India announces disaster management guidelines

India's Minister for Health and Family Welfare Anbumani Ramadoss has released the National Disaster Management Guidelines—Medical Preparedness and Mass Casualty Management, drafted by the National Disaster Management Authority.
Published on 11/15/2007 5:32:00 PM

New Delhi: India's Minister for Health and Family Welfare Anbumani Ramadoss on Wednesday released the National Disaster Management Guidelines—Medical Preparedness and Mass Casualty Management, drafted by the National Disaster Management Authority (NDMA).Releasing the comprehensive document, the Minister said that India like any other nation in the world has its own share of vulnerability, risk and its capacity to respond to the disasters.

He also stressed the need to adopt multi-disciplinary and multi-sectoral approach for prevention and mitigation strategies so as to develop capacities to improve response.The Minister shared many critical gaps in managing mass casualties and said that the concept of pre-hospital care is only emerging now.

Mentioning the lack of emergency medical facility of the hospitals, especially at the district level, he added that the human resource especially in super specialities required to support mass casualty management are lagging even in major towns and cities.

 The requirement of rural India to manage peripheral emergencies is addressed by the National Rural Health Mission which has laid down public health standards for medical care and operationalised Community Health Centres to work on 24x7 basis.The urban India's health care problems may be addressed through the proposed National Urban Health Mission.

 Strengthening the existing infrastructure had been his priority, Ramadoss said that the National Highway Trauma Care Project is an ambitious project in its scale and reach.The project intended to cover the entire Golden Quadrilateral and North-south-east-west corridors for trauma care which envisage strengthening about 200 hospitals from basic trauma care to advanced tertiary care.

These hospitals would all be networked with pre-hospital care ambulances as to provide care during transit and hospitalize within the golden hour.He also informed that the Ministry is also considering acquiring the capacities for managing nuclear, biological and chemical disasters. Ramadoss also said that to deal with disasters, the government would be procuring mobile hospital systems having facilities for operation theatres, pathology labs, imaging units and other support functions, which can be moved or airlifted to the disaster site at very short notice.

Pressing concern on public health emergencies with mass casualty potential, he said that the Ministry is in the process of bringing in a legislation for public health emergencies.The implementation would be supported by another major programme namely the Integrated Disease Surveillance which relies on satellite and terrestrial information technology system for data management.

 The minister further said that under the Pradhan Mantri Swasthya Suraksha Yojana (PMSSY) imbalances in availability of affordable and reliable tertiary level healthcare in the country is being corrected.It also provides an opportunity to augment facilities for quality medical education in the under-served states.

The PMSSY envisages setting up of six AIIMS like institutions and strengthening 13 other existing medical institutions, according to a government release.In addition to the various man-made disasters and peripheral emergencies, Ramadoss said that India's unique geo-climatic conditions make it vulnerable to natural disasters like floods, drought, cyclones, earthquakes, and outbreak of diseases accounts for large number of mortalities and morbidities.

The Disaster Management Act 2005 seeks to institutionalize mechanisms at the national, state and district levels to ensure a swift response including medical response to both natural calamities and manmade disasters and accidents, the Minister added.According to him, the NDMA has been supporting various initiatives of the central and state governments to strengthen the disaster management capacities by is accelerating capacity building in disaster reduction and recovery activities at the national level and in some of the most-vulnerable regions of the country.

 Disaster management is a continuous and integrated process of planning, organizing, coordinating and implementing measures, which are necessary or expedient for prevention of danger or threat of any disaster, mitigation or reduction of risk of any disaster or its severity or consequences.

It includes capacity-building, preparedness to deal with any disaster, prompt response to any threatening disaster situation or disaster assessing the severity or magnitude of effects of any disaster, evacuation, rescue and relief, rehabilitation and reconstruction.NDMA forms an integral part of the overall all hazard approach to prepare the healthcare sector to respond effectively to any mass casualty events.

It is also dealing with strengthening of all the preventive measures like Integrated Disease Surveillance Programme (IDSP) at all levels to restrict the occurrence of impending disasters of any particular area.Ramadoss further said the guidelines highlight all the medical preparedness measures to be in place to mitigate the impact of any mass casualty event on human lives, health and safety aspects and is indispensable to involve the private sector with the public health care provisions.

He appreciated NDMA seriousness to identify the salient gaps and develop a comprehensive document as National Disaster Management Guidelines covering the aspects of incident site management, evacuation of casualties and hospital disaster management planning for acute and delayed health effects in the post disaster phase.

 The guidelines have been designed to cover the important roles to be played by Medical First responders at the incident site to the psychosocial support provided by the community and the health care providers, according to Minister.It gives sufficient directions for development of action plans and other medical preparedness component of DM plans for central ministries and department and states.

Mentioning on the making of the guidelines, Ramadoss said the document has revisited the present regulations and in synergy with them, suggested a series of valuable recommendations to improve the status.Further stressing on the importance of the guidelines, he said these are developed to make legislations and their enforcement more stringent, developing conduct of programmes for increasing awareness, training of different target groups and implementation of projects with national and international inputs.

 The Ministry has already taken few proactive initiatives like the development of trauma care centers along the National Highways at every 100 km. A few states have taken initiatives to develop network of ambulance services.The Minister, further pressing on rural health, said a number of National programmes have already been initiated including National Rural Health Mission, NACO for HIV control, Revised National Tuberculosis Control Programme (RNTCP), National Vector Borne Diseases Control Programme, Yaws Eradication Programme, National Leprosy Elimination Programme, and that for prevention and containment of Bird Flu and promotion of alternative systems of medicine.


The guidelines also seeks for a Crisis Management Group under the Ministry itself which is the decision making body to tackle any emergency situation arising from time-to-time.The various tertiary health care institutions present all across the country are playing an important role in providing advanced health care to large number of victims of mass casualty events.

The guidelines have also highlighted the present status of the health care infrastructure at all levels and under different sectors of the society, including public and private bodies.The Minister also informed that issues pertaining to upgradation of critical infrastructure specifically for Chemical Biological Radiological and Nuclear (CBRN) emergencies, development of skilled and competent manpower at all levels equipped with all necessary equipments and essential medicines were also discussed within the ministries.It has been identified that the sector needs major funding and thereby the Planning Commission has earmarked a sum of Rs 10,000 crore for the same in the 11th Five Year Plan.

The Minister said that the numerous mitigation projects for the development of the facilities to manage any mass casualty event will be undertaken by the Ministry in consultation with NDMA. These guidelines have included the recommendations for the strengthening of the existing IDSP, which would serve as an effective early warning system for impending disasters like epidemics and pandemics

It would also impart training of medical doctors, specialists, paramedics for the different aspects of medical management of mass casualties and availability of skilled and competent mobile teams at all levels able to provide resuscitation, triage to large number of victims at the incident site itself.It has highlighted the need of the development of Integrated Ambulance Network of Road, Railways, Aerial and private sector at all levels with a single toll free telephone number.Stressing on the need to medical education for disaster management, the Minister said that the guidelines also seek to develop full-fledged containerized hospitals, disaster resilient communication network systems, inter- and intra- hospital networks, community preparedness, and establishment of trauma facilities, burns centers, blood banks and laboratory network at all levels.


 There is also need to integrate psychosocial support and mental health services with general medical services for which community best practices will also be encouraged at all levels.Ramadoss further said that the basic and applied research and development would focus on development and/or adoption of newer technologies, testing of different models, table top exercises at each level for quick decision making and response, and technology upgradation for effective medical management.

The specific aspects of medical preparedness including relevant diagnostic tests, treatment protocols, antidotes, medications, equipment, and specialized expertise are necessary for effective disaster management planning.

 The guidelines have also enumerated the recommendations for defining the minimum standards of food, water, shelter, environmental sanitation and personal hygiene.It also recommends the mechanism for providing adequate relief and necessary rehabilitation options to be adopted based upon the post disaster analysis.

Expressing his satisfaction on the guidelines, Ramadoss said that a significant part of it is dedicated towards the development of medical management capabilities by up-gradation of critical infrastructure required for effective management of CBRN emergencies.It includes the development of decontamination, protection, and detection, decorporation and specific medical facilities at all levels.

The emergency inventory for CBRN emergencies would also be established at all levels dealing with all aspects of emergency medical response.

 The Minister further added that on the basis of the guidelines, the Ministry would develop an effective DM plans in consultation with all stakeholders.A comprehensive DM plan would be forwarded to NDMA through National Executive Committee (NEC) for submission to the Government and would ultimately be leading to the formulation of a national plan.

Training manuals, standard operating procedures and documentation of the best practices are important components of disaster preparedness programmes and would be developed for different levels for easy adoption, replication and sharing.



 According to Ramadoss, the guidelines also seeks human resource development for the entire health sector both for medical, paramedical and nursing is my priority and for disaster management the training programmes in mass casualty management has being institutionalized on regional basis.

 Ramadoss said that the National Disaster Management Act, 2005 and setting up of National Disaster Management Authority have given the right impetus for the country's vision for a paradigm shift from response to prevention, preparedness and mitigation.

The minister is very positive that the document guidelines would lay the foundation for the country to prepare for managing mass casualty incidents.—iGovernment Bureau

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India getting ready to face biological war from terrorists
Indo Asian News Service
Last Updated: August 22, 2008 08:36:02
New Delhi, Aug 22 (IANS) India Friday released its biological disaster management guidelines with a focus on preparing for biological warfare from terrorists using bacteria and viruses.
The guidelines also emphasise developing a medical network to handle critical situations.
'While biological warfare does not appear to be a global threat, the use of some agents such as anthrax by terrorist groups poses a serious threat,' stated the guidelines, which were released by Union Home Minister Shivraj Patil here.
'The ease of production, packaging and delivery using existing non-military facilities are major factors in the threat perception. The threat posed by bio-terrorism is nearly as great as that by natural epidemic-causing agents,' underlined the guidelines.
'Biotechnology is fascinating as well as frightening,' Patil said urging the National Disaster Management Authority (NDMA) to 'sensitise and prepare people to face any disaster with minimum loss of life and property'.
The guidelines also speak of establishing an early warning system and coordination between public health medical care and intelligence agencies to prevent bio-terrorism.
NDMA Vice-chairman N.C. Vij, a retired Army chief, said besides bio-terrorism, the guidelines also focus on several problems like bird flu, plague and other such pandemics.
'There is a need to develop emergency medical centres, mobile hospitals and faster DNA identification system. When we prepare to face biological disaster, the country should not ignore international cooperation,' Vij told IANS.
Lt. Gen. (Retd) J.R. Bharadwaj, a member of NDMA, quoted the guidelines and said in case of a biological disaster, the country must stock enough personal protective equipment. This will stop the spread of disease to people who come in contact with the disease while combating it.
The guidelines emphasise that mobile tele-health services, and networking of hospitals, ambulance service and state police departments are a must for biological disaster management.
© Copyright 2008 Indo Asian News Service.

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