MPA – 06/2019

Section-I

3) Explain the various components of logistics management. 10

Logistics as a set of activities of linking the producers and consumers has good many functional
elements. 

These elements are:

1. Logistics and Maintenance Support Planning:

Interactive planning, organisation and management activities are necessary to ensure that

logistics requirements for any given program are properly coordinated and implemented. Initial

planning and analysis lead to the establishment of requirements for logistics and the overall

support of the system throughout its life cycle.

Maintenance planning for those activities related to the reverse flow convinces with the

definition of maintenance concept and continues through supportability analysis to the

ultimate development of a maintenance plan.

A comprehensive logistics plan needs to be implemented through the establishment and

control functions to ensure that the plan is properly carried out.

2. Logistics Maintenance and Support Personnel:

The personal required to perform unique logistics and system maintenance activities are

covered in this category.

Such activities include the initial provision and procurement of items of support, production

related logistics functions, the installation and checkout of the system and its elements at the

user’s operational sites customer service functions, the sustaining support of the system

throughout its planned period of use, and those functions required for the retirement and

recycling or disposal of material.

Personnel at all levels of maintenance mobile teams, and operation or maintenance at special

test facilities and calibration laboratories are included. It is important to include only those who

can be directly attributed to the support of that system in evaluation of a particular system.

3. Training and Training Support:

This category includes all personnel, equipment, facilities data or documentation and

associated resources necessary for the training of operational and maintenance personnel to

include both initial and replenishment or replacement training.

Training equipment say simulators, mock-ups, special devices, training manuals and computer

resources Software are developed and utilized as necessary to support the day-to-day-site

training, distance education of a more formal nature.

4. Supply Support—Spares or repair parts and associated inventories:

This elements covers all spares say, repairable units, assemblies, modules and the like, repair

parts say, non-repairable pasts or components, Censurable, liquids, lubricants, gases disposable

items special supplies, and related inventories needed to maintain the prime mission related

equipment computers and software, test and support equipment, transportation and handling

equipment, training equipment, communications equipment and facilities or utilities.

Spares or repair parts are required throughout the system operational share and in support of

the retirement and recycling or disposal of system components.

5. Computer Resources:

This category covers all computers, associated software connecting components, net works,

and interfaces necessary to support the day-to-day flow of information for all logistics

functions, scheduled and unscheduled maintenance activities and special monitoring and

reporting requirements such as those pertaining to CAD/CAM/CAS data the implementation of

condition monitoring programs and in support of system diagnostic capabilities.

6. Technical data, Reports and Documentation:

Technical data may include system installation and check out procedures operating and

maintenance instructions inspection and calibration procedures, overhaul instruction, facilities

data, system modification’s engineering data such as specifications, drawings, materials and

parts list, CAD/CAM/CAS data, special reports Logistics provisioning and procurement data,

Supplier data, system operational and maintenance data, and supporting data bases. Included

in this category is the on-going and interactive process of data collection, analysis and reporting

covering the system throughout its life- cycle,

7. Maintenance and Support Facilities and Utilities:

This category covers all special facilities that are unique and are required to support logistics

activities, to include storage buildings and warehouses and maintenance facilities at all levels.

Physical plant, portable buildings, mobile vans, personnel housing structures, intermediate level

maintenance shops, calibration laboratories and special repair shops such as depots, overhaul

material suppliers are considered.

Capital equipment and utilities heat, power, energy requirements, environmental controls,

communications, safety and security provisions and the like are generally included as the part

of facilities.

8. Packaging, Handling, Storage or ware housing and Transportation:

This category logistics includes all materials, equipment special provisions, containers both

resistible and disposable and supplies necessary to support the packages, safety and

preservation, storage, handling and or transportation of the prime mission related elements of

the system, personnel spares and repair parts, test and support equipment technical data,

computer resources and mobile facilities.

Covered in this group are the initial and sustaining transportation requirements for the

distribution of materials and for the maintenance and support activities throughout the system

life cycle. The primary modes of transportation—air, highways, pipelines railways and water

ways and intermodal, truck, rail, truck, waters, rail, water, truck, air and the like are considered.

9. Test, Measurement, Handling and Support Equipment:

This category includes all tools, condition monitoring equipment, diagnostic and checkout

equipment, special test equipment, metrology and calibration equipment, maintenance fixtures

and stands and special handling equipment required to support operational and maintenance

functions through-out the forward and reverse flows, Test and support equipment

requirements at each level of maintenance must be considered as well as the overall

traceability of test requirement or measures to a secondary standard, a transfer standard and

finally to a primary standard.

10. Logistic Information:

This refers to the resources necessary to ensure that an effective and efficient logistics

information flow is provided throughout and to the organizations responsible for all the

activities that come within its focus. This flow includes the necessary, communication links

among the customer, producer or prime contractor, sub-contractors, sup- priors and supporting
maintenance organisations.

It is but essential that the proper type and amount of information be provided to the

appropriate organisational elements, in proper formats and in a reliable and timely manner

with the necessary security provisions included.

Inherent within this category is the utilisation of the latest EC methods, EDI capabilities e-mail

and the Internet.

This capability not only tends to facilitate the integration of the organisations participating in a

given project but aids in the integration of SC and maintenance activities and the various

logistic elements identified for this propose.

5) Discuss the assets and difficulties of remote areas in disaster situations. 10

Disasters are abnormal events which create great potential losses .Some of the disasters are
natural such as earthquakes, fires, and floods. However, there are unnatural and man-made
disasters like terrorist attacks .Some researchers consider disasters as a function of risk and
they believe that a disaster can be considered as a serious disruption to the functions of a
community or a society as well as incurring material, economic or environmental losses. By the
same token, it would have an impact on the ability of the affected community or society to
cope with its own .
Different consequences of disasters have been stated by researches. They can encompass the
death of so many people, high costs over time great economic and political impacts social and
psychological disorders, destruction of infra-structure, damage to the residential houses, loss of
properties, and generally the disruption of social life in societies Among all these, the
consequences that may harm the people’s health and lives are vital .Following a disaster, a
significant number of people will need proper healthcare .The risk of outbreak is often more in
emergencies .Disasters reduce the physical health of survivors with injuries, intensifying chronic
diseases and decreasing access to the health services .
There are three basic criteria for critical situations: first, there must be an expectation of serious
harm; second, there must be an expectation that someone can do something to prevent or
reduce that harm; and the third criteria, there must be time pressure. Healthcare services
would be different in these situations. Disasters need to be followed by quick decisions .The
consequences of disasters and their impact on delivering health care services put the health
care in the agenda of disaster management.New approaches to disaster know it as a paradox of
the threat and opportunity .In the health system, evaluating programs and making known their
challenges is necessary in order to improve and implement the reforms .
Disasters demand various needs as they are very different according to time, place, and their
extent .In a critical situation, great efforts should be made to ensure that each person receives
proper care and the lives are preserved .A well-organized disaster preparedness plan and
effective community participation are crucial to mitigate the impacts of a natural disaster
.Disaster healthcare management is a systematic process, administrative, organizational, and
operational decision-making skills and capacities, that deals with the challenges of planning in
order to improve and reduce the healthcare consequences of natural disasters . The
effectiveness of disaster management should be studied in all hazardous countries .Iran, a
Middle East country with a population of 75 million is a high-risk country .Several studies in Iran
have identified the challenges of healthcare services in response to disasters .Responding to
these challenges requires an operational planning.
Natural disasters are led to the destruction of healthcare resources .In Bam earthquake, there
was the shortage of essential drugs that had to be used in the first day of the disaster.
However, the inventory of these drugs in pharmaceutical companies was much less than the
expectation. In order to respond quickly to disasters, medical supplies, food, and hygiene items
should be stored in the warehouses in case of an emergency.
In many past disasters, there was no control on how to send and receive donations and this led
to wastage of many resources. Most of the posted drugs from foreign countries were close to
the expiry date, unfamiliar to physicians, with quite different doses in comparison to local
drugs; so they were actually unusable. As the basic needs of the disaster were not announced
publically, people donated whatever they did not need. In this case, the required needs were
not met.
According to the incurring costs of importing these items into the country, foreign aids would
not be much economical and if the medication is supplied from internal resources, the waste of
costs will be lower. Since different organizations played a part in the disaster zone, they
distributed their resources in the regions in a way that was not conducted based on a certain
order and this led to the unequal distribution of resources.

Section II

7) Explain medical and health response to fire disaster. 10

Disaster medicine is the area of medical specialization serving the dual areas of
providing health care to disaster survivors and providing medically related disaster
preparation, disaster planning, disaster response and disaster recovery leadership throughout
the disaster life cycle. Disaster medicine specialists provide insight, guidance and expertise on
the principles and practice of medicine both in the disaster impact area and healthcare
evacuation receiving facilities to emergency management professionals, hospitals, healthcare
facilities, communities and governments. The disaster medicine specialist is the liaison between
and partner to the medical contingency planner, the emergency management professional,
the incident command system, government and policy makers.
Disaster medicine is unique among the medical specialties in that unlike all other areas of
specialization, the disaster medicine specialist does not practice the full scope of the specialty
everyday but only in emergencies. Indeed, the disaster medicine specialist hopes to never
practice the full scope of skills required for board certification. However, like specialists
in public health, environmental medicine and occupational medicine, disaster medicine
specialists engage in the development and modification of public and private policy, legislation,
disaster planning and disaster recovery. Within the United States of America, the specialty of
disaster medicine fulfils the requirements set for by Homeland Security Presidential
Directives (HSPD), the National Response Plan (NRP), the National Incident Management
System (NIMS), the National Resource Typing System (NRTS) and the NIMS Implementation
Plan for Hospitals and Healthcare Facilities.
The Disaster Medicine practitioner must be well-versed in the ethical dilemmas that commonly
arise in disaster settings. One of the most common dilemmas occurs when the aggregate
medical need exceeds the ability to provide a normal standard of care for all patients.
Triage
In the event of a future pandemic, the number of patients that require additional respiratory
support will outnumber the number of available ventilators. Although a hypothetical example,
similar natural disasters have occurred in the past. Historically, the influenza pandemic of 1918-
19 and the more recent SARS epidemic in 2003 led to resource scarcity and necessitated triage.
One paper estimated that in the United States, the need for ventilators would be double the
number available in the setting of an influenza pandemic similar to the scale of 1918.In other
countries with fewer resources, shortages are postulated to be even more severe.
How, then, is a clinician to decide whom to offer this treatment? Examples of common
approaches that guide triage include “saving the most lives”, calling for care to be provided to
“the sickest first” or alternatively a “first come, first served” approach may attempt to sidestep
the difficult decision of triage.Emergency services often use their own triaging systems to be
able to work through some of these challenging situations; however, these guidelines often
assume no resource scarcity, and therefore, different triaging systems must be developed for
resource-limited, disaster response settings. Useful ethical approaches to guide the
development of such triaging protocols are often based on the principles of the theories
of utilitarianism, egalitarianism and proceduralism
Utilitarian Approach
The Utilitarian theory works on the premise that the responder shall 'maximise collective
welfare'; or in other words, 'do the greatest good for the greatest numbers of people. The
utilitarian will necessarily need a measure by which to assess the outcome of the intervention.
This could be thought of through various ways, for instance: the number of lives saved, or the
number of years of life saved through the intervention. Thus, the utilitarian would prioritize
saving the youngest of the patients over the elderly or those who are more likely to die despite
an intervention, in order to 'maximise the collective years of life saved'. Commonly used
metrics to quantify utility of health interventions include DALYs (Disability Adjusted Life Years)
and QALYs (Quality Adjusted Life Years) which take into account the potential number of years
of life lost due to disability and the quality of the life that has been saved, respectively, in order
to quantify the utility of the intervention.
Egalitarian Approach
Principles of egalitarianism suggest the distribution of scarce resources amongst all those in
need irrespective of likely outcome.The egalitarian will place some emphasis on equality, and
the way that this is achieved might differ. The guiding factor is need rather than the ultimate
benefit or utility of the intervention. Approaches based on egalitarian principles are complex
guides in disaster settings. In the words of Eyal (2016) “Depending on the exact variant of
egalitarianism, the resulting limited priority may go to patients whose contemporaneous
prognosis is dire (because their medical prospects are now poor), to patients who have lived
with serious disabilities for years (because their lifetime health is worse), to young patients
(because dying now would make them short-lived), to socioeconomically disadvantaged
patients (because their welfare prospects and resources are lower), or to those who queued up
first (because first-come first-served may be thought to express equal concern.”
Procedural Approach
The inherent difficulties in triage may lead practitioners to attempt to minimize active selection
or prioritization of patients in face of scarcity of resources, and instead rely upon guidelines
which do not take into account medical need or possibility of positive outcomes. In this
approach, known as proceduralism, selection or prioritization may be based on patient’s
inclusion in a particular group (for example, by citizenship, or membership within an
organization such as health insurance group). This approach prioritizes simplification of the
triage and transparency, although there are significant ethical drawbacks, especially when
procedures favor those who are part of socioeconomically advantaged groups (such as those
with health insurance). Procedural systems of triage emphasize certain patterns of decision
making based on preferred procedures. This can take place in the form of a fair lottery for
instance; or establishing transparent criteria for entry into hospitals - based on non
discriminatory conditions. This is not outcome driven; it is a process driven activity aimed at
providing consistent frameworks upon which to base decisions.
These are by no means the only systems upon which decisions are made, but provide a basic
framework to evaluate the ethical reasoning behind what are often difficult choices during
disaster response and management.

8) Briefly examine the role of Geographical Information System (GIS) and Remote Sensing
(RS) in medical and health response at times of disasters.

Medical researches as well as the study of the Earth’s surface, better still, geography are
interlinked with each other; their relationship dates from antiquity. Hippocrates was the first to
describe the relationship between the geographical characteristics of a place and the
inhabitants’ health. Hippocrates described all these in his treatise “On Air, Water and Places”.
As the time goes by, it has become increasingly apparent that the mapping and the geographic
information might be both very useful and vital not only for research but also for understanding
the processes of diseases. The study of the English Physician John Snow in 1854 was a
milestone towards this direction. It led to the detection of the source of infection in a cholera
epidemic that broke out in London. Having mapped the locations of those individuals who were
affected, he concluded that contaminated water was the cause of the outbreak. This research
laid the foundations for both cartographic and geographic applications as a tool in medical
science. Nowadays, the rapid development of technology has resulted, among other things, in
the creation and deployment of new disciplines that cooperate with both the science of
medicine and medical research. The science of Geographic Information Systems and, by
extension Geomatics belongs to a discipline which is constantly developing at a global level.
This sector has many applications regarding medical / epidemiological research and generally,
the social sciences.

The first maps were made due to the fact that people needed to classify the special elements of
the earth’s surface. These elements relate to spatial distribution as well as the demand for
specialized maps regarding the earth’s surface. The rapid development of information
technology and the extension of the concept of data have led to the need for the creation of
electronic maps. Geographic Information Systems came as a natural evolution of cartography.
Geographic Information Systems (GIS) are spatial data management systems. These data are
associated with respective geographic features. They are digital systems that can integrate,
store, adjust, analyze and arrange geographically-referenced information. Generally, they could
be described as smart maps that offer a simulation of the real world to their users. They can
also generate interactive spatial or descriptive questions (research that has been created by the
user), analyze spatial data, adapt and adopt them in analogue (prints maps and diagrams) or
digital media (records of spatial data, interactive maps on the Internet).
The function of GIS is based on a database which may be used by different users in order to
meet various information needs. This database consists of a series of information layers, which
refer to the same geographical area. Each of these layers contains either raw data such as
topographic or satellite data or thematic data such as health services. All these are strictly
oriented towards a common geographic system so as the combination among some of them to
be possible according to the user’s needs. Geographic Information Systems can convert spatial
data into the Geographic or Cartographic or Cartesian coordinate system. A key feature is that
spatial data are related to descriptive data. For example, a group of points that represent
different areas of different cities that are connected by a table, in which each record except for
the exact location, contains information such as name, population etc. Such systems provide
pieces of information regarding the data that are associated with the location for their
collection, management, storage, processing, analysis and visualization in a digital environment.
These data are usually called cartographic, geographic or spatial ones. Moreover, they may be
associated with a series of descriptive data which characterize them as unique.

Geographic Information Systems (GIS) and public health

The public health sector is a very complex and controversial field. Professionals who are
interested in this domain should have critical understanding as regards the correlation amongst
factors that affect health. In recent years, the work of health professionals is constantly
becoming more and more effective owing to the use of both various information technology
services and software. There are much more problems and challenges in relation to the public
health sector than Dr. Snow faced in 1854 when he introduced mapping in medical research.
Recently, the use of GIS and spatial representation of various health issues make professionals
arrive at conclusions in a faster and better way in the field of both public health and decision-
making.
The use of these systems has a wide impact on the public health and lots of studies are based
on them. Prediction as well as simulation models rely on these systems. Additionally, risk
assessment models in relation to the contamination of drinking water in London are based on
them. Aside from this, other researches that focus on Hepatitis c and intravenous drug use have
been displayed with the aid of GIS.
Besides, GIS can contribute to public health in many ways due to the fact that they can provide
information on many issues and support correctly the decision making process. They can
provide information regarding the distribution of health services. Thus, any growing disparities
might be eliminated. Also, policy-makers would make right decisions. Health professionals can
easily identify the difficulties and disparities regarding the accessibility to health services; and
so, they are able to cope with the current situation. Generally, the planning of health and social
care is of major importance since it is a fundamental issue. At the dawn of the 21 st century, in
the midst of remodeling the entire health care system, the use of new approaches relating to
health issues may become useful tools for the providers of these services. The use of GIS so as
public health issues to be solved has grown exponentially. Those systems have been vital to
both the assessment and treatment of health problems that relate to different areas of land.
As it was mentioned above, epidemiology was one of the fields, in which maps was firstly used
on health research. It is essential we be able to understand a disease and how it spreads
through human-to-human transmission.
A Geographic Information System can play an important role as regards the surveillance,
management and analysis of diseases. There seem to be important tools for analysis and
visualization of epidemiological data. Furthermore, trends and correlations would be difficult to
be understood with traditional ways of processing and imaging of these data. Public health
services, diseases, and any information regarding health can be displayed on a map and
correlated amongst many pieces of information such as environmental data, elements of health
concern and social information.
Thus, it is created a means of monitoring and management of both diseases and health
programs. It is necessary we be able to understand, monitor and emphasize on the reasons that
may be correlated to the development of a disease. Some of these factors could be the
environment, conduct and the socioeconomic level of an area. Should the “source” of a disease
is identifiable and its development and transmission are known, health administrators will able
to deal effectively with pandemic outbreaks. A GIS is a tool with great potential that might also
contribute to the assessment of environmental risks and people’s exposure to them.

9) ‘Follow up activities help in reducing stress symptoms and promote post disaster
readjustment.’ Discuss.
In the contemporary world, disasters are inevitable truth of our life, preventable but completely
unavoidable and they are part of our living in this complex globalised, industrialized and
civilized world. Disasters are as old as mankind. Disaster is a very a broad term, which implies a
diverse set of circumstances from an act of terrorism (manmade disaster) to natural calamities
like earth quake. Developing countries are at high-risk for disaster proneness and also they
have to face challenges like poverty, meager resources, illiteracy, poor infrastructure,
corruption, lack of trained manpower and poor knowledge of disaster mental health.Disasters
are known to have substantial effect on both physical and mental health of the affected
population. The burning issue is, what constitutes a disaster? Can a railway accident be a
disaster? Terrorist attack? Religious Riots? War? Rapid spread of Ebola virus? Difficulty to define
a disaster has been further accentuated by the inconsistent use of terminologies such as
calamity, catastrophe, crisis, emergency, misfortune, tragedy, trauma and stress. Defining
‘Disaster’ is inevitable because it poses a real challenge to any country to know what to include
and what not, for planning, policy making, legislation and for research purpose. Disasters
cannot be avoided completely but we need to learn how to prepare, respond, recover,
rehabilitate and re-integrate. There is a need to understand the effects of disaster on health so
that precautionary measures can be adopted to mitigate the suffering. Hence, this article
attempts to define, classify and discuss the management of disasters from mental health
perspective.

The root of the word disaster (“bad star” in Greek) comes from an astrological idea that when
the stars are in a bad position a bad event will happen.Disasters can be simply defined as
violent encounters with nature, technology or humankind.In 1978, Lazarus & Cohen defined it
as a specific cataclysmic event, that is, a stressor depicted by immense power, large scope,
suddenness, and placing excessive demands on individual coping. Similarly, in 1992 the World
Health Organisation's (WHO) defined disaster as ‘a severe disruption, ecological and
psychosocial, which greatly exceeds the coping capacity of the affected community’
In 1995, Federal Emergency Management Agency of US have defined ‘disaster’ as, ‘Any natural
catastrophe, regardless of cause, any fire, flood, or explosion that causes damage of sufficient
severity and magnitude to warrant assistance supplementing State, local, and disaster relief
organization efforts to alleviate damage, loss, hardship, or suffering’.
The Disaster Management Act 2005 of India, disaster is defined as a catastrophe, mishap,
calamity or grave occurrence in any area, arising from natural or manmade causes, or be
accident or negligence which results in substantial loss of life or human suffering or damage to,
and destruction of property, or damage to, or degradation of, environment, and is of such a
nature or magnitude as to be beyond the coping capacity of the community of the affected
area.
From above various definitions it is clear that there is no one single acceptable definition of
disaster. However, there are some common characteristics across all definitions. They are:
a. Sudden onset,
b. Unpredictability,
c. Uncontrollability,
d. Huge magnitude of destruction,
e. Human loss and suffering and
f. Greatly exceed the coping capacity of the affected community.