DISASTER NURSING

NURSES AND
EDUCATION
EDUCATION IS THE MOST POWERFUL WEAPON WHICH
YOU CAN USE TO CHANGE THE WORLD.

NELSON MANDELA
MISSION STATEMENT

• Disasters are a primary cause of morbidity and mortality.

Nurses can play an important role in disaster mitigation, but
they receive very little training. This lecture is designed to
help to introduce to nursing the concepts of disasters and
disaster mitigation. We propose that you teach this lecture
to your nursing students to build awareness world wide.
 OBJECTIVES

1. Define a disaster
2. Discuss patterns of mortality and injury
3. Understand impact of disasters on health
4. Describe the factors that contribute to disasters severity
5. Discuss role of nursing in disasters
6. Apply principles of triage in disaster
7. Analyze the WHO components of effective disaster nursing
WHAT IS DISASTER

• Is a result of vast ecological breakdown in the relation

between humans and their environment, as serious or
sudden event on such scale that the stricken community
needs extraordinary efforts to cope with outside help or
international aid.
TYPES

• Natural
• Pandemics
• Transportation
• Technological
• Terrorism
 HURRICANES

• The primary health hazard from hurricanes or cyclones lies in the

risk of drowning from the storm surge associated with the landfall of
the storm. Most deaths associated with hurricanes are drowning
deaths.
• Secondarily, a hazard exists for injuries from flying debris due to the
high winds.

• Nurses can be instrumental in providing direct emergency care to

drowning and head injuries.
TORNADOES

• The primary hazard from a health perspective in a tornado is the risk for
injuries from flying debris. The high winds and circular nature of a
tornado leads to the elevation and transport of anything that is not
fastened down. Most victims of tornadoes are affected by head and chest
trauma due to being struck by debris or from a structural collapse. Some
individuals are injured while on the ground. Others are lifted into the air
by the tornado and dropped at another location.
 FLOODS

• Floods may originate very quickly following a quick rain storm, or they
may develop over a short period following an extended period of rain or
quick snow melt
• The primary hazard from flooding is drowning
• Longer term health concerns from flooding is the development of disease
from contaminated water and lack of hygiene.
 EARTHQUAKES

• A significant global concern

• The primary health concern:
• Injuries arising from structural collapse
• Most injuries occur amongst individuals trapped at the time
of the earthquake
• Well known prevention strategy is to prevent buildings from collapsing
• There is a recognized need to develop better rescue strategies for retrieving
individuals from collapsed buildings
VOLCANOES

• Rare, but can be catastrophic when they occur

• Over the 25 year period (1972-1996), there was an average of 6
eruptions per year, causing an average of 1017 deaths and 285
injuries
• Health outcomes are associated with volcanic eruptions:
• Respiratory illnesses from the inhalation of ash
• For individuals close to the volcano, some danger
exists from lava flows, or more likely mud flows
VULNERABILITIES, NEEDS, AND ABILITIES
VARY
10000000

9000000

8000000

7000000

6000000

5000000

4000000

3000000

2000000

1000000

0
1900
1905
1910
1915
1920
1925
1930

1940
1945
1950
1955

1975

1990
1995
1935

1960
1965
1970

1980
1985

2000
Conflict Natural Disasters
MAN-MADE THREAT

Unpredictable Challenges
Disruptive
Unexpected
Targeting weaknesses
Very rare, impossible to conceive before event
Threats to Civilians, Information
Infrastructure
COMPONENTS OF DISASTER
DEBRIS
• Building Debris
• Household Debris
• Vegetative Debris
• Problem Waste Streams
MYTHS ASSOCIATED WITH
DISASTERS
 Any kind of assistance needed in disasters
 A response not based on impartial evaluation contributes to chaos

 Epidemics and plagues are inevitable after every disaster

 Epidemics rarely ever occur after a disaster
 Dead bodies will not lead to catastrophic outbreaks of exotic disease
 Proper resumption of public health services will ensure the public’s safety (sanitation, waste
disposal, water quality, and food safety)

 Disasters bring out the worst in human behavior

 The majority responses spontaneous and generous

 The community is too shocked and helpless

 Cross-cultural dedication to common good is most common response to natural disasters
PATTERNS OF MORTALITY AND
INJURY
• Disaster events that involve water are the most significant in
terms of mortality
• Floods, storm surges, and tsunamis all have a higher proportion
of deaths relative to injuries
• Earthquakes and events associated with high winds tend to
exhibit more injuries than deaths
• The risk of injury and death is much higher in developing
countries – at least 10 times higher because of little
preparedness, poorer infrastructure.
DISPLACEMENT OF DISASTER
VICTIMS
• Mass Shelters
• Shelter management:
• Organized team (chain)
• Sleeping area and necessities
• Water and food handling
• Sanitation (toilets, showers,..)
• Special care to children and elderly
• Health services (physical, mental)
DISASTER AND HEALTH

• In a major disaster water treatment plants,

storage & pumping facilities, & distribution
lines could be damaged, interrupted or
contaminated.
• Communicable diseases outbreak due to:
• Changes affecting vector populations (increase vector),
• Flooded sewer systems,
• The destruction of the health care infrastructure, and
• The interruption of normal health services geared towards communicable
diseases
 DISASTER AND HEALTH

• Injuries from the event

• Environmental exposure after the event (no shelter)
• Malnutrition after the event (feeding the population affected)
• Excess NCD mortality following a disaster
• Mental health (disaster syndrome)
MENTAL WELLNESS

• Little attention is paid to the children

• Listen attentively to children without denying their feelings
• Give easy-to-understand answers to their questions
• In the shelter, create an environment in which children can
feel safe and secure (e.g. play area)
 MENTAL WELLNESS

• In any major disaster, people want to know where their loved ones are,
nurses can assist in making links.
• In case of loss, people need to mourn:
• Give them space,
• Find family friends or local healers to encourage and support them
• Most are back to normal within 2 weeks
•  About1% to 3%, may need additional help
THE MOST VULNERABLE
THE PHASES OF DISASTER

• 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

• Activities that reduce or eliminate a hazard

• Prevention
• Risk reduction

• Examples
• Immunization programs
• Public education
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
RESPONSE

• Activities a hospital, healthcare system, or public health

agency take immediately before, during, and after a disaster
or emergency occurs
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
 WHAT IS TRIAGE?

• French verb “trier” means to sort

• Assigns priorities when resources limited
• Do the best for the greatest number of patients
WHY IS DISASTER TRIAGE
NEEDED
• Inadequate resource to meet immediate needs
• Infrastructure limitations
• Inadequate hazard preparation
• Limited transport capabilities
• Multiple agencies responding
• Hospital Resources Overwhelmed
ADVANTAGES OF TRIAGE

• Helps to bring order and organization to a chaotic scene.

• It identifies and provides care to those who are in greatest
need
• Helps make the difficult decisions easier
• Assure that resources are used in the most effective manner
• May take some of the emotional burden away from those
doing triage
WHO DECIDES IN TRIAGE

• Nurses don’t act for legal fears of being blamed for deaths,
and lack of clarity on where they fit in the command
structure
• Nurses function to the level of their training and experience.

• If nurses they are the most trained personnel the site, they
are in charge.
ARE NURSES PREPARED??
 HEALTH WORKER
DENSITY BY REGION
S ub - S a ha r a n A f r ic a 0.8

2.3
A s ia
2.6
S &C e nt r a l A m e r ic a
4.2
G lo b a l
6.9
M id d le Ea s t
8.7
W e s t e r n P a c if ic
9.9
N o r t h A me r ic a
10.3
Eur o p e

0 2 4 6 8 10 12

Workers per 1,000 population

NURSES
KILLED BY DISASTERS
 ROLE OF NURSING IN
DISASTERS
Disaster preparedness, including risk assessment and multi-disciplinary
management strategies at all system levels, is critical to the delivery of
effective responses to the short, medium, and long-term health needs
of a disaster-stricken population.
International Council of Nurses (2006)
NURSES’ ROLES IN DISASTERS

 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
 Communication
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 between nurses and their
families
THE NEED FOR DISASTER
NURSING TRAINING
• 11 million nurses world wide:
• Form the backbone of the health care system
• Are the frontline health care workers who are in
direct contact with the public
• Contribute to health of individuals, families,
communities, and the globe
• Schools of nursing offer little or no information on disaster
nursing (WHO, 2008)
• Shortage of trained instructors/faculty (WHO, 2008)
CORE COMPETENCIES IN
DISASTER NURSING TRAINING
• Ethical and legal issues, and decision making;
• Care principles;
• Nursing care;
• Needs assessment and planning;
• Safety and security;
• Communication and interpersonal relationships;
• Public health; and
• Health care systems and policies in emergency situations
(WHO, 2008)
 TOPICS THAT MUST BE COVERED
BY DISASTER NURSING
•
TRAINING
Basic life support
• System and planning for settings where nurses work
• Communications (what to report and to whom)
• Working in the damaged facilities and with damaged equipment
• Safety of clients and practitioners
• Working within a team (understand each member’s role and
responsibility)
• Infection control
• Mental and psychosocial support
(WHO, 2006)
SUPERCOURSE INITIATIVE
BUILDING DISASTER NURSING
SUPERCOURSE
BUILDING DISASTER NURSING
SUPERCOURSE
BUILDING DISASTER NURSING
SUPERCOURSE
• “Most of all, if gains in health and nutrition during emergencies are to be
sustained, graduates need to understand the importance of capacity
building of national staff and institutions.”

Salama et al, Lessons Learned from Complex Emergencies

DISASTER NURSING SUPERCOURSE
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