14. Disaster planning

13.4. The disaster crunch and release models

model. Figure 8 shows the Manitoba model [52].

prevention and mitigation (Figure 7).

108 Essentials of Accident and Emergency Medicine

13.6. The comprehensive model

shows the comprehensive model.

Figure 9. The comprehensive model.

13.5. Manitoba model

The disaster crunch model states that a disaster occurs only when a hazard affects vulnerable people [51] (Figure 6). It concentrates on the causes of disasters and how the impact can lead to them. On the other hand, the release model concentrates on the risk reduction and hazard

It separates the disaster cycle into six stages; each one has its own boundaries and limitations. The balance between preparedness and flexibility is considered a main advantage of this

The previous models are meant to deal with certain aspects of the management cycle; therefore, they do not help decision makers in all phases of the cycle. The comprehensive model is built to link all aspects of the cycle with the disaster response acts in each phase [53]. Figure 9 Having good knowledge on the disaster management cycle and the models, it is time to advance for discussing the disaster planning.

	- recognition that hazards and vulnerability exist and that emergencies can occur;
	- awareness among the community, government, and decision;
	- makers of the need to plan and of the benefits of planning;
	- appropriate legislation to guarantee implementation of the plan;
	- a designated organization responsible for coordinating both planning and response recovery in the event of a disaster.
	- All hazards approach: This means that the set of actions put in the plan should be flexible to accommodate several types of hazards. Even if there are counteract measures for some hazards, it is desirable to make this type of response.
	- Comprehensive approach: This means all phases of the disaster cycle which include mitigation, preparedness, response, and recovery.

#### • Mitigation:

Mitigation is defined as: "The act of making a condition or consequence less severe" [55].

In the medical field, it is defined as "the effort to reduce loss of life and property by lessening the impact of disasters. It is most effective when implemented under a comprehensiv, longterm mitigation plan" [56]. The mitigation deals with the identification of the risks and trying to prevent them or decrease their effects. The fundamental steps in risk management are as follows:


These steps are better described with their relation and interaction as shown in Figure 10 [57].

Cost-effective mitigation measures on long term are the key for reducing disaster losses on long term and Table 3 lists the examples of measures that are not exhaustive [57].

#### • Preparedness:

Merriam Webster dictionary defined preparedness as: "the quality or state of being prepared; especially: a state of adequate preparation in case of war" [58].

In disaster perspective, response encompasses the decisions and actions taken to deal with the immediate effects of an emergency [62]. Usually, it is for a short period of hours or days starting from the time of the impact or shortly before that if there are predicting signs like hurricanes. Response plan is the best put with the preparedness and whole plan to make a complete coordinated plan rather than making a fragmented plan and there is difficulty in

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Medical response during disaster can be summarized in the CO-S-TR Model framework [63].

The first column (C4) in Table 4 deals with the higher-management level and reaching the

The second column (S4) looks on the surges of the resources to accommodate the increase in

The third one (T4) deals with victims, how to define and follow them in different places, and

It is the restoration or return to any former and better state or condition [64]. In disaster medicine, recovery for hospitals is defined as: "The process by which a hospital minimizes the impact an emergency has made on its operations in an effort to resume normal operations or establish new norms for operations" [65]. The concept of recovery has changes over years from regaining normality in four added-on steps proposed by Hass et al. in 1977 [66] to a more long and complex process that incorporates all other phases of the disaster [67]. To get best results and rapid regain of normality, recovery planning should be incorporated with mitigation process [68]. In disasters with a short response time, recovery starts after ending the acute phase. However, if the disaster took a long time, then review the situation every 12-h period and assess the possibility of starting the recovery processes. Sometimes, in long-lasting disasters, both response and recovery processes go side by side. We can

1. Early recovery: in this stage, regaining the basic services and trying to work as normal as possible or having a new normal. For example, working in an alternative place and this

C4 S4 T4 Command Staff Tracking Control Stuff Triage Communication Space Treatment Coordination Special Transportation

This framework can be expressed by 4Cs, 4Ss, and 4Ts as shown in Table 4.

incorporating the different fragments together [54].

frontline staff in direct response to the disaster.

how to deliver treatment to them in different places.

demands because of the disaster.

divide recovery into three stages:

becomes the new normal place.

Table 4. An outline of CO-S-TR framework.

• Recovery:

CO-S-TR framework

Figure 10. Fundamental steps in risk analysis [57].


Table 3. Examples of cost-effective mitigation measures.

IFRC defines preparedness as: "Disaster preparedness refers to measures taken to prepare for and reduce the effects of disasters; that is, to predict and, where possible, prevent disasters, mitigate their impact on vulnerable populations, and respond to and effectively cope with their consequences" [59]. It takes the results of mitigation and uses it to prepare the community on how to deal with them.

The goal of preparedness is to raise the ability and readiness of a community, an organization, or a country to respond timely and efficiently to any disaster that may occur. The basic components of disaster preparedness involve the following [60]:


#### • Response:

Response in biology means: "Any behavior of a living organism that result from an external or internal stimulus" [61].

In disaster perspective, response encompasses the decisions and actions taken to deal with the immediate effects of an emergency [62]. Usually, it is for a short period of hours or days starting from the time of the impact or shortly before that if there are predicting signs like hurricanes. Response plan is the best put with the preparedness and whole plan to make a complete coordinated plan rather than making a fragmented plan and there is difficulty in incorporating the different fragments together [54].

Medical response during disaster can be summarized in the CO-S-TR Model framework [63]. This framework can be expressed by 4Cs, 4Ss, and 4Ts as shown in Table 4.

The first column (C4) in Table 4 deals with the higher-management level and reaching the frontline staff in direct response to the disaster.

The second column (S4) looks on the surges of the resources to accommodate the increase in demands because of the disaster.

The third one (T4) deals with victims, how to define and follow them in different places, and how to deliver treatment to them in different places.

#### • Recovery:

IFRC defines preparedness as: "Disaster preparedness refers to measures taken to prepare for and reduce the effects of disasters; that is, to predict and, where possible, prevent disasters, mitigate their impact on vulnerable populations, and respond to and effectively cope with their consequences" [59]. It takes the results of mitigation and uses it to prepare the community on how to deal with them. The goal of preparedness is to raise the ability and readiness of a community, an organization, or a country to respond timely and efficiently to any disaster that may occur. The basic

checking.

• Safety improvements, for example, annual technical care

• Zoning/land-use management • Building codes and building use regulations

• Community awareness and education • Tax, insurance incentives or disincentives

Response in biology means: "Any behavior of a living organism that result from an external or

components of disaster preparedness involve the following [60]:

• Legislations to put disaster response plan. • Public information

3. Developing policies and procedures and planning activities.

1. Identifying organizational resources, 2. Determining roles and responsibilities,

Figure 10. Fundamental steps in risk analysis [57].

110 Essentials of Accident and Emergency Medicine

• Relocation of people living in vulnerable and risky

Table 3. Examples of cost-effective mitigation measures.

• Response:

areas.

internal stimulus" [61].

It is the restoration or return to any former and better state or condition [64]. In disaster medicine, recovery for hospitals is defined as: "The process by which a hospital minimizes the impact an emergency has made on its operations in an effort to resume normal operations or establish new norms for operations" [65]. The concept of recovery has changes over years from regaining normality in four added-on steps proposed by Hass et al. in 1977 [66] to a more long and complex process that incorporates all other phases of the disaster [67]. To get best results and rapid regain of normality, recovery planning should be incorporated with mitigation process [68]. In disasters with a short response time, recovery starts after ending the acute phase. However, if the disaster took a long time, then review the situation every 12-h period and assess the possibility of starting the recovery processes. Sometimes, in long-lasting disasters, both response and recovery processes go side by side. We can divide recovery into three stages:

1. Early recovery: in this stage, regaining the basic services and trying to work as normal as possible or having a new normal. For example, working in an alternative place and this becomes the new normal place.


Table 4. An outline of CO-S-TR framework.

2. Rehabilitation: in this stage, save the undamaged issues, restore the restorable, and try to go back to pre-disaster condition. In the example in the first point, work to fix and rebuild the health-care facility is done in this stage.

16. CBRNE

• C: chemical, • B: biological, • R: radiological, • N: nuclear, and

17. Conclusion

Acknowledgements

Conflict of interest

Author details

Abdulnasir F. Al-Jazairi

with the needed time to finish the chapter.

I have no conflict of interest of any sort.

Address all correspondence to: ahuaidi@hamad.qa

• E: high-yield explosives.

community. Details are beyond the scope of this book.

This abbreviation denotes the use of abnormal or unusual agents which are as follows:

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These weapons can create large disruption in terms of the number and level of wellness of the

Disaster is a special situation requiring different management styles and techniques. It is mainly the difference in number which exceeds the resources, and for its proper management there is a desperate need for planning to recall staff and surge space and stuff. There are situations which require the utilization of the entire country's resources, while others may even necessitate international aid. The recent examples of Haiti earthquakes, Iraq and Syrian

I would like to acknowledge my mentors in the European Masters in Disaster Medicine who taught me a lot and allowed me to refer to their valuable lectures and articles on disaster medicine. I would also specially wish to thank my department and chairman who provided me

Emergency Department, Adult Urgent Care Centers, Hamad General Hospital, Doha, Qatar

mass immigration due to internal wars, and anti-terrorism war are still going on.

3. Development: this will be a long-lasting stage (maybe to the next disaster impact); it will intermingle with the mitigation plan, and in it, new standards are set in the building codes or electricity sources to decrease the harmful effects of disasters and go back to normality more rapidly with less damage or work with better efficiency. In the same example as discussed earlier, building or making modifications in other buildings to use them as alternative places will serve patients in time of disaster.
