NUR 114 DISASTER NURSING

Ariel R. Malinao, RN, MN, HAAD-RN

Clinical Instructor
DISASTER
DISASTER
 INTRODUCTION
⋅ The word derives from
⋅ Greek pejorative prefix dus = "bad" + aster = "star".
The root of the word disaster ("bad star" in Greek)
comes from an astrological theme in which the
ancients used to refer to the destruction or
deconstruction of a star as a disaster.
⋅ The ancient people believed that the disaster is
occurred due to the unfavorable position of the
“planets” or “Act of God”. Gradually they understand
the mysteries of nature.
 DISASTER
⚫D -detection
⚫I - incident
⚫S - safety & security
⚫A - assess hazards
⚫S - support
⚫T - triage & treatment
⚫E – evacuation
⚫R - recovery
 Definition
Disaster –
•Any occurrence that causes damage, ecological
disruption, loss of human life,deterioration of
health and health services on a scale,
sufficient to warrant an extraordinary response
from outside the affected community
or area.(WHO)
•A disaster can be defined as an occurrence
either nature or man made that causes human
suffering and creates human needs that
victim cannot alleviate
without assistance. 4
 Disaster nursing
Disaster nursing can be defined
as ''a adaptation of professional
nursing skills in

recognizing and meeting the

nursing physical and emotional needs

resulting from the disaster.''

Classificati of Disaster
on 8
s
Natural Man made
Disasters Disasters

Meteorological Technological

Topographical Industrial

Environmental Warfare
Meteorological Topographical Environmental
Disasters Disasters Disasters
• Floods • Earthquake • Global
• Tsunami • Volcanic warming
• Cyclone Eruptions • Ozone
• Hurricane • Landslides depletion-
• Typhoon and UVB
• Avalanches Radiation
Snow storm • Solar flare
• Blizzard
• Hail storm

9
 10

Technological Industrial Warfare

• Transport • Chemical • War

failure spills • Terrorism
• Public place • Radioactive • Internal
failure spills conflicts
• Fire • Civil
unrest
• CBRNE
 TYPES OF
DISASTER
1. Natural Disaster – tornados,
hailstorms, tsunami, floods,
Earthquakes, communicable disease etc.

2. Man-Made Disaster- fires, explosions,

toxic materials, pollution, terrorist
attack, transportation accidents etc.
 DISASTER dimensions
– Disruption to normal pattern of life, usually
severe and may also be sudden, unexpected
and widespread
– Human effects like loss of life, injury, hardship
and adverse effect on health
– Effect on social such as
infrastructure destruction ofgovernment
or
systems, damage communications
buildings, to
and essential services
– Community needs such shelter,
food, clothing, medical assistance and social
care.
 Goals of the Disaster
• To meet the immediate basic survival needs of
Nursing
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.
 Contd..
• 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.
 PRINCIPLES OF DISASTER
 Minimize the casualties.
 Prevent further casualties.
 Rescue the victims.
 First aid.
 Medical care.
 Reconstruction.
 Disaster management is the responsibility of
all spheres of govt.
 Disaster management should use
resources that exist for a day-to-day
purpose.
 Principles of Disaster
• Nursing
Rapid assessment of the situation and of nursing care needs.

• Triage and initiation of life-saving measures first.

• The selected use of essential nursing interventions and the

elimination of nonessential nursing activities.

Contd..
• Evaluation of the environment and
the mitigation or removal of any health hazards.
• Prevention of further injury or illness.
• Leadership in coordinating triage,
patient care, and transport during times
of crisis.
 Contd..
• The teaching, supervision, and
utilization of
auxiliary medical personnel and volunteers.
• Provision of understanding, compassion
and emotional support to all victims and
their
families.
 Health Effects of Disasters
• Disasters may cause premature deaths, illnesses,
and injuries.
• Disasters may destroy the local health
care infrastructure.
• Disasters may affect the psychological,
emotional, and social well being of the population.
 Contd…
• Disasters may cause shortages of food and
cause

severe nutritional deficiencies.

• Disasters may create large population movements.

• Disasters may create environmental imbalances.

 Phases of a Disaster
• Pre-impact phase

• Impact phase

• Post-impact
phase
 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 meteorological disasters can be

predicted.

• The role of the nurse during this warning phase is to assist

in preparing shelters and emergency aid stations and

establishing contact with other emergency service group.

 IMPACT PHASE
• The impact phase occurs when the disaster actually
happens. It is a time of enduring hardship or injury end of
trying to survive.
• This is the time when the emergency operation center is
established and put in operation. It serves as the center for
communication and other government agencies of health
tears care healthcare providers to staff shelters. 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
• Recovery begins during the emergency phase ends with the
return of normal community order and functioning. The
victims of disaster in go through four stages of
emotional response.
• 1. Denial – during the stage the victims may deny the
magnitude of the problem or have not fully registered.
• 2. Strong Emotional Response – in the second stage,
the person is aware of the problem but regards it as
overwhelming and unbearable.
 Contd..
3.Acceptance – During the third stage, the
victim begins to accept the problems caused
by the disaster and makes a concentrated
effect to solve them.

4.Recovery – The fourth stage represent a

recovery from the crisis reaction. Victims feel
that they are back to normal.
DISASTER MANAGMENT
A AND INTEGRATED PROCESS OF PLANNING,
ORGANISING,
CONTINUOUS COORDINATING AND IMPLEMENTING MEASURES
WHICH ARE NECESSARY OR EXPEDIENT FOR:

i) Prevention of danger or threat of any disaster.

(ii)Mitigation or reduction of risk of any disaster or its
severity or consequences.
(iii) Capacity-building.
(iv) Preparedness to deal with any disaster;
(v)Prompt response to any threatening disaster situation or
disaster.
(vi)Assessing the severity or magnitude of effects of any
disaster; evacuation, rescue and relief.
(vii)Rehabilitation and reconstruction.
(Disaster Management Act,
• Prevention • Response
• Mitigation • Rehabilitation
• Preparedness • Reconstruction

Six elements that defines the complete approach

to Disaster Management.
DISASTER MANAGEMENT
CYCLE
What is Disaster
Management
Activities that reduce
effects of disasters Activities prior to a disaste
• Building codes • Preparedness plans
& zoning Prepared • Emergency exercises
• Vulnerabilit - ness • Training,
y analyses • Warning systems
• Public
education

Integrated
Mitigation Disaster Response
Management

Activities during
a disaster.
Activities following a • Public warning
Recovery systems
disaster.
• Temporary • Emergency
housing operations
• Claims processing • Search &
Medical care
• Grants rescue
Disaster
preparedness
Preparedness should be in the form
of money, manpower and materials

🞇 Evaluation from past experiences

about risk

🞇 Location of disaster prone areas

🞇 Organization of communication,
information and warning system

🞇 Ensuring co-ordination and

response mechanisms
Contd….
🞇 Development of public education
programme

🞇 Co-ordination with media

🞇 National & international relations

🞇 Keeping stock of foods, drug and
other essential commodities.
Disaster
impact
Rehabilitation
phase
🞇 Water supply

🞇 Food safety

🞇 Basicsanitation and personal

hygiene

🞇 Vector control
 Disaster
mitigation
□ This involves lessening the likely effects of emergencies.
□ These include depending upon the disaster, protection
of vulnerable population and structure.
Eg. improving structural qualities of schools, houses and
such other
buildings so that medical causalities can be minimized.
□ Similarly ensuring the safety of health facilities and public health
services including water supply and sewerage system to reduce the
cost of rehabilitation and reconstruction.
This mitigation compliments the disaster preparedness and disaster
DISASTER-
EFFECTS
🞇 Deaths

🞇 Disability

🞇 Increase in communicable disease

🞇 Psychological problems

🞇 Food shortage

🞇 Socioeconomic losses

🞇 Shortage of drugs and medical

supplies.

🞇 Environmental disruption
DISASTER
RECOVERY
🞇 Suc c essful Recovery Preparation

🞇 Be vigilant in Health teaching

🞇 Psychological support

🞇 Referrals to hospital as needed

🞇 Remain alert for environmental

health

🞇 Nurse must be attentive to the

danger
 E.g.: Indian Meteorological department (IMD) plays a key
in forewarning the disaster of cyclone-storms by detection tracing. It
role
has 5 centres in Kolkata, Bhubaneswar, Vishakapatanam, Chennai &
Mumbai. In addition there are 31 special observation posts setup a
long the east coast of India.

The International Agencies which provides humanitarian assistance to the

disaster strike areas are United Nation agencies.
 Office for the co-ordination of Humanitarian Affair (OCHA)
 World Health Organization (WHO)
 UNICEF
 World Food Programme (WFP)
 Food & Agricultural Organisation (FAD)

E.g.: Non Governmental Organizations

🞇 Co-Operative American Relief Every where (CARE)
🞇 International committee of Red cross
🞇 International committee of Red cross
TRIAGE
⚫ Derived from a French word ‘triar’ which means
‘to separate out’

⚫A method of quickly identifying victims who have

immediately life-threatening injuries and who have
the best chance of surviving

⚫ Use when the quantity severity of injuries

overwhelm the operative capacity of health
facilities .
⚫ The principal of “first come” “first treat” is not
followed in mass emergencies

⚫ Processing of determining the priorities patients

treatment based on their severity

⚫ Itconsist of rapidly classifying the patients as

per the severities as High priorities
Low priorities
 The goal of managing a mass casualty
incident

⚫ Priorities for transportation to the hospital

⚫ Priorities for care in the field

ADVANCED TRIAGE CATEGORIES
CLASS I (EMERGENT) RED IMMEDIATE

– Victims with serious injuries that are life threatening but has a high probability of survival if they received immediate care.
– They require immediate surgery or other life-saving intervention, and have first priority for surgical teams or transport to advanced
facilities; they “cannot wait” but are likely to survive with immediate treatment.
“Critical; life threatening—compromised airway, shock, hemorrhage”

CLASS II (URGENT) YELLOW DELAYED

– Victims who are seriously injured and whose life is not immediately threatened; and can delay transport and treatment for 2 hours.
– Their condition is stable for the moment but requires watching by trained persons and frequent re-triage, will need hospital care
(and would receive immediate priority care under “normal” circumstances).
“Major illness or injury;—open fracture, chest wound”

CLASS III (NON-URGENT) GREEN MINIMAL

– “Walking wounded,” the casualty requires medical attention when all higher priority patients have been evacuated, and may not
require monitoring.
– Patients/victims whose care and transport may be delayed 2 hours or more.
“minor injuries; walking wounded—closed fracture, sprain, strain”

CLASS IV (EXPECTANT) BLACK EXPECTANT

They are so severely injured that they will die of their injuries, possibly in hours or days (large-body burns, severe trauma, lethal
radiation dose), or in life-threatening medical crisis that they are unlikely to survive given the care available (cardiac arrest, septic
shock, severe head or chest wounds);
They should be taken to a holding area and given painkillers as required to reduce suffering.
“Dead or expected to die—massive head injury, extensive full-thickness burns”
⚫ Created in the 1980’s by Hoag Hospital and the
Newport Beach CA Fire Dept
⚫ Allows rapid assessment of victims
⚫ It should not take more than 15 sec/ Pt
Once victim is in treatment area more detailed
assessment should be made Clasificación is
based on three items

⚫ Respiratory
⚫ Perfusion (bld loos)
⚫ Mental status evaluation(neuro)
Organizing an effective
Disaster System
The nurse must be familiar
with the personnel at the
disaster scene and their roles
and functions. A disaster scene
is usually broken up into three
zones-
 Contd..

1. Disaster zone
2. Treatment zone
3. Transport zone
1.Disaster
zone:
•Itis the actual location of the incident from
where patient are to be removed as soon as
possible. Majority of disaster personnel are
sent to this zone initially.
 2.Treatment zone:
Nurses spend most of their time in their
zone during a disaster, where equipment
and personnel to carry out patient care are
concentrated. Activities carried out in this
zone includes.
- Assessment of each patient
- Treatment of injuries
- Preparation for transport.
3.Transportation zone:
•It should be situated directly next to the

treatment zone so that ambulances and

other vehicles can load patient and leave
for hospitals. delivering appropriate
patient care:
Triage area must be equipped
with the following
⋅ Wheelchairs ⋅ Pens
⋅ Stretchers ⋅ Adhesive tape
⋅ Backboards ⋅ Oral airway
⋅ IV poles ⋅ Scissors
⋅ Splints, ⋅ Blankets
bandages ⋅ Stethoscope
⋅ Emesis basins ⋅ Emergency trolley
⋅ Disaster tags with equipment
 MAJOR ROLES OF NURSE IN
DISASTER

1. Define health needs of the affected

groups

2.Establish priorities and objectives

3.Identify actual and potential public

health problems
 Contd..

5. Determine resources needed to respond to

the
needs identified
6.Collaborate with other professional
disciplines, governmental and non-
governmental agencies

7. Maintain a unified chain of command

 CONCLUSION
Hardly a day now passes without news about a
major or complex emergency happening in
some part of the world. Disasters continue to
strike and cause destruction in developing and
developed countries about their vulnerability
to occurrences that can gravely affect their day
to day life and their future. Nurses in any
location will be on the frontline as care giver
and managers in the event of damaging
disaster.
 Contd..

• So they need to have adequate knowledge and

framing to work in such a unique, chaotic
stressful situations and to identify and meet
the complex, multifarious health needs of
victims of disaster.
SUMMARY/EVALUATION
• Define the term Disaster and Disaster
Nursing.
• Explain the type of disaster.
• Enlist the goals of disaster nursing.
• List down the principles of disaster
nursing.
• Explain about phases of disaster.
• Explain disaster Management cycle and
how to organize an effective disaster
system
• Discuss about major roles of nurse in