Disaster Nursing

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Introduction
Disaster is an occurrence arising with little or no warning, which causes serious disruption of life and
perhaps death or injury to large number of people. It is any man made or natural event that causes
destruction and devastation which cannot be relieved without assistance. Natural disasters are
catastrophic events with atmospheric, geologic, and hydrologic origins.  Natural disasters can have rapid
or slow onset, with serious health, social, and economic consequences. Developing countries are
disproportionately affected because they may lack resources, infrastructure, and disaster-preparedness
systems. India has been traditionally vulnerable to natural disasters on account of its unique geo-
climatic conditions.

Types of disaster
 Natural. Eg : earthquake, floods, hurricane, tsunami.
 Manmade.Eg: nuclear accidents, industrial accidents
 Hybrid Eg: spread of disease in community, global warming.

Levels of disaster
 Level iii disaster – considered a minor disaster. These are involves minimal level of damage
 Level ii disaster- considered a moderate disaster. The local and community resources has to be
mobilized to manage this situation
 Level i disaster- considered a massive disaster- this involves a massive level of damage with
severe impact.

Disaster mitigation
Disaster mitigation refers to actions or measures that can either prevent the occurrence of a disaster or
reduce the severity of its effects. (American Red Cross).
Mitigation activities include:
 Awareness and education, such as holding community meetings on disaster preparedness
 Disaster prevention-such as building a retaining wall to prevent flood water from the residences
 Advocacy such as supporting actions and efforts for effective building codes or proper land use.

Disaster management
Phases of disaster management
 Prevention phase
 Preparedness phase
 Response phase
 Recovery phase

Prevention phase
The task during this phase is to identify community risk factors and to develop and implement programs
to prevent disasters from occurring. Programs developed during this phase may also focus on strategies
to mitigate the effects of disaster that cannot be prevented such as earth quakes, cyclones etc. Task
force includes are local and national government, social service providers, police & fire department,
major industries, local medias etc.

Preparedness phase
Personal preparedness:Health care professionals with client responsibilities can also become disaster
victims. Conflicts arise between client related and work related responsibilities. Personal and family
preparation can help to ease of some of the conflicts.

Professional preparedness: Professional preparedness requires that health care professionals become
aware of and understand the disaster plans at their work place and community. Adequately prepared
professionals can function as leaders in the disaster management areas. Personal items that are
recommended for a professional to keep for the disaster management are- copy of professional license,
personal equipments such as stethoscope, flash light and extra batteries, cellular phone, warm clothing
or heavy jackets, protective shoes, pocket sized reference books, watch etc.
 Key organizations and professionals in disaster management
Health care community-
  hospitals
 Mental health professionals
 Pharmacies
 Public health departments
 Rescue personnel

Non health care community

 Clergy
 Fire fighters
 Municipal or government officials
 Media
 Medical examiners
 Medical supply manufactures
 Police

Community preparedness -
 The level of community preparedness for a disaster is only as high as the people and organization
in the community make it. Some communities stay prepare for disaster with written plans and by
participating in disaster drills. Community must have adequate warning system and a back up evaluation
plan to remove people from the area of danger

Response phase
The level of disaster varies and the management plans mainly based on the severity or extent of the
disaster.
 Level iii disaster- considered a minor disaster. The disaster is classifies as one that involves a
minimal level of damage
 Level ii disaster- considered a moderate disaster that is likely to result in major disaster.
Mobilizations of support system are necessary at this level.
 Level i disaster- considered a massive disaster. This disaster involves a massive damage to lives
and property.

Recovery phase
During this phase the community take actions to repair, rebuilt, or reallocate damaged homes and
businesses and restore health and economic vitality to the community. Psychological recovery must be
addressed. The emotional scars of witnessing a disaster may persist for long duration. Both victims and
relief workers should be offered mental health activities and services.

Disaster management cycle

Prevention                            ------>        preparedness
         I                                                                v
                                               
Recovery                       <---------              response

Disaster management plans

Although no disaster management plans can be made to fit every emergency but protocols and
chronological action plans to prove to deal emergency situation efficiently if executed in coordinated
manner.

Aims of disaster plans

 to provide prompt and effective medical care to the maximum possible in order to minimize
morbidity and mortality

Objectives-
 To optimally prepare the staff and institutional  resources for effective performance in disaster
situation
 To make the community aware of the sequential steps that could be taken at individual and
organizational levels
 Constitution of disaster management committee
The following members would comprise the disaster management committee under the chairmanship of
medical superintendent/ director
 Medical superintendent/ director
 Additional medical superintendent
 Nursing superintendent/ chief nursing officer
 Chief medical officer (casualty)
 Head of departments- surgery, medicine, orthopedics, radiology, anesthesiology, neurosurgery
 Blood bank in charge
 Security officers
 Dietitian
 Transport officer
 Sanitary personnel
The disaster management committee is overall responsible for managing the disaster situation, take
administrative decisions, review the disaster plans and inform authorities.
Disaster control room
In the eventuality of a disaster the existing casualty would be referred as the disaster control room. It
would be managed round the clock.
Rapid response team
The medical superintendent will identify various specialists, nurses and pharmacological staff to respond
within a short notice depending up on the time and type of disaster. The list of members and their
telephone numbers should be displayed in the disaster control room.

Information and communication- the disaster control team would be responsible for collecting,
coordinating and disseminating the information about the disaster situation to the all concerned.
Information would be sort on time, place and nature of the disaster, approximate number of the
causalities.

Disaster beds
Requirement of beds depends up on the magnitude of the disaster. Some beds can ear marked as
disaster beds. The efforts should be created to allocate additional beds by-
 Utilization of vacant beds, day care beds, and pre-operative beds
 Convalescing patients, elective surgical cases and patients who can have domiciliary care or opd
management should be discharged
 Utility areas to be converted in to temporary wards such as wards with side rooms, corridors,
seminar rooms etc.
 Creating additional bed capacity by using trolleys, folding beds and floor beds
 
Logistic support system
Separate cupboards marked as disaster shelf and should be kept in disaster control rooms, equipped
with all essential medicines and surgical supplies. The disaster cupboard should contain-
 Resuscitation equipments
 Iv sets, iv fluids,
 Disposable needles, syringes and gloves
 Dressing and suturing materials and splints
 Oxygen masks, nasal catheters, suction machine and suction catheters
 Ecg monitors, defibrillators, ventilators
 Cut down sets, tracheostomy sets and lumbar puncture sets
 Linen and blankets
Keys of these cupboards should be readily available at the time of disaster

Training and drills

Mock exercise and drills at regular intervals to ensure that all the staff in the general and those
associated with management of causalities are fully prepared and aware of their responsibilities. 

Elements of disaster plan

A disaster plan should have the following elements
 Chain of authority
 Lines of communication
 Routes and modes of transport
 Mobilization
 Warning
 Evacuation
 Rescue and recovery
 Triage
 Treatment
 Support of victims and families
 Care of dead bodies
 Disaster worker rehabilitation

Activation of disaster management plans

A standard operating procedure should be developed that defines how each task would be
accomplished.  As soon as the information regarding disaster is received emergency control room officer
on duty in consultation with ms/ director would activate the disaster plan.

Reception area- the disaster control room will act as the reception area to receive the causalities and
to screen them.
Triage-  a predetermined triage should be undertaken to classify the causalities. For large number of
casualties the triage team should incorporate a surgeon, an orthopedic surgeon, physician and an
anesthesiologist.
 Priority one- needing immediate resuscitation, after emergency treatment shifted to intensive
care unit
 Priority two- immediate surgery, transferred immediately to operation theatre.
 Priority three- needing first aid and possible surgery- give first aid and admit if bed is available or
shift to hospital
 Priority four- needing only first aid-discharge after first aid.

Documentation-A comprehensive documentation is essential. Documentation will be done at the

casualty by cmo and attending health care professionals. All mlcs  will be recorded as per the
institutional policy. However the treatment of patients will get priority over the paper work.

Public relations- the identified officer would liaison with relatives of the victims to inform them on their
clinical status. The list of casualties along with their status displayed at prominent place outside casualty
in both english and local language and should be update regularly. The ms or the authorized person
should brief the media (press, radio, tv).

Essential services- adequate provision should be made to meet additional requirement of water &
power supply and other services prominent to patient care.

Crowd management/ security arrangement- immediate mobilization of security staff available

within the hospital campus to ensure security of admitted patients, their belongings, hospital staff
equipments and crowd management. The local police station should be informed to provide assistance in
managing the crowd.

Disaster management- nurse’s role in community

Assess the community
Assess the local climate conducive for disaster occurrence, past history of disasters in the community,
available community disaster plans and resources, personnel available in the community for the disaster
plans and management, local agencies and organizations involved in the disaster management activities,
availability of health care facilities in the community etc.

Diagnose community disaster threats

Determine the actual and potential disaster threats (eg; explosions, mass accidents, tornados, floods,
earthquakes etc).

Community disaster planning

 Develop a disaster plan to prevent or deal with identified disaster threats
 Identify local community communication system
 Identify disaster personnel, including private and professional volunteers, local emergency
personnel, agencies and resources
 Identify regional back up agencies and personnel
 Identify specific responsibilities for various personnel involved in the disaster plans
 Set up an emergency medical system and chain for activation
 Identify location and accessibility of equipment and supplies
 Check proper functioning of emergency equipments
 Identify outdated supplies and replenish for appropriate use.

Implement disaster plans

 Focus on primary prevention activities to prevent occurrence of manmade disasters
 Practice community disaster plans with all personnel carrying out their previously identified
responsibilities (eg: emergency triage , providing supplies such as food, water, medicine, crises and grief
counseling)
 Practice using equipment; obtaining and distributing supplies

Shelter management plans

 nurses can act as shelter managers
 listen to the victims and retell their feelings related to disaster
 encourage victims to share their feelings
 help victims to over come the crisis
 delegate tasks to team members and coordinate activities
 provide the basic necessities(food, water, shelter etc)
 provide compassion and dignity to the victim

Evaluate effectiveness of disaster plan

 Critically evaluate all aspects of disaster plans and practice drills for speed, effectiveness, gaps
and revisions.
 Evaluate the disaster impact on community and surrounding regions
 Evaluate the response of personnel involved in disaster relief efforts.

Conclusion
Disaster is an emergency situation, therefore coordination of actions and various departments is an
essential requisite for efficient management of mass casualties.
References
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