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Environmental Health Management after Natural Disaster − A StudyGuide

Table of ContentsEnvironmental Health Management after Natural Disaster − A Study Guide..............................................1

Foreword.................................................................................................................................................2Introduction.............................................................................................................................................3Pretest....................................................................................................................................................4Outline of content....................................................................................................................................9Course objectives.................................................................................................................................10Lesson 1 − An Overview.......................................................................................................................11Lesson 2 − Factors to consider for effective management...................................................................13Lesson 3 − Phase one: Predisaster health measures..........................................................................15Lesson 4 − Phase two: Measures taken during the disaster and in the aftermath...............................19Lesson 5 − Phase three: Rehabilitation measures...............................................................................23Final exam package − A.......................................................................................................................26

Final examination...........................................................................................................................26Final examination − Answer sheet.................................................................................................33Course evaluation..........................................................................................................................34

Final exam package − B.......................................................................................................................35Final examination...........................................................................................................................35Final examination − Answer sheet.................................................................................................42Course evaluation..........................................................................................................................43

Final exam answer key − A..................................................................................................................44Answer key − Environmental health management.........................................................................44

Final exam answer key − B..................................................................................................................47Answer key − environmental health management.........................................................................47

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Environmental Health Management after Natural Disaster − A StudyGuide

To be used in conjunction withPan American Health Organization Scientific Publication No. 430

PAN AMERICAN HEALTH ORGANIZATIONPan American Sanitary Bureau Regional Office of theWORLD HEALTH ORGANIZATION525 Twenty−third Street, N.W.Washington, D.C. 20037, U.S.A.

DisasterManagement CenterUNIVERSITY OF WISCONSIN−EXTENSIONEngineering and Applied Science432 North Lake StreetMadison, Wisconsin 53706608−262−2061 Telex No: 265452

This Study Guide is one in a series of five prepared by the University of Wisconsin−Extension, Department ofEngineering and Applied Science, Disaster Management Center with financial support from the Pan AmericanHealth Organization (PAHO).

This self−study series is designed to use scientific publications of the Pan American Health Organization astexts for the study of health−related issues in disaster management. Each module of the series includes aPAHO text, a study guide, pretest, self−assessment tests and a final examination.

This Study Guide was prepared for the Disaster Management Center by Ruth Newman, Richard Hansen,John Quigley and Don Schramm.

Legal Notice

This report was prepared by the University of Wisconsin (UW). Neither the UW nor any of its officers oremployees makes any warranty, express or limited, or assumes any legal liability or responsibility for theaccuracy, completeness, or usefulness of any information, apparatus, product, or process disclosed, orrepresents that its use would infringe privately owned rights. Reference herein to any specific commercialproduct, process, or service by trade name, mark, manufacturer, or otherwise, does not necessarily constituteor imply its endorsement by the UW.

Five self−study courses, based on Pan American Health Organization scientific publications, are nowavailable. They are designed to assist in the development of disaster management plans or the improvementof existing plans. These publications and their companion study courses are entitled:

Scientific Publication No. 407Emergency Health Management after Natural Disaster

Scientific Publication No. 419Emergency Vector Control after Natural Disaster

Scientific Publication No. 420Epidemiologic Surveillance after Natural Disaster

Scientific Publication No. 430Environmental Health Management after Natural Disaster

Scientific Publication No. 443Health Services Organization in the Event of Disaster

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Foreword

Emergency Management after a Natural Disaster

Organization of a National Emergency Committee

* NGO = Nongovernmental organizations (also called voluntary agencies)

Coordination of Health Relief Activities

In the event of a natural disaster, a nation, region, community or individual will return to normal more quickly ifthere has been advance planning on the use of available resources.

A plan to mobilize a country's resources for disaster management is a complex undertaking, as illustratedabove.

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The health sector must cooperate with other groups involved in the overall plan. In addition, they must workwithin the framework and priorities established by those in higher authority. Within the overall plan is a sectiondealing specifically with health and subplans for various units of the health sector. (See illustration at right.)

Acknowledgements

The Disaster Management Center at the University of Wisconsin−Extension thanks the Pan American HealthOrganization for early support of course development. In particular, Dr. Claude de Ville de Goyet and EllenWasserman deserve special recognition for their understanding of this innovative educational process. Inaddition the thoughtful reviews of Pierre Léger and Fred Reiff were of great help in the preparation of thisguide. At the University of Wisconsin−Extension, Linda Hook, Darrell Petska, Susan Kummer, Lolette Guthrie,and Connie Quamme must be thanked for their efforts in editing, design and production. The coursedevelopment process is never over, and each of these people understands that very well.

Introduction

How to Get Started

This self−study course is designed to assist those responsible for meeting the health needs of peoplefollowing a sudden natural disaster. It is designed for health care professionals, paraprofessionals, and thosein training, as well as government personnel, and representatives of private voluntary agencies.

This course deals with disasters caused by destructive storms, earthquakes, volcanic eruptions, and seasurges. Specifically, it covers the effects of such disasters on environmental health.

The course is based primarily on the scientific publication, Environmental Health Management after NaturalDisasters, published by the Pan American Health Organization.

The procedure of self−study is:

Complete and score the Pretest. Do not be disappointed if you have a low score. if you had a high score, youprobably do not need this course.

Read the Outline of Content, to get a general idea of what is covered in the course.

Read the Learning Objectives, to gel a general idea of what you are expected to learn from the course.

Turn to Lesson 1: An Overview.

• Review the Study Guide section for a brief description of the lesson and any specialsuggestions on how to study.

• Again read the Learning Objectives.

• Carry out the Learning Activities listed.

• Complete the Self−Assessment Test at the end of the lesson and score it using the answerkey provided. If you have not answered most of the questions correctly, re−study the lesson.

If you score well on the Self−Assessment Test, proceed to Lesson 2.

Continue to study each lesson and complete each Self−Assessment Test until you have finished the course ofstudy.

When you have completed all the Self−Assessment Tests to your satisfaction, you should request the FinalExamination Package. This will include the Final Exam and a Disaster Development Problem.

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Pretest

Multiple Choice

Circle the correct answer(s):

1. An example of a natural disaster is

a. disease epidemicb. an outbreak of food poisoningc. a hurricaned. mine explosione. forest fire

2. The primary goal of a disaster preparedness plan is:

a. to protect the populationb. to protect valuable resourcesc. to keep communications lines opend. to protect environmental health personnele. to procure needed funding

3. Priority environmental health concerns during a natural disaster are providing victims with:

a. food, radio, water, portable generatorb. food, fuel, refrigeration, shelterc. water, food, shelter, sanitationd. water, heat, clothing, medicinee. water, food, medicine, electricity

4. Disaster management is aimed ultimately at:

a. resettling people in the closest unaffected urban areab. collecting valuable data for future management objectivesc. strengthening sewage and drinking water treatment facilities to resist the impact of a futuredisasterd. incorporating needed reforms into community government structuree. restoring a community's services, facilities, and residences to predisaster levels

5. The most valuable information to have on hand in case a disaster strikes is:

a. phone numbers and addresses of local, national and international aid societiesb. knowledge of which areas are likely to be hardest hit and resources and services availablein and around these areasc. first aid manuals, maps, and emergency operations manualsd. addresses of all hospitals and clinics throughout the countrye. phone numbers of all communications media

6. Environmental sanitation involves:

a. quarantining of areas in which individuals with communicable diseases are residingb. collecting, treating, and disposing of human waste to prevent risk of diseasec. hygienic management of dairy and livestock operationsd. spraying of areas with pesticides to reduce or eliminate disease riske. treatment and disinfection of drinking water supplies

7. It is important to test the quality of the water because:

a. it might transmit diseaseb. it might clog pipesc. it might stain laundryd. it might be unacceptable for use in food preparation

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e. it might be harmful to aquatic life

8. Educating the public on what to expect in the event of a disaster and what emergency steps to take:

a. would lull the population into a false sense of securityb. is an unwise use of time and moneyc. would increase the likelihood of survivald. could cause unnecessary panic and disorientatione. would eliminate the need for centralized disaster management

9. The most important use of water is:

a. cleaningb. drinkingc. bathingd. washinge. cooking

10. The major risk associated with overcrowding is:

a. proliferation of mosquito breeding sitesb. heightened exposure to decaying matterc. creation of nuisance problemsd. increase in mental stresse. increase in diarrhea! disease

11. Relocation of disaster victims in camps:

a. is the preferred way to provide essential services to disaster victimsb. can result in secondary health emergenciesc. usually represents the most efficient use of scarce resourcesd. should never be attempted

12. Once an area has been singled out as requiring priority intervention following a disaster, attention shouldturn next to:

a. determining high risk factors based on relative incidence of diseaseb. instituting short−term rehabilitation measuresc. ranking the needs for essential lifeline services in order of priority and providing therequisite manpowerd. conducting technical surveys to evaluate and plan the restoration of lifeline servicese. assessing the technical feasibility of emergency measures

13. Predisaster environmental health measures are intended to reduce or eliminate environmental healthhazards, caused or aggravated in a disaster, by:

a. developing evacuation strategies, coordinating transport and distribution of emergencysupplies, and developing a public education program

b. developing an emergency operations plan, establishing an immunization program, andadopting routine measures to protect lifeline services

c. developing a public education program, conducting epidemiologic surveys, andcoordinating transport and stockpiling of emergency relief supplies

d. developing an emergency operations action plan, adopting routine measures to protectlifeline services, and developing a public education program

e. assigning key military personnel to special emergency relief teams, organizing anemergency administration, and developing an emergency operations action plan

14. Delivery of enough water and food to stricken areas will depend largely upon:

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a. national and international cooperation in stockpiling and distributing relief suppliesb. inspection and analysis of food and water supplies conducted by trained techniciansc. financing efforts organized on a national scale to purchase necessary goods and treatmentunitsd. willingness of local people to eat and drink products which taste unfamiliar to theme. protective and emergency measures taken to keep vital transportation routes open

15. The primary cause of food and water contamination after a disaster is:

a. damage to civil engineering structures, such as dams, pipelines, etc.b. large−scale looting of public and private facilitiesc. difficulty in maintaining standards of personal hygiened. interruption of inspection and monitoring activitiese. personnel shortages

16. Alternate sources of drinking water may include all of the following except:

a. drinking water stored in gasoline containersb. undamaged wellsc. breweriesd. power plantse. rainwater cisterns

17. Tent camps should be located:

a. close to the nearest field hospital or emergency care unitb. where slope and soil type favor easy drainagec. where shelter material and vegetation are easily accessibled. where the water table is no deeper than 3 meterse. along a paved highway

18. Emergency environmental health control measures are carried out:

a. during phase two of a disasterb. as soon as a warning is receivedc. after the rescue and accommodation of displaced personsd. only by qualified environmental health specialistse. in response to requests from officials in the stricken area

19. Potential breeding sites of mosquitos should be identified by:

a. surveying areas where there has been an increase in vector−borne diseaseb. surveying areas that sustained the heaviest flood damagec. surveying areas of lush vegetationd. surveying campsites and other densely populated arease. use of phosphatase determination kits

20. After mains, reservoirs, and wells have been repaired, they should be:

a. monitored weekly for chlorine residualsb. put immediately back into servicec. cleaned and disinfectedd. inspected by a qualified environmental health specialiste. lined with a water−proof sealant

21. If water is found to contain E. coli and dramatically increased levels of chloride, this may indicate:

a. contamination of water by insect vectorsb. presence of a chlorine residualc. a possible laxative effect on the consumerd. high salt levels, rendering the water unfit to drink but acceptable as an ingredient in foode. contamination of water by human waste

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22. Short−term rehabilitation measures are undertaken with three principal objectives in mind. They are:(select three)

a. make emergency information available to the publicb. prepare lists of needed assistance and submit them to relief agenciesc. restore essential lifeline servicesd. locate sites for establishing tent campse. clear vital roadways and distribute emergency relief suppliesf. conduct technical surveysg. restore environmental health surveillance activitiesh. evaluate the emergency operations plan once it has been implemented

23. The should be determined before any disinfectant is distributed to individual users.

a. pHb. chlorine residualc. E. coli countd. tastee. nitrate level

24. All relief workers should receive:

a. appropriate technical aidesb. appropriate antibioticsc. appropriate vaccinationsd. copies of the emergency operations action plane. first aid kits

25. All emergency, consolidation, and short−term rehabilitation measures should be carried out within of theoccurrence of a disaster.

a. three daysb. three weeksc. three monthsd. six monthse. one year

26. Improper disposal of human waste can lead to: (select the best answer)

a. spread of diseaseb. food spoilagec. odor problemsd. fire hazarde. fouling of water

27. Select the three primary areas of environmental health surveillance and list them in order of theirimportance:

a. transportation Order of importanceb. sanitationc. communication lines —d. power —e. water quality —f. food suppliesg. shelter28. When groups of displaced populations migrate en masse from the stricken area to other, unaffectedareas:

a. sewage and water treatment facilities may become overloadedb. it increases their likelihood of survival

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c. they become more susceptible to diseased. environmental health surveillance activities should be stepped upe. they should be provided with disinfection agents in the form of a liquid, powder, or tablet

29. To assess the potential vulnerability of an area, one must first:

a. monitor food and water supplies and determine priorities of need

b. conduct hydrological, geological, and topographical studies of disaster prone areas

c. identify and describe components of the environmental health service system and chart thecharacteristics of those natural disasters that might occur

d. inventory equipment, supplies and other emergency materials and determine numbers ofgas stations, retail food stores, and alternate water supply sources

e. determine areas of greatest population density and identify potential vector breeding sitesin areas where vector−borne disease is endemic

True/False

Indicate T or F:

___30. If the public water supply is found to be contaminated, mobile treatment units should be requisitionedautomatically.

___31. Latrines should be inspected by qualified environmental health personnel.

___32. All food should be inspected and analyzed in the immediate aftermath of a disaster.

___33. There is usually a need for officials to provide large areas for emergency accommodation of homelessfamilies.

___34. With current technology, we now can predict all disasters before they strike.

___35. Conducting technical and environmental health surveys are luxuries in the immediate aftermath of adisaster.

___36. The public should have accessible information about location and kind of resources and environmentalhealth services available, and names and titles of authorities to contact regarding emergency situations.

___37. Some short−term rehabilitation measures must usually be taken during the emergency and immediatepost−emergency periods.

___38. During a disaster, health−related agencies should act independently of one another to avoid confusionand disharmony.

___39. Personal hygiene is a primary consideration in relocation camps.

Answer Key

1. c 16. a2. a 17. b3. c 18. b4. e 19. d5. b 20. c6. b 21. e7. a 22.

c,g,h8. c 23. b

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9. b 24. c10. e 25. b11. b 26. a12. c 27.

e,f,b13. d 28. a14. e 29. c15. a30. F − Mobile treatment units produce limited quantities of water, are expensive, and occupy valuable spacewhen shipped. However, they are worthwhile if available locally.

31. T

32. F − All food should be inspected, but analysis of food products is too complex an undertaking to initiate inareas affected by the disaster.

33. F − Most families appear to go to official shelters only when all other alternatives have failed.

34. F − With current technology, we can predict some disasters at best only a few days before they strike.

35. F − Accurate survey−taking enables officials to set emergency priorities for restoring essential lifelineservices and ascertaining that no increased risk of disease exists.

36. T − When people are informed of what services are available, where to go and whom to contact, theeffectiveness of environmental health activities improves.

37. T

38. F − Health−related agencies should exchange information and supplies, coordinate their activities, andshare personnel. This helps avoid duplication and assures the best use of manpower and resources.

39. T

Outline of content

Lesson 1 − An Overview

Types of disastersDamage caused by sudden natural disastersEffects on conditions and services

Lesson 2 − Factors to Consider for Effective Management

Factors in establishing priorities and determining courses of actionTiming of emergency measures

Lesson 3 − Phase One: Predisaster Health Measures

The plan for emergency health operationsDeveloping an environmental health emergency operations planProtective measuresEducation of personnel and public

Lesson 4 − Phase Two: Measures Taken during the Disaster and in the Aftermath

Emergency warning periodDisaster occurrence periodImmediate postdisaster emergency period

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Consolidation period

Lessons 5 − Phase Three: Rehabilitation Measures

Restoration of lifeline servicesRestoration of essential environmental health surveillance activityEvaluating the emergency operations action plan

Course objectives


Identify four types of sudden natural disasters.Be aware of their potential effects on essential lifeline services.Recognize the hazards to public health that could result, especially when large numbers ofpeople are displaced.

Lesson 2 − Factors to Consider for Effective Management

List three factors to be considered in determining a course of action in disaster managementof environmental health.

List the five necessary services that must be provided at least at minimum levels toindividuals in high risk areas.

Partition disaster management into three phases.

Lesson 3 − Phase One: Predisaster Health Measures

Recognize the critical importance of detailed advance planning for effective management ofenvironmental health services and resources in the event of a sudden natural disaster.

Know the elements that go into developing an environmental health emergency operationsplan.

List the effects of natural disaster that are most likely to occur and create high health risks incertain areas.

Know the protective measures that can be taken to minimize the effects listed in Objective 3above.

Explore ways to educate environmental health personnel and the public to prepare for andrespond effectively to a natural disaster.

Lesson 4 − Phase Two: Measures Taken during the Disaster and in the Aftermath

List the three time frames within phase two − that is, during and immediately following anatural disaster.

Understand the principal objectives that should be met during each time frame.

Know ways to assure safe food, potable water, facilities for sanitation and hygiene, adequateshelter, and vector control during and immediately following a disaster.

Be aware of the necessity of keeping the population fully informed during this period.

Know the measures to be taken during the period of consolidation, as steps toward recoverybegin.

Lesson 5 − Phase Three: Rehabilitation Measures

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Understand the factors involved in planning for systematic restoration of environmental healthservices.

List the six lifeline services that should receive the highest priority in short−term rehabilitation.

Understand the purpose and application of technical health surveys during the rehabilitationphase.

Consider when to take environmental health surveys, their order of importance, and basicparameters used for determining disease risk.

Understand the importance of evaluating the emergency operations action plan and considerthe types of questions that should be posed and to whom a final report should be sent.


Study Guide

In this introductory lesson you should gain a general awareness that damage from suddennatural disasters disrupts environmental health conditions and services and consequently canaffect the health of people.

Learning Objectives

Identify four types of sudden natural disasters.Be aware of their potential effects on essential lifeline services.Recognize the public health hazards that could result.

Learning Activities

Read pages 3−6 in the manual. Read, but do not memorize, Tables 1 and 2 in the manual.

Evaluation

Complete the Self−Assessment Test.

Notes

Lesson 1 − Self−Assessment Test

Multiple Choice


1. Relocation of disaster victims in camps:

a. is the preferred way to provide essential services to disaster victimsb. can result in secondary health emergenciesc. usually represents the most efficient use of scarce resourcesd. should never be attempted

2. Match each lifeline service with one common effect a disaster could have on it:

Lifeline Service

− water supply and wastewater disposal− solid waste handling− food handling− vector control− home sanitation

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Effect

a. increase in human contact with malaria mosquitoesb. water, soil and air pollutionc. overcrowdingd. system overloadinge. contamination of relief supplies

3. If food and water supplies are contaminated by untreated human waste, the greatest concern is:

a. creation of a fire hazard in densely populated areasb. lack of clean clothing and utensilsc. creation of nuisance problemsd. fouling of the food and watere. increased risk of diseasef. resurgence of disease vectors

4. The major risk associated with overcrowding is:

a. introduction of new vectorsb. heightened exposure to decaying matterc. increase in mental stressd. increase in diarrheal Diseasee. disruption of power and heat fuel

5. Which pair combines a consequence with the correct natural disaster (i.e. tsunami − volcanic eruption):

a. winds − earthquakeb. floods− hurricanec. heavy rains − tsunamid. fires − hurricanee. none of the above

6. Proliferation of disease vectors is of particular concern in areas where:

a. water supply systems have been overloadedb. they were prevalent before the disasterc. they were not prevalent before the disasterd. solid waste disposal systems have been disruptede. there is an increase in waterborne disease

7. Areas most deficient in adequate sanitation and washing facilities are likely to be:

a. densely populated urban centersb. areas farthest from a centralized waste treatment facilityc. widely scattered rural communitiesd. camps for displaced persons

8. It is absolutely critical that water be provided to disaster stricken populations:

a. only after it has been disinfectedb. where fire hazards have been created due to disruption of solid waste disposal systems.c. in quantities sufficient to satisfy drinking, washing, bathing, and laundering needs.d. in sufficient quantities for drinking purposese. to enable sanitation measures to be carried out

True/False

Indicate T or F:

___9. In disaster preparedness planning, it should always be assumed and anticipated that a natural disasterwill disrupt basic lifeline services.

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___10. Long and short−term effects on environmental health services will vary according to the type ofdisaster.

Lesson 2 − Factors to consider for effective management

Study Guide

This lesson establishes the framework for effective disaster management of environmental health. Itdiscusses criteria on which priorities are established and actions planned or taken. It defines three phases indisaster management that will be covered in detail in subsequent lessons.

Learning Objectives

List three factors to be considered in determining a course of action in disaster management of environmentalhealth.

List the five necessary services that must be provided at least at minimum levels to individuals in high−riskareas.

Partition disaster management into three phases.

Learning Activities

Read pages 9−12 in the manual.

Evaluation


Notes

Lesson 2 − Self Assessment Test

Multiple Choice


1. The main reason that locally available experts should be called on first to take part in relief efforts is:

a. they would most likely be immune to endemic diseasesb. they would be familiar with pre− and likely postdisaster conditions in the affected areac. they would be trusted more by residents of the stricken aread. they would be the ones most in need of employmente. outside disaster personnel need not be diverted from other tasks

2. The major factor that determines what areas should be given priority for intervention once a disaster hasoccurred is:

a. extent of property damageb. availability of manpowerc. availability of medical personnel and drugsd. presence or absence of disease−related riskse. shortage of food and water

3. Preparedness planning focuses on areas where likelihood of___ is known to be high.

a. infant mortalityb. public ignorancec. natural disasterd. insect resurgence

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e. telecommunications failure

4. The first phase of environmental health management begins:

a. long before a disaster strikesb. when a disaster strikesc. within the first three hours after the disaster has struckd. after the warning periode. at the moment local officials request help

5. The main objective of phase three is:

a. to institute immediate emergency relief measuresb. to focus on areas of known high riskc. to develop and maintain a state of preparednessd. to return environmental conditions and services to predisaster levelse. to initiate rescue and evacuation activities

6. Phase two is divided into:

a. immediate and consolidation measuresb. short−term and long−term measuresc. emergency and rehabilitation measuresd. predisaster and postdisaster measurese. emergency and control measures

7. After a disaster, as soon as an area has been singled out as requiring priority intervention, attention shouldnext turn to:

a. determining high risk factors based on relative incidence of diseaseb. determining the extent to which environmental health measures return conditions topredisaster levels.c. ranking needs of essential services in order of priority and providing the requisitemanpowerd. instituting short−term rehabilitation measurese. assessing the technical feasibility of emergency measures

8. Immediate emergency measures should be taken

a. within the first three days after the disaster strikesb. within the first seven days after the disaster strikesc. prior to the disasterd. as soon as short−term measures have been initiatede. as soon as consolidation measures have been initiated

9. Consolidation measures should be initiated:

a. once areas of known high risk of natural disaster have been designatedb. once short−term rehabilitation measures have been implementedc. once long−term reconstruction measures have been implementedd. once immediate emergency measures have been implementede. once local officials have been consulted

10. When considering emergency steps to take in the aftermath of a disaster, highest priority should beaccorded to:

a. returning environmental conditions to predisaster levelsb. establishing settlements in peripheries of urban centersc. immunizing the stricken population against typhus and malariad. protecting environmental health personnele. providing the minimum levels of essential services

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True/False

Indicate T or F:

___11. Phase one consists of measures undertaken immediately after a disaster strikes.

___12. All phases of disaster management are Undertaken during time frames that overlap.

___13. The five necessary services that must be provided at minimum levels are: shelter, drinking water, food,vector control, and antibiotics.

___14. Environmental control measures are always undertaken before, during, and after a natural disaster.

Answer Key

1. b 8. a2. d 9. d3. c 10. e4. a 11. F5. d 12. T6. a 13. F7. c 14. F

Lesson 3 − Phase one: Predisaster health measures

Study Guide

This lesson begins the detailed presentation of how to prepare for a sudden natural disaster that could disruptenvironmental health services. The information is presented in both Chapter 2 and Annex 1 of the manual.Since this gives a fragmented and sometimes confusing presentation, it is suggested that you read throughthe material once, and then go back and study it in detail in the sequence presented in the table at the right.

Learning Objectives

Recognize the critical importance of detailed advance planning for effective management of environmentalhealth services and resources in the event of a sudden natural disaster.

Know the elements that go into developing an environmental health emergency operations plan.

List the effects of natural disaster that are most likely to occur and create high health risks in certain areas.

Know the protective measures that can be taken to minimize the effects listed in Objective 3.

Explore ways to educate environmental health personnel and the public to prepare for and respond effectivelyto a natural disaster.

Learning Activities


Read pages 43−46 in the manual (Annex 1).


Study the material in detail, in the sequence given in the table at the right. The page references are toScientific Publication No. 430.

Plan for Emergency Environmental Health Operations

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Prior to a disaster − Phase One Page1. Assessing extent of damage likely 14Vulnerability Analysis 43

• disaster: type, characteristics, potential effect on each component of serviceDuring a disaster − Phase Two2. Estimating resources likely to remain after disaster 14Identifying organizational resources 43

• emergency staffs and teams• advisory committee• channels of liaison• coordination agreements 45

Inventorying supplies and equipment 443. Calculating needs of affected communities 14Determining margin of safety between service requirements and capacities vsminimum estimated need

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4. Matching community needs with remaining resourcesFollowing a disaster − Phase Three5. Setting a timetable for addressing specific needs 14

• specifying recovery measures 466. Determining the best program for using resources 14

• allocating resources 447. Assigning specific tasks 14Routine Measures to Protect Environmental Health

1. Civil engineering structural damage 15−162. Contamination of food and water supplies 16−183. Power outage 184. Transportation failure 18−205. Protecting personnel 446. Improving capabilities 46

Emergency Education & Information Program 20−21EvaluationComplete the Self−Assessment Test.

Lesson 3 − Self assessment test

Multiple Choice


1. Predisaster environmental health measures are intended to reduce or eliminate environmental healthhazard by:

a. developing evacuation strategies, coordinating transport and distribution of emergencysupplies, and developing a public education program

b. developing an emergency operations plan, establishing an immunization program, andadopting routine measures to protect lifeline services

c. developing a public education program, conducting epidemiologic surveys, andcoordinating transport and stockpiling of emergency relief supplies

d. developing an emergency operations action plan, adopting routine measures to protectlifeline services, and developing a public education program

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e. assigning key military personnel to special emergency relief teams, organizing anemergency administration, and developing an emergency operations action plan

2. To ensure safe delivery of water in the event of equipment failure at a water treatment plant, it may beexpedient to:

a. provide for bypass facilities to a point where raw water can be chlorinatedb. conduct education campaigns to warn the public of possible contamination of watersuppliesc. monitor raw water on a more frequent basis prior to and during a disasterd. install auxiliary pipelines for delivery from the plant to private householdse. all of the above

3. Preventive strategies in disaster management should focus on which environmental health impact area(s):

a. power outageb. building structural damagec. food and water contaminationd. water pipeline damagee. a, c and d onlyf. all of the above

4. Delivery of enough water and food to stricken areas is likely to depend largely upon:

a. national and international cooperation in stockpiling and distributing relief suppliesb. inspection and analysis of food and water supplies conducted by trained techniciansc. financing efforts organized on a national scale to purchase necessary goods and treatmentunitsd. protective and emergency measures taken to keep vital transportation routes opene. willingness of local people to eat and drink products that taste different than what they areused to

5. To be effective, a public education program should:

a. persuade people to rely on government assistanceb. persuade people to go immediately to centralized relocation camps in the event of adisasterc. inform people of emergency phone numbers to use in obtaining emergency informationduring and after a disasterd. inform people of what to expect and appropriate emergency steps to takee. enable communities to be totally self−reliant

6. Programs to educate environmental health services staff about emergency measures should be conducted:

a. once it is known that a disaster is imminentb. at least once a yearc. only for essential emergency personneld. on a voluntary sign−up basise. at least twice a year

7. To be able to plan effectively for protecting lifeline services and facilities before, during, and after a disaster,one should consider: (select two)

a. a community's ability to pay for training programs and emergency drillsb. the number of environmental health personnel in urban centers and their proximities toother disaster prone areasc. effects on environmental health services common to all disasters and effects associatedwith a specific disaster type unique to a particular aread. risk of disease in areas prone to disastere. baseline environmental health levels

8. The primary cause of food or water contamination after a disaster is:

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a. damage to civil engineering structuresb. interruption of inspection and monitoring activitiesc. large−scale looting of public and private facilitiesd. personnel shortagese. difficulty in maintaining standards of personal hygiene

9. One way to reduce the chemical strength of contaminants in water is to:

a. provide for a reservoir storage capacity of 1½ to 2 times normal capacityb. add sufficient quantities of water from a protected source to the contaminated supplyc. identify alternative sources of safe waterd. dilute the supply with floodwaters

10. A margin of safety for a particular service is achieved when:

a. the estimated capacity of that service after a disaster has occurred exceeds the minimumneed for it in the population

b. manpower and resources allocated to that service prior to a disaster exceed the estimatedrequirements

c. multiple copies of maps, personnel and supplies lists, and descriptions of emergencyprocedures have been made

d. advanced preparations have been made to reinforce structures or provide for alternativesources

e. mutual aid agreements are drawn up among related services and shelter is guaranteed toessential environmental health personnel

11. Water treatment processes and equipment may shut down because of:

a. power outageb. transportation failurec. lack of field test kitsd. sudden reductions in water supply levelse. contamination of water supplies

12. The first step in developing an environmental health emergency operations plan is to:

a. adopt routine measures to protect environmental health servicesb. list all organizations that will participate in emergency activities and assign individualmembers to emergency teamsc. develop an emergency education and information programd. inventory stockpiles of all equipment, supplies, and other materials necessary for theemergencye. estimate the margin of safety between the capacities of services to meet requirements andthe minimum estimated need for a service in the population

13. All relief workers should receive:

a. appropriate technical aidsb. appropriate antibioticsc. first aid kitsd. copies of the emergency operations action plane. appropriate vaccinations

True/False

Indicate T or F:

18

___14. The principal objective of predisaster preventive environmental health measures is to eliminate orreduce hazards after a disaster event.

___15. Power outages are a common occurrence only during the initial impact of a disaster.

___16. In planning for power outages, on−site standby generators are always preferable to portablegenerators.

___17. Damage to reservoir retaining walls can cause serious injury or death to nearby individuals.

Answer Key

1. d 10. a2. a 11. a3. f 12. b4. d 13. e5. d 14. T6. b 15. F7. c,d 16. F8. a 17. T9. b

Lesson 4 − Phase two: Measures taken during the disaster and in the aftermath

Study Guide

In this lesson the importance of advance planning is evident. It provides detailed information on how to carryout the Environmental Health Emergency Operations Plan during the warning period, as the disaster occurs,and in the immediate postdisaster emergency period. Finally, during the consolidation period, recoverymeasures begin.

Learning Objectives

List the three time frames within phase two: during and immediately following a natural disaster.

Understand the principal objectives that should be met during each time frame.

Know ways to assure safe food, potable water, facilities for sanitation and hygiene, adequate shelter, andvector control during and immediately following a disaster.

Be aware of the necessity of keeping the population fully informed during this period.

Know the measures to be taken during the period of consolidation, as steps toward recovery begin.

Learning Activities


Read pages 47−50 in the manual (Annex 2), particularly if you will be involved in provision of safe drinkingwater.

Scan pages 51−55. This will be useful for detailed planning of environmental health measures during theimmediate postdisaster emergency period.

Evaluation


19

Notes

Lesson 4 − Self Assessment Test

Multiple Choice


1. Activities taken during the emergency warning period include:

a. testing of water for the presence of Escherichia coli and unsafe concentrations of nitrateb. providing safe, adequate shelter to stricken populationsc. dusting of displaced persons to protect against spread of typhusd. mobilizing emergency personnel and informing threatened population of what to doe. preparing lists of needed assistance and submitting them to relief agencies

2. Food spoilage is commonly the result of:

a. overcrowdingb. power outagec. shortages of environmental personneld. interruption of vector control activities

3. During the immediate postdisaster emergency period, ways to determine which areas merit greaterattention include: (select two)

a. sending out questionnaires to all stricken areas for distribution to and response from eachhousehold or displaced personb. conducting epidemiologic surveys of the incidence of diseasec. checking population movements within or near stricken sitesd. determining remaining stocks of all perishable foodstuffse. surveying the availability of water, food, shelter, and waste disposal in stricken areasf. calculating the reserve capacities of retail and wholesale food outlets

4. The most essential item that disaster−stricken populations must be provided with is:

a. nonperishable foodb. medicinec. fueld. drinking watere. adequate waste disposalf. shelter material

5. Latrine requirements in disaster operations include:

a. 1 seat/20 persons in tent campsb. 1 seat/35 women in temporary building sheltersc. 1 bore−holed trench/10 personsd. 1 shallow trench/200 personse. none of the above

6. Large volumes of water that will be hauled to camps or to consumers in affected areas should be:

a. cooledb. storedc. aeratedd. strainede. disinfectedf. heated

7. A____ is essential to the sanitary maintenance of latrines.

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a. sufficient supply of cleaning agentsb. health education program in latrine Usage and upkeepc. survey of latrine construction projectsd. sufficient quantity of watere. system of monitoring for the presence of nitrates

8. Overturning receptacles can prevent:

a. damage to materials from constructing temporary sheltersb. proper functioning of a refuse collection systemc. proliferation of disease−carrying insectsd. accumulation of foul−tasting water

9. In general, displaced persons should be encouraged and assisted to:

a. evacuate to temporary resettlement campsb. stay with family, friends, or in nearby public buildingsc. construct permanent settlements as far away as possible from the stricken aread. apply to aid organizations for tents and sleeping bagse. move to the nearest urban center

10. Tablets can be used to disinfect water following which guideline(s):

a. the eight milligrams of elemental iodine released by the most common iodine tablet cantreat 10 liters of water in one minute.

b. water should be strained through layers of cloth or allowed to settle before disinfectanttablets are added

c. 160 milligram Halazone tablets can disinfect 40 liters of turbid water

d. all of the above

11. In relief operations. which of the following water requirements is incorrect:

a. 50 liters/person in field hospitalsb. 35 liters/person in washing installationsc. 25 liters/person in mass feeding centersd. 5 liters/person in temporary campse. all of the above

12. Overcrowding can lead to disease principally because:

a. accessibility to medical care is severely curtailedb. maintaining standards of personal hygiene becomes more difficultc. water supplies are likely to become contaminatedd. lack of privacy, introduction of unfamiliar food, and mental stress all lead to a breakdown inthe body's immune systeme. people generally take their pets and domestic livestock with them

13. In camps for displaced persons, it is important that residents be made aware of:

a. the camp's sanitation regulationsb. where to locate alternate sources of drinking waterc. names and titles of authorities to contactd. how to disinfect their own watere. timetables for returning to their homes

14. Emergency environmental health control measures are carried out:

a. during phase one of a disasterb. as soon as a warning is received

21

c. after the rescue and accommodations of displaced personsd. only by qualified environmental health specialistse. in response to requests from officials in the stricken area

15. Water located near sewage outfalls, chemical plants, solid waste disposal fields and abandoned mines

a. should be boiledb. should be disinfected before usingc. should be tested for the presence of E. colli and high concentrations of nitratesd. should never be usede. should not be used unless determined safe by a knowledgeable environmental healthspecialistf. should be used only as a last resort

16. After mains, reservoirs, and wells have been repaired, they should be:

a. put back into service immediatelyb. inspected by a qualified environmental health specialistc. cleaned and disinfectedd. monitored daily for chlorine residuals

17. Match water requirements in different settings with the appropriate volumes:

___Minimum daily water capacity in temporary settlements and camps

___Daily consumption of water in field hospitals

___Minimum daily amount of water needed during evacuation in the tropics

a. 3 liters/personb. 6 liters/personc. 15 liters/persond. 40−60 liters/person

18. Tank trucks are used for transporting

a. solid wasteb. drinking waterc. emergency personneld. equipment and suppliese. gasolinef. milk

19. Final disposal of solid waste in tent camps should be by:

a. waterproof and insectproof solid waste disposal containersb. transportc. incinerationd. treatment at a sewage treatment plante. burialf. a or bg. c or eh. d or e

20. Covering food and water containers and removing all debris and garbage protects against:

a. pets and domestic livestockb. contact with insecticidesc. fire hazardd. disease vectorse. spoilage

22

21. The first concern of decision makers during emergency periods is:

a. chemical contamination of food and water suppliesb. salt water contamination of food and water suppliesc. chlorine contamination of food and water suppliesd. heavy metal contamination of food and water suppliese. microbial contamination of food and water suppliesf. vector contamination of food and water supplies

22. Precautions regarding the use of Halazone tablets in water disinfection include:

a. dosages for turbid and clear water are identicalb. before consumption, water should always stand one hour following disinfectionc. tablets come in two strengths with different tablet−to−water ratiosd. all of the above

True/False

Indicate T or F:

___23. All food should be inspected and analyzed in the immediate aftermath of a disaster.

___24. Priority should be given to the consumption of non−perishable food.

___25. When people are informed of what services are available, where to go and whom to contact, itimproves the effectiveness of environmental health activities.

Answer Key

1. d 9. b 17. c,d,b2. b 10. b 18. b3. c,e 11. d 19. g4. d 12. b 20. d5. e 13. a 21. e6. e 14. b 22. c7. b 15. e 23. F8. c 16. c 24. F

25. T

Lesson 5 − Phase three: Rehabilitation measures

Study Guide

This final lesson deals primarily with short−term rehabilitation measures that should be started as soon aspossible, such as restoration of lifeline environmental health services and restoration of essential surveillanceactivities. It also outlines the process for evaluating how well the emergency operations action plan worked.

Learning Objectives

Understand the factors involved in planning for systematic restoration of environmental health services.

List the six lifeline services that should receive the highest priority in short−term rehabilitation.

Understand the purpose and application of technical health surveys in the rehabilitation phase.

Consider when to take environmental health surveys, their order of importance, and basic parameters usedfor determining disease risk.

23

Understand the importance of evaluating the emergency operations action plan, and consider the types ofquestions that should be posed and to whom a final report should be sent.

Learning Activities


Evaluation


Note

Lesson 5 − Self−Assessment Test

Multiple Choice


1. What is the primary role of a national committee?

a. to mobilize and coordinate military and civil defense personnel in carrying out emergencyrelief effortsb. to receive and distribute relief supplies obtained from national and international agenciesc. to plan, monitor, and coordinate the reconstruction and restoration of all lifeline servicesd. to make policy changes at the national level for rechanneling appropriations into priorityarease. to review and evaluate the emergency operations action plan so that strengths andweaknesses of the plan observed under disaster conditions can be recognized andimprovements incorporated in preparedness planning for future disaster occurrences

2. Technical surveys are performed to:

a. train environmental specialistsb. let the people know that something is being donec. assist officials in determining areas of priority interventiond. test the usefulness of equipment and suppliese. determine the incidence of disease

3. Environmental health surveillance activities are aimed principally at:

a. determining whether or not there is any increased risk of disease.b. evaluating the emergency operations action planc. gathering information about specific equipment and supplies neededd. contacting and reassuring victims that order will be restorede. taking epidemiologic surveys of the incidence of disease

4. If water is found to contain E. coli and dramatically increased levels of chloride, this may indicate:

a. contamination of water by insect vectorsb. contamination of water by human wastec. presence of a chlorine residuald. a possible laxative effect on a consumere. high salt levels, rendering the water unfit to drink but acceptable as an ingredient in food

5. Besides testing the quality of the food itself, inspections should be made to determine the cleanliness of:

a. premises where food is handled and preparedb. washing facilitiesc. food storage facilitiesd. facilities for sanitary excrete disposale. all of the above

24

f. none of the above

6. It is especially critical that settlements for displaced persons, hospitals, and schools be surveyed for:

a. food handling and preparation activitiesb. children who have been separated from their parentsc. incidence of malaria and yellow feverd. adequacy of clothing provisionse. adequacy of solid and liquid waste handling systems

7. In order to better coordinate routine activities and improve emergency response as part of a future disasterpreparedness plan, it is first necessary to:

a. create a national committee of all local and government service agenciesb. conduct technical and environmental health surveysc. evaluate the emergency operations action plan as it was carried out before, during, andafter a disasterd. map all areas that were in greatest need of outside disaster reliefe. develop separate subplans for water supply service, solid waste service, and so forth

8. Environmental health surveys should begin:

a. as soon as water, food, and sanitation services have been restoredb. as soon as technical surveys have been initiatedc. throughout all phases of a disasterd. as soon as electricity, transportation, and communications services are in operatione. during the immediate postdisaster emergency period

9. Short−term rehabilitation measures are undertaken to achieve three primary objectives: (select three)

a. make emergency information available to the publicb. prepare lists of needed assistance and submit them to relief agenciesc. restore lifeline servicesd. locate sites for tent campse. restore environmental health surveillance activitiesf. conduct technical surveysg. return hospitals, schools and churches back to a normal stateh. evaluate the emergency operations plan once it has been implemented

10. Phosphatase determination kits check for:

a. high levels of totally dissolved solids in drinking water suppliesb. deterioration in food qualityc. presence of disease vectors in foodd. presence of chlorine residuale. milk qualityf. contamination of food or water with human waste

11. Chlorine residuals should be tested:

a. only where water is suspected of contamination by human or chemical wasteb. on a short−term basisc. between the disaster occurrence period and the consolidation periodd. immediately after the disaster and on a routine basis thereaftere. only until routine testing for E. coli and nitrates has been instituted

True/False

Indicate T or F:

___12. Only water used in the preparation of food should be tested for microbial and chemical contaminants.

25

___13. Supplies and parts should be ordered from local sources only if they cannot be obtained frominternational relief agencies.

___14. Some rehabilitation measures must be taken during the emergency and immediate post emergencyperiods.

___15. Latrines should be inspected by qualified environmental health personnel during and after theirconstruction.

___16. Heating fuel, communication, and electricity are not of primary concern during short−termrehabilitation.

Answer Key

1. c 7. c 12. F2. c 8. a 13. F3. a 9. c,e,h 14. T4. b 10. e 15. T5. e 11. d 16. F6. e

Final exam package − A

To be used in conjunction withPan American Health OrganizationScientific Publication No. 430

PAN AMERICAN HEALTH ORGANIZATIONPan American Sanitary Bureau, Regional Office of theWORLD HEALTH ORGANIZATION525 Twenty−third Street N.W.Washington, D.C. 20037, U.S.A.

DisasterManagement CenterUNIVERSITY OF WISCONSIN−EXTENSIONEngineering and Applied Science432 North Lake StreetMadison, Wisconsin 53706

608−262−2061 Telex No: 265452

Final examination

Multiple Choice


1. Drainage, filling, and overturning receptacles are measures taken to:

a. dispose of human waste in modified soakage pitsb. eliminate vector breeding sitesc. establish temporary camps for displaced personsd. provide displaced persons with cleaning and bathing facilitiese. clean out tanks used for transport and storage of drinking water

2. Flooding can lead to:

26

a. proliferation of vector breeding sitesb. contamination of foodc. contamination of waterd. damage to civil engineering structurese. transportation failuref. all of the aboveg. none of the above

3. Diseases that can be transmitted by vectors include all except:

a. malariab. yellow feverc. typhusd. infectious hepatitise. tularemia

4. To assess the potential vulnerability of an area, one must first: (select two)

a. determine priorities of need according to minimum essential lifeline servicesb. conduct hydrological, geological, and topographical studies of disaster prone areasc. identify and describe the components of the entire environmental health service systemsd. gauge nutritional and medical needs of the populatione. determine the extent to which environmental health personnel have received theappropriate vaccinationsf. chart the characteristics of those natural disasters that might occurg. monitor food and public water supplies for microbial contaminationh. inventory equipment, supplies, and other materials necessary for the emergency

5. Provision of safe food and water, adequate waste disposal, and shelter should be considered:

a. prior to a disaster and during the emergency warning periodb. during and immediately after the disasterc. during the consolidation and rehabilitation phases of a disasterd. during all phases of a disaster

6. To avert health problems related to food and water contamination, it is especially important to:

a. launch vector control campaignsb. create a national committee of representatives of all local and government servicesc. inform the public of hazards of consuming contaminated food and water and of methods toensure their safetyd. conduct technical surveyse. ship mobile purification units to stricken areas

7. Vector−borne means that a disease agent has been transmitted by:

a. insects and rodentsb. contaminated water and foodc. viruses and bacteriad. humans and livestocke. sewage and solid waste

8. Match a lifeline facility or service with the most appropriate protective measure associated with it.

____civil engineering structures____water supplies____power____transportation

a. develop means to allow for using large dilution capacities to reduce the strength of contaminants

27

b. conduct soil, engineering, and meteorologic studies to locate sites that are not vulnerable to a disaster'simpact

c. make agreements with local distributors to ensure that a minimum five day supply of certain items exists atall times.

d. determine the feasibility of using gravity flow

9. Deciding which emergency steps to take should be based largely on:

a. the type of disasterb. the level of disease endemicity in the regionc. emergency calls received from stricken populationsd. assessment of damages, calculating needs, and matching with estimated resources andpersonnel remaininge. establishment of mutual aid agreements and other cooperative arrangements with relatedservices

10. All emergency, consolidation, and short term rehabilitation measures should be carried out within_______of the occurrence of a disaster.


11. Which of the following occurs commonly as a result of deterioration in sanitation and personal hygiene?

a. an increase in diarrheal diseaseb. transportation failuresc. water shortagesd. overchlorination of the water supply

12. List the following phases in the order that they occur and match them with their appropriate time span:

Timespan

Order

a. consolidation period ____ ____b. long−term rehabilitation period ____ ____c. predisaster ____ ____d. immediate emergency period ____ ____e. short−term rehabilitation period ____ ____

1. 0 days after the disaster2. between 1 and 3 days after the disaster3. between 1 and 7 days after the disaster4. between 2 and 12 days after the disaster5. between 3 and 21 days after the disaster6. 14 days and beyond

13. Select the three primary areas of environmental health surveillance and list them in order of theirimportance

a. transportationb. sanitation Order of primary areasc. communication lines ____d. power ____e. water quality ____f. food supplies

28

g. shelterFor each numbered statement from 14−36, select the lettered heading(s) that is (are) most closely associatedwith it.

a. measures taken before a disaster strikesb. emergency warning measuresc. disaster occurrence measuresd. immediate post disaster emergency measurese. consolidation measuresf. short−term rehabilitation measures

____14. Unclog sewer lines and manholes.

____15. Conduct search and rescue operations.

____16. Notify all essential environmental health services to carry out protective and emergency readinessmeasures.

____17. Make systematic surveys of the availability of water and food in affected areas.

____18. Establish a program for cleaning and disinfecting wells.

____19. Conduct disaster simulation drills.

____20. Decide on whether and where to set Up temporary camps.

____21. Inventory and distribute relief supplies.

____22. Conduct public education campaigns.

____23. Sink bore−hole wells at Undamaged locations.

____24. Broadcast disaster watch bulletins, informing the population of what to expect and emergency stepsto take.

____25. Salvage local resources, such as leftover building material or bamboo, to use for building temporaryshelters.

____26. Evaluate the strengths and weaknesses of the emergency operations action plan.

____27. Determine disaster prone areas and capacity of local environmental health services in those areas tomeet needs of affected communities.

____28. Organize immediate distribution of perishable and rain−soaked food.

____29. Assess damages.

____30. Mobilize emergency personnel of critical environmental health services.

____31. Develop routine measures for protecting critical components of water and sanitation systems.

____32. Create a national committee.

____33. Specify emergency measures.

____34. Specify measures to restore lifeline services.

____35. Survey latrine construction projects.

____36. Request that stricken population store ample quantities of water in clean containers.

37. Careful siting, design, and layout of tent camps is particularly critical because:

29

a. it is extremely difficult to convince people to move away from family and friendsb. camps could, and occasionally do, develop into permanent settlementsc. once people are settled in an area, it is difficult to ask them to move againd. contamination of the groundwater should be avoided at all costs

38. Accommodating displaced persons in tent camps should be considered:

a. when public water and sanitation systems have been disruptedb. only as a last resortc. if there is easy access to canvas, tents, camping equipment, and chemical toiletsd. only when displaced persons cannot stay with family or friends

39. The_______should be determined before any disinfectant is distributed to individual users.

a. chlorine residualb. E. coli countc. nitrate leveld. turbiditye. pH

40. All of the following are concerns of the warning period except:

a. maps and engineering plansb. personnelc. plants and equipmentd. community action liaisone. public information

41. An area has a history of earthquakes. It is found that the public drinking water reservoir lies directly over afault. What would be the preferred protective measure?

a. relocate reservoir at a protected site away from the fault lineb. reinforce structures to withstand the impactc. establish an alternate gravity flow system of water supplyd. increase the protection of structures, equipment, and personnele. identify standby or portable water processing or treatment units for use if the system fails

42. Disinfecting tablets, powders, or liquids should never be distributed to the general public unless:

a. people are warned of the hazards associated with drinking contaminated waterb. people are instructed on how to use themc. each household is visited by an environmental health specialistd. vector control activities are instituted at the same timee. people are instructed on how to monitor water for indicators of contamination

43. Disease−carrying rodents and flies may proliferate in:

a. uncovered wellsb. gasoline cansc. overturned receptaclesd. broken mainse. garbage

44. Mosquitoes can proliferate in:

a. garbageb. soiled clothingc. spoiled foodd. tanks used for transporting and storing drinking watere. human waste

True/False

30

Indicate T or F:

____45. Water supplies can become contaminated after earthquakes, floods, and cyclones.

____46. Pathogens can be transmitted through overcrowding and poor sanitation in temporary settlementcamps.

____47. If the public water supply is determined to be contaminated, mobile treatment units automaticallybecome a high priority item on the needs list for emergency relief supplies.

Disaster Development Problem (A) Hurricane

After reading about the disaster described below, you are to make decisions and answer questions relating tothis disaster. For each question, record your responses on the answer sheet provided before going on to thenext question.

Background

This Caribbean island has a population of about 90,000, half of whom live in the centrally located capital city.The remainder live in two towns and three small villages with only a scattered rural population.

The southern third of the island is flat, but there is little agriculture due to lack of rainfall. The central sectionconsists of low hills, rising to high hill country in the north. Agriculture in the northern two−thirds of the islandprovides sufficient food to meet the needs of the population.

Good roads connect all the communities except a village in the north, which is reached by a poorly maintainedroad. There is an international airport in the south and an air strip in the north. Two radio stations, one in thecapital city and the other in a centrally located town, are the primary communications methods. Because of itsstrategic location and a good deep−water harbor, the island serves as a food distribution point for manyislands to the south. Warehouses provide temporary storage for food in transit.

News accounts have reported a tropical storm, building to hurricane level winds, about 500 miles away. Sinceit is expected to pass no closer then 150 miles and there has been no hurricane damage to the island in thepast 10 years, there is little concern. There is no national guidance in disaster management.

As the hurricane nears its point of closest expected approach, it suddenly veers west and increases in speed.Within six hours it hits the southern half of the island.

Problem (A−1)

Since there has been no hurricane damage or other disaster for ten years, development of a disastermanagement plan has been a low priority. There is no comprehensive disaster management plan.

However, there is a strong, well−organized government and an environmental health unit within the Ministry ofHealth. Disaster management of environmental health is assigned immediately to this ministry.

What is the most essential service that must be assured immediately after the disaster?

Check the one correct answer on the answer sheet before going on to the next problem.

____Provide adequate shelter.____Provide safe drinking water.____Remove human excrete and liquid and solid wastes.____Control vectors that transmit disease.____Ensure food supplies.

Problem (A−2)

Due to lack of rainfall, the population in the southern part of the island, including the capital city, depends ondrinking water from a desalinization plant located near the harbor. The towns and villages in the central andnorthern areas rely on wells and cisterns for their water supplies.

31

Immediate reports reveal that the desalinization plant is operational and the storage tanks nearly full.However, there is damage to the pumping station so the water cannot be pumped through the mains. Thereare no reports yet from other communities about availability of safe water supplies.

In what order should the official in charge of environmental health address the following?

Rank the options on your answer sheet, with 1 being the highest priority and 4 the lowest.

____Assess the need for drinking water in all communities affected by the disaster.____Request mobile water purification plants from relief agencies.____Assure drinking water for victims and relief workers in hospitals and treatment centers.____Repair the pumping station.

Problem (A−3)

Reports of extensive damage to housing have come from the northern section of the capital city. Damage tobuildings in the harbor area has also been reported. Other communities in the central and southern regionsreport minor damage to housing, and no report has been received from the remote northern village. There islittle damage to roads and transportation systems.

One or more of the actions below could be correct, depending on the circumstances and the amount of timethat has passed since the hurricane struck.

What action(s) should be taken for the homeless people in the northern section of the capital city?

On your answer sheet check all the options that might be appropriate during the immediate postdisasterperiod (1−3 days).

____Use existing public buildings such as schools, meeting halls, and churches.____Encourage people to stay with other family members or friends.____Establish tent camps to provide shelter.____Encourage people to construct temporary shelter on their own property.

Problem (A−4)

Those responsible for food supply and transportation have asked the Ministry of Health for advice andassistance. While there was much damage to the harbor area, the food in temporary storage in thewarehouses is an important source of emergency food supplies. The Ministry of Transportation has assignedmilitary personnel and vehicles, and distribution points have been established in areas most damaged by thedisaster.

In what order should the following problems be addressed?

Rank the problems from 1 through 3 on your answer sheet, with 1 being the highest priority and 3 the lowest.

____While warehouses storing perishable food have not been damaged, damaged powerlines have put many refrigeration units out of operation.

____Rats now have access to much of the food in storage because of damage to somewarehouses.

____Some food supplies may have become contaminated and it is not known if the food issafe for distribution.

Problem (A−5)

By the end of the third day following the disaster, all immediate emergency problems appear to be undercontrol, at least temporarily.

Fortunately, most of the people were able to solve their own problems concerning water, food, and shelter.Major damage in the northern part of the capital city and minor damage to a town in the southern area will llbe main concerns during the rehabilitation period.

32

What is the first short−term measure that should be taken in order to restore all lifeline services to theirpredisaster level?

Check the one correct answer on the answer sheet.

____Conduct technical surveys for evaluating and planning the restoration of lifeline services.____Create a national committee to plan, monitor, and coordinate all reconstruction activities.____Restore essential environmental health surveillance activities.

Problem (A−6)

The final step during the rehabilitation phase following a disaster is to evaluate comprehensively all of theactivities that have taken place.

Such an evaluation demonstrates that the major failure was the lack of any emergency operations action planfor the island. Had such a plan existed, advance protective measures might have reduced the impact of thedisaster on the population.

Protective measures might have prevented, solved, or at least reduced problems encountered in which of thefollowing areas:

On your answer sheet check each of the areas where protective measures might have prevented, solved orreduced the severity of problems encountered during this disaster.

____Damage to civil engineering structures____Contamination of food and water supplies____Power outages____Transportation failure

Final examination − Answer sheet

(A−1) Check the one correct answer.

____Provide adequate shelter.____Provide safe drinking water.____Remove human excrete and liquid and solid wastes.____Control vectors that transmit disease.____Ensure food supplies.

(A−2) Rank the following options, with 1 being the highest priority and 4 the lowest.

____Assess the need for drinking water in all communities affected by the disaster.____Request mobile water purification plants from relief agencies.____Assure drinking water for victims and relief workers in hospitals and treatment centers.____Repair the pumping station.

(A−3) Check all of the options below that might be appropriate during the immediate postdisaster period (1−3days).


(A−4) Rank the following options, with 1 being the highest priority and 3 the lowest.


33

____Rats now have access to much of the food in storage due to damage to somewarehouses.


(A−5) Check the one correct answer.


(A−6) Check all of the options below where problems caused by the disaster might have been prevented,solved, or reduced by advance planning.

____Damage to civil engineering structures.____Contamination of food and water supplies.____Power outages.____Transportation failures.

Course evaluation

Self Study Course on Environmental Health Management

1. What is your present position?________________________________________________

2. How many years have you spent in disaster−related work?__________________________

3. How many years of formal education do you have?

____0 to 6 years____7 to 12 years____12 to 16 years____more than 16 years

4. How was the level of content in this course?

____too difficult____about right____too easy

5. Was the course material relevant to your work?

____yes____no

6. How useful to you were the various components of the course? (Circle)

Very Useful OK Not UsefulStudy Guide 1 2 3 4 5Textbook (PAHO Sci. Pub. #430) 1 2 3 4 5Self−Assessment Tests 1 2 3 4 57. How valuable to you was the total course? (Circle)s

Very Valuable Of Some Value NotValuable

1 2 3 4 5

34

8. Additional comments_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Please return this to:Disaster Management CenterUW−Extension Engineering432 North Lake StreetMadison, WI 53706, USA

Thank you for taking a moment to complete this Course Evaluation.

Final exam package − B


PAN AMERICAN HEALTH ORGANIZATIONPan American Sanitary Bureau, Regional Office of theWORLD HEALTH ORGANIZATION525 Twenty−third Street, N.W.Washington, D.C. 20037, U.S.A.


608−262−2061 Telex No: 265452

Final examination

Multiple Choice


1. Drainage, filling, and overturning receptacles are measures taken to:

a. dispose of human waste in modified soakage pitsb. eliminate vector breeding sitesc. establish temporary camps for displaced personsd. provide displaced persons with cleaning and bathing facilitiese. clean out tanks used for transport and storage of drinking water

2. Flooding can lead to:

a. proliferation of vector breeding sitesb. contamination of foodc. contamination of waterd. damage to civil engineering structurese. transportation failuref. all of the aboveg. none of the above

35

3. Diseases that can be transmitted by vectors include all except:

a. malariab. yellow feverc. typhusd. infectious hepatitise. tularemia

4. To assess the potential vulnerability of an area, one must first: (select two)

a. determine priorities of need according to minimum essential lifeline servicesb. conduct hydrological, geological, and topographical studies of disaster prone areasc. identify and describe the components of the entire environmental health service systemsd. gauge nutritional and medical needs of the populatione. determine the extent to which environmental health personnel have received theappropriate vaccinationsf. chart the characteristics of those natural disasters that might occurg. monitor food and public water supplies for microbial contaminationh. inventory equipment, supplies, and other materials necessary for the emergency

5. Provision of safe food and water, adequate waste disposal, and shelter should be considered:

a. prior to a disaster and during the emergency warning periodb. during and immediately after the disasterc. during the consolidation and rehabilitation phases of a disasterd. during all phases of a disaster

6. To avert health problems related to food and water contamination, it is especially important to:

a. launch vector control campaignsb. create a national committee of representatives of all local and government servicesc. inform the public of hazards of consuming contaminated food and water and of methods toensure their safetyd. conduct technical surveyse. ship mobile purification units to stricken areas

7. Vector−borne means that a disease agent has been transmitted by:

a. insects and rodentsb. contaminated water and foodc. viruses and bacteriad. humans and livestocke. sewage and solid waste

8. Match a lifeline facility or service with the most appropriate protective measure associated with it.

_____civil engineering structures_____water supplies_____power_____transportation

a. develop means to allow for using large dilution capacities to reduce the strength of contaminants

b. conduct soil, engineering, and meteorologic studies to locate sites that are not vulnerable to a disaster'simpact

c. make agreements with local distributors to ensure that a minimum five day supply of certain items exists atail times.

d. determine the feasibility of using gravity flow

9. Deciding which emergency steps to take should be based largely on:

36

a. the type of disasterb. the level of disease endemicity in the regionc. emergency calls received from stricken populationsd. assessment of damages, calculating needs, and matching with estimated resources andpersonnel remaininge. establishment of mutual aid agreements and other cooperative arrangements with relatedservices

10. All emergency, consolidation, and short−term rehabilitation measures should be carried out within_______of the occurrence of a disaster.


11. Which of the following occurs commonly as a result of deterioration in sanitation and personal hygiene?

a. an increase in diarrheal diseaseb. transportation failuresc. water shortagesd. overchlorination of the water supply

12. List the following phases in the order that they occur and match them with their appropriate time span:

Timespan

Order

a. consolidation period ____ ____b. long−term rehabilitation period ____ ____c. predisaster ____ ____d. immediate emergency period ____ ____e. short−term rehabilitation period ____

1. 0 days after the disaster2. between 1 and 3 days after the disaster3. between 1 and 7 days after the disaster4. between 2 and 12 days after the disaster5. between 3 and 21 days after the disaster6. 14 days and beyond

13. Select the three primary areas of environmental health surveillance and list them in order of theirimportance

a. transportationb. sanitation Order of primary areasc. communication lines ____d. power ____e. water quality ____f. food suppliesg. shelterFor each numbered statement from 14−36, select the lettered heading(s) that is (are) most closely associatedwith it.

a. measures taken before a disaster strikesb. emergency warning measuresc. disaster occurrence measuresd. immediate post disaster emergency measurese. consolidation measuresf. short−term rehabilitation measures

37

____14. Unclog sewer lines and manholes.

____15. Conduct search and rescue operations.

____16. Notify all essential environmental health services to carry out protective and emergency readinessmeasures.

____17. Make systematic surveys of the availability of water and food in affected areas.

____18. Establish a program for cleaning and disinfecting wells.

____19. Conduct disaster simulation drills.

____20. Decide on whether and where to set up temporary camps.

____21. Inventory and distribute relief supplies.

____22. Conduct public education campaigns.

____23. Sink bore−hole wells at undamaged locations.

____24. Broadcast disaster watch bulletins, informing the population of what to expect and emergency stepsto take.

____25. Salvage local resources, such as leftover building material or bamboo, to use for building temporaryshelters.

____26. Evaluate the strengths and weaknesses of the emergency operations action plan.

____27. Determine disaster prone areas and capacity of local environmental health services in those areas tomeet needs of affected communities.

____28. Organize immediate distribution of perishable and rain−soaked food.

____29. Assess damages.

____30. Mobilize emergency personnel of critical environmental health services.

____31. Develop routine measures for protecting critical components of water and sanitation systems.

____32. Create a national committee.

____33. Specify emergency measures.

____34. Specify measures to restore lifeline services.

____35. Survey latrine construction projects.

____36. Request that stricken population store ample quantities of water in clean containers.

37. Careful siting, design, and layout of tent camps is particularly critical because:

a. it is extremely difficult to convince people to move away from family and friendsb. camps could, and occasionally do, develop into permanent settlementsc. once people are settled in an area, it is difficult to ask them to move againd. contamination of the groundwater should be avoided at all costs

38. Accommodating displaced persons in tent camps should be considered:

a. when public water and sanitation systems have been disruptedb. only as a last resortc. if there is easy access to canvas, tents, camping equipment, and chemical toilets

38

d. only when displaced persons cannot stay with family or friends

39. The_______ should be determined before any disinfectant is distributed to individual Users.

a. chlorine residualb. E. coli countc. nitrate leveld. turbiditye. pH

40. All of the following are concerns of the warning period except:

a. maps and engineering plansb. personnelc. plants and equipmentd. community action liaisone. public information

41. An area has a history of earthquakes. It is found that the public drinking water reservoir lies directly over afault. What would be the preferred protective measure?

a. relocate reservoir at a protected site away from the fault lineb. reinforce structures to withstand the impactc. establish an alternate gravity flow system of water supplyd. increase the protection of structures, equipment, and personnele. identify standby or portable water processing or treatment units for use if the system fails

42. Disinfecting tablets, powders, or liquids should never be distributed to the general public unless:

a. people are warned of the hazards associated with drinking contaminated waterb. people are instructed on how to use themc. each household is visited by an environmental health specialistd. vector control activities are instituted at the same timee. people are instructed on how to monitor water for indicators of contamination

43. Disease−carrying rodents and flies may proliferate in:

a. uncovered wellsb. gasoline cansc. overturned receptaclesd. broken mainse. garbage

44. Mosquitoes can proliferate in:

a. garbageb. soiled clothingc. spoiled foodd. tanks Used for transporting and storing drinking watere. human waste

True/False

Indicate T or F:

____45. Water supplies can become contaminated after earthquakes, floods, and cyclones.

____46. Pathogens can be transmitted through overcrowding and poor sanitation in temporary settlementcamps.

____47. If the public water supply is determined to be contaminated, mobile treatment units automaticallybecome a high priority item on the needs list for emergency relief supplies.

39

Disaster Development Problem

(B) Earthquake

After reading about the disaster described below, you are to make decisions and answer questions relating tothis disaster. For each question, record your responses on the answer sheet provided (see page 9) beforegoing on to the next question.

Background

This Central American region has a population of about 4,000,000. Half the population lives in the regionalcapital city. The rest of the population lives in 20 towns and 35 small villages, or in scattered rural sites.

The southern third of the region is flat agricultural land, and its main industry is growing and processing fruitsand vegetables for export. The central portion consists of low hills, rising to high hill country in the north.

One town and two villages are located in the southern section, one town and a village in the central hills, anda village in the north. Good roads connect all of the communities except the village in the north, which isreached by a poorly maintained road. A railroad serves both the capital city and the town in the south. Thereis an international airport in the south and an air strip in the north. Two radio stations, one in the capital andone in the town in the central hills, are the main communication systems for the region.

Earth tremors have been reported 100 miles to the south, but are not of concern to the people of the region.Although a fault runs through the region, there have been no major earthquakes for the past ten years. Thereis no national guidance in disaster management.

With no advance warning, an earthquake measuring 5.6 on the Richter scale strikes the southern half of theregion.

Problem (B−1)

Since there has been no earthquake damage or other disaster for ten years, development of a disastermanagement plan has been a low priority. There is no comprehensive disaster management plan.

However, there is a strong, well−organized government and an environmental health unit within the Ministry ofHealth. Disaster management of environmental health is assigned immediately to this ministry.

What is the most essential service that must be assured immediately after the disaster?

Check the one correct answer on the answer sheet before turning to the next page.

____Provide adequate shelter.____Provide safe drinking water.____Remove human excrete and liquid and solid waste.____Control vectors that transmit disease.____Ensure food supplies.

Problem (B−2)

The population in the southern part of the region and in the centrally−located capital city have a plentifulsupply of drinking water, provided by deep wells. The towns and villages in the central and northern areas relyon wells and cisterns for their water supplies.

Immediate reports reveal that the main well in the capital has been damaged, and there are breaks in thewater mains. However, at least two high−volume irrigation wells near the capital are undamaged and cansupply adequate potable water for the urban population. There are no reports yet from other communities.

In what order should the official in charge of environmental health address the following?

Rank the options 1 through 4 on your answer sheet, with 1 being the highest priority and 4 the lowest.

40

____Assess the need for drinking water in all communities affected by the disaster.____Request mobile water purification plants from relief agencies.____Assure drinking water for victims and relief workers in hospitals and treatment centers.____Repair the main well and broken water mains

Problem (B−3)

Reports of extensive damage to housing have come from the northern section of the capital city. Damage tobuildings in the industrial area has also been reported. Other communities in the central and southern regionsreport minor damage to housing. No report has been received from the remote northern village. There is littledamage to roads and transportation systems.

What action(s) should be taken for the homeless people in the northern section of the capital city?

One or more actions could be correct, depending on the circumstances and the amount of time that haspassed since the earthquake struck.

On your answer sheet check all of the options that might be appropriate during the immediate postdisasterperiod (1−3 days).


Problem (B−4)

Those responsible for food supply and transportation have asked the Ministry of Health for advice andassistance. The industrial area contains canning factories and packing plants for fresh fruits and vegetables,as well as warehouses for temporary storage. While there was much damage in the area, the food stored inthe warehouses is an important source of emergency food supplies. The Ministry of Transportation hasassigned military personnel and vehicles, and distribution points have been established in areas mostdamaged by the disaster.

In what order should the following problems be addressed?

Rank the problems 1, 2 and 3 on your answer sheet, with 1 being the highest priority and 3 the lowest.




Problem (B−5)

By the end of the third day following the disaster, all immediate emergency problems appear to be undercontrol, at least temporarily.

Fortunately, most of the people were able to solve their own problems concerning water, food and shelter.Major damage in the northern part of the capital city and minor damage in the town in the southern area willbe main concerns during the rehabilitation period.

What is the first short−term measure that should be taken in order to restore all lifeline services to theirpredisaster level?

Check the one correct answer on the answer sheet.

41

____Conduct technical surveys for evaluating and planning the restoration of lifeline services.____Create a national committee to plan, monitor, and coordinate all reconstruction activities.____Restore essential environmental health − surveillance activities.

Problem (B−6)

The final step during the rehabilitation phase following a disaster is to evaluate comprehensively all of theactivities that have taken place.

Such an evaluation demonstrates that the major failure was the lack of any emergency operations action planfor the region. Had such a plan existed, advance protective measures might have reduced the impact of thedisaster on the population.

Protective measures might have prevented, solved, or at least reduced problems encountered in which of thefollowing areas:

On your answer sheet check each of the areas where protective measures might have prevented, solved, orreduced the severity of problems encountered during this disaster.

____Damage to civil engineering structures____Contamination of food and water supplies____Power outages____Transportation failure

Final examination − Answer sheet

(B−1) Check the one correct answer.

____Provide adequate shelter.____Provide safe drinking water.____Remove human excrete and liquid and solid wastes.____Control vectors that transmit disease. Ensure food supplies.

(B−2) Rank the following options, with 1 being the highest priority and 4 the lowest.

____Assess the need for drinking water in all communities affected by the disaster.____Request mobile water purification plants from relief agencies.____Assure drinking water for victims and relief workers in hospitals and treatment centers.____Repair the main well and broken water mains.

(B−3) Check all of the options below that might be appropriate during the immediate postdisaster period (1−3days).


(B−4) Rank the following options, with 1 being the highest priority and 3 the lowest.




(B−5) Check the one correct answer.

42


(B−6) Check all of the options below where problems caused by the disaster might have been prevented,solved, or reduced by advance planning.

____Damage to civil engineering structures.____Contamination of food and water supplies.____Power outages.____Transportation failures.

Course evaluation

Self Study Course on Environmental Health Management

1. What is your present position?___________________________________________________

2. How many years have you spent in disaster−related work?______________________________

3. How many years of formal education do you have?

____0 to 6 years____12 to 16 years____7 to 12 years____more than 16 years

4. How was the level of content in this course?

____too difficult____about right____too easy

5. Was the course material relevant to your work?

____yes____no

6. How useful to you were the various components of the course? (Circle)

Very Useful OK Not UsefulStudy Guide 1 2 3 4 5Textbook (PAHO Sci. Pub. #430) 1 2 3 4 5Self−Assessment Tests 1 2 3 4 57. How valuable to you was the total course? (Circle)

Very Valuable Of Some Value NotValuable

1 2 3 4 58. Additional comments_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Please return this to:Disaster Management CenterUW−Extension Engineering432 North Lake Street

43

Madison, WI 53706, USA

Thank you for taking a moment to complete this Course Evaluation.

Final exam answer key − A




608−262−2061 Telex No: 265452

Answer key − Environmental health management

1. b 13. e,f,b 25. d 37. c2. f 14. d 26. f 38. b3. d 15. c 27. a 39. a4. c,f 16. b 28. d 40. a5. d 17. d 29. c and d 41. a6. c 18. d 30. b 42. b7. a 19. a 31. a 43. e8.b,a,d,c

20. c 32. f 44. d

9. d 21. e 33. b,c,d 45. T10. b 22. a 34. f 46. T11. a 23. d 35. f 47. F12. 1−c 24. b 36. b

2−d4−a5−e6−b

Disaster Development Problem − Hurricane

Note: Page numbers cited refer to Pan American Health Organization Scientific Publication No. 430,Environmental Health Management after Natural Disasters.

(A−1) Correct answer:

Provide safe drinking water.

44

Drinking water, the most essential item provided to disaster−stricken populations, is both indispensible to thesupport of life and a major vehicle of disease transmission. Thus, although provision of adequate amounts ofwater for drinking purposes is of utmost importance after a disaster, it is simultaneously necessary to ensurethe safety of the water used for drinking in affected sites.

(A−2) Correct Rankings:

1. Assure drinking water for victims and relief workers in hospitals and treatment centers.

Adequate drinking water should first be made accessible to victims and relief workers in essential locations,such as hospitals and treatment centers.

A major factor in the decision−making process is the risk to health involved, which is evident. If there areinadequate supplies at any essential locations, water is available in storage tanks at the desalinization plant,and it is probable that manpower and vehicles could be provided to transport it to the hospitals and treatmentcenters in need.

2. Repair the pumping station.

Repair and restoration of public water supplies should also be undertaken immediately.

Another major factor in decision making is the technical feasibility of an action. In this case it is not yet knownif the pumping station can be immediately repaired.

3. Assess the need for drinking water in all communities affected by the disaster.

After victims and essential relief workers have an assured supply of water, the needs of populations inperipheral areas of urban centers and in densely settled rural areas and scattered rural sites should tee met.

In the immediate post−disaster emergency period, it is necessary to determine which areas merit greaterattention because of multiple risk factors for disease and other health problems. At this point in thedecision−making process, there is insufficient information on need and risk to take appropriate action.

4. Request mobile water purification plants from relief agencies.

In most cases mobile units are not essential and are a low priority in requests for aid. It is usually worthwhileto use mobile water purification plants during natural disaster emergencies if they are available locally.However, they produce limited quantities of water. They are also expensive and require considerable upkeepand servicing whether or not they are in use.

(A−3) Correct options:

As soon as rescue work has started, accommodating displaced persons under conditions that will not lead todeterioration of public health and the environment should be considered.

Three of the four options could be correct during the immediate post−disaster period, depending on thecircumstances and the amount of time that has passed since the hurricane struck.

1. Encourage people to stay with other family members or friends.

Encouraging and assisting people to stay with family and friends will reduce the number of displaced personswho require shelter.

2. Use existing public buildings such as schools, meeting halls, and churches.

In some cases, public shelter has to be provided temporarily until more permanent locations can be planned.Existing public buildings such as schools, meeting halls, churches and hotels are often chosen as temporaryshelters because they can be converted easily into dormitories. They are also likely to have sources of watersupply and waste disposal, as well as bathing and washing facilities.

3. Encourage people to construct temporary shelter on their own property.

45

After the first two or three days following a disaster, more permanent shelters may become necessary. Ifadequate resources exist to provide materials for constructing temporary shelter on their own property, peopleshould be encouraged and assisted to do so. Wherever they locate, however, they must have access towater, food, and a sanitary means of waste disposal.

4. Establish tent camps to provide shelter.

Accommodating displaced persons in tent camps should be considered only as a measure of last resort.

It is important to emphasize that once individuals have been located and established on a site, it is difficult toask them to move again.

(A−4) Correct rankings:

1. Warehouses storing perishable food have not been damaged, but damaged power lines have put manyrefrigeration units out of operation.

Priority should be given to the consumption of uncontaminated, perishable food, particularly if the food supplyoriginates in areas where there has been a power outage. A complete accounting of available food supplies iscritical.

Since the food is known to be uncontaminated, its immediate distribution should take top priority. Any foodthat will be cooked is safe since pathogens will be destroyed.

2. Some food supplies may have become contaminated and it is not known if the food is safe for distribution.

The analysis of food products should be a low priority, because it is often too complex an undertaking toinitiate in areas affected by the disaster.

The food should not be distributed until it has been inspected. Canned food can normally be used withouthesitation.

3. Rats now have access to much of the food in storage because of damage to some warehouses.

Rodents are nearly impossible to control in the aftermath of disaster.

Since rodent control is not a possible option, the food to which they have access should not be used if thereare ample alternate food sources. Contamination by rats is the most important reason for eliminating any food.


Create a national committee.

The first short−term measure to address breakdown in lifeline services is to create a national committee ofrepresentatives of all local and government service agencies and at least one environmental health specialist.The committee should assume responsibility for planning, monitoring, and coordinating all reconstructionactivities.

The other two options are important steps in rehabilitation, but they should follow appointment of the nationalcommittee.


Advance planning may have helped in all of the four areas listed.

A review of the known effects of disasters on environmental health reveals that damage to civil engineeringstructures, contamination of food and water supplies, power outages, and transportation failure are highlyprobable and often are critical elements of a state of emergency.

1. Damage to civil engineering structures

46

Because more than half of the population depends on the desalinization plant for its water supply, thisstructure warrants maximum protection. In this instance, the failure was at the pumping station. Advanceplanning might have included: (a) emergency pumping equipment that could bypass the main pumping station(b) stockpiling of spare parts for the pumps.

2. Contamination of food and water supplies

The food supplies in temporary storage constitute an excellent source of emergency food and warrant specialprotective measures. In this instance, an effective, on−going rodent control program might have preventedone form of contamination. Strengthening of the warehouse structures might have prevented thecontamination due to damage to the buildings.

3. Power outages

Loss of power to the refrigeration units threatened the perishable food supply in some warehouses.Emergency or portable generators might have provided a fast solution. The feasibility of underground electriccables in an area where hurricanes are a disaster threat should also be explored.

4. Transportation failure

This was not an important factor in this disaster, but it could be in the future. In the case of moving potablewater from the storage tanks at the desalinization plant to hospitals and treatment centers, prior identificationand assignment of personnel and vehicles would have been of value.

Final exam answer key − B



DisasterManagement CenterUNIVERSITY OF WISCONSIN−EXTENSIONEngineering and Applied Science432 North Lake StreetMadison. Wisconsin 53706

608−262−2061 Telex No: 265452

Answer key − environmental health management

1. b 13. e,f,b 26. d 37. c2. f 14. d 26. f 38. b3. d 15. c 27. a 39. a4. c, f 16. b 28. d 40. a5. d 17. d 29. c and d 41. a6. c 18. d 30. b 42. b7. a 19. a 31. a 43. e8. b, a,d, c

20. c 32. f 44. d

47

9. d 21. e 33. b, c, d 45. T10. b 22. a 34. f 46. T11. a 23. d 35. f 47. F12. 1 −c

24. b 36. b

2−d4−a5−e6 − b

Disaster Development Problem − Earthquake

Note: Page numbers cited refer to Pan American Health Organization Scientific Publication No. 430,Environmental Health Management after Natural Disasters.

(B−1) Correct answer:

Provide safe drinking water.

Drinking water, the most essential item provided to disaster−stricken populations, is both indispensible to thesupport of life and a major vehicle of disease transmission. Thus, although provision of adequate amounts ofwater for drinking purposes is of utmost importance after a disaster, it is simultaneously necessary to ensurethe safety of the water used for drinking in affected sites.

(B−2) Correct Rankings:

1. Assure drinking water for victims and relief workers in hospitals and treatment centers.

Adequate drinking water should first be made accessible to victims and relief workers in essential locations,such as hospitals and treatment centers.

A major factor in the decision−making process is the risk to health involved, which is evident. If there areinadequate supplies at any essential locations, water is available from nearby wells, and it is probable thatmanpower and vehicles could be provided to transport it to the hospitals and treatment centers in need.

2. Repair the pumping station.

Repair and restoration of public water supplies should also be undertaken immediately.

Another major factor in decision making is the technical feasibility of an action. In this case it is not yet knownif the well and broken mains can be immediately repaired.

3. Assess the need for drinking water in all communities affected by the disaster.

After victims and essential relief workers have an assured supply of water, the needs of populations inperipheral areas of urban centers and in densely settled rural areas and scattered rural sites should tee met.

In the immediate post−disaster emergency period, it is necessary to determine which areas merit greaterattention because of multiple risk factors for disease and other health problems. At this point in thedecision−making process, there is insufficient information on need and risk to take appropriate action.

4. Request mobile water purification plants from relief agencies.

In most cases mobile units are not essential and are a low priority in requests for aid. It is usually worthwhileto use mobile water purification plants during natural disaster emergencies if they are available locally.However, they produce limited quantities of water. They are also expensive and require considerable upkeepand servicing whether or not they are in use.

(B−3) Correct options:

48

As soon as rescue work has started, accommodating displaced persons under conditions that will not lead todeterioration of public health and the environment should be considered.

Three of the four options could be correct during the immediate post−disaster period, depending on thecircumstances and the amount of time that has passed since the earthquake.

1. Encourage people to stay with other family members or friends.

Encouraging and assisting people to stay with family and friends will reduce the number of displaced personswho require shelter.

2. Use existing public buildings such as schools, meeting halls, and churches.

In some cases, public shelter has to be provided temporarily until more permanent locations can be planned.

Existing public buildings such as schools, meeting halls, churches and hotels are often chosen as temporaryshelters because they can be converted easily into dormitories. They are also likely to have sources of watersupply and waste disposal, as well as bathing and washing facilities.

3. Encourage people to construct temporary shelter on their own property.

After the first two or three days following a disaster, more permanent shelters may become necessary. Ifadequate resources exist to provide materials for constructing temporary shelter on their own property, peopleshould be encouraged and assisted to do so. Wherever they locate, however, they must have access towater, food, and a sanitary means of waste disposal.

4. Establish tent camps to provide shelter.

Accommodating displaced persons in tent camps should be considered only as a measure of last resort.

It is important to emphasize that once individuals have been located and established on a site, it is difficult toask them to move again.

(B−4) Correct rankings:

1. Warehouses storing perishable food have not been damaged, but damaged power lines have put manyrefrigeration units out of operation.

Priority should be given to the consumption of uncontaminated, perishable food, particularly if the food supplyoriginates in areas where there has been a power outage. A complete accounting of available food supplies iscritical.

Since the food is known to be uncontaminated, its immediate distribution should take top priority. Any foodthat will be cooked is safe since pathogens will be destroyed.

2. Some food supplies may have become contaminated and it is not known if the food is safe for distribution.

The analysis of food products should be a low priority, because it is often too complex an undertaking toinitiate in areas affected by the disaster.

The food should not be distributed until it has been inspected. Canned food can normally be used withouthesitation.

3. Rats now have access to much of the food in storage because of damage to some warehouses.

Rodents are nearly impossible to control in the aftermath of disaster.

Since rodent control is not a possible option, the food to which they have access should not be used if thereare ample alternate food sources. Contamination by rats is the most important reason for eliminating any food.


49

Create a national committee.

The first short−term measure to address breakdown in lifeline services is to create a national committee ofrepresentatives of all local and government service agencies and at least one environmental health specialist.The committee should assume responsibility for planning, monitoring, and coordinating all reconstructionactivities.

The other two options are important steps in rehabilitation, but they should follow appointment of the nationalcommittee.


Advance planning may have helped in all of the four areas listed.

A review of the known effects of disasters on environmental health reveals that damage to civil engineeringstructures, contamination of food and water supplies, power outages, and transportation failure are highlyprobable and often are critical elements of a state of emergency.

1. Damage to civil engineering structures

Because more than half of the population depends on deep wells for its water supply, these wells warrantmaximum consideration. In this instance, both the main well and the water mains sustained damage. Advanceplanning might have included: (a) emergency transportation and distribution provisions (b) speciallyconstructed water storage tanks with plans for emergency distribution.

2. Contamination of food and water supplies

The food supplies in temporary storage constitute an excellent source of emergency food and warrant specialprotective measures. In this instance, an effective, ongoing rodent control program might have prevented oneform of contamination. Strengthening of the warehouse structures might have prevented the contaminationdue to damage to the buildings.

3. Power outages

Loss of power to the refrigeration units threatened the perishable food supply in some warehouses.Emergency or portable generators might have provided a fast solution.

4. Transportation failure

This was not an important factor in this disaster, but it could be in the future. In the case of moving potablewater from nearby wells to hospitals and treatment centers, prior identification and assignment of personneland vehicles would have been of value.

50

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