As disasters cannot be prevented, contingency planning for disaster management involving preparedness, mitigation, relief and rehabilitation are essential. Even though disaster demands immediate response, the resilience after disaster depends upon the level of preparedness. The current study addresses Disaster Kit which is one of the most important priority tools in disaster preparedness. The Global initiatives for disaster preparedness and reduction should be given highest priority by the international community. The purpose of the article is to disseminate information related to disaster preparedness kit to the entire scientific community thereby empowering the concept of disaster preparedness to enable each individual and family to remain comfortable during and after disaster.
Disasters in modern times have transcended borders of nation, class and have devastating impact in terms of human and material losses . A wide variety of disasters, natural as well as manmade are faced by human beings, since the beginning of human evolution . A disaster may lead to number expected adjustments: immediate displacement from place of living and community, difficulties in temporary shelters, lose of livelihood, uncertainties about future and demands of rebuilding of life . However the major impact of disaster could be mitigated by proper household emergency preparedness [4,5].
Emergency preparedness involves knowing the risks particular to a community, developing an emergency plan, and having an emergency kit in the home containing food, water, and medical supplies to shelter in place for 72h [7,8]. The human and economic loss resulting from disasters have made the community and nations to think on strategies for mitigating the risk and vulnerability associated with it.
The survival after a disaster should be thought and planned in advance.
Manual Textbook of Equipping for Disasters. Sheltering at Home
The planning involves preparation in terms of food, water and other supplies in sufficient quantity for a minimum of three days or until the rescue workers arrival. The arrival of rescuers depends on the extend of distraction occurred. Furthermore a proper planning helps the survivors to continue their life in the midst of breakdown of basic amenities like electricity, communication system, cooking gas, water, waste disposal and treatment. The exit time available during the evacuation plan on sudden warning sign of disaster will be only few seconds which alarms the necessity of an emergency disaster supply kit .
A paradigm shift towards community based preparedness in recent years is preparation of emergency disaster preparedness kit.
Hazards and how you can prepare
A disaster supplies kit includes all the basic items for the members of the family in the event of catastrophe. Moreover the scientific technological advancement or the nature itself will give warning to disastrous events which can happen at any time either in home, in vehicle or at office which warrants each one of us to be ready anytime with basic supplies to sustain our life . The exact location of an individual at the time of a disaster varies.
It can be home, work place or being travelling in car. Make sure you have comfortable walking or running shoes in your disaster preparedness kit, if evacuation requires walking of long distances. The kit in your car must contain food, water, first aid supplies, jumper cables, flares and seasonal supplies according to weather Table 1. Table 1: Basic disaster supply kit . Serial Number. Battery-powered or hand crank radio. Flashlight and extra batteries. First aid kit. Whistle to signal for help.
Dust mask to. Moist towelettes, garbage bags and plastic ties. Wrench or pliers. Manual can opener for food. Local maps. Cell phone with chargers, inverter or solar charger. Water: a Quantity of water; A normally active person needs about three quarters of a gallon of fluid daily, from water and other beverages.
Hence forth storing one gallon of water per person for three days would be adequate. However the following points has to be taken into consideration while estimating the amount of water to be kept in disaster preparedness kit: Personal needs vary, depending on physical condition, gender, age group, activity, dietary pattern and climatic condition. Children, sick individuals, nursing mothers, need more amount of water, hot weather condition can double the amount of water requirement.
Furthermore a medical emergency might demands additional quantity of water b Storage of water: i The most reliable supply of water to store is bottled drinking water from market. The bottle should be unopened till the time of use and ensure the expiry of water bottle ii The water can be stored in unbreakable food grade water storage containers from supply stores which should be cleaned with dish wash soap solution, and water iii Storage containers such as two litre plastic soft drink bottles can be utilized but preferred to avoid containers that had milk or fruit juice in them.
The following steps are helpful while storing water in plastic bottles: 1. Thoroughly clean the bottles with soap solution and rinse out soap completely from it. Sanitize the bottles with one tea spoon of non-scented liquid domestic chlorine bleach to quarter litre of water. Swish the solution thoroughly in the bottle to touch all the surfaces.
After sanitization, rinses out the sanitizing solution with clean water. Fill the bottle with commercially treated water, if water is treated no need for adding anything to cleanse the water. If well water or from other safe water sources which are not properly treated, add two drops of non-scented liquid house hold chlorine bleach to the water.
Tighten the container with original cap, while capping be careful enough not to contaminate the cap by touching inside of it with soiled finger or any other articles. Place the filling date on outside the container, so that you will come to know when you filled, store it in a cool, dark place.
Replace the water at every six month interval if not using commercially bottled water. Food: a Choose salt free cookies, whole grain cereals, and canned foods with high liquid content and avoid foods that will make you thirsty b keep ready canned foods, dry fruits, high calorie yielding food stuffs like nuts, peanut butter, one box of twelve or more high-energy bars or snacks. One can of meat or protein such as spam or underwood chicken spread, other staple food of your own choice, which does not require refrigeration, cooking, water or special preparation c Keep a manual can opener, if you prefer canned foods.
Other items: The disaster kit should contain the following other items which are pertinent for the survival apart from the basic supply of life-water and food. The comprehensive list includes a Portable, battery powered radio and extra batteries. The maintenance of kit is equally important as preparation considering the safety of stored items. The measures which can be initiated are: a Keep canned food in a cool, dry place b Store boxed food in tightly closed plastic or metal containers to protect from pests and to extend its shelf life.
The national and international regulatory bodies in the developing and developed countries have clear-cut policy guidelines for household emergency preparedness but the depth at which the knowledge and practice regarding the same has been rooted in the community is questionable. The decreased rate of adherence to family disaster preparedness by preparing and maintaining a disaster kit can be multi factorial a Lack of knowledge regarding what to prepare-The public may be unaware of the concept of disaster kit, items in disaster kit and maintenance of disaster kit.
Much of the information related to disaster preparedness are internet based and it will not reach the people who do not have internet access-Multiple channels of communication must be utilized to diffuse the information on disaster kit to the public .
Research need to be conducted regarding the effectiveness of disaster kit in improving self sufficiency of individuals and disaster related resilience. The association between being prepared for disaster and surviving the disaster without outside assistance should be clearly ruled out by using a household emergency preparedness instrument which can further strengthen the effectiveness of disaster preparedness kit. An effective collaboration between the government agencies and community are essential for disaster preparedness since it is a dynamic, multifaceted, large-scale public health concern.
Community education on disaster preparedness is the only effective tool to address the gap existing between the disaster management authorities and public. The policies formulated by global organizations on disaster preparedness have highlighted the roles and responsibilities to be carried out by the individual and community in mitigating the risk and vulnerabilities associated with disasters.
Moreover empowering the local level preparedness from the incipient units in the community i. Furthermore an effective citizen and community preparedness warrants public awareness and education programs to ensure citizens will take appropriate advance actions to reduce their vulnerability especially during the initial days 72hrs after disaster impact. The Disaster preparedness kit is an indispensable part of preparedness and it should start with a gold standard set of essential supplies. This gold standard should be based on the common conditions that any natural or manmade disaster would likely present and equip each household to face the common conditions.
In particular, the common conditions include living without power, limitations on drinking water, and being unable to leave the home to acquire additional supplies for a few a days. The goal of a gold standard is to provide everyone with proven essentials so individuals and households are empowered to further customize their disaster supply kits to best serve their unique needs . For people to take action, they must recognize the hazard, believe it to be avoidable, and believe that there is an advantage in taking preventative actions [ 33].
Government of India. National Disaster Management Division. Series 2. Disaster Management Programme. New Delhi: Ministry of Home Affairs; Park K. Text book of Preventive and Social Medicine. Banarsidas Bhanot; ; Disaster preparedness. Times Foundation India Times.
Falkiner L. Aghababian, February 28, Pediatric disaster education should be widely accessible and an important component of training for all emergency care providers. A DMAT is a group of professional and paraprofessional medical personnel who provide medical care during a disaster or other event. National Disaster Medical System, ; it typically consists of 35 physicians, nurses, emergency medical technicians EMTs , and support personnel Lawrence, After arriving on site, DMATs triage and stabilize the injured, assist with the transfer of patients to hospitals in other areas, and set up temporary clinics for victims.
DMATs are organized by a sponsor, usually a major medical center, health department, or disaster organization. The sponsor signs a memorandum of agreement to recruit volunteer team members, coordinate training, and dispatch the team National Disaster Medical System, The teams are able to provide care at a disaster site for up to 72 hours without resupply Lawrence, There is a standardized training program for all field teams, which includes a pediatric component National Disaster Medical System, The median age of the pediatric patients was 4.
The authors concluded that, based on the experience from these four disasters two hurricanes, an earthquake, and a flood , DMATs should be adequately prepared to treat pediatric patients, particularly the very young Nufer and Gnauck, However, there is reason to be concerned that DMATs are not sufficiently prepared to treat pediatric patients.
Their responses see Table were not as positive as one would hope. The survey found that DMATs were not fully prepared for pediatric patients. Pediatric treatment tools most frequently lacking were backboards 62 percent of teams , a Broselow tape 46 percent , pediatric medications 38 percent , and cervical collars 38 percent. How well does the standardized DMAT curriculum meet the needs of pediatric patients? How well is the team equipped to respond to a disaster with pediatric patients? The survey also provided insight into the DMAT members and their training and experience with regard to pediatric patients.
The majority of DMAT physicians 74 percent reported that they specialize in emergency medicine. Slightly more than half 54 percent of physicians, 40 percent of nurses, 44 percent of midlevel providers nurse practitioners and physician assistants , and 44 percent of paramedics reported working with children on a daily basis.
Many of the problems apparent in the emergency care system for children, particularly lack of equipment and training, are also apparent on DMATs. To address these shortcomings, strategies to improve the level of pediatric expertise on DMATs and other organized disaster response teams need to be developed.
This can be accomplished by improving the pediatric training required of teams, equipping them with appropriate pediatric resources, and taking active steps to recruit pediatricians and pediatric emergency medicine physicians to serve on the teams. While children represent approximately 25 percent of the U. Census Bureau, , they consume a smaller proportion of inpatient hospital services Freishtat, Since most children are relatively healthy, the U. As a result, compared with. In the event of a disaster, the capacity of the health care system to care for a large number of children is likely to be inadequate.
Although much of the focus of disaster planning has been on large-scale disasters, even modest incidents have the potential to push system resources to their limits. For example, a number of victims of the Rhode Island nightclub fire in required supplemental staff and specialized resources that overwhelmed local capacity Hick et al. A total of victims sought care at local hospitals. It received 82 patients, 25 percent of whom were admitted, while 25 percent were transferred to other hospitals.
A level I trauma center located 12 miles away from the nightclub received 68 patients, approximately 63 percent of whom were admitted Gutman et al. It was only the second time Shriners had opened its doors to adult patients Ginaitt, What would have happened had the fire occurred in a venue filled with children? The hospitals most proximate to a disaster may not normally care for children but must still be ready to receive some pediatric victims.
Other hospitals must be prepared to handle pediatric patients with more minor conditions and stabilize those in critical condition until they can be transported to a pediatric center. Pediatric centers should have predetermined means of communicating with one another so they can share patients in the event those in critical condition need to be evacuated. DMATs may be able to offer local emergency care providers some relief, but given that there are only two pediatric specialty DMATs nationwide, their reach would be limited in the event of a large-scale event.
A review of one pediatric disaster in England provides some insight into what could happen in the absence of regional planning for such disasters. In , a double-decker bus full of school children was involved in a crash. Two children were killed and 56 injured. The local hospital received notification of the crash just as the first victims began to arrive.
At that hospital, 42 injured children were taken to the ED. Most injuries were minor in nature, although 15 children were admitted; 4 had serious head injuries, and 2 required neurosurgical intervention. Although the hospital had a disaster plan in place, the lack of advance notification, the rapid influx of patients, and. This incident also highlights the importance of all hospitals being prepared for pediatric emergencies, particularly in areas that lack pediatric centers.
Disaster planning must also take into account children who are not hurt but need evacuation and sheltering. The importance of having pediatric resources e. Steps to ensure that these resources are on hand must be taken before a disaster strikes. Involvement of pediatric experts in disaster planning is critical to ensure that evacuation and sheltering plans can meet the needs of children, particularly those with special needs, as the plans are operationalized.
Disaster plans should include protocols for schools and day care centers and other places where children congregate. Planners need to think about where children might be at different times of day.
For example, had the September 11 attacks occurred a half hour earlier, while more than , New York City school children were in transit to school, where would the bus drivers have taken these children? Would the places selected have been adequately equipped to handle the surge of children?
Children affected by disasters have a number of medical, mental health, and social service needs that must be met. Under the current system, however, services appropriate for children may not be available. As discussed in Chapter 5 , medications appropriate for children are not always available; the same is true for antidotes in the event of a terrorist attack.
Additionally, resources and therapies developed specifically for children may not be accessible when needed. Potassium iodide prevents thyroid cancer and is highly recommended for children in the event of exposure to radioactive material. However, potassium iodide is currently available only in tablet form and therefore cannot be readily administered to infants and very young children.
The pill can be dissolved in water, but since the resulting fluid is so salty, it must be mixed with something to disguise the taste. The tablet can be crushed and mixed with raspberry syrup, low-fat chocolate milk, or other drinks, but these mixtures will keep for only 7 days and must be stored in a refrigerator.
Parents would have to crush a new tablet every 7 days to have the medication on hand when needed FDA, Even if parents went through these steps every 7 days, however, the stability of potassium iodide when mixed with other liquids is not well known. There are also issues related to the strategic national stockpile SNS , which would be used in the event of a disaster severe enough to deplete local resources.
Within the SNS are hour push packages that contain pharma-. They are positioned in strategically located, secure warehouses ready for immediate deployment in the event of a disaster CDC, Historically, the SNS did not meet the needs of most children, but that has changed somewhat. Today, there are pediatric representatives on every SNS advisory committee, and every new item for the SNS is reviewed for pediatric implications.
However, the SNS must comply with Food and Drug Administration FDA labeling requirements, and if a medication is not approved for pediatric patients, it cannot be included in the push packages for children. Since most antidotes for terrorism agents are designed for adult use and not approved by the FDA for pediatric patients, they are not available for use in children Markenson, Even with pediatric representation on SNS advisory committees, pediatric concerns are not fully addressed in developing the push packs because of the absence of approved antidotes for children.
There are also controversies regarding the use of Mark 1 kits for children. Mark 1 kits contain two antidotes—atropine and pralidoxime chloride—that are effective if a person is exposed to certain types of nerve gas. The consensus in the medical community is that this treatment is appropriate for infants and children with severe, life-threatening nerve agent toxicity National Center for Disaster Preparedness, However, there are no protocols for providers with regard to using a Mark 1 kit to treat children because it is not approved by the FDA.
Pediatric dosing for atropine was approved by the FDA in June , but it remains unclear how emergency providers should treat children exposed to nerve gas; some may give children only the pediatric dose of atropine, while others may give them the full dose in the Mark 1 kit. The Mark 1 kit is not a unique example—no specific pediatric dosage guidelines exist for a large number of drugs used in disaster situations. Based on a survey of parents, it is estimated that approximately 18 percent of children aged 6—17 in New York City had severe or very severe post-traumatic stress reactions after September 11, , but only 10 percent received counseling Fairbrother et al.
Approximately two-thirds of children with probable post-traumatic stress disorder may not have received mental health services Hoven et al. Hurricane Katrina highlighted the vast social service needs of all displaced victims, regardless of age. It would be a challenge for disaster plan-. However, the development of evacuation plans should take into account how children can attend schools in different areas, the availability of health care services for children, pediatric capacity in the SNS, ways to expedite Medicaid enrollment for pediatric disaster victims, and long-term sheltering options available for children.
Although difficult for disaster planners to address, these issues must be considered. The American College of Emergency Physicians ACEP has reported that the lack of bioterrorism training for medical responders is so severe that patient treatment could be seriously compromised Maniece-Harrison, It is perhaps not surprising that pediatric training is particularly lacking. Most bioterrorism training initiatives, for example, make no reference to the needs of children Maniece-Harrison, Disaster drills have long been central to disaster preparedness efforts for all types of emergency responders.
Such drills have proven to be effective in training hospital providers to respond to mass casualty incidents Hsu et al.
Hospitals must also participate in at least one communitywide drill per year to assess the communications, coordination, and effectiveness of hospital and community command structures JCAHO, However, the JCAHO requirements do not specifically address conducting disaster drills with children, and in fact, many disaster drills do not include pediatric patients. For example, one hospital held a disaster drill for a mock earthquake, in which a pediatric patient was simulated by a 5-gallon water bottle on which was taped a list of symptoms Fields, Obviously, this is a poor means of simulating a pediatric patient.
Some disaster drills do not consider children at all. Most 68 percent of DMATs include pediatric patients in disaster drill scenarios Mace and Bern, , but it is significant that 32 percent do not. An assessment of EMS agencies in Arkansas found that few had participated in school disaster drills or planned for school responses Dick et al. With few exceptions, natural and man-made disasters affect children as well as adults, and there is no better way to expose weaknesses in current preparedness than to demonstrate how poorly children fare in disaster drills.
Children are often located in large groups schools, day care centers Romig, , and it is unclear how the system would respond if a disaster incident occurred at one of those locations and a large number of children required care. Therefore, disaster drills should include a meaningful pediatric component. Aghababian R. EMSC News 15 2 Associated Press. Hurricane Katrina: By the numbers. The Sun Herald. Volunteers try to reunite children separated from parents.
Union Tribune. Katrina is voted top story of USA Today. Regionalization of Bioterrorism Preparedness and Response. Strategic National Stockpile. Center for Catastrophe Preparedness and Response. New York: New York University. Influenza Flu. Cottman M. More than 2, young Katrina survivors still separated from their parents. EMS preparedness for mass casualty events involving children.
Academic Emergency Medicine 11 5 Traumatic stress reaction in New York City children after the September 11th terrorist attacks and subsequent use of counseling services. Presentation to the AcademyHealth Annual Meeting. Nashville, TN. Fields H. Hospital disaster drill follows mega-quake scenario. Stanford Report. Pediatric Terrorism and Disaster Preparedness Resource. Freddy Mac Foundation. Freishtat R.
Clinical Pediatric Emergency Medicine 3 4 — Ginaitt PT. Survey of nationally registered emergency medical services providers: Pediatric education. Annals of Emergency Medicine 36 1 — The station nightclub fire and disaster preparedness in Rhode Island. Medicine and Health Rhode Island 86 11 — Health care facility and community strategies for patient care surge capacity.
Annals of Emergency Medicine 44 3 — Hicks M. Holbrook PR. Pediatric disaster medicine. Critical Care Clinics 7 2 — Training to hospital staff to respond to a mass casualty incident. Pediatric Disaster Preparedness Guidelines. Hospital disaster preparedness in Los Angeles County, California. Annals of Emergency Medicine 44 4. Analysis of a school bus collision: Mechanism of injury in the unrestrained child.
Canadian Journal of Surgery 46 4 — Lawrence T. EMSC News 15 2 :6—7. Needs assessment of current pediatric guidelines for use by disaster medical assistance team members in response to disaster and shelter care. Annals of Emergency Medicine 44 4 :S Mace SE, Jones G.maisonducalvet.com/conocer-a-gente-de-barx.php
Stay safe in a disaster!
An analysis of disaster medical assistance team deployments in the United States. Maniece-Harrison B. Markenson D. Mattox K. Life in astrocity, population: 23, Emergency Medicine News. How prepared are Americans for public health emergencies? Twelve communities weigh in. Health Affairs Millwood 23 3 — Pediatric Disaster and Terrorism Preparedness. Domestic Terrorism: Issues of Preparedness. Resource Document.
National Advisory Committee on Children and Terrorism. Recommendations to the Secretary. National Center for Disaster Preparedness. Pediatric Preparedness for Disasters and Trauma. Brief 1 1. National Disaster Medical System. Noji EK. Disaster epidemiology. Emergency Medicine Clinics of North America 14 2 — Nufer KE, Gnauck K. Clarifying needs of the pediatric disaster patient: A descriptive analysis of pediatric patient encounters from four disaster medical assistance team deployments.
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Ohio Pediatric Disaster Preparedness Committee. Pediatric Issues in Disaster Preparedness. Ong B. Fractured families. Newsweek Web Exclusive. Hurricane Andrew and a pediatric emergency department. Annals of Emergency Medicine 23 4 — Emergency department disaster preparedness: Identifying the barriers. Romig L. EMSC News 15 2 :3—4. Sears M. Organized effort aims to improve response when a child is hurt; club supplies bags that streamline ambulance care. Milwaukee Journal Sentinel. Shannon M. Shute N, Marcus MB.
Crisis in the ER. Turning away patients. Long delays. A surefire recipe for disaster. US News World Report 9 — Hospital preparedness for weapons of mass destruction incidents: An initial assessment. Annals of Emergency Medicine 38 5 — Census Bureau. Pediatrics 92 1 — A review of the management of a major incident involving predominantly pediatric casualties. Injury 25 6 — Children represent a special challenge for emergency care providers, because they have unique medical needs in comparison to adults. For decades, policy makers and providers have recognized the special needs of children, but the system has been slow to develop an adequate response to their needs.