INTRODUCTION

In recent years, there is growing interest in the topic of disasters, not only on
the part of public institutions, but also on the part of health professionals 1, 2 .
A catastrophe or disaster is that situation or event that exceeds the local
response capacity, generating a significant number of victims and may also
damage existing infrastructure 3-6 .

It is therefore essential that health centers have previously prepared and

agreed action plans, in order to act quickly and effectively in a catastrophe
situation 4, 6. Disasters cause significant damage, destruction and human
suffering. They can be classified as natural (earthquakes, hurricanes,
tornadoes and floods) or technological or man-made (fires, accidents, terrorist
acts) 1, 3, 5, 7, 8.

In this research work we will face a Disaster Medicine plan in case of floods,
since the community of the Carrizalito Sector is at risk of this type of natural
disaster, as reflected in the Analysis of the Health Situation of the
aforementioned Sector. . Which forces us to prepare to promptly serve this
population adjacent to the Las Minas River, whose floods are frequent
throughout the year.

A flood is an accumulation of water in a certain place where there is usually

none. This accumulation occurs due to excess water, recorded in a given
place and time. The dangers of floods, apart from how sudden they are
sometimes, are the environment in which they occur, the urban environment
(like the one in question) is more dangerous than the rural environment.

Worldwide, floods are the most frequently occurring disaster situations and
are among the most destructive. They can be caused by rising water levels
due to heavy rains, or be associated with seasonal weather patterns. 6, 8.
At the end of 1999, Venezuela suffered one of the largest natural disasters in
its history. During the month of December 1999, rains occurred that led to
floods, landslides, flows of mud, stones and trees, which culminated in a
great tragedy. for the country and a national emergency situation, for which
all health personnel of the Venezuelan State must prepare for contingencies
due to natural disasters, especially floods.

RESEARCH OBJECTIVES

General objective

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Develop an Emergency plan that allows in the event of flooding in the
Carrizalito Sector, Villa de Cura Parish of the Zamora Municipality of the
State of Aragua; have a functional and operational structure; in the
development of actions aimed at prevention and timely response.

Specific objectives

 Train health personnel; and community leaders in the action

mechanism in case of Natural Disasters.

 Coordinate with the different authorities in the Zamora Municipality

area; to delineate the roles and responsibilities of resources in a timely
manner before; during and after the disaster.

 Conduct an inventory of resources; humans, supplies and medications

available in the Office.

 Provide timely medical, preventive and curative care in risk areas and
areas affected by the flood.

 Monitor that basic sanitation conditions are adequate in shelters and

areas affected by the flood.

METHODS, TECHNIQUES AND PROCEDURES

Research Level

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According to the problem referred to the design of an Emergency Plan in
case of flooding in the Carrizalito Sector, the research was of a feasible
project type. For UPEL (1998)

“the feasible project consists of the research, elaboration and

development of a proposal for a viable operating model to solve
problems, requirements or needs of organizations or social
groups; It can refer to the formulation of policies, programs,
technologies, methods or processes.”

In response to this research modality, two phases were introduced in the

study, in order to meet the requirements involved in a feasible project. In the
first of them, an evaluation of the background and current situation was
initially developed, in order to determine the needs of the community. In the
second phase of the project and based on the results of the evaluation,
proposals were presented for the design of the emergency plan.

Design of the investigation

The proposed study was adapted to the purposes of non-experimental

research. Based on the objectives defined in this study, the design of an
Emergency Plan was proposed.

Located within the modality of feasible projects, a series of instruments and

information collection techniques were used. To do this, three stages had to
be completed, the first was related to the delimitation of the object of study
and the development of the theoretical framework, the second stage involved
carrying out the evaluation of the background and current situation, where
variables such as occurrence were evaluated. , intensity, vulnerability and
exposed people or structures. The third stage corresponded to the proposal
of the Health Emergency Plan, which allows the risks to be minimized and the
population to be promptly attended to when the phenomenon occurs.

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 Information Collection Instruments

For the development of this research it was necessary to use tools that
allowed collecting the greatest amount of information necessary, in order to
obtain a broader knowledge of the reality of the problem. Due to the nature of
the study, documentary compilation was required, that is, the collection of
background information related to the research.

For this purpose, written, formal and informal documents were consulted,
direct observation and interviews were also used, which complemented the
survey applied.

THE PROBLEM

The Community – Carrizalito Sector

The Carrizalito Urbanization was built by Banco Obrero and has been
inhabited since 1973. It arose in response to the housing need of new
couples in the city and to house the workers of the industrial zone of Los
Tanques, since geographically the Urbanization is located between the city of
Villa de Cura and the industrial zone, the homes are of good quality, with
piped water and sewer service, it consists of three (3) paved streets, 4
parking lots, 30 cemented sidewalks; Demographic growth caused
neighborhoods to be formed to the south of the Sector, currently they are
covered by clinic No. 8 Barrio Adentro de Carrizalito, the neighborhoods
Carmen I, Los Samanes, José Díaz, Valle Verde and entrance to Camejo.

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Fig. No. 1 Sector Carrizalito, Zamora Municipality, Aragua State (Google Earth, 2011)

History of disasters in the community

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 No. DATE EMERGENCY OR DISASTER

1 24-09-2009 Toxic spill (chlorine gas)

2 16-04-2010 Flood (Las Minas River flood)

3 01-06-2010 Flood (Las Minas River flood)

4 14-06-2010 Toxic Spill (Pesticide)

5 25-09-2010 Flood (Las Minas River flood)

6 05-12-2010 Flood (Las Minas River flood)

7 16-04-2011 Flood (Las Minas River flood)

8 22-04-2011 Flood (Las Minas River flood)

Source: Local Press

Threat

As seen in the previous table, the population of the Carrizalito Sector lives
under constant threat of flooding due to the flooding of the Las Minas River.
The probability of the event occurring is estimated at four times or more per
year, depending on the intensity of the rainy period in the country.

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The magnitude of the destruction caused by this natural phenomenon
depends on multiple factors, these range from the time the event occurs, the
amount of rain that fell during the period and the state of the river bed.

The affected population is around 2,000 families, with around 500 of the most
high-risk families in recent settlements (invasions) mostly located in the river
bed or its banks.

Regarding the exposure of the structures, it is estimated that a high intensity

flood could cause the total loss of 300 homes, for a total of about 1,200
victims and 800 affected.

Exposure

As indicated in the previous item, a large-magnitude flood would cause the

loss of family space for at least 300 families, who would be affected with the
total loss of personal and real property. But we would also be in the presence
of a similar number of people affected by losses of belongings or parts of the
home.

Regarding the vital lines, the drinking water, electricity and sewage disposal
service would affect the entire Carrizalito Sector (2,000 families) including the
surrounding areas Francisco de Miranda I and II.

Communication (transport), within the vital lines, would be one of the most
affected. The background indicates that medium intensity floods that occurred
in the Sector, due to the overflowing of the Las Minas River, have meant the
isolation of the Villa de Cura Parish with the San Francisco de Asís, Augusto
Mijares and Magdaleno Parishes. Likewise, landline communications,
internet and cable TV signals have been significantly affected.

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 Vulnerability

Carrizalito and the nearby neighborhoods make up a densely populated

2,
Sector; with a perimeter of about 2.6 kilometers and an area of 0.50 km with
a population of approximately 4000 inhabitants. This high population density
added to the disorderly growth of settlements (invasions) of constructions on
unstable terrain, in the bed of streams or in the bed of the Las Minas River
itself, without lifelines; They make the Sector vulnerable to the type of event
under study, since it increases the number of potentially affected people.

On the other hand, the lack of basic services in these invasions places their
inhabitants in greater health vulnerability in the event of disasters.

Regarding social vulnerability, every day the number of families that cannot
satisfy their basic needs increases. Only with the favorable point of the
organization and citizen participation in the Community Councils. However,
the population's individual response to risk is quite poor.

Resolving Capacity

Regarding the resolution capacity, the community organization and the

disposition of the official organizations (Civil Protection, Firefighters, Police,
health services), they have demonstrated a satisfactory speed of response in
events that have occurred recently.

However, in the event of a flood of the Las Minas River that overflows its two
slopes, the Community would be isolated and with few possibilities for
evacuation, which is why safe shelters on high ground within the community
must be considered.

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Regarding resources, Venezuelan legislation, particularly that approved by
the Revolutionary Government on the occasion of the last floods suffered in
the Country, guarantees economic resources in a timely manner to care for
the victims.

Risk Characterization

From an anthropic point of view, floods can be generally defined as the

presence of water on the ground in places, forms and times that are
inappropriate for human activities and therefore produce economic, social
and environmental effects.

It is clear, therefore, in this definition that three elements are combined that
determine a flood situation: the origin or source of the waters, the natural
characteristics of the physical environment (relief-soil-vegetation complex)
and the type of use and occupation of the area. space.

Therefore, the flooding of a river is a natural phenomenon that is part of the

hydrological processes typical of the meteorological and physiographic
characteristics of each region, while the flood is a concept of impact on the
natural and built environment as a result of occupation or use of the medium.

One of the main problems that arise in the characterization of flood risk is that
the concepts of risk and uncertainty used are extremely varied, not always
shared between different specialists and in general poorly transmitted to the
levels of political leadership. and to the population in general.

In our case, the risk of being affected by flooding will depend on the "threat",
hydrological risk of rains and/or floods and the vulnerability of the
environment (ability to resist the threat). The vulnerability of the environment

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in turn depends on the susceptibility of the flooded area and the risk of
protection works, when available.

REQUIRED ACTIONS

The Emergency Plan will start from the creation of a Local Health Emergency
Committee, made up of:

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 Medical
attention

(Health
personnel)

Health
Commission
Epidemiological
(Health surveillance
Personnel +
Health (MIC students)
Chief
Committee) Chief
coordinator
coordinator

(Doctor)
(Doctor)

Logistics and
Temporary Sanitation
Shelters Commission
Commission
(Habitat (Health
Committee) Committee)

And from the inventory of local capacities in the health aspect:

Health Services: Primary Care Module of the Barrio Adentro Mission,

Corposalud Outpatient Clinic (Primary Care). Type II Hospital “José Rangel

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(109 architectural beds, 84 functional), Guayabal Comprehensive Diagnostic
Center.

Medical Transportation : There is no ambulance in the Sector.

Location of private pharmacies : La Villa Pharmacy (Closest)

Epidemic Background: Among the main epidemic outbreaks are Dengue

and bacterial conjunctivitis.

FUNCTIONS OF THE HEALTH EMERGENCY COMMITTEE

CHIEF COORDINATOR:

BEFORE:

 Evaluate and plan with the coordinators of the different commissions the
work to be carried out.

 Coordinate and give general guidelines (voice of command) to the

different health commissions.

 Ensure and manage that the supplies, materials and equipment

necessary for the operation of the different commissions exist.

 Meet with other municipal authorities and community representatives to

evaluate and plan the different activities.

 Execute the goals and strategies of the local health emergency plan,
especially prevention, mitigation and preparation measures for
emergency situations or disasters.

 Manage training for personnel that make up the organizational structure

for emergency situations.

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 Keep the registry of people in the sector updated by age groups and sex,
in order to make use of this data in the event of a disaster.

 Coordinate the permanent dissemination of the emergency plan and

recommendations on how to act in different events Local Health
Emergency Plan.

DURING:

 Implement the local health emergency plan for emergency situations.

 Call on health personnel to begin their responsibilities in the different

commissions.

 Monitor execution in all areas of the organizational structure for

emergency situations.

 Provide preliminary reports to the corresponding institutions.

 Facilitate the transition from response to rehabilitation of all activities.

AFTER

 Provide a general report to the corresponding authorities, of the results of

all the activities carried out, making a general evaluation of the material
and human damages.

 Evaluate the effectiveness of the local health emergency plan.

 Identify all the strengths and weaknesses of all brigades.

 Adopt the necessary corrective measures to improve the response

capacity based on the evaluation carried out.

EPIDEMIOLOGICAL SURVEILLANCE COMMITTEE:

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BEFORE:

 Have a list of diseases of epidemiological interest during a disaster, to

take measures so that at the time of a disaster they do not increase too
much.

DURING:

 Monitor and report the behavior of different diseases that may arise in the
shelters.

 Monitor and report the increase in diseases of epidemiological interest.

AFTER:

 Carry out a study and monitoring of communicable diseases.

 Communicate findings and behaviors of different diseases to the general

coordinator.

ENVIRONMENTAL SANITATION COMMISSION:

BEFORE:

 Identify places for garbage disposal and areas for locating sanitary
services within the possible shelters.

 Manage the provision of supplies necessary for the use of basic

sanitation, such as drinking water containers, tools, etc.

 Provide training to food and beverage handlers.

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DURING:

 Coordinate with the representatives of the shelters the way in which the
toilets and areas for personal hygiene will be used (form of use and
alternate schedule).

 Monitor and establish coordination with the people housed in the

maintenance and cleaning of the facilities.

 Coordinate with shelter members surveillance for the existence of

disease-transmitting vectors.

 AFTER:

 Monitor and coordinate with members of shelters and other institutions

the management and final disposal of waste (garbage).

 Monitor and promote the maintenance and cleaning of the food handling
areas in the shelters.

 Monitor that the conditions of water and food are optimal for human
consumption.

TEMPORARY SHELTER COMMISSION:

BEFORE:

 Manage possible shelters in a disaster with the different authorities.

 Make a list of the supplies and materials to use in a shelter.

 Coordinate with the corresponding authorities that the shelter facilities

meet the physical requirements for the number of families that are
intended to be sheltered.

 Ensure and coordinate so that the different supplies in the health area
exist and are supplied on time to the different commissions.

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 Prepare a dynamic inventory of the material, equipment and supplies
available for care, coordinating with the medical care commission.

 Manage and notify the general coordinator of the existence and/or needs
of the different supplies in each commission.

DURING :

 That the shelter has the minimum necessary for the personal hygiene of
the victims.

 Maintain monitoring of drinking water.

 Establish a dynamic population census in the different shelters by ethnic

groups.

AFTER:

 Maintain control of food, vectors and basic sanitation within the different
shelters.

 Identify strengths, threats, weaknesses and opportunities within the

shelter.

HEALTH COMMISSION:

BEFORE :

 Make an evaluation of the areas of greatest risk in a disaster within the

Community, and at the same time identify possible places for shelters.

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 Organize a EDAN (Damage Assessment and Needs Analysis) committee,
so that at the time of the disaster it immediately prepares a preliminary
assessment of the damages and needs.

 DURING:

 Timely evaluate and identify the extent, severity and location of the
effects of the disaster.

 Verify in general terms where there has been the greatest disaster and
where there will be the greatest need for help.

 Carry out the preliminary evaluation in the first 8 hours and thus detect
the effects of the event and the type of priority aid.

 Carry out the complementary evolution in the next 72 hours, to identify

major damage in the health area, vital lines and critical rehabilitation
points.

AFTER:

 Continuously evaluate the disaster situation and assess the subsequent

consequences.

 Perform a SWOT analysis (Strengths, Weaknesses, Opportunities and

Threats) , and strategic recommendations for decision making.

HEALTH CARE COMMISSION:

BEFORE:

 Develop an injury care plan and identify the area where care will be
provided to the injured.

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 Coordinate training on Triage for the committee.

 Obtain the minimum resources to care for the injured, as well as keep
them in good condition.

 Carry out simulations and drills to test and keep injured classification
procedures and care updated.

DURING:

Implement and direct the injury care plan.

Carry out Triage for the respective transfer of the injured.

Keep a record of the injured, missing and deceased.

AFTER:

 Present a report on the number of injured people treated.

 Maintain record control of all victims treated.

 Evaluate the health care plan and actions taken.

 Identify strengths and weaknesses.

 Adopt necessary corrective measures to improve response capacity.

 Isolate and manage patients with communicable diseases.

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 CONCLUSIONS

 Health personnel must be trained; and community leaders in the action

mechanism in case of Natural Disasters.

 It is necessary to coordinate with the different authorities in the Zamora

Municipality area; to delineate the roles and responsibilities of
resources in a timely manner before; during and after the disaster.

 An inventory of resources must be carried out; humans, supplies and

medicines available in the Barrio Adentro Clinic and the Health
Services available.

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 It is necessary to guarantee timely medical, preventive and curative
care in risk areas and areas affected by flooding, when an event of this
nature occurs.

 One of the most important sanitary tasks in the event of floods will be
monitoring the basic sanitation conditions in shelters and affected
areas.

RECOMMENDATIONS

 Include within the functional organization of the Community Councils

an Emergency Committee for disaster cases.

 Raise awareness among the community's natural leaders of the need

to educate the population to minimize damage from natural and man-
made disasters.

 Include in population censuses the characterization of risk areas.

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 BIBLIOGRAPHIC REFERENCES

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García P, Pulido Arroyo A, Merino Caballero R. Questions about action
plans in the event of disasters. Role of hospital emergency services. A
topic for debate. Emergencies. 1997.

3. RomigLE.Catastrophe Management.In: Gausche-HillM, Fuchs S,

YamamotoL. Emergency reference manual. First edition in Spanish.
Medical Ed.AWWE2007.p.542—63.

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4. Arcos González P, Pérez-Berrocal Alonso J, Castro Delgado R,
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5. Collective of Authors. Disaster Medicine. Havana: Medical Sciences

Editorial; 2004. Xiii. 206p.

6. Argentine Society of Trauma Medicine and Surgery. Trauma Priorities.

Ed. Medical Pan-American, 2003 - 620 pages

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House. Havana Cuba, 2004. 192 pages.

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