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| ARTICLE |
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| Year : 2018 | Volume
: 19
| Issue : 2 | Page : 35-37 |
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Kerala flood: A situational experience and response
Angela Gnanadurai
Professor, Jubilee College of Nursing, Kerala, India
| Date of Web Publication | 5-Jun-2020 |
Correspondence Address:
 Source of Support: None, Conflict of Interest: None
The mass casualty incident associated with a disaster requires immediate and effective response. Thoughtful planning and coordination of relief work mitigates the effect of disasters. This article describes the author’s situational experience of being part of the response and relief team of mass casualty management in a tertiary hospital during the Kerala floods, South India, 2018.
Keywords: flood, disaster, kerala, experience
How to cite this article:
Gnanadurai A. Kerala flood: A situational experience and response. Indian J Cont Nsg Edn 2018;19:35-7 |
| Background | |  |
In the aftermath of the severe southwest monsoon that devastated the South Indian state of Kerala, many lost their lives and millions were displaced. Kerala Floods - Rescue and Relief (2018) reported that 100 people died in a single day. The torrential rains and flood resulted in 221 collapsed bridges, 537 landslides, and many miles of damaged roads. About 42,000 hectares of crop were completely destroyed, affecting a large numbers of farmers. The biggest calamity over the past century had resulted in estimated losses of over $3 billion. The floods had affected 14 districts and more than 480 lives have been lost (Emmanuel Hospital Association, 2018). According to National Disaster Management Authority (2007) and the National Disaster Management Authority (2016) Centre declared the August, 2018 Kerala floods as ‘Level-З' calamity.
As a staff of 1650 bedded Tertiary hospital in Thrissur, Kerala, the author had first-hand experience of responding to disaster in one of the flooded district of Kerala, South India. The grimness of the flood situation was assessed and the response activities were planned by the hospital administration based on the following facts:
- Four other hospitals in the district within 10 kilometer radius were flooded and had become nonfunctional. This tertiary hospital remained the one hospital which was functional and available for the victims.
- Patients from the nearby hospital which were flooded needed evacuation and transfer to the tertiary hospital.
- Plans had to be made for accommodating patients in surge capacity and treat them effectively.
- Transfer of patients in and out of hospitals had tobe planned.
- Many employees of all categories from doctors, nurses and the house keeping staff of the functional hospital were stranded either in hospital or in their homes because of floods. Therefore hospital had to plan staffing for surge capacity (in the wards, intensive care units other supportive services).
- The Accident and Emergency Department of the tertiary hospital was overcrowded with many casualties including enormous number of people with snake bites. Resources including many doses of anti- snake venom had to be mobilized.
- The Government had announced holidays for all educational institutions and the nearby schools and colleges were available for sheltering victims.
| Disaster Response by the Hospital Administration | | |
An emergency administrative meeting was held in the tertiary hospital and an emergency disaster response plan was developed. The instructions on relief work were passed on to all the staff. The Director of the institution requested the heads of all departments to be alert and available to respond in any emergency relief work. Two teams of trained medical professionals were kept ready to receive patients who were transported by air. An indoor stadium in the hospital’s premises was prepared to receive the air lifted casualties with all facilities. The Social and Preventive Medicine Department took charge of this operation. The Air Force Relief work identified the tertiary hospital as a center that would collaborate and work with four helicopters. Distribution of food and medicines were done in collaboration with the Air Force.
To accommodate the overwhelming influx of patients and to respond to the needs of the patients and employees the following arrangements were made in the hospital:
- Number of beds was increased in the adult and pediatric ICUs and the CCUs.
- The outpatient consultation timings were stretched as needed.
- On the third day of the heavy rain (24th Aug, 2018) 400 staff nurses could not report for duty. Hence the 225 nursing students from hostel along with 7 faculty from school and college of nursing (including the administrators of nursing education) worked with the nursing services and made 24 hours coverage for the hospitalfor one week.
- Forty volunteers were enrolled to help with hospital services.
- Nurses from other hospitals were involved in helping with care activities as many of their patients were accommodated in this hospital.
- Free food and accommodation was provided for about 378 employees who could not return home.
- Free food was provided for patients and bystanders affected by flood.
- Patients who could not return home after discharge were allowed to stay in the hospital free of cost.
- Alternate arrangements were made for patients who had difficulty in paying hospital bills.
The tertiary hospital worked with the district medical office and assisted in all their relief activities.
- Medical camps were conducted in 70-100 relief camps in three shifts.
- Food and other relief material (relief kits) were distributed for the stranded victims and those who were in the relief camps.
- Medical camps were conducted along with rescue teams (where the team members were instructed strictly to adhere to the medical camp activities and not to go for any rescue activities to avoid problems).
- The Department of Mental Health arranged short workshops on how to initiate and sustain communication with the people in relief camps and the appropriate types of communication pattern that be acceptable by victims, family members, and volunteers working in relief camp. This initiative was very helpful. The above initiative continued as post disaster counseling and was very much welcomed by the flood affected victims.
- The medical, nursing, and other staff members (specially the dialysis technicians) of the hospitals which became flooded were invited to work in the tertiary hospital as their patients were already there.
| Challenges Encountered in the Aftermath of the Floods | | |
Lack of knowledge of regional language, finding addresses of the families of victims, lack of proper roads and disabled transport system made it difficult to find the residences of victims’ families. The district medical office took help of a local NGO to resolve its problems and completed the survey of flood-affected region. On the basis of the survey report, families were selected and distributed reliefkit.
The stagnated water in the flood-affected regions provided favorable environment to mosquito breeding which increased the threat of spread of several mosquito prone diseases such as malaria, dengue, Leptospirosis etc. Considering the possibility of spread of diseases, the hospital distributed mosquito nets and medicines (Cap. Doxycycline) to victims stranded or lodged near stagnated water sources. Health education, along with instruction leaflets were distributed to all individuals in the flood relief camps and in the flooded areas. In August 2018 alone, the state government’s Integrated Disease Surveillance Project recorded 171 cases of Leptospirosis with four deaths (Prasad, 2018). The resource hospital faced four deaths against 28 cases of Leptospirosis who were treated.
The Emergency Medicine Department of the hospital functioned efficiently during the flood with available resources. They faced 350 snake bites during the flood in the month of August 2018 and all were saved by efficient and timely response and treatment with anti-snake venoms. The victims who were rescued from drowning were brought in to the hospital by various modes of transportation and treated.
The flood had destroyed the residences of some of the villagers and also ruined agricultural activities. Catties were lost in the flood. People became homeless. They lost their livelihood and jobs. The stagnated water in the fields made it impossible to do agricultural activities. In this phase, all who lost the households were helped to register themselves in the relief camp for obtaining Government relief measures like reimbursement for lost items and the procedures to follow for the houses to be rebuilt for the homeless victims.
Post disaster counseling teams trained by Department of Psychiatry of the hospital are still visiting the victims in selected intervals to provide psychological and emotional support to the victims.
| Conclusion | | |
Every level of employees of the hospital contributed financially, physically and with their presence by working long hours and being available for all needs of the institution to cater to needs of the flood affected victims. The response as a hospital community to the disaster was remarkable. Effective and appropriate planning and involvement of the administration in the relief measures, coordination of relief work from all departments in their expected roles and willingness to extend assistance for overtime work enabled the hospital to successfully respond to this mass casualty incident.
The need is great in terms of post flood recovery and rehabilitation efforts restoration of drinking water source/open wells, essential family kits, restitution of essential furniture (cots/beds), reconstruction of houses and in some cases re-building houses, loss of livestock, loss of agricultural land due to massive landslides(more than thousand landslides in record days), livelihoods as well as psychosocial care etc. The victims’ resilience in rebuilding their lives has been observed and it is expected that the disaster will be an event of the past soon. However as the Sendai framework for disaster risk reduction 2015-2030 highlights (United Nations Office for Disaster Risk Reduction, 2015), the hospital is looking forward to intentionally getting involved in disaster risk assessment, mitigation and preparedness activities in future which will enable them to further respond effectively if need arises.
Conflicts of Interest: The author has declared no conflicts of interest.
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