Disaster nursing and role of nurse in disaster management

DISASTER
MANAGEMENT
BY
CH. ANTHONAMMA

Definition
 Disaster means any occurance that causes
damage, ecological destruction, loss of
human life or detereoration of health and
health services on a scale sufficient to
warrant an extra ordinary response from
outside the affected community area.
(WHO , 1995)

 Disaster is a catastrophe causing injury or
illness simultaneously to at least 30 people
who will require hospital emergency
treatment.
 A disaster is any human made or natural
event that causes destruction and
devastation that can’t be relieved without
assistance.

Causes and Types of disaster
 Natural disaster – It is a consequence when
a natural hazard affects humun; Due to
violence of nature. Eg-earthquake.
 Man-made – Disaster caused by human
action, negligence,error or involving the
failure of a system are called man-made
disaster.

Natural disasters
 Natural phenomena beneath earth’s
surface;
 Earthquake
 Tsunamis
 Volcanic eruptions
 Natural phenomena at earth’s surface;
 Landslide
 Avalanches

Natural disasters (cont….)
 Meterological / hydrological phenomena
 Wind storms, cyclones, typhoon, hurricane.
 Tornadoes
 Hailstorms and snow storms
 Sea surges
 Floods
 droughts
 Biological phenomena
 Locust
 Epidemics of disease

Man made disasters
 Caused by warfare (intentional)
 Conventional warfare
 Nuclear, biological and chemical warfare
 Caused by accidents (unintentional)
 Vehicular
 Plane crash, ship wreck
 Train and car accidents
 Collapse of building
 Explosion
 Fires
 Biological
 Chemical
 poisoning

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.
The impact of many disasters are followed by
unstable situations which are dangerous to life
and can be more dangerous than the original
disaster.
• Rescue the victims; Removal of victims to
safety.

management
 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 or
health care center to initiate medical
management as soon as possible.

management
 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. However health
professionals should be trained to
improvise, where necessary with whatever
available resources, so as to provide as
effective and efficient care to the disaster
victims as possible.

Team, Guidelines,
protocols, Equipments
and Resources

Co-ordinated response of emergency
services
 The individuals are responsible for
maintaining their wellbeing.
 Inter service co-ordination is the core of any
disaster operation.
 Activities associated with disaster
preparedness, mitigation and disaster response
in a community has to be multidisciplinary in
nature.
 Following are some of the emergency services
which should be co-ordinated at the onset of
any disaster;

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.

Doctors
 The primary role of 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

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.

The Phases of Disaster management
• Mitigation:
– Lessen the impact of a disaster before it strikes
• Preparedness:
– Activities undertaken to handle a disaster when it strikes
• Response:
– Search and rescue, clearing debris, and feeding and
sheltering victims (and responders if necessary).
• Recovery:
– Getting a community back to its pre-disaster status

Mitigation
“Includes any activities
that prevent a disaster,
reduce the chances of a
disaster happening, or
reduce the damaging
effects of unavoidable
disasters”
(FEMA,1986)

Mitigation
• Activities that reduce or eliminate a hazard
– Prevention
– Risk reduction
• Examples
– Immunization programs
– Public education
– Improved building codes

Role of Nurse in Mitigation
 Nurses have key role in disaster mitigation by
working with local, state and federal agencies in
identifying disaster risks and developing disaster
prevention strategies through extensive public
education in disaster prevention and readiness.
 The nurse needs to have knowledge about
community assessment information, community
resources (e.g., hospitals, clinics), community
health personnel (e.g., nurses, doctors, emergency
medical teams), community govt. officials and
local industry.

Preparedness
“Includes plan and
preparation made to
save lives and help
rescue operations”
(FEMA 1986)

Preparedness
• Activities that are taken to build capacity
and identify resources that may be used
– Know evacuation shelters
– Emergency communication plan
– Preventive measures to prevent spread of
disease
– Public Education

Role of nurse
 Community health nurse have skills in crises
intervention and are involved in acute care, first aid,
rescue and evacuation procedures, recognizing and
preventing communicable illnesses.
 To establish an effective public communication
system.

Response
• Activities a hospital,
healthcare system, or
public health agency take
immediately before,
during, and after a disaster
or emergency occurs.

Response
 How these goals are achieved will vary with the type of
disaster and the type of rescue worker.
 Police officers and firefighters will have an entirely
different focus than health care workers.
 Preplanning mandates the designation of a command
center and coordinated interactions among various
response personnel.
 In the event of a disaster situation, the emergency
operation center (EOC) becomes operational. The EOC
includes health personnel from the local emergency
medical system (EMS). These personnel will be included
in treating people at the scene of the disaster as well as
at other designated location, including local hospitals.

Response
 The management of mass casualties can be
further divided into;
 Search and rescue.
 Field care/ first aid
 Triage and stabilization of victims.
 Hospital treatment and redistribution of
patients to other hospitals, if necessary.

Response
• 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.

Recovery
• Activities undertaken by a
community and its
components after an
emergency or disaster to
restore minimum services
and move towards long-
term restoration.
– Debris Removal
– Care and Shelter
– Damage Assessments
– Funding Assistance

Recovery
 The reconstruction of the victim’s life
begins with initial care and continues until
the victim has recovered. 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.

Disaster triage
 To determine the priorities of care, victims
are classified into several groups.
 Classification according to treatment need;
 Minimal treatment; Persons who may assist
others after treatment is given.
 Immediate treatment; persons who will benefit
most by treatment.
 Delayed treatment; Persons who will not die if
treatment is delayed.
 Expectant treatment; critically injured persons
who will receive treatment if time permits.

Classification according to
priority of care
 Priority one; Emergency; Persons who need
immediate attention to save their lives.
 Priority two; Urgent; Persons who need attention
within a few hours; If they do not receive attention,
may suffer serious consequences.
 Priority three; Non-urgent; Persons who can
tolerate a delay in receiving attention. Victims in
this group can be attended in order of arrival and
will need assurance that they have not been
forgotten about.
 Priority four; Non-acute; Persons who do not
require the services from rescuing/emergency
department but can be examined by the medical
staff as a regular or routine case.

Disaster prevention
 The measures designed to prevent natural
phenomenon from causing or resulting in
disaster or other emergency situations. It
include;
 Formulation and implementation of long range
policies and programs to prevent or eliminate
the occurrence of disaster.
 Enactment of legislation and regulatory
measures pertaining to physical and urban
planning, public works and building.

Role of nurse in
disaster management

Role of the Nurse at the Disaster
Site• Ensure safety
• First Aid
• Emergency care

Role of the Nurse in a Shelter
• Objective: temporary means of caring
• Assessment
• Planning:
• 24/7 nursing and ancillary coverage
• Supplies
• Implementation
• Evaluation

Role of the CHN in a
Community Setting After a
Disaster
• Goal: Achieve the best possible level of
health for persons in a community after a
disaster
• Primary Prevention
• Secondary Prevention
• Tertiary Prevention

Prevention Levels in Disaster
Management
• Primary Prevention
• Secondary
Prevention
• Tertiary Prevention

Nurses’ roles in disasters
 It depend on the ability of the nurse and the
specific situation.
 A nurse may be the only healthcare
provider in a given area and be responsible
for giving initial first aid treatment or
supervising the activity of others.

 Identifies the type of disaster that may occur in local
community.
 Organizes a disaster plan to be followed for
different situations.
 Arrange for stimulated skills to test the effectiveness
of plan.
 Determines need for education or updating of
necessary skills of participants.
 Actively participates in planning, implementing and
evaluating phase of community disaster
preparedness.
 Develops their own nursing response plan to
determine role of community health, institutional
and volunteer nurse in the event of a disaster in
their community.

Nurses’ roles in
disasters
During a disaster, she becomes
actively involved and provides
proper nursing care to the
community.
Determine magnitude of the
event
Define health needs of the
affected groups
Establish priorities and
objectives
Identify actual and potential
public health problems

 Determine resources needed to respond to
the needs identified
 Collaborate with other professional
disciplines, governmental and non-
governmental agencies
 Maintain a unified chain of command
 Informs the relatives about the accident or
illness and the name of the place where the
patient is admitted.

• Handles the patient properly if she
is alone, because too much
investigation and moving of the
body parts for inspection can have
adverse effect.
• Assess health needs.
• Provide physical and
psychological support to victims in
the shelters.
• Shift the patient at safer places.
Eg. If the patient is feeling
suffocation in room, shift the
patient in veranda.

 During the impact phase injured persons are triaged.
 Give comfortable position to the patient.
 Gives psychological support to the patient, his family
and other people.
 Avoid handling the patient unnecessarily.
 Avoid the people to crowding around the patient
because it may increase the anxiety if the patient. Only
allow the people to come close who can provide the first
aid.
 Give artificial respiration immediately, if breathing
stops.
 Morgue facilities are established and coordinated.
 Search and reunion activities are organized.

Nursing role in disasters
1. Assess the community
2. Diagnose community
disaster threats
3. Community disaster
planning
4. Implement disaster
plan
5. Evaluate effectiveness
of disaster plan

Communication is a success key
• Nursing organizations must have a
comprehensive and accurate registry for all
members
• Have a structured plan:
• Collaborate and coordinate with local
authorities
• Have a hotline 24x7
• Inform nurses where to report and how (keep
records)
• Make sure have a coordinator to prevent chaos
• Ensure ways to maintain communication

Disaster nursing and role of nurse in disaster management

Disaster nursing and role of nurse in disaster management

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