About Biological Disasters

Biological disasters might be caused by epidemics, accidental release of virulent microorganism(s) or Bioterrorism (BT) with the use of biological agents such as anthrax, smallpox, etc.

Medical Preparedness

Medical preparedness will be based on the assessment of biothreat and the capabilities to handle, detect and characterise the microorganism. Specific preparedness will include preimmunisation of hospital staff and first responders who may come in contact with those exposed to anthrax, smallpox or other agents. It further relates to activities for management of diseases caused by biological agents, EMR, quick evacuation of casualties, well-rehearsed hospital DM plans, training of doctors and paramedics and upgradation of medical infrastructure at various levels which will reduce morbidity and mortality.

Medical preparedness will also entail specialised facilities including chains of laboratories supported by skilled human resource for collection and dispatch of samples.

The infectious control practices include the following: –

1. When dealing with biological emergencies, the health workers associated with the investigation of such exposures will have adequate personal protection.
2. Depending upon the risk, the level of protection will be scaled up from use of surgical masks and gloves, to impermeable gowns, N-95 masks or powered air-purifying respirators. They will follow laid down SOPs for use of PPE. Infection control practices will be followed at all health care facilities, including laboratories.
3. Of the potential biological disaster agents, only plague, smallpox and VHFs are spread readily from person to person by aerosols and require more than standard infection control precautions (gowns, masks with eye shields, and gloves).
4. The suspected victims and those who have been in contact with them will be advised to follow simple public health measures such as using masks/ handkerchief tied over the nose and mouth, frequent washing of hands, staying away from other people by at least a metre, etc.

To handle biological disasters, the following is necessary:

1. Medical and paramedical staff: It is important to train medical staff and paramedics properly in universal safety precautions, use of PPE, communication, triage, barrier nursing, and collection and dispatch of biological samples. A team of specialists must be made available to handle infectious diseases affecting various body systems and they will be suitably immunised against agents such as anthrax and smallpox.
2. Expansion of casualty area: If the hospital casualty ward is unable to accommodate a large number of casualties, provision will be made to use the patients’ waiting hall, duly reoriented, to receive the casualties. Each major hospital will cater to at least 50 additional patients at times of disaster.
3. Isolation wards: Many biological agents cause infective diseases of various body systems which can spread the infection to other patients. Therefore, adequate number of isolation wards are required to be planned with surge capacity to accommodate a large number of patients. If required, side rooms, seminar rooms, other halls can be improvised for this purpose.
4. Security arrangements: Hospital security staff will prepare SOPs to prevent overcrowding of hospitals by visitors, relatives, VIPs, and the media at the time of a disaster. Help of the district administration will be sought, if required.
5. Identification of patients: The process will start at the time of giving first aid and triage. A system of labelling and identifying patients during spot registration by giving a serial number to the patient and putting an identification tag around the wrist can be done. In mass casualties, it can be supplemented by giving colour coded tags, such as red for serious patients, yellow for moderately serious patients, blue for those in need of observation and black for the dead.
6. Brought dead: All those brought in dead and patients who die while receiving resuscitation will be segregated and shifted to the mortuary through a separate route. Temporary mortuary facilities will be created to cater for a mass casualty incidence.
7. Diagnostic services: All laboratories and radio diagnostic services will be kept fully operational and utilised as and when required. These services will be available within the emergency treatment areas.
8. Communication: Both extramural and intramural communication facilities will 57 be made available. These can be further augmented by the use of mobile phones.
9. Medical supplies: Adequate supply of essential drugs and non-drug items will be made available for at least 50 patients in the emergency complex itself for immediate use. Additionally, hospital medical stores will have adequate buffer stocks.
10. Blood bank services: The services will cater for an adequate supply of safe blood and its components. Voluntary blood donations will be encouraged to fulfil the increased demand of blood. k. Other logistic support: Adequate, uninterrupted supply of water and electricity will be ensured for proper management of casualties.

Mobile Teams

The mobile teams perform the following functions:

1. To be mobilised to the disaster site for management of cases at times of any epidemic outbreak or biological disaster.
2. Provide on-site medical treatment to casualties as per triage and evacuation guidelines. The teams will also make a complete assessment of the situation and transmit information to the appropriate authorities.
3. Additional medical teams will be mobilised to assist in handling the large number of casualties in the wake of a mass casualty event.
4. Adequate stock of medical stores, including essential drugs, will be stocked and made available to the medical teams.
5. The stocking of emergency medical stores shall be done by the state government. Brick of medical stocks capable of treating 25/50/100 casualties will be kept ready to move with the QRMTs at short notice.
6. Drills will be conducted at regular intervals by mobile hospitals and mobile teams to keep them in a functional mode at all times.

Dos and Don’ts

DIARRHEA GROUP OF DISEASES INCLUDING CHOLERA

Do’s

1. Hand Hygiene.
2. Encourage drinking of water from a safe source or water that has been disinfected (chlorinated). Add bleaching powder in all community wells at regular intervals. Use water pumped out from India Mark II hand pumps, if installed in the village/community.
3. Drink boiled potable water in an emergency that has been boiled for at least 15 minutes and consumed it the same day.
4. Promote storage of water in narrow mouthed container.
5. Cook food thoroughly especially meat, poultry, eggs and seafood until it is steaming and eat it while it is still hot.
6. Ensure cooked meat and poultry is safe and no part of the meat discoloured or foul smelling, or in the case of egg, their shells are not cracked.
7. If food is not eaten immediately, reheat cooked until it is steaming hot prior to serving.
8. Keep food items covered.
9. Increase fluid intake as soon as diarrhoea starts by drinking ORS solution or home-made preparation of Table Salt 5 grams (1 teaspoon) in and 20 grams (4 teaspoons) of Sugar dissolved in 1 litre of drinking water.
10. Encourage banana eating, which provides potassium.
11. Continue feeding children when they are sick and to continue breastfeeding if the child is being breast fed.
12. Refer the diarrhoea case to the nearest health facility in case of the following : Child is irritable, restless or lethargic or unconscious: eating or drinking poorly; child has marked thirst; child has fever or blood in stool.

Don’ts

1. Do not drink water from unsafe sources.
2. Do not eat uncooked food unless it is peeled or shelled.
3. Do not leave cooked food at room temperature longer than 2 hours.
4. Do not consume cut fruits from vendors.
5. Do not defecate in open area.
6. Do not give access to rats and houseflies in your premises.

 2. RESPIRATORY GROUP OF DISEASES LIKE TUBERCULOSIS, INFLUENZA, CHICKENPOX, MENINGITIS

Do’s and Don’ts:

1. Avoid close contact with people who are having respiratory illness.
2. The sick person should stay at home, and avoid going into the community, school/office, public places for at least 24 hours after symptoms have resolved.
3. Sick persons at home should keep distance from others.
4. Respiratory Hygiene/Cough Etiquette:-

1. Cover the nose/mouth with a handkerchief/ tissue paper when coughing or sneezing which should be disposed off in dustbins;
2. Perform hand hygiene (e.g., frequent hand washing with soap and water, alcohol-  based hand rub, or antiseptic hand wash) and thoroughly dried preferably using disposable tissue/ paper/ towel after contact after having contact with respiratory secretions and contaminated objects/materials.

5. Triple layer surgical Mask of standard and certified make should be worn by Suspected/ probable/confirmed cases of influenza or by the care provider in home care settings and close family contacts of such cases undergoing home care.
6. Get plenty of sleep, be physically active, manage your stress, drink plenty of fluids, and eat nutritious food.
7. Avoid smoking.
8. Persons who have difficulty breathing or shortness of breath should seek immediate medical attention and report to the nearby hospital.
9. If sick persons must go into the community (e.g., to seek medical care), then they should wear a face mask or use a handkerchief or tissues to cover any coughing and sneezing so as to reduce the risk of spreading the infection in the community.
10. Immunization status should be upto date as per National Universal Immunisation Programme.

3. MOSQUITO BORNE DISEASES LIKE MALARIA, DENGUE, FILARIA, CHIKUNGUNYA

Do’s

1. Follow “sun-down sleeves-down” approach. Wear clothes that cover arms and legs.
2. Prevent water collections on ground and other places to prevent malaria breeding.
3. Empty water containers at least once a week.
4. Remove water from coolers from time to time.
5. Cover and seal any septic tanks.
6. Use Mosquito Nets preferably Insecticide Treated Bed Nets (ITBN).
7. Apply insect repellants while sleeping to keep away mosquitoes.
8. Seek medical advice in case of rashes, mental irritation or unconsciousness..

Don’ts

1. Do not encourage children to wear shorts and half sleeved clothing.
2. Do not allow water to stagnate.
3. Do not allow discarded items to accumulate such as tires, tubes, empty coconut shells, household items and objects wherein water may collect.
4. Do not bathe in village ponds and allow cattle to take bath in the same pond.

The detailed guidelines with respect to Biological disasters is available in https://ndma.gov.in/en/ndma-guidelines.html