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Disaster Management


  1. Disaster
    1. Disaster (WHO): Is any occurrence that causes damage, ecological disruption, loss of human life or deterioration of health and health services on a scale sufficient to warrant an extraordinary response from outside the affected community or area.
    2. Disaster (Colin Grant): Is catastrophe causing 'injury or illness simultaneously to at least 30 people', who will require hospital emergency treatments.
      1. Most commonly reported disease in post-disaster phase is Gastroenteritis
      2. Most practical and effective strategy of disease prevention and control in post-disaster phase is 'supplying safe drinking water and proper disposal of excreta's
      3. Foremost step for disease prevention and control in post-disaster phase is chlorination of all water bodies
      4. Level of residual chlorine to be maintained in all water bodies in post-disaster phase is> 0.7 mg/1 (>0.7 ppm)
      5. A common micronutrient deficiency in disasters is Vitamin A deficiency: It occurs due to deficient relief diets, measles and diarrhea (gastroenteritis)
      6. Other common deficiencies include scurvy (Vitamin C), anemia (iron) and pellagra (Vitamin B4 -niacin).
  2. Stages of a Disaster Cycle
    1. Disaster impact and response:
      1. Search, rescue and first aid
      2. Field care
      3. Triage
      4. Tagging
      5. Identification of dead
    2. Stage of health and medical relief
      Disaster containment :
      1. Primary phase (0-6 hours): First aid, medical care
      2. Secondary follow-up (6-24 hours): Transportation, sanitation and immunization
        - Tertiary clean up (1-60 days): Food, clothing, shelter assistance, social service,
         employment, rehabilitation  
    3. Rehabilitation:
      1. Water supply
      2. Sanitation and personal hygiene
        - Food safety
      3. Vector control
    4. Mitigation: Measures designed to either prevent hazards from causing emergency or to lessen the effects of emergency
    5. Disaster preparedness
  3. Triage
    1. Triage: Consists of rapidly classifying the injured 'on the basis of severity of their injuries and likelihood of their survival' with prompt medical interventions
      1. First come first serve is NOT followed in emergencies
      2. Triage yields best results when carried out at the site of disaster
    2. Triage sieve: Quick survey to separate the dead and the walking from the injured
    3. Triage sort: Remaining casualties are assessed and allocated to categories
    4. Triage system: Most commonly uses FOUR color code system
      1. Red (Highest Priority): Immediate resuscitation or limb/life saving surgery in next 6 hours
      2. Yellow (High Priority): Possible resuscitation or limb/life saving surgery in next 24 hours
      3. Green (Low Priority): Minor illness/ AMBULATORY patients
        - Black (Least Priority): Dead and moribund patients
    5. Tagging: Is the procedure where identification, age, place of origin, triage category, diagnosis and initial treatment are tagged on to every victim of disaster through a Colour Coding.

Types of Triage

Triage is of two types:

  1. Simple triage: Simple triage is used in a scene of mass casualty, in order to sort patients into those who need critical attention and immediate transport to the hospital and those with less serious injuries
    1.  This step is required before transportation becomes available
    2. The categorization of patients based on the severity of their injuries can be aided with the use of printed triage tags or colored flagging
  2. Rapid triage: S.T.A.R.T. (Simple Triage and Rapid Treatments is a simple triage system that can be performed by lightly-trained lay and emergency personnel in emergencies
    1. It is not intended to supersede or instruct medical personnel or techniques
      - It may serve as an instructive example
    2. It has been field-proven in mass casualty incidents such as train wrecks and bus accidents
  3. Reverse Triage: In addition to the standard practices of triage as mentioned above, there are conditions where sometimes the less wounded are treated in preference to the more severely wounded. This may arise in,
    1. A situation such as war where the military setting may require soldiers be returned to combat as quickly as possible
    2. Disaster situations where medical resources are limited in order to conserve resources for those likely to survive but requiring advanced medical care.

Occupational Health

Physical Hazards and Diseases

  1. High Temperature



  1. Pneumoconiosis occur due to: occupational exposure to dust
  2. Particles size: 0.5 to 3.0 microns are the most dangerous (as a health hazard causing pneumoconiosis), as they reach the interior of lungs with ease
  3. Particle size and behavior:

Particle size


> 10 microns

Settle down by gravity

< 10 microns

Remain suspended in air

5 – 10 microns

Arrested in upper respiratory tract

3-5 microns

Deposited in mid respiratory tract

1-3 microns

Enter alveoli and settle there

< 1 microns

Brownian movement


List of Pneumoconioses:



Exposure source


Silica dust


Coal dust


Asbestos dust


Cotton fibre


Molasses (sugarcane)



Farmer's Lung

Mouldy hay


Iron dust


Tin dust

Bird fancier's lung

Avian! bird droppings

Compost lung



Antigens involved in Pneumoconioses:





Thermoactinomyces sacchari

Farmer's Lung

Micropolyspora faeni

Compost lung


Chemical workers lung




  1. Asbestosis is a pneumoconiosis which occurs due to: Exposure to asbestos
  2. Asbestosis does not usually appear until after 5-10 years of exposure
  3. Sputum shows 'asbestos bodies', which are asbestos fibres coated with fibrin
  4. Asbestos may lead to pulmonary fibrosis, carcinoma of bronchus, mesothelioma of peritoneum/ pleura and cancer of GIT
  5. Asbestos type most dangerous is 'amphibole'


  1. Bagassosis occurs due to: Occupational exposure to fibrous residue of sugarcane (bagasse); Bagassosis has been shown to be due to Thermoactinomyces sacchari
  2. Bagassosis is a form of extrinsic allergic alveolitis
  3. Pathogenesis:
    1. Bagasse contains a percentage of silica, innumerable fungal spores and micro- organisms
    2. Bagasse dust blocks bronchioles thus leading to bronchitis and bronchopneumonia
  4. Prevention and Bagasse control measures:
    - Keeping moisture content> 20%     - Spraying bagasse with 2% propionic acid (fungicide)
  5. Organisms involved in causation of bagassosis:
    - Thermoactinomyces sacchari - Thermoactinomyces vulgaris   - Micropolyspora faeni

Lead Poisoning

  1. Lead Poisoning is known as 'Plumbism', Saturnism or Painter's Colic
  2. Greatest source of lead in Lead Poisoning (Plumbism, Saturnism or Painter's Colic) is Gasoline/ petrol/ vehicular exhaust/ automobile exhausts
  3. Mode of absorption: Lead can be absorbed by inhalation (most common mode), ingestion or through skin
  4. Clinical picture of lead poisoning:
    1. Facial pallor: Earliest and most consistent sign
      - Anemia: Microcytic hypochromicv
    2.  Punctate basophilia or basophilic stippling of RBCs
      - Burtonian Line: Lead sulphide line on gums (upper jaw)
    3. - Lead colic: Constipation (but sometimes diarrhea) Lead Palsy (Peripheral neuropathy): Wrist drop or Foot drop
      - Lead encephalopathy
    4. CNS effects: mostly due to organic lead compounds
  5. Diagnosis of lead poisoning:

Laboratory parameter


Coproporphyrin in Urine (CPU) >150 mcg/l

Exposure to lead

Amino levulinic acid in urine (ALAU) >5 mg/l

Indicates lead absorption

Lead in blood >70 mcgl100 ml

Clinical symptoms appear

Lead in urine >0.8 mg/l

Lead exposure and absorption

Basophilic stippling of RBC

Punctate basophilia


- A useful screening test is Coproporphyrin in Urine (CPU).

6.  Treatment: EDT A.


Occupational Dermatitis

Causes of occupational dermatitis





Heat, cold, moisture, pressure, friction, x-rays, other rays


Acids, alkalis, dyes, solvents, grease, tar, pitch, chlorinated phenols


Viruses, bacteria, fungi, parasites

Plant products

Leaves, vegetables, fruits, flowers, vegetable dust

Primary irritant

Acids, alkalis, dyes, solvents


Sensitization of skin


Prevention of occupational dermatitis: [Mnemonic: P4]

  1. Pre-selection: Similar to pre-placement examination
  2. Protection: Protective clothing, barrier creams
  3. Personal hygiene: Washing facilities, water, soap, towel
  4. Periodic inspection: Post-placement examination

Occupational Carcinomas

  1. Most common: Nearly 75% of occupational cancers are skin cancers?
    1. Type: Predominantly 'squamous cell carcinomas
    2. Characteristic feature: Occurrence on exposed parts of the body (head, neck, hands, arms) that have remained in direct contact with a carcinogenic source
      - Carcinogens implicated: UV light, ionizing radiation, coal products, petroleum
       products, lubricating oils, fuel oils, etc
  2. Occupational cancers affect: Skin, lungs, bladder and blood forming organs
  3. Occupational exposures and cancers


Cancer(s) caused?




Skin, Lung, Liver




Urinary bladder






Nasal sinus, Lung

Ethylene oxide


Ionizing radiation

Skin, Thyroid, Lung


Nasal sinus, Lung

Polycyclic aromatic hydrocarbons

Skin, Scrotum, Lung





Vinyl chloride


Wood dust

Nasal sinus


Carcinoma Bladder in Occupational Exposures

  1. Cancer bladder was first noted in man in Aniline industry in 1895
  2. Now following has been mentioned as possible bladder carcinogens:
    1. β-napthylamines
    2. Benzidine
    3.  Paramino-diphenyl
    4. Auramine
    5. Magenta
    6. Certain drugs: Cyclophosphamide, Phenacetin
  3. Industries associated with cancer bladder  
    - Dye-stuffs and dyeing industry
    - Rubber, gas and electric cable industry
  4. Most common symptom: Blood in the urine (hematuria) 
  5. Most common type: Transitional Cell (urothelial cell) carcinoma (TCC) [90%]
  6. Immunotherapy in the form of 'Intravesical (pharmacotherapeutic) BCG instillation is also used to treat and prevent the recurrence of superficial tumors.

Decompression Sickness (Caisson's Disease)

  1. Caisson Disease (Decompression Sickness, DCSQ): Occurs due to low pressure, when a diver ascends rapidly to surface or air passengers ascend too rapidly to high altitudes.
  2. Manifestations of air expansion's:
    1. Barodontalgia: Air trapped beneath teeth expands
    2. Barosinusitis: Compressed air trapped in sinuses expands
    3. Barotitis: Air under pressure trapped in middle ear expands
    4. Emphysema: Most serious complications (may lead to cerebral embolism)
    5. Abdominal distension: Air trapped in intestinal canal expands
  3. Effects of Nitrogen effervescence:
    1. Bends: Steady aching pain in joints
    2. Chokes: Rapid, shallow, dyspneic breathing
      1. Prickles: Irritation of nerve terminals in skin
      2. Paralysis: Most Serious Complications
    3. Aseptic bone necrosis: Hip, knee and shoulder joints
  4. Gases implicated in DCS:
    1. Nitrogen
    2. Trimix (nitrogen + oxygen + helium)
      - Heliox (oxygen + helium)
  5. Caisson Disease is a type of diving hazard and dysbarism.
  6. Recompression is the only effective treatment for severe DCS, although rest and oxygen applied to lighter cases can be effective.

Sickness Absenteeism

  1. Sickness absenteeism is a 'useful index in industry to assess the state of health of workers and their physical, mental and social well-beings
  2. Causes of sickness absenteeism may not be entirely due to sickness:
  3. - Economic causes
    - Social causes

    - Medical causes
  4.  Methods of reducing sickness absenteeism:
    - Good factory management and practices

    - Adequate pre-placement examination
    - Good human relations
    - Application of ergonomics
  5. Rate of absenteeism reported in India: 8-10 days per worker per year.

Occupational Health Examination

Pre-placement Examination: Is the foundation of an efficient occupational health service

- Timing: At the time of employment and includes worker's history (medical, family, occupational and social), physical examination and biological and radiological examinations

- Main purpose of Pre-placement Examination is to place 'the right man in right job so that worker can perform his duties efficiently without detriment to his health (Ergonomics)

- Pre-placement Examination also serves as a useful benchmark for future comparison (examination and epidemiology).


Periodic Post-placement Medical Examination: (for industrial workers) is held at appropriate intervals to test their physical and mental efficiency and to detect any departure from health at the earliest; objective being early diagnosis and prompt treatment (Secondary level of prevention). Frequency of periodic examinations:

- Frequency and content depend upon the type of occupational exposure: 

- Annual: for most of occupational exposures

- Monthly: for lead, radium and dye-stuffs exposure

- Daily: for dichromates exposure.



  1. Ergonomics (human factors): Is the application of scientific information concerning objects, systems and environment for human use
  2. Physical Ergonomics: deals with the human body's responses to physical and physiological stress.
  3. Cognitive Ergonomics (engineering psychology): concerns mental processes as they affect interactions among humans and other elements of a system; includes workload, training, interaction, decision-making, errors, etc.
  4. Organizational Ergonomics (macro ergonomics): is concerned with the optimization of systems, including their organizational structures, policies, and processes; includes job-satisfaction, motivation, supervision, team work, ethics, etc.

The Factories Act, 1948

  1. Scope: The Act defines factory as an establishment employing 10 or more persons where power is used and 20 or more persons where power is not used?
  2. Work related norms:  
    1. Employment of young persons:
    2. Employment prohibited for age less than 14 years
    3. 15-18 years old adolescents to be declared fit by I certifying surgeons'; will work only between 6AM to 7PM
    4. Employment prohibited in certain dangerous occupations
      - Hours of work:
    5. A maximum of 41/2 hours of work per day for adolescents
      - 48 hours per week (9 hrs per day)
    6. Maximum 60 hours per week (including overtime)
      - Leave with wages:
    7. 1 day per 15 days of work for adolescents
      - Leaves can be accumulated up to 40 days
  3. Health, Safety and Welfare recommendations:
    1. A minimum of 500 cubic feet space per workers
      - 1 Safety Officer per 1000 workers
    2. 1 Welfare Officer per 500 workers
    3. 1 Canteen for greater than 250 workers
    4. 1 Crèche for greater than 30 women workers
  4. Under Factories Act 1948, there are 29 diseases which are notifiable (Schedule 3):
    1. Silicosis
      - Anthracosis

      - Byssinosis
      - Bagassosis.

The Employees State Insurance (ESI) Act, 1948 [New Guidelines]

  1. ESI Act Is an important measure of social security and health insurance in India
  2. Scope of ESI Act: The act covers all the factories in India 'excluding mines, defense, railways, educational institutions.
    1. Act in the first instance applies to: All non-seasonal factories, employing 10 or more persons, for wages on any day in implemented areas. It also covers shops, hotels and restaurants, cinemas and theatres, road-motor transport establishments and newspaper establishments.
    2. It covers all states except: Nagaland, Manipur, Tripura, Sikkim, Arunachal Pradesh and Mizoram; and UTs of Delhi, Pondicherry and Chandigarh
    3. It covers all employees getting income up to Rs 15,000/- per month
  3. Administration: The Union Minister of Labour is the Chairman of ESI Corporation
  4. Finance:
    1. Employer contributes 4.75% of total wage bill
      - Employee contributes 1.75% of wages
    2. State and Central Government share medical expenditure in ration of 1:7
    3. Benefits to employees under ESI:
    4. Medical benefit: Full medical care
    5. Sickness benefit: 50% of the average daily wages and is payable for 91 days (in any continuous period of 365 days)
    6. Extended sickness benefit: Payable for 2 years for a set of 34 diseases
    7. Enhanced sickness benefit: Full average daily wage for duration upto 7 days in the case of Vasectomy and up to 14 days in the case of the Tubectomy
    8. Maternity benefit: Full average daily wage for duration upto 12 weeks (confinement) or 6 weeks (miscarriage or MTP) or 4 weeks (sickness arising out of pregnancy, confinement, premature birth), as the case may be
    9. Temporary disablement benefit: 90% of the average daily wages till recovery
      - Permanent disablement benefit: Pension (full/partial) as worked out by a medical board
    10. Dependents' benefit: Pension at rate of 70% of wages
      - Funeral expenses: Cash not exceeding Rs 5000/-

      - Rehabilitation benefit


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