DISASTER NURSING

DISASTER
PREPAREDNESS
SUBMITTED TO: MS. KARUNANIDHI MA’AM
{NURSING TUTOR}
SUBMITTED BY: MS. DEEPIKA RANA (17)
{BSC.(H)NURSING}
FOURTH SEMESTER
 INTRODUCTION
• Disaster are not confined to a particular part of the world; they
can occur any where and any time.
• Integral part of human experiences since beginning of the
time, which creates all kind of losses to the individual.
• French word “DISASTRE” and Italian word
“DISASTRO”
which means “Bad star”
• India has been traditionally vulnerable to natural disasters on
account of its unique geo-climatic conditions. Floods,
droughts, cyclones, earthquakes and landslides have been
• About 60% of the landmass is prone to earthquakes of various
intensities; over 40 million hectares is prone to floods; about 8% of
the total area is prone to cyclones and 68% of the area is
susceptible to drought.

• A disaster may have the following main features:-

a) Unpredictability
b) Unfamiliarity
c) Speed
d) Urgency
e) Uncertainty
f) Threat
“DISASTER” alphabetically means:
 DEFINITION
 Any occurrence that cause damage ecological disruption, loss
of human life, deterioration of health and health services on a
scale sufficient to warrant an extra ordinary response from the
outside community or area
By: WHO

 Disaster may be termed as “a serious disruption of the

functioning of society, causing widespread human, material or
environmental losses which exceed the ability of the affected
society to cope using its own resources”.

By: Lakhwinder Kaur

 Types of disaster
Sudden- onset hazard (geological
and climatic hazards
D
I Slow-onset
hazards(environmental hazards)

S
Industrial/technological disasters
A

S Wars and civil strife

T Epidemics
Commonly divided according to their causes into two
distinct categories.

Meterological

1. Natural disaster Geological

Environmental/ biological
 Conventiona
l warfare
Warfare
Non-
conventiona
2. Man – made l warfare
disaster Civil disaster

Accidents
1. Nuclear
2. Biological
3. Chemical
 1) NATURAL DISASTER
• A serious disruption triggered by a natural hazard (hydro-
metrological, geological or biological in origin) causing human,
material, economic or environmental losses, which exceed the
ability of those affected to cope.

• Natural hazards can be classified according to their (1) hydro

meteorological, (2) geological or (3) biological origins.

1) Hydrometer logical disaster - Natural processes or phenomena

of atmospheric hydrological or oceanographic nature.
Phenomena
/ Examples - Cyclones, typhoons, hurricanes, tornados,
Storms, hailstorms, snowstorms, cold spells, heat waves and
droughts.
2)Geographical disaster - Natural earth processes or phenomena
that include processes of endogenous origin or tectonic or
exogenous origin such as mass movements, Permafrost, snow
avalanches. Phenomena / Examples - Earthquake, tsunami,
volcanic activity, Mass movements landslides, Surface collapse,
geographical fault activities etc.

3)Biological Disaster - Processes of organic organs or those

conveyed by biological vectors, including exposure to pathogenic,
microorganism, toxins and bioactive substances. Phenomena /
Examples - Outbreaks of epidemics Diseases, plant or animal
contagion and extensive infestation etc.
 2) HUMAN-INDUCED /MAN-MADE
DISASTERS
• A serious disruption triggered by a human-induced hazard causing
human, material, economic or environmental losses, which exceed
the ability of those affected to cope. These can be classified into –
(1) Technological Disaster and (2) Environmental Degradation.

1) Technological disaster - Danger associated with technological or

industrial accidents, infrastructure failures or certain human activities
which may cause the loss of life or injury, property damage, social or
economic disruption or environmental degradation, sometimes
referred to as anthropological hazards. Examples: include industrial
pollution, nuclear release and radioactivity, toxic waste, dam failure,
transport industrial or technological accidents (explosions fires
spills).
2) Sociological disasters - Processes induced by human
behaviors and activities that damage the natural
resources base on adversely alter nature processes or
ecosystems. Potentials effects are varied and may
contribute to the increase in vulnerability, frequency and
the intensity of natural hazards. Examples: include
land degradation, deforestation, desertification, wild
land fire, loss of biodiversity, land, water and air
pollution climate change, sea level rise and ozone
depletion.
 FACTORS AFFECTING DISASTER
1. HOST FACTORS
the host factors include:
a) Age
b) Immunization status
c) Degree of mobility
d) Emotional stability

2. ENVIRONMENTAL FACTORS
a) Physical factors
b) Chemical factors
c) Biological factors
d) Social factors
e) Psychological factors
Principles of disaster management
• Prevent the disaster; Prevent the occurrence of
disaster whenever possible.
• Minimize casualties; Minimize the number of
casualties if the disaster cannot be prevented.
• Prevent further casualties; Prevent further casualties
after the initial impact of disaster.
• Rescue the victims; Removal of victims to safety.
• First aid; Provide first aid to the injured;
prompt first aid must be initiated to prevent
further damage /trauma and to prevent
complications.
• Evacuate; Evacuate the injured to the hospital
or health care center; the victims are to be
transported carefully and as quickly as
possible to the nearby hospital as soon as
possible.
• Medical care: Provide definite medical care;
efficient handling of a large number casualties
depends upon training of doctors and nurses
and to disaster preparedness of the concerned
institution.
PHASES OF DISASTER
 Pre-impact phase
• It is the initial phase of disaster, prior to the actual
occurrence. A warning is given at the sign of the first
possible danger to a community with the aid of weather
networks and satellite many metrological disasters can be
predicted.
• Communication is a very important factor during this
phase.
• The role of nurse in this warning phase is to assist in
preparing shelters and emergency aid stations and
establishing contact with other emergency service group.
 Impact phase:
• This phase occurs when the disaster actually happens. It
is a time of enduring hardship or injury end of trying to
survive. This phase may last for several minutes (e.g.
after an earthquake, plane crash or explosion) or for
days or weeks (e.g. in a flood, famine or epidemic).
• This is the time when the emergency operation center is
established and put in operation.
• Every shelter has a nurse as a member of disaster action
team. The nurse is responsible for psychological support
to victims in the shelter.
 Post-impact phase:
• Recovers begins during the emergency phase
and end with the return of normal community
order and functioning. For persons in the
impact area this phase may last a lifetime(e.g.
victims of the atomic bombing of Hiroshima)
DISASTER MANAGEMENT
CYCLE ( STAGES OF
DISASTER
MANAGEMENT)
• Prevention • Response
• Mitigation • Rehabilitation
• Preparedness • Reconstruction

Six elements that defines the complete approach to

Disaster Management.
 Prevention
• The measures designed to prevent natural
phenomenon from causing or resulting in
disaster or other emergency situations.
 Mitigation
• These are steps that are taken to lessen the
impact of a disaster should one occur and
can be considered as prevention and risk
reduction measures. Examples of mitigation
activities include installing and maintaining
backup generator power to mitigate the
effects of power failure.
 Preparedness
“Includes plan
preparation and
save lives andmadehelp
rescue operations” to
(FEMA 1986)
 Response
• Activities a hospital,
healthcare system, or public
health agency take
immediately before, during,
and after a disaster or
emergency occurs.
Continue…….
• Tagging
• All patients should be identified with tags stating their
name, age, place of origin, triage category, diagnosis and
initial treatment.
• Identification of dead
• Removal of dead from the disaster scene.
• Shifting to mortuary
• Reception of bereaved relatives.
• Triage
 TRIAGE
It is the process by which patients are classified according
to the type and urgency of their condition to get the
right patient to the right place at the right time with the
right care provider
• Routine Triage
(depending on the condition of the patients).
• Mass Influx Triage.
 Priority I (Immediate): life threatening injuries or
conditions
 Priority II (Delayed): Patients may remain stable for 10
to 20 mins.eg: Limb injuries
 Priority III (Minimal): minimal injuries or minor
conditions, and are ambulatory
 Priority 0 (Expectant/Dead): Victims are dead or have
lethal injuries and will die despite treatment. 116
Rehabilitation phase
🞇 Water supply

🞇 Food safety

🞇 Basic sanitation and personal

hygiene

🞇 Vector control
 Recovery
• Activities undertaken by
a
community and
components
emergency its
restore minimum after an
services
or disaster
and move towards long-
term restoration. to
– Debris Removal
– Care and Shelter
– Damage Assessments
– Funding Assistance
 Recovery
• This may take few days, months, or years.
• Victim and disaster workers must receive
adequate psychological counseling and
emotional support to be able to effectively
return to normal living.
 HEALTH EFFECTS OF DISASTER
• Disaster may cause premature deaths, illness
and injuries in the affected community.
• Disaster may destroy the local health care
infrastructure, which will therefore be
unable to respond to the emergency.
• Disaster may create environmental imbalances,
increasing the risk of communicable diseases
and environmental hazards.
• Disaster may affect the psychological,
emotional and social well being of the
population in the affected community.
Impact on health and after effects
• Social reaction • Food & Nutrition
• Communicable • Water supply &
diseases sanitation
• Population • Mental health
displacements • Damage to the
• Climatic health
exposure infrastructure
POST TRAUMATIC STRESS DISORDER
Post traumatic stress disorder is a severe
anxiety disorder that can develop after
exposure to any event which results in
psychological trauma,
Such as earthquake, floods, war, rape, tsunami,
or serious physical assault.
 ETIOLOGY
 GENETIC (Monozygotic twins are more susceptible)
 Neuro-endocrinological factors:-
 Low secretion of cortisol
 High secretion of catecholamine in urine
 Abnormality in the hypothalamic pituitary adrenal axis
 NEURO-ANATOMICAL:- Damage to the prefrontal
cortex, Hippocampus.
 PSYCHOLOGICAL FACTORS:-
 Physical ,emotional ,& sexual abuse
 Accident, Drug addiction, illnesses, sexual assault
 Exposed to war (such as soldiers & disaster)
 Being punished severely during childhood.
Sign and symptoms
• Emotional

numbness
• Distressin
g
dreams
• Irritabilit
y
• Impaired social
function
• Loss of interest
• Flashback fear
• Social isolation
• Hostility
• Aggressiveness
 Diagnostic evaluation
History collection about the
exposure events
Assess
symptoms Physical and
psychological
 Observation method
 Check the Level of depression
 Others psychological methods
 NURSING MANAGEMANT
1. ASSESSMENT:-
 Assist the patient past exposure situation & flashbacks.
 Assist the physical movement and symptoms of the
patient exposure about any events.
2. NURSING DIAGNOSIS:-
 Post trauma syndrome related to distressing event
considered to be outside the range of usual human
experience evidenced by flashbacks, nightmares,
psychological numbness related to the event.
 Complicated grieving related to post traumatic events
evidenced by irritability, verbalization of guilt.
 NURSING INTERVENTION
 Establish therapeutic nurse patient relationship.
Provide calm, quiet & non stimulating
environment.
 Do not leave client alone.
Observe the client for suicidal tendency,
ideation or thoughts.
Provide situational support to the client & family
members.
 Support the client in rehabilitative process.
Team, Guidelines,
Protocols, Equipments
and Resources
 Disaster Management Team
• Medical Superintendent
• Additional Medical Superintendent
• Nursing superintendent
• Chief medical officer (Casualty)
• HOD’d of all the dept.s
• Blood bank incharge
• Security officers
• Dietician
• Transport officer
• Sanitary personnel
 Doctor
• The primary role sof doctors is to save lives and
to prevent further trauma and injury;
– First aid
– Surgical support
– Evacuation decisions
– Triage
– Providing basic life support measures to the victim
in critical condition. I.e. Basic airway maintenance
and control of serious bleeding.
 Nurses
• Assessment of victims
• Triage
• Giving basic life support measures to the victims
in critical condition. I.e, Basic airway maintenance
and control of serious bleeding.
• Documentation of triage findings
• Regulating flow of victims for first aid
• First aid
• Evacuation
 Police
• Police department provides 24 hours service.
• Police is the first to get information about the
onset of disaster and to reach to the site.
• They disseminate the information for the
organization of an orderly rescue and relief
operation.
• The task responsibilities of the police in disaster
are;
– Control of traffic and crowd
– Protection of life and property
– Search and rescue operations
– Warning and evacuation
 Firemen
• Primary role of the firemen is
the extinguishing and prevention of fire.
• The task responsibilities of firemen are;
– Extinguishing and preventing fire
– Rescue
– First aid
 Civil defence personnel
• The role of civil defence personnel is to co-
ordinate the activities of the police and
fireman.
• The tasks usually performed are;
– Co-ordinating the services of police and firemen
– Organising and directing
– Set up communication system
 Armed forces
• Assist police and firemen in their function as
needed
• Organize and establish the pattern of
communication, rescue, evacuation, first aid,
transportation of victims, direct relief
operation.
 Red cross personnel
• Ambulance services
• Setting up first aid team
• Providing food, drink and temporary
shelters for victims and rescuers
• Supplying drugs and equipment
• Helping in rehabilitation
• Supply of clothes, blankets, etc.
 Volunteers
• The genuine contribution of ‘public spirited’
citizen should provide the bulk of disaster
operation in co-ordination with the
professionally trained persons.
• Rescue
• First aid
• Evacuation
 Public work personnel
• They may perform any action which would lessen
the chance of a secondary disaster.
• Removing road blocks to clear traffic for relief
vehicle, dozers, ambulances.
• Prevention of any untoward effects. I.e,
breakdown of power lines, water lines and gas
lines.
• Assistance to firemen in obtaining adequate
water for fire fighting.
• Removing victims from under debris.
 GUIDELINES
One leader should be identified who will
issue instructions usually sequence;
• Information received at health care
institution.
• The team leader & members of team
are informed.
• The team member gets ready & is in
position with all necessary facilities.
• Preliminary examination & surgeries
Guidelines/Elements of disaster plans
• Chain of authority
• Lines of communication
• Routes & modes of transport
• Mobilization
• Warning
• Evacuation
• Rescue & recovery
• Triage
• Treatment
• Support of victims and families
• Care of dead bodies
• Disaster worker rehabilitation
 Equipments
• Resuscitation equipment
• IV sets and IV fluids
• Disposable needles, syringes & gloves
• Dressing & suturing materials and splints
• Oxygen delivery devices
• Suction catheter and machine
• ECG monitors, defibrillators and ventilators
• Cut down sets, tracheostomy sets and lumbar
puncture sets
• Linens and blankets
 Resources for disaster management
• Administrative system
• Policies, procedures and protocols
• Physical facilities
• Components & equipments
• Emergency/Disaster medical systems
• Staffing and training
• Resources for disaster drills
• Effective evaluation system
 Legal aspects of disaster nursing
• Licensure • Correct identity
• Good Samaritan law • Drug maintenance
• Good rapport • Self discharge of the
• Standard care patient
• Standing order • Documentation
• Written consent for • Protection of patient
operation and property
procedures • Reporting
 Rehabilitation after Disaster
• Water supply
• Food supply
• Basic sanitation
• Personal hygiene
• Physical rehabilitation
• Psychosocial rehabilitation
• Financial rehabilitation
• Relocation
 Treatment
s
A. PHARMACOLOGICAL:- B.NON-PHARMACOLOGICAL:-
 Selective serotonin  Counselling
reuptake inhibitors (First  Exposure therapy
line drug for the treatment  Cognitive therapy
of PTSD such as  Relaxation therapy
citalopram, fluvoxamine)  Interpersonal psychotherapy
 EMDR (Eye movement
 Tricyclic antidepressants
Desensitization &
 Beta blockers (propranolol) Reprocessing , is an
 Mood stabilizers (Lithium psychotherapy treatment that
alleviate the distress
carbonate & carbamazepine) associated with traumatic
 Benzodiazepines memories)
 Anticonvulsant such as
clonidine
 ROLE OF NURSE IN DISASTER
• Determine magnitude of the event.
• Participate in the development of
community disaster plans.
• Mitigate all ongoing hazards.
• Establish need for mutual aid relationship.
• Integrate State & Federal resources.
• Define health needs of the affected group.
• Identify actual and potential public
health problems.
 GOALS OF THE DISASTER NURSING
• To meet the immediate basic survival needs of
populations

affected by disasters.

• To identify the potential for a secondary disaster.

• To appraise both risks and resources in the environment.

• To correct inequalities in access to health care or appropriate

resources.
• To empower survivors to participate in and advocate

for their own health and well being.

• To respect cultural, lingual, and religious diversity in

individuals and families and to apply this principle in

all health promotion activities.

• To promote the highest achievable quality of life for

survivors.
 ROLE OF NURSE IN DISASTER
MANAGEMENT

Assess the Community Diagnose Community Disaster Threats

ROLE OF NURSE

Evaluate Effectiveness of Disaster Plan Community Disaster Planning

Implementation Disaster Plan
 The Nursing Role in Disaster
Management
Nurses work in all phases of disaster management. Some of
the community disaster strategy for nurses include:
1.Assess the Community:
-Is there a current community disaster plan in place?
-Previous disaster experiences?
-How is the local terrain conductive to disaster formation(
hurricanes, tornados, blizzards)
-What are local industry?
-What personnel are available for disaster interventions? (
)
-What are local agencies and organization? (hospital,
schools, Red cross)
2.Diagnose Community Disaster Threats:
•Determine actual and potential
disaster threats.(eg. toxic
waste,explosions,road
accidents,hurricanes,
tornandos,floods,earthquicks)
3.Community Disaster Planning:
•Develop a disaster plan to prevent or
deal with identified disaster threats.
•Identify a local community
communicable system.
•Set up of an emergency medical systems
and chain for activation.
4.Impliment Disaster plan:
Focus on primary prevention activities to prevent occurrence
ofman made disaster.
Practice using equipments, obtaining and distributing
supplies.

5.Evaluate effectiveness of Disaster plan:

Critically evaluate all aspects of disaster plan and practical
drills for speed, effectiveness, gaps and revision.
Evaluate the disaster impact on community and surrounding
regions.
133