Community medicine chapters
Disaster management
What a disaster is and its types, the disaster management cycle (mitigation, preparedness, response, recovery), mass-casualty triage colours, the public health problems after disasters, and how disaster management is organised in Pakistan.
- A disaster is a serious disruption of a community that causes widespread human, material or environmental losses exceeding its ability to cope with its own resources.
- The disaster management cycle: mitigation and preparedness before; response (rescue, relief, triage) during; rehabilitation and reconstruction after.
- In mass casualties, triage sorts victims by urgency: red immediate, yellow delayed, green minor (walking wounded), black dead or expectant.
On this page
Overview
Pakistan faces frequent disasters: floods (2010 and the record floods of 2022), earthquakes (2005 Kashmir earthquake), heatwaves, droughts, landslides and man-made emergencies. Doctors are often the first to respond and must know how to organise care when needs exceed resources.
Definitions
- Disaster: an event that seriously disrupts the functioning of a community, causing widespread human, material, economic or environmental losses that exceed the community's ability to cope with its own resources.
- Hazard: an event or condition with the potential to cause harm (for example an earthquake fault or a river that floods).
- Vulnerability: how susceptible a community is to harm (poor housing, poverty, living on flood plains).
- Risk = hazard × vulnerability (reduced by capacity to cope).
A hazard becomes a disaster only when it strikes a vulnerable community and overwhelms its coping capacity.
Types of disaster
| Natural | Man-made |
|---|---|
| Floods, earthquakes, cyclones, tsunamis, landslides, droughts, heatwaves, epidemics | Road and rail accidents, fires, building collapse, industrial and chemical accidents, explosions, terrorism, war, refugee crises |
The disaster management cycle
| Phase | Timing | Activities |
|---|---|---|
| Mitigation (prevention) | Before | Reducing the impact: building codes for earthquakes, flood embankments, land-use planning, reforestation |
| Preparedness | Before | Plans, early warning systems, training and drills, stockpiles of supplies, hospital emergency plans, community awareness |
| Response | During and immediately after | Search and rescue, first aid, triage, evacuation, relief (water, food, shelter), communication and coordination |
| Rehabilitation | After | Restoring essential services (water, sanitation, health care), temporary housing, psychosocial support |
| Reconstruction | Long term | Rebuilding infrastructure "better and safer", returning to normal life |
Mitigation and preparedness together form disaster risk reduction. Internationally, the Sendai Framework for Disaster Risk Reduction (2015–2030) guides this work.
Building flood embankments or earthquake-resistant houses is mitigation; drills, early warning and stockpiling are preparedness.
Mass casualty management and triage
Triage means sorting casualties by urgency of need and likelihood of benefit, so that limited resources do the greatest good for the greatest number.
| Colour | Priority | Who |
|---|---|---|
| Red | Immediate (first priority) | Life-threatening injuries that can be saved with prompt treatment (airway problems, severe bleeding, shock) |
| Yellow | Delayed (second) | Serious injuries but stable for now (fractures without shock, burns without airway problems) |
| Green | Minor (third) | "Walking wounded": minor injuries |
| Black | Dead, or unsurvivable injuries (expectant) | Given comfort care when resources are overwhelmed |
Simple systems such as START (Simple Triage and Rapid Treatment) use the ability to walk, breathing, respiratory rate, circulation (capillary refill or radial pulse) and mental status to assign colours quickly.
Red = immediate. In a mass casualty, the most seriously injured patient is not always treated first: those who cannot survive are given lower priority so more lives can be saved.
Hospital role
- An activated hospital emergency (disaster) plan with a clear chain of command.
- Triage at the entrance, clearing beds, calling in extra staff, blood supply, communication with other hospitals.
Public health problems after disasters
- Water and sanitation failure: diarrhoea, cholera, typhoid, dysentery, hepatitis A and E (especially after floods).
- Vector-borne diseases: malaria, dengue as stagnant water increases mosquito breeding.
- Respiratory infections and measles in crowded camps.
- Skin and eye infections, leptospirosis, snake bites.
- Malnutrition, especially in children.
- Injuries, wound infections and tetanus (earthquakes).
- Mental health problems: acute stress, post-traumatic stress disorder, depression.
- Disruption of routine care (antenatal care, immunisation, treatment of chronic diseases).
Dead bodies after natural disasters rarely cause epidemics; the main risks come from unsafe water, poor sanitation and overcrowding. Hasty mass burial without identification is not needed for disease control.
Priority public health measures
Safe water (chlorination), sanitation, food, shelter, measles vaccination in camps, vector control, disease surveillance (early warning for outbreaks), maternal and child health services, and psychosocial support.
Disaster management in Pakistan
- National Disaster Management Authority (NDMA): formed in 2007, given legal backing by the National Disaster Management Act 2010; coordinates disaster management nationally.
- Provincial Disaster Management Authorities (PDMAs) and District Disaster Management Authorities (DDMAs) at lower levels.
- The armed forces, Rescue 1122 (emergency service in Punjab and other provinces), the health department and NGOs play major roles in response.
Expect: the definition of a disaster, hazard vs vulnerability, the phases of the disaster cycle and examples of mitigation vs preparedness, triage colours and their meaning, diseases after floods and in camps, and Pakistan's NDMA, PDMA and DDMA structure.
Quick revision
- Disaster: impact exceeds the community's coping capacity.
- Risk = hazard × vulnerability.
- Cycle: mitigation, preparedness → response → rehabilitation, reconstruction.
- Triage: red immediate, yellow delayed, green minor, black dead.
- After floods: water-borne (cholera, typhoid, hepatitis E) and vector-borne (malaria, dengue) diseases.
- Pakistan: NDMA (2007; Act 2010), PDMAs, DDMAs.
Written by The House Job from Excel Community Medicine and Park's Textbook of Preventive and Social Medicine (named in the UHS PGET syllabus), with Pakistan's NDMA structure from the National Disaster Management Act 2010.
FAQ
What is a disaster?
A serious disruption of a community causing widespread losses that exceed the community's ability to cope using its own resources.
What are the phases of the disaster management cycle?
Mitigation and preparedness before the event, response during it, and rehabilitation and reconstruction afterwards.
What does a red triage tag mean?
The casualty needs immediate treatment for a life-threatening but survivable injury.
Which diseases commonly follow floods?
Water-borne diseases such as cholera, typhoid and hepatitis A and E, and vector-borne diseases such as malaria and dengue.