Disasters refer to collective stress situations that happen or at least manifest themselves suddenly in a particular geographic area, involve some degree of loss, interfere with the ongoing social life of the community, and are subject to human management (Gist and Lubin, 1989). The World Disaster Report (2001) has reported that about 211 million people are affected by natural disasters every year and the poorest are becoming more exposed to disaster risks and disasters set back the development process by decades. The Tsunami imposed a huge burden on the community not only physically but also in terms of psychological trauma inflicted on them. Asia remained the most affected continent. Nine of the top 10 countries with the highest number of disaster-related deaths were in Asia. Women play an integral part in the functioning of societies, with established roles and rules. Enerson (1998) in her review of twenty years of disaster studies reports study findings that show that women are progressively vulnerable. The vulnerability of women stems due to the pre existing social epi- centres. Vulnerable woman-headed households generally consist of women with severely handicapped husbands and young children, handicapped women, widows, and young single women. The widows have to bear and go through the grief of the loss of their spouse. They have the burden of increased responsibility towards their surviving children, aged parents/ in laws and other family members. The current study focus on understanding the impact of widowhood in the after math of the disaster.

The impact of natural disasters on individuals is substantial. Among the affected population in any disaster, children are identified as the most vulnerable group along with women, aged and disabled people. An estimated 77 million children under 15, on average, had their lives severely disrupted by a natural disaster or an armed conflict, each year, between 1991 and 2000 (Plan UK, 2003). Children are most affected since they loose the familiar environment, loss of parents, witness death of their loved ones, fear of reoccurrence of the disaster event. The impact of disaster on children of different age group is multiple times greater than that of the adults. This leads to various psychological problems in children (Dave et al., 2003). Disaster preparedness, through care givers, is one among the ways to reduce the distress of individuals followed by any disaster because it reduces the vulnerability factor that minimizes the impact of any disaster on the individual. A disaster preparedness program with special reference to psychosocial aspects was developed and implemented among the school children through teachers in Kanniyakumari District, Tamil Nadu, India, one of the severely affected areas in Tsunami. The current attempt was to standardize a disaster preparedness module focusing on preparing children to deal with their psychosocial issues before and after disaster in an effective manner. The outcome of disaster preparedness input through teachers and its reach out to the students was determined through an experimental research. The results reveal that the teachers and students from the experimental group gained significantly more knowledge on psychosocial disaster preparedness after implementation of the program in comparison to control group where the program was not implemented. The implications of the study points out the need to integrate psychosocial component of disaster preparedness in to the broader Community Based Disaster Preparedness (CBDP) programs.

Tsunami left 7997 people dead in Tamil Nadu. Nagapattinam, Cuddalore and Kanyakumari districts were worst affected in terms of human and property loss.. Highest number of children death (1776) were reported in Nagai District. In Project Area, Totally 522 children died due to tsunami in Pondicherry (152), Cuddalore (222), Chennai (48) respectively. Considering massive death of Children in Tsunami Disaster, Rural Development Integrated organization (RIDO) along with partnership of Plan International and Technical Support from National Institute of Mental Health and Neuroscience (NIMHANS) provided psychosocial care for tsunami affected children in the regions of Union territory of Pondicherry, Cuddalore and Chennai. Totally 150 community level workers; 50 from each region were selected and trained for a period of 1 week on psychosocial care for children affected in Disaster through using different mediums by master trainers who underwent intensive Training of Trainers program on psychosocial care for tsunami affected children at National Institute of Mental Health and Neurosciences, Bangalore which is a nodal agency in India on psychosocial care in Disaster management. Psychosocial care program for tsunami affected children was carried out over a period of 2 years in afore said regions and handholding support was given to the community level workers periodically in the field. The psychosocial care program was provided for children in their own community by their own community volunteers through group based activities using different mediums. Mediums used to provide psychosocial care were unique in their own way which brought out the underlying emotions of children related to tsunami. Emotional perceptions differed among children across the age groups. Involving the community level workers in providing the psychosocial care for children survivors of tsunami disaster showed encouraging results. Challenges, limitations and lessons learnt in providing psychosocial care for tsunami affected children through community level workers will be discussed.

A Disaster is the tragedy of a natural or human made hazard that negatively affects society or environment. Disaster impacts physical, psychological, social and economic areas of the individual and family and community. Most of the time these are interlinked to each other and its total impact on the survivors is substantial. Children are more susceptible to disaster suffering, and it is noticeable in many complex psychological and behavioral symptoms. On the other hand, the post-disaster psychological effects on children are not recognized and underestimated by the mental health professionals. India is highly prone to natural disasters such as floods, droughts, cyclones, earthquakes and landslides have been recurrent phenomenon in India. Out of 602 districts in the country, 125 districts have been identified as most hazard prone areas. The recent heavy rainfall and flood between 28th September to 2nd October 2009 in the Northern region of Karnataka State caused several deaths and massive destructions. This was the first time that North Karnataka received highest rainfall. The incessant rainfall that poured for four days caused the flood and devastated and destroyed the entire social fabric of the community. Floods carry greater risks to psychological as well as physical health of children. The psychological impact of the floods on children has been carried out both qualitatively and quantitatively. The quantitative assessment was done to assess the severity of floods impact on children using the Impact of Event Scale (Dyregrov and Yule, 1995). The results showed the children showed higher level of intrusion and avoidance aftermath of floods. Boys had significantly higher psychological impact than girls. However, both boys and girls showed moderate to severe level of psychological impact on the domains of intrusion, avoidance and hypervegilence. The implication of the findings are discussed in the context of framing psychosocial programmes.

Training special medical teams to be prepared for delivering emergency relief to the injured requires a special psychological conformity of individuals and mutual inter-understanding based on professional qualifications. The psycho-physiological approach comprises a set of methods of computerized tools for medical staff education, training, and preparedness, keeping in mind the aim of the necessity of mutual activities in triage process, medical care, and decision-making for evacuating injured victims from the emergency site. The goal of this presentation is to expose the battery of new original methods and technologies of staff preparedness in order to realize the maximum conformity of personal composed together in one unique mobile team sent into the situations of emergency accompanied by psychological tension, insufficient volume of info sharing, field conditions, etc. Methods are based on the measurements of the functional asymmetry of brain hemispheres tested by computer-loaded, original software. Several levels of evaluation of functional asymmetry status have been proposed for discussion and for choosing of criteria for the conformity matrix study. These include: (1) a primary table of digital variables characterizing the first level of comparison of psycho-physiological individual regulation obtained for everyone of the emergency medical team permitting to propose the primary team composition; (2) co-efficients of psycho-physiological regulation for the determination of conformity between the individualities of medical staff team and the dynamics of psychological resistance in emergency environment; and (3) integrative profiles of functional asymmetry, giving the objective fundamentals for team composition and its training, to the ideal sophisticated model of psycho-physiological conformity. Quantitative, objective data give the arguments to prepare the criteria for the composition of field medical team. The individual programs issued from examination are proposed for the improvement of permanent psycho physiological staff conformity.

Les crises récentes montrent, si besoin en était, la complexité de leur traitement. Alors que la capacité de l'Etat à gérer les situations de crise est à la fois un élément essentiel de notre politique étrangère et une nécessité de résultat, il était essentiel de se doter d'un outil gouvernemental performant. Cet outil, apte à la prévention des risques (naturels, sanitaires et technologiques) et des menaces à l'étranger, comme en matière de gestion de crises est né en juillet 2008 et a été placé sous l'autorité du Ministre des affaires étrangères et européennes. Doté de plus de cinquante agents le Centre de Crise résulte de la fusion de deux services, initialement indépendants: la sous direction de la sécurité des français à l'étranger et la délégation à l'Action humanitaire. Aujourd'hui les moyens humains et matériels de ces deux entités travaillent dans un but commun: porter assistance aux populations françaises et étrangères partout dans le monde. Compte-tenu de sa vocation à mobiliser l'ensemble des moyens de l'Etat, le Centre de Crise a été placé sous l'autorité directe du Ministre. Il entretient des liens étroits et privilégiés avec ses homologues français de la Santé et de la Sécurité civile, ainsi qu'avec ses partenaires européens, les organismes internationaux (nations unies notamment) et ses partenaires européens (MIC, SitCen).

Le feu dans un hôpital ou une maison de retraite présente des caractéristiques de risque particulier. A propos de la combustion d'un mètre cube de couches culottes pour adulte au Centre hospitalier de Pfastatt dans le Sud de l'Alsace, ces risques particuliers seront montrés. Ce feu globalement insignifiant en terme de quantité de comburant a cependant entraîné quatre morts par inhalation des fumées et plusieurs intoxiqués ainsi que l'évacuation de tout une aile de l'hôpital avec hospitalisation d'une cinquantaine de patients dans d'autres structures de soins sans compter les pertes matérielles et financières liées à la réparation des dégats. Les opérations d'extinction, de triage et d'évacuation des patients se sont déroulées simultanément nécessitant la mise en oeuvre du plan rouge pour nombreuses victimes, une opération de mise en sécurité des patients hospitalisés et l'évacuation vers les structures adaptées avec une coopération et une coordination entre les diférentes structures de secours intervenantes. Les investigations médico-légales secondaires ont permis de montrer chez tous les patients décédés une forte intoxication aux cyanures liée à la nature du comburant et responsables du décès rapide. Ceci pose le problème du stockage de ce type de produit et surtout de la disponibilité d'Hydroxocobalamine, antidote spécifique, en quantité suffisante pour des établissements à risque possédant beaucoup de produits synthétiques. Enfin il convient de signaler que le personnel hospitlier doit être entraîné à avoir les bonnes réactions devant un développement de fumées car c'est en premier de leurs attitudes que dépend la vie des patient en particulier s'ils sont alités.

Le triage des victimes en nombre s'impose aujourd'hui comme une nécessité opérationnelle. Les deux actions complémentaires qui le caractérisent: catégorisation des blessés et dispensation des soins d'urgence sont universellement admis. Il a plusieurs buts: repérer les blessés les plus graves pour leur donner les soins dans les meilleurs délais, les regrouper par niveaux de soins afin d'y consacrer les sauveteurs-soignants correspondants, mieux gérer les flux de blessés et dans le même temps administrer les premiers soins. Le triage de victimes de catastrophes civiles, a longtemps été considéré en France comme un acte médical, réalisé par les seuls médecins placés à l'entrée du Poste Médical Avancé, où sont dispensés les soins d'urgence et la mise en condition des victimes, nécessaires à leur évacuation vers les structures d'accueil et de soins. Aujourd'hui, notamment sous l'influence anglo-saxone un triage préalable est effectué par les sauveteurs sur le terrain, afin de catégoriser les victimes du ramassage avant leur transfert sur le PMA: ce pré-triage, premier triage, est connu sous le nom de « Simple Triage And Rapid Treatment ». Une synthèse est nécessaire afin notamment que dans des conditions d'intervention internationalisées, les personnels de sauvetage et de soins d'urgence disposent d'une méthode à application universelle. Cela est rendu possible en soulignant l'aspect dynamique du triage qui se réalise et se complète d'étape en étape: sur le terrain au moment du ramassage par les sauveteurs, médicalisés ou non, au niveau du PMA ou du module de chirurgie vitale où seront pratiquées « damage control », réanimation et mise en condition d'évacuation, à la structure d'accueil ou sera réalisé le triage de vérification. Les critères retenus pour le triage des enfants, des brûlés, des victimes irradiées ou contaminées chimiques, les blessés psychiques viennent compléter les critères fonctionnels et lésionnels classiquement retenus.

Catastrophe Biologique dans la Ville de Rio. Silveira L, Plotkowski LM, Arouche I, Borghi D, Julien H. Sécretariat d'Etat de ls Santé et Defense Civile.. Au début de l'été de 2007 la ville Rio a subi une catastrophe responsable de 232 morts (42% d'enfants ) et 150.00 malades. En quelques semaines, l'épidémie de dengue a bloqué toute la structure de soins de Rio. Les hôpitau pourtant dotés de plans blancs, n'ont pu faire face a l'afflux massif de patients. La gravité était due au choc hypovolémique par perte de plasma, plus qu'aux hémorragies. La diffusion alarmiste de la presse a augmenté les réactions de panique populaire. En février 2008, chaque heure des centaines de nouveaux cas ont été enregistrés. Les autorités réunies (Secrétariat d” État de la Santé et Sécurité Civile, Le Service de santé du Sapeur Pompier, de l Ármée de Terre, de la Marine et de l' Armée de L'Air) ont décidé d'installer 12 PMA (Hôpitaux de Campagne) pour trier les malades et les hydrater sur place. Chaque “ Tente d'Hydratation” a été équipée d'un laboratoire d'analyse (hémogramme et plaquettes ) de 30 lits pour l'hydratation en perfusion, deux lits de réanimation et une ambulance, pour le transfert vers l'hôpital de référence. Près de 1000 professionnels de santé y ont travaillé. Dans le premier mois, 49 700 consultation on été assurées dans les PMA. Les patients étaient tous triés et 10 % ont eu besoin d'une hydratation par perfusion pendant 12 heures en moyenne. Seulement 2% des malades ont été hospitalisés. Le diagnostique précoce et l'hydratation rapide a permis aux PMA de renvoyer les malades chez eux, de réduire efficacement l'afflux hospitalier et la mortalité par dengue. Les PMAs ont été démontés progressivement à mesure du contrôle de l'épidémie, jusqu'a 2 mois plus tard.

Le tableau croisé, un outil pour la maîtrise de l'accident collectif Dr J.-C. Pitteloud, Sion (Suisse) Lorsqu'on est confronté Á un accident Á plusieurs victimes, il est souvent difficile de garder en tête Á la fois les victimes et les moyens dont vous disposez. Le tableau croisé est un formulaire qui permet de diriger et de documenter efficacement une intervention sur un accident Á plusieurs victimes. Le principe du tableau croisé est que vous allez regrouper les informations sur les victimes, comme leur numéro et leur catégorie de triage sur les lignes horizontales de votre tableau (l'axe des X). Les information sur les vecteurs (heure d'appel, heure d'arrivée) seront notées sur les colonnes (l'axe des y). L'heure de prise en charge de chaque victime par une unité est notée Á l'intersection correspondante. L'heure d'Évacuation vers l'hôpital est notée au bout de chaque colonne et de chaque ligne. Ce formulaire permet de garder une vue d'ensemble des opérations de secours Á victime ainsi que de documenter l'action de chaque Équipe et le devenir de chaque patient. Il est utilisable dû l'arrivée de la première Équipe sur place, puisqu'il suffit d'un stylo et d'une feuille de papier pour le réaliser. Dans notre expérience, une feuille de format A4 européen permet de gérer une intervention pour une dizaine de victime, une feuille de format A5 jusqu'Á une trentaine.

On February 22, 2011 at 12:51 pm an earthquake measuring 6.3 on the Richter scale struck the city of Christchurch, population 376,700 in the South Island of New Zealand. This followed a 7.3 magnitude earthquake in September 2010, but the shallowness (5km) and proximity of the February earthquake to the central city, resulted in far more devastation, with Modified Mercalli scores reaching ten in some areas and upward ground acceleration exceeding 2.4G. The application of the Coordinated Incident Management System (CIMS) routinely used by New Zealand Civil Defence agencies was swift, innovative and efficient, facilitating rapid deployment of local and international emergency teams and response resources. The effectiveness of this response was partially attributed to lessons learnt from the September earthquake which, with hindsight, was a practise for the more serious February event. The community response was equally remarkable, with standard approaches to measuring preparedness and resilience suggesting that community resilience in Canterbury was high. A number of initiatives by the New Zealand Ministry of Civil Defence and Emergency Management may have fostered some of this resilience,particularly community- based resilience-building projects initiated by the Regional Emergency Management Office on 2009 and 2010, supported by the Ministry of Civil Defence and Emergency Management. In addition, website education resources and media promotion (“Get Ready Get Thru”) and a travelling exhibition called “The Pandemic Roadshow” had been particularly well received and remembered by Canterbury residents. However, two key events provided an impetus for the Canterbury community to burnish its resilience. First, the Swine flu (AH1N1) pandemic in 2009 resulted in a greater awareness of public health in emergencies along with a doubling of neighbourhood support groups. Secondly, the September 2010 earthquake resulted in the establishment of the student army of volunteers and improvement of public information management. This presentation will describe the markers of community resilience following the Christchurch earthquake and discuss how such resilience can be fostered in communities where emergency preparedness is not recognised as a priority.

It is extremely rare in disaster mental health annals to have consistent psychosocial interventions pre-disaster. For the third year in a row, the Red River Valley of the United States and Canada has experienced catastrophic flooding, on the heels of almost two decades of yearly major flooding. This paper describes the community and individual psychosocial responses to the current Red River flood, based on resiliency paradigms and the backdrop of successful mitigation of serial disasters. In addition, the author will present examples of real-time networking with colleagues around the world who are responding to natural disasters.

The existence of a prehospital emergency care system signifies how secure an area is in aftermath of a health-related emergency. The systems save lives during most out-of-hospital health emergencies. Until 2010, there was no regular prehospital care system in Anuradhapura, or even in the entire north central region of Sri Lanka. Trauma patients were brought to the hospital generally with little or no prehospital care. They were transported to hospital by relatives or other people at the scene with using whatever vehicle was available at the time, which in many occasions was a trishaw. The concept of developing a prehospital emergency ambulance service to cover the municipality of Anuradhapura as a pilot project was formulated in 2009. The objectives were to: (1) provide emergency prehospital care in the municipality; (2) identify the difficulties; and (3) assess the feasibility of implementing it in the entire district. Some of the challenges faced in the process from the initial draft of the concept up to now include: 1. Studying an established emergency medical services (EMS) system; 2. Developing a pressure group in hospital; 3. Convincing the need to administration; 4. Funding in the initial period; 5. Selecting the proper team and supportive peers; 6. Providing standard training to selected staff; 7. Formulating duty norms and standard operating procedures; 8. Infrastructure development, acquiring instruments, and vehicles with limited fund capacities; 9. Cooperating with the trade unions and external/internal negative forces; 10. Rallying the collaborators with same interest; 11. Handling donors; 12. Getting the support of other key institutions (police/municipal council); 13. Utilizing local media to help promote the project; 14. Social mobilization to ensure sustainability; and 15. Ensuring worker satisfaction, encouragement, and liaison with other units of hospital.