Communal Violence: Being a growing industrial township, the politicization is bound to occur and with that inter-communal incidents of violence cannot be ruled out.