Role of Nepalese Army and Lessons Learnt Nepal Earthquake 2015
Mega Earthquake 2015
Date 25 April 2015 Origin time Magnitude Depth Type 11:56 (NST) 7.8 or 15.0 km (9.3 mi) Thrust Max. intensity IX (Violent) Aftershocks 6.8 on 26 April at 12:54 No. of aftershocks( >=4ML )=306 (as of 10 June 2015) Casualties 8,786 dead in Nepal (officially) and 8,947 in total 21,952 injured (officially)
Mega Earthquake in Nepal 2015
Worst Affected Area
Aftershocks
Buildings damaged in Kathmandu
Operation Sankat Mochan (Operation Crisis Relief) Nepal Army earthquake relief operation Nepal army took three phase operation initiative Phase 1: Immediate response Phase 2: Coordinating Rescue and Relief Phase 3: Current Recovery operations Hundreds of army personnel from USA, India, China, Pakistan, Sri Lanka, Turkey, Bangladesh, Israel, Netherlands, Bhutan, Poland,, Canada, Japan, Malaysia, France, Spain, South Korea, Singapore, Thailand, Belgium, Russia, Norway, UK, Switzerland, Germany and UAE.
Nepal is in 11 th position Vulnerability for earthquake NEPAL
KATHMANDU, LALITPUR & KIRTIPUR ROAD & BRIDGES DAMAGE MAPS
Con-Ops (Q1 & Q2-Medical) Phase 1: Immediate response Nepalese Army MNMCC (Medical Operations) Phase 2: Coordinated Search and Relief Nepalese Army MoH, UN (WHO) FMMTs Phase 3: Recovery Operations Reconstruction of Hospital Field Hospital (Vehicle & Tented) Govt. Health Facilities
Medical Operations (DMO) DGMS MEDICAL COMMAND CENTRE MNMCC CasEvac Coordination NAMC Response MoH & WHO FMMT SBH Fd Amb No 6 & 26 Field Hospitals Mobile Medical Teams Forward Medical Teams Stand By Medical Teams
1400 Q1 & Q2: BIRENDRA HOSPITAL CASUALTY REPORT (1242) 1200 1000 800 600 400 Total 987 325 Minor 1242 1210 413 Ortho Minor Heli-CasEvacs: 793 Others 64% Oxygen Plant FMMT 5% Army Hospital 31% 200 0 249 Major Casualty Operation Discharge Death 46
Q-1 & Q-2, Phase-1 & 2: Forward Medical Teams Forward Medical Team 1 (6) Forward Medical Team 2 (9) Forward Medical Team 3 (1) ard Medical Team 7 (3) rward Medical am 6 (Trishuli) ward Medical Team 5 (3) Stand by Medical Teams x 2 Forward Medical Team 4 (2) Total patients seen by doctors and paramedics in field: 23,956
Total Pt. seen at SBH: 1242 Total Pt. seen by NAMC: 15,076 Total Pt. seen by NA Medics: 8,880 Grand Total: 25,198
Total seen by NA: 25,198 Total seen by FMMTs: 26,133 Total: 51,331
Nepalese Army Medical Corps Casualty Management Forward Medical Teams Medical Camps Epidemiology Team Food Inspection Forensic support Continue CasEvac & Reach the Unreached
Nepalese Army Medical Corps Reaching the Unreached
Sri Lanka Armed Forces (L-1) Dolalghat & Panchkhal Bhutan Civ-Mil (L-2) Bidur, Trishuli India Armed Forces (L-2) Lagankhel & Sinamangal Bangladesh Mil (L-1) China Mil & Civ (L-2) Dhulikhel & Singha Darbar Neighbours; within 72 hrs South Kathmandu Pakistan Mil (L-2) Bhaktapur Neighbours: 626 (Mil 527 + Civ 99) Remaining: 0
Israel Indonesia Singapore Thailand Japan Other FMMTs Depart L-3 No; 150 Depart L-2 20 Depart L-1 16 Depart L-1 17 Depart L-1 50 FMMTs: 929 (Mil 780 + Civ 149) Remaining: 0
FMMTs Total Patients 26,366 Thailand Team Medical Army, 1320 Sri Lanka, 2820 Nepal Army + India Army + Civil, 223 Bangladesh, 1942 Bhutan Medical Team, 1996 Canada, 713 Singapore Army, 2890 China (Civil), 1774 China Medical Team (Army), 309 Pakistan, 2649 Indonesia, 2348 Japanese, 2898 Israel, 1503 India para FD Hospital, 2310 India (IAF), 671
Phase-2 (Plan) Hand over to Ministry of Health and UN agencies/ngo & INGOs (3-6 months) MoH in constant touch UN Health Cluster coordination Deployment of Civilian teams in locations Informing about the gaps in health support (health facilities, medicines etc.)
Phase-3 SBH damaged: Tented Hospital Field Hospitals (Vehicles)x2sets = Chhauni based Temporary Hospital: Tents & Prefabs Medical Camps: Retd & Families, Serving Families and needy civillians DMO guided reaching to unreached
Issues and Challenges Reach out to casualties in remote villages Lack of reliable medical information from field Transportation (Air/Road) Wide spread distribution of casualties in pockets Foreign-Civ-Health-Mil Medical Coordination getting better Disease epidemic monitoring & prevention Continuation of National program & policy New casualties (CasEvac) - decreasing trend
Issues & Challenges Arrangements for discharged patients: Establish transit camps Definitive Treatment-Orthopedics: Ext/ Intfixators High level Orthopedic Committee Mid/Long term management Field Hospitals: 3-6 months (in each district) Management of amputees Reconstruction of Medical facilities (PHC, HC)
Hub hospitals
T. U. Teaching Hospital Shree Birendra Hospital Civil Hospital
Model diagram of referral hospital with associate hospitals AH 1 Sub hub hospital AH4 Hub hospital AH2 AH3
Hub hospi tal A H 4 A H 1 A H 2 A H 3 Refer ral hospi tal A H 4 A H 1 A H 2 A H 3 Refer ral hospi tal A H 4 A H 1 A H 2 A H 3 Hub Hosp Hu b ho spi tal A H 4 A H 1 A H 2 A H 3 Hub hospi tal A H 4 A H 1 A H 2 A H 3 TUTH Army Patan Civil Bir Kathmandu valley Nepal Med. Col. Kathmandu Med. Col.
Army Hub Hospitals Janamaitri Sahid Memorial Kirtipur APF Army Hospital Manmohan Vayodha Shiv Jyoti
HEOC S H 1 S H4 Hub hospital S H2 S H3
Reason Resource poor not Nil Some hospitals may not function Equipment Human resources Communication may not be possible Distance between hospitals less Regional cooperation easier than national one
Conditions Hub and satellite hospitals have plan Plan consist Incident command system (ICS) Planning chief of all ICS coordinator of hub hospital system Prior planning of communication and coordination system between hospitals Prepare assessment and assistance tools Communication between hub hospital and HEOC
Planning Chief (Administrative chief) Manage: Food for staff and patients Rooms to rest for staffs Blood monitoring Administration management of staffing Hub hospital system Regular update (6 monthly) from all satellite and hub hospitals Identify a staffs with vehicle for data collection Six monthly meeting with all satellite hospitals planning chiefs
Planning chief Before disaster Contact list All satellite hospitals Hub hospitals Planning chiefs of all satellite and Hub hospitals Incident commander of all satellite and Hub hospitals Assessment of Satellite hospitals 6 monthly update Structure Specialties Human resources Special equipments High dependency beds
During disaster Assessment of Satellite hospitals As soon as disaster occurred within 2 4 hours Every 8 hours after that By mobile Runner Structure Specialties Human resources Special equipments High dependency beds
Plan referral Inform HEOC and pre-hospital care system for referral of patients Post disaster Final assessment Closure
Roster development
Lessons learnt WHO and Ministry of Health
Public health interventions Key Recommendation Develop guidelines and tools: Information management, EOC. Ensure the emergency Unit can coordinate and maintain preparedness and response capacity Develop multi sectorial coordination mechanism in any level Revise contents of Kits according to settings Maintain readiness: functionality of structures and surge capacity tested through: 1) training and drills at all relevant levels; 2) maintaining rosters of skilled professionals.
Medical Intervention Key Recommendations To make the inventory of tools and guidelines developed or translated during the emergency: Review them, make them endorsed by the MoH and to disseminate them ( HOPE, PTC, trauma guidelines) Centralization of all medical data to HEOC To implement the Mental Health policy To develop step-down health facilities and active rehab units.
Medical Intervention Key Recommendations To strengthen infection control (guidelines especially in temporary settlements) Early Deployment Medical Teams Discharge and referral systems Pre-hospital care mechanism-community To provide Disaster management training to all staff in Hub and Satellite hospitals. Hospitals > 50 beds should have disaster management plan Every hospital should have non-structural retrofitting
Stewardship Key Recommendations 1. National framework and protocols to be developed on: Integration Guidelines (FMT, Financing, Information management, HR, waste management etc) 2. Adaptation of Medical Team Mobilization guidelines. 3. Institutional architecture in place at ministry for ERM DRR framework (health) Community engagement.
Stewardship Key Recommendations Strengthen Information management and use (integrated) for all sectors Coordination, standard guidelines form, formats; use of data, role, responsibilities, communication mechanism (for different scenario) Institutionalize and strengthen HUB hospitals To strengthen monitoring and evaluation of the impact and response mechanism.
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