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Disaster Nursing
Disaster Nursing
Disaster definitions:
(Parker, 1984) a disaster is any patient generating incident that overloads either existing personnel, supplies,
and equipment, or is any patient-generating incident in which backup supplies and personnel are not available in
a reasonable amount of time.
(American Red Cross, 1975) an occurrence, either natural or man-made that causes human suffering and
creates human needs that victims cannot alleviate without assistance.
1. Major Disaster defined as: any hurricane, tornado, storm, flood, high water, wind-driven water, tidal
wave, earthquake, drought, fire, explosion, or other catastrophe in any part of the Philippines which, in the
determination of the president, causes damage of sufficient severity and magnitude to warrant major disaster
assistance above and beyond local/state emergency services by the government to supplement the effort and
available resources of local governments and private relief organizations in alleviating the damage, loss,
hardship, or suffering caused by a disaster.
2. State of Emergency defined as: any of the various types of catastrophes included in the definition of a
major disaster which requires Federal emergency assistance to supplement State and Local efforts to save
lives and protect property, public health and safety, or to avert or lessen the threat of a disaster.
Disaster Categories:
1.Multiple patient incident the multiple patient incident occurs daily in EDs throughout the country.
- An incident that generates at least two, but fewer than 10 patients. Is self-limiting and can
usually be handled effectively without requiring aid from resources outside of the community.
- Typical incidents that generate multiple patient incidents are MVA, fires, and public carrier
incidents.
- Most EDs have some type of plan for recalling additional personnel, if needed, in a limited
situation.
2.Multiple casualty incident generates at least 10 but fewer than 100 casualties and necessitates total
community and
perhaps state involvement. Ex. Airplane crashes, snow storms, and floods.
- The community-wide disaster plan must be established and functional to coordinate this type of
situation.
3.Mass casualty incident generates more than 100 victims
- Additional aid and assistance is required.
- Occur infrequently but still must be anticipated in any disaster planning activity.
- Ex. Wars, major hurricanes, and earthquakes in which thousands of casualties may be generated
on a continuing basis.
Types of Disasters:
1. External disasters- disasters which occurs outside the hospital. Can be labeled natural or man-made.
a. Natural floods, tornadoes, blizzards, earthquakes, hurricanes, fire.
b. Man-made war, transportation accidents, fire, building collapse, food/water contamination.
2. Internal disasters- disasters which occur within an institution, such as hospital fire or bomb threat.
Epidemiology of a Disaster
1. Agent the physical items that actually causes the injury or destruction.
a. Primary agents falling building, heat, wind, rising water, and smoke.
b. Secondary agents bacteria and viruses that produces contamination or infection after the
primary agent has caused injury and destruction.
2. Host humankind. Host factors include age, immunization status, preexisting health status, degree of
mobility, and emotional stability.
3. Environment there are four factors that affect the outcome of a disaster.
a. Physical Factors time when the disaster occurs, weather conditions, the availability of food
and water, and the functioning of utilities such as electricity and telephone.
b. Chemical Factors leakage of stored chemicals into the air, soil, ground water, or food.
c. Biological factors those that occur or increase as result of contaminated water, improper
waste disposal, insect or rodent proliferation, improper food storage.
d. Social factors those that contribute to the individuals social support system. Loss of family
members, change in roles, and the questioning of religious beliefs.
Factors that influence response to disaster (Demi and Miles, 1983)
1. Situational Factors warning time before the disaster occurs, the nature and the severity of the
disaster, physical proximity and closeness to the victims affected.
2. Personal Factors psychological proximity, coping ability, losses, role overload, and previous
disaster experience.
Stages of a Disaster
- Regardless of the origin, type or extent of a disaster, the stages are identical. Although the time involved in
each stage will vary depending on the type of disaster, each situation will progress through the following
stages:
1. Warning stage In every situation a warning period exist. The warning stage can extend from seconds to
days. This stage may provide sufficient time for preparing to handle the potential event.
- Important aspect in minimizing the loss of lives and mitigating damage.
- It is during the warning phase that disaster plans are activated, emergency operations centers are
established, and the affected area is evaluated or provided with in-place protection.
Problems during the Warning Place:
1. Communication dissemination of vital information is a problem due to lack of time
2. Doubt the community must recognize the threat as legitimate and serious
3. Adaptation frequent false alarms are likely to jeopardize future responses to warnings
2. Impact stage The primary objective is staying alive. The impact phase can last anywhere from a few
seconds or minutes (earthquake, plane crash, explosion) to a few days or weeks (floods, heat waves) to
several months (droughts, epidemics).
3. Inventory stage After the impact stage, survivors first assess the effects of the event and then identify
what must be done next. It is essential that a preliminary damage assessment be conducted to determine
emergency response priorities, needs, and limitations. This period of isolation is the interval in which
immediate mitigative actions are required to prevent additional loss of life.
4.
Rescue stage During the rescue stage, help arrives to rescue survivors and to help the injured. This
begins when the first survivors render first aid to the victims, especially their own family members and
continues through the arrival of the first local rescue organization, the establishment of a command post,
and the convergence of other local and neighboring rescue organizations.
5. Remedy stage Recovery activities are initiated during the remedy stage. The remedy stage begins with
the establishment of organized, professional, and voluntary relief operations. There is directed movement
of the injured to the hospitals. Definitive actions aimed at preventing further injuries and damages are
undertaken. This stage may last from days to weeks or even months before normal activities are resumed.
6. Recovery stage Encompasses total recovery from the impact and resulting situation. Holistic recovery
and development of adaptive behavior required to produce lasting changes.
Four Stages of the Victims emotional response:
1. Denial the victim may deny the magnitude of the problem or will understand the problem but seem
unaffected emotionally.
2. Strong emotional Response the person is aware of the problem but regards the problem as
overwhelming and unbearable. Reactions include sweating, speaking with difficulty, weeping,
restlessness, sadness, anger, passivity. The may want to retell or relive the experience over and over.
3. Acceptance begins to accept the problems caused by the disaster and makes a concentrated effort to
solve them. Feels more hopeful and confident.
4. Recovery recovery from the crisis reaction. Victims feel they are back to normal and routines become
important again. A sense of well-being is restored. The ability to make decision and carry out plans
returns.
Principles of disaster management:
Garb and Eng (1969) identified 8 basic principles of disaster management
1. Prevent the occurrence of the disaster whenever possible.
2. Minimize the number of casualties if the disaster cannot be prevented.
3. Prevent further casualties from occurring after the initial impact of the disaster.
4. Rescue the victims.
5. Provide first aid to the injured
6. Evacuate the injured to medical facilities
7. Provide definitive medical care
8. Promote reconstruction of lives
their condition so as to treat as many as possible when resources are insufficient for all to be treated
immediately.
CATEGORIES OF SEVERITY/ PRIORITIZATION