The Union Minister for Health & Family Welfare, Dr. Anbumani Ramadoss, today released the National Disaster Management Guidelines - Medical Preparedness and Mass Casualty Management, drafted by the National Disaster Management Authority (NDMA). The meeting was attended by Gen. N. C. Vij, Vice-Chairman, NDMA, Gen.(Dr.) J. R. Bhardwaj, Member, NDMA, Shri H.S. Brahma, Addl. Secretary, NDMA and other senior Officials from the Defence Research Development Organisation, NDMA and Ministry.
The following is the text of the Health Minister’s speech:
It is a great pleasure for me to be here today amongst the august gathering and to release the National Disaster Management Guidelines - Medical Preparedness and Mass Casualty Management. I congratulate National Disaster Management Authority (NDMA) for bringing out such a comprehensive document on such a relevant field.
Under Allocation of Business Rules of the Government of India, the Ministry of Health and Family Welfare is assigned the legislative capacity for a number of subjects including all matters relating to the medical, dental, nursing and pharmacy professions and education; mental health; standards for drugs; prevention of food adulteration; and epidemic prevention and control, etc. Thus, Ministry of Health & Family Welfare is the nodal Ministry dealing with Medical Preparedness and Mass Casualty Management.
We all know that India like any other nation in the world has its own share of vulnerability, risk and its capacity to respond to the disasters. The equations of these three factors can be well visualized in some of the worst disasters of the past - the Super Cyclone in Orissa in October 1999, the Bhuj earthquake in January and Tsunami in December 2004. All these revealed the mass casualty potential of natural disasters.
We also increasingly getting vulnerable to man-made disaster events associated with industrialization, transportation and environmental degradation. Added to this is the new facet of terrorist attacks using nuclear, biological, chemical materials.
The underlying message is whether it is natural or manmade, these disasters have the potential of causing mass casualties and we need to address these issues squarely. We need to adopt multi-disciplinary and multi-sectoral approach for prevention/mitigation strategies so as to develop capacities to improve response.
I may like to share with you that there are many critical gaps in managing mass casualties. The concept of pre-hospital care is only emerging now. Outside the Metros it would have been difficult to spot equipped and manned ambulances. The emergency medical technicians are also conspicuous by their absence. The hospitals, especially at the district level do not have infrastructure to manage mass casualties including critical care. The human resource especially in super specialities required to support mass casualty management are lagging even in major towns and cities.
But I may like to assure that things are changing and changing fast. The requirement of rural India to manage peripheral emergencies is addressed by the National Rural Health Mission. It has laid down public health standards for medical care and operationalized Community Health Centres to work on 24x7 basis. The urban India’s health care problems may be addressed through the proposed National Urban Health Mission.
Strengthening the existing infrastructure had been my priority. Let me touch some of the areas where the Government has been working towards this direction. The National Highway Trauma Care Project is an ambitious project in its scale and reach intending to cover the entire Golden Quadrilateral and North-south-east-west corridors for trauma care which envisage strengthening about 200 hospitals from basic trauma care to advanced tertiary care all networked with pre-hospital care ambulances as to provide care during transit and hospitalize within the golden hour. Some of these highways pass through disaster vulnerable zones hence contributing to disaster preparedness. My Ministry is also considering acquiring the capacities for managing nuclear, biological and chemical disasters.
Our hospitals are not retrofitted or seismic resistant and have witnessed collapse in disasters like Bhuj and Uri earthquakes. This has been engaging the attention of my Government and a solution has been found in mobile hospital systems having facilities for operation theatres, pathology labs, imaging units and other support functions, which can be moved or airlifted to the disaster site at very short notice. This would augment the quick response mechanism. Ministry is procuring one such system and I understand that Ministry of Home Affairs have planned to procure three more.
Public health emergencies with mass casualty potential is another area which concerns all of us. There had been a spate of threats from emerging and re-emerging diseases such as SARS, Avian Influenza, Chikungunya, Dengue, Nipha etc. We are in the process of bringing in a legislation for public health emergencies. The implementation would be supported by another major programme namely the Integrated Disease Surveillance which relies on satellite and terrestrial information technology system for data management.
Under the Pradhan Mantri Swasthya Suraksha Yojana (PMSSY) the imbalances in availability of affordable/reliable tertiary level healthcare in the country is being corrected. It also provides an opportunity to augment facilities for quality medical education in the under-served States. The PMSSY envisages setting up of six AIIMS like institutions and strengthening 13 other existing medical institutions.
India’s unique geo-climatic conditions make it vulnerable to natural disasters like floods, drought, cyclones, earthquakes, and outbreak of diseases leading to a sizable number of human casualties. In addition, the various man-made disasters and peripheral emergencies also accounts for large number of mortalities and morbidities. In view of the above, there is a need to develop an institutionalized mechanism for medical preparedness and mass casualty management.
Disaster Management Scenario in India has undergone a paradigm shift in orientation from relief-centric approach to a multi-disciplinary and multi-sectoral preparedness approach. The Disaster Management Act 2005 seeks to institutionalize mechanisms at the National, State and District levels to ensure a swift response including medical response to both natural calamities and manmade disasters/accidents. The first step towards this has been achieved by establishment of NDMA. It has been supporting various initiatives of the Central and State Governments to strengthen the disaster management capacities. NDMA is accelerating capacity building in disaster reduction and recovery activities at the national level and in some of the most-vulnerable regions of the country.
Disaster Management is a continuous and integrated process of planning, organizing, coordinating & implementing measures, which are necessary or expedient for prevention of danger or threat of any disaster, mitigation or reduction of risk of any disaster or its severity or consequences. It includes capacity-building, preparedness to deal with any disaster, prompt response to any threatening disaster situation or disaster assessing the severity or magnitude of effects of any disaster, evacuation, rescue and relief, rehabilitation and reconstruction. The medical preparedness for mass casualty management is an important cross cutting issue to be addressed all across the nation.
The NDMA is responsible for framing Disaster Management (DM) Policies, Plans & Guidelines. The existing institutional mechanisms of management of medical preparedness and mass casualty management have been revisited.
It forms an integral part of the overall all hazard approach to prepare the health care sector to respond effectively to any mass casualty events. It is also dealing with strengthening of all the preventive measures like Integrated Disease Surveillance Programme (IDSP) at all levels to restrict the occurrence of impending disasters of any particular area. The guidelines highlight all the medical preparedness measures to be in place to mitigate the impact of any mass casualty event on human lives, health and safety aspects. It is indispensable to involve the private sector with the public health care provisions. I am happy to learn that to achieve this arduous task the NDMA has taken serious initiatives to identify the salient gaps and develop a comprehensive document as National Disaster Management Guidelines covering the aspects of incident site management, evacuation of casualties and hospital disaster management planning for acute and delayed health effects in the post disaster phase.
The guidelines has been designed to cover the important roles to be played by Medical First responders at the incident site to the psychosocial support provided by the community and the health care providers. It gives sufficient directions for development of action plans and other medical preparedness component of DM plans for central ministries/department and States.
The document has revisited the present regulations and in synergy with them, suggested a series of valuable recommendations to improve the status. It is important to understand that these guidelines are developed to make legislations and their enforcement more stringent, developing conduct of programmes for increasing awareness, training of different target groups and implementation of projects with national and international inputs.
As a nodal Ministry, we have already taken few proactive initiatives like the development of trauma care centers along the National Highways at every 100Km. Few States have taken initiatives to develop network of Ambulance services. A number of National programmes are already initiated including National Rural Health Mission, NACO for HIV control, Revised National Tuberculosis Control Programme (RNTCP), National Vector Borne Diseases Control Programme, Yaws Eradication Programme, National Leprosy Elimination Programme, programmes for prevention and containment of Bird Flu and promotion of alternative systems of medicine. Under the aegis of ICMR, there are few Biosafety Laboratories, few of them are being upgraded to Level III and IV. There is a Crisis Management Group under the Ministry itself which is the decision making body to tackle any emergency situation arising from time-to-time. The lessons learnt from the previous mass casualty events have revealed the importance of having containerized hospital readily, which could be made available at shortest possible notice.
The various tertiary health care institutions present all across the country are playing an important role in providing advanced health care to large number of victims of mass casualty events. The guidelines have also highlighted the present status of the health care infrastructure at all levels and under different sectors of the society i.e. public and private bodies. We are looking forward towards the NDMA for active participation in effective mass casualty management by developing a coordinated and structural framework with all stakeholders and health care providers from other ministries and active role played by community itself.
During the process of development of these guidelines, Gen (Dr.) Bhardwaj has regularly interacted with me and apprised me about the relevant issues pertaining to upgradation of critical infrastructure specifically for Chemical Biological Radiological and Nuclear (CBRN) emergencies, development of skilled and competent manpower at all levels equipped with all necessary equipments and essential medicines etc. It has been identified that the sector needs major funding and thereby the Planning Commission has earmarked a sum of Rs 10,000 crores for the same in the XI Five Year Plan. The numerous mitigation projects for the development of the facilities to manage any mass casualty event will be undertaken by the Ministry in consultation with NDMA.
These guidelines have included the recommendations for the strengthening of the existing IDSP, which will serve as an effective Early Warning System for impending disasters like epidemics and pandemics, training of medical doctors, specialists, paramedics for the different aspects of medical management of mass casualties and availability of skilled and competent mobile teams at all levels able to provide resuscitation, triage to large number of victims at the incident site itself. It has highlighted the need of the development of Integrated Ambulance Network of Road, Railways, Aerial and private sector at all levels with a single toll free telephone number. There is also a need to develop full-fledged containerized hospitals, disaster resilient communication network systems, inter- and intra- hospital networks, community preparedness, medical education for disaster management and establishment of trauma facilities, burns centers, blood banks and laboratory network at all levels.
There is also need to integrate psychosocial support and mental health services with general medical services for which community best practices will also be encouraged at all levels. The basic and applied Research and Development will focus on development and/or adoption of newer technologies, testing of different models, table top exercises at each level for quick decision making and response, and technology upgradation for effective medical management. The specific aspects of medical preparedness including relevant diagnostic tests, treatment protocols, antidotes, medications, equipment, and specialized expertise are necessary for effective disaster management planning. Disaster plans shall specify how these resources would be available and used in the post-disaster phase.
The guidelines have enumerated the recommendations for defining the minimum standards of food, water, shelter, environmental sanitation and personal hygiene and the mechanism for providing adequate relief and necessary rehabilitation options to be adopted based upon the post disaster analysis. The role of private sector in strengthening this sector and necessary funding and implementation strategies to be adopted are given in the guidelines in detail.
I am happy that a significant part of the guidelines is dedicated towards the development of medical management capabilities by up-gradation of critical infrastructure required for effective management of CBRN emergencies. It includes the development of decontamination, protection, and detection, decorporation and specific medical facilities at all levels. The emergency inventory for CBRN emergencies will also be established at all levels dealing with all aspects of emergency medical response.
On the basis of the guidelines, the Ministry may develop an effective DM Plans in consultation with all stakeholders. A comprehensive DM plan will be forwarded to NDMA through National Executive Committee (NEC) for submission to the Government and would ultimately be leading to the formulation of a national plan. Training manuals, standard operating procedures and documentation of the best practices are important components of disaster preparedness programmes and will be developed for different levels for easy adoption, replication and sharing.
I am very hopeful that all of us will gain from this exercise. On behalf of the Ministry, I can assure the total cooperation from the Ministry and we will make our best efforts at Ministry level in the areas of upgradation of the medical infrastructure to implement the guidelines in a time-bound manner.
Strengthening of mechanisms for dealing with medical preparedness and mass casualty management is a continuous process and with time, it is even important to revisit it at timely intervals to further reinforce the system.
Human resource development for the entire health sector both for medical, paramedical and nursing is my priority and for disaster management the training programmes in mass casualty management has being institutionalized on regional basis.
I wish to emphasize once again that the risks, the hazards of the disaster may not be possible to be nullified in totality but what lies in our hands is our capacity to be prepared to able to respond to these disasters.
The National Disaster Management Act, 2005 and setting up of National Disaster Management Authority have given the right impetus for the country’s vision for a paradigm shift from response to prevention, preparedness and mitigation. I appreciate the NDMA’s contribution to this effect in such a short span of time and giving the necessary focus to health sector. This document I am sure will lay the foundation for the country to prepare for managing mass casualty incidents.
I once again thank Gen. Vij and Gen. (Dr.) Bhardwaj for coming out with such useful Guidelines. We look forward to NDMA in helping us in all our future endeavors. I wish continued success to NDMA in their endeavours.
Source: http://pib.nic.in/release/
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