SEMINAR ON

DISASTER
NURSING

SUBMITTED TO SUBMITTED BY
Mrs Bindu K Sankar Athira PS
Asst. professor 1st year Msc nursing
Govt.college of nursing Govt.college of nursing
Thrissur Thrissur
INTRODUCTION
Disasters have been integral parts of the human experience since the beginning
of time, causing premature death, impaired quality of life, and altered health
status.. On average, one disaster per week that requires international assistance
occurs somewhere in the world. The recent dramatic increase in natural
disasters, their intensity, the number of people affected by them, and the human
and economic losses associated with these events have placed an imperative on
disaster planning for emergency preparedness. Global warming, shifts in
climates, sea-level rise, and societal factors may coalesce to create future
calamities. Finally, war, acts of aggression, and the incidence of terrorist attacks
are reminder of the potentially deadly consequences of man’s inhumanity
toward man.

The word derives from French “désastre” and that from Old Italian “disastro”,
which in turn comes from the 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 unfavourable position of the “planets” or “Act of
God”. Gradually they understand the mysteries of nature.
India has been traditionally vulnerable to natural disasters on account of its
unique geo-climatic conditions. Floods, droughts, cyclones, earthquakes and
landslides have been recurrent phenomena. About 60% of the landmass is prone
to earthquakes of various intensities; over 40 million hectares is prone to floods;
about 8% of the total area is prone to cyclones and 68% of the area is
susceptible to drought. So, nurses have an important role to play during a
disaster to save the lives and to provide healthcare to the victims.

DEFINITION
“Disaster is any occurrence that cause damage, economic destruction, loss of
human life and deterioration in health and health services on a scale sufficient to
warrant an extraordinary response from outside the affected community or area”
 - WHO (2009)
“Disaster is a serious disruption triggered by a hazard, causing human, material,
economic or environmental losses, which exceed the ability of those affected to
cope”
-UNDP (2004)
Thus, a disaster may have the following main features:- unpredictability,
unfamiliarity, speed, urgency, uncertainty, threat.
DISASTER alphabetically means:
D: Destruction
I : Incidents
S: Sufferings
A:Administrative failures
S:Sentiments
T:Tragedies
E:Eruption of communicable diseases
R:Research programme and its implementation

DISASTER NURSING

Disaster nursing is a branch of nursing practiced in a situation where

professional,
personnel, supplies, equipment, physical facilities and utilizes are limited or not
available.
Disaster nursing can be defined as the adoption of the professional nursing
skills in recognizing and meeting the nursing, physical & emotional needs
resulting from a disaster.
TYPES OF DISASTER

Based on observations from the field suggest Disasters are classified under the
two broad classifications:
 I. NATURAL DISASTER
II. MANMADE DISASTER
And On the basis of speed of onset-
-Sudden onset disasters
- Slow onset disasters
NATURAL DISASTERS
A serious disruption triggered by a natural hazard (hydro-metrological,
geological or biological in origin) causing human, material, economic or
environmental losses, which exceed the ability of those affected to cope.
Natural hazards can be classified according to their (1) hydro meteorological,
(2) geological or (3) biological origins.
Hydrometer logical disaster - Natural processes or phenomena of atmospheric
hydrological or oceanographic nature. Phenomena / Examples - Cyclones,
typhoons, hurricanes, tornados, Storms, hailstorms, snowstorms, cold spells,
heat waves and droughts.
Geographical disaster - Natural earth processes or phenomena that include
processes of endogenous origin or tectonic or exogenous origin such as mass
movements, Permafrost, snow avalanches. Phenomena / Examples -
Earthquake, tsunami, volcanic activity, Mass movements landslides, Surface
collapse, geographical fault activities etc.
Biological Disaster - Processes of organic organs or those conveyed by
biological vectors, including exposure to pathogenic, microorganism, toxins and
bioactive substances. Phenomena / Examples - Outbreaks of epidemics
Diseases, plant or animal contagion and extensive infestation etc.
Earthquake
An earthquake is the result of sudden release of energy in the earth’s crust that
creates seismic waves. Intensity of shaking a measured on the modified Mercalli
scale.
There is high level of mortality as a result of people being crushed by following
objectives:
 The risk is greater inside or near dwellings but is very small in the open.
 Earthquakes at night are more deadly. during the night fractures of pelvis,
thorax and spine are common because earthquakes strike while people are
lying in bed.
Management
1. There is the greatest need for emergency care occurring in few hours
2. Precautons: Before entering a building: Observe the construction of the
building and be careful for possible hazards, which may occur from weak
structure.
3. When entering a damaged building use helmet, listen for possible sounds
and keep calling
4. People affected need psychological support as they have lost their and near
and clear ones and property also.

Volcanic Eruptions
Volcano is an opening, or rupture, is a planet’s surface or crust, which allows
magma, ash and gases to escape from below the surface. The word volcano is
derived from the name of Volcano Island off Sicily, which in turn was named
after Vulcan, the Roman god of fire. Mortality is high in the case of mudslides
(23,000 deaths in Colombia in 1985) and glowing clouds there may be injuries,
burns and suffocation.
Floods
Mortality is high only in case of sudden flooding. Bangladesh is a riverine
country, where recurrent flooding is both common and necessary. Most
vulnerable things which are affected due to floods are homes, buildings, and
huts made from bio-mas materials like bamboo leaves.
E.g: flash floods, collapse of dams or tidal waves fractures, injuries and bruises
may occur, if whether is cold, cases of accidental hypothermia may occur.
Management
1. Warming should be given through proper media
2. Research should be sent to safe areas
3. Proper treatment must be done for injuries.

Cyclone and Hurricanes

This is usually characterised by inward spiralling winds that rotate counter
clock wise in the northern hemisphere and clock wise in the southern
hemisphere of the earth. The largest low pressure systems are cold core polar
cyclones and extra tropical clones which lie on the synoptic scale. Mortality is
not high unless tidal waves occur. The combined effect of wind rain may cause
houses to collapse.
A large number of objects may be lifted in the air and carried along with the
wind. This may give risk to injuries.
Management
1. Warning should be given through proper media
2. Research should be sent to safe areas
3. Proper treatment must be done for injuries

Droughts
A droughts is an extended period of months or years when a region notes
deficiency in its water supply. This phenomenon usually accompanied by
regional malnutrition, starvation and epidemic. Mortality may increase
considerably in areas where drought cause famines in which case there may be
protein-caloric malnutrition and vitamin deficiencies.
Biological Warfare
It is a purposeful contamination of food, drinking water and clothing is carried
out by the enemies. This causes the suffering of both soldiers and the public
with all kinds of communicable diseases, malaria, food poisoning, other water
borne diseases like plaque, typhoid, paratyphoid, etc.
Fires
A wildfire is any uncontrollable fire that occurs in the country side or
wilderness area.Other names such as brush fire, forest fire, grass fire, hill fire,
and wild and land fires. A wild fire differs from the fires by its extensive size,
the speed at which it can spread out from its original source, and its ability to
change direction unexpectedly and jump gaps, such as roads, rivers and fire
breaks.

MANMADE DISASTER
These include technical disasters like dam failure, nuclear accidents, hazardous
waste accidents, oil spills and leakages. Social disasters like mass -migration,
riots etc.
A serious disruption triggered by a human-induced hazard causing human,
material, economic or environmental losses, which exceed the ability of those
affected to cope. These can be classified into – (1) Technological Disaster and
(2) Environmental Degradation.
Technological disaster - Danger associated with technological or industrial
accidents, infrastructure failures or certain human activities which may cause
the loss of life or injury, property damage, social or economic disruption or
environmental degradation, sometimes referred to as anthropological hazards.
Examples include industrial pollution, nuclear release and radioactivity, toxic
waste, dam failure, transport industrial or technological accidents (explosions
fires spills).
Environmental Degradation - Processes induced by human behaviors and
activities that damage the natural resources base on adversely alter nature
processes or ecosystems. Potentials effects are varied and may contribute to the
increase in vulnerability, frequency and the intensity of natural hazards.
Examples include land degradation, deforestation, desertification, wild land fire,
loss of biodiversity, land, water and air pollution climate change, sea level rise
and ozone depletion.

 Minor disasters involving approximately 25 victims

 Moderate disasters involving approximately 100 victims
 Major disaster involving more than 100 victims
 Warfare: conventional warfare (bombardment, blockade and siege)non-
conventional warfare (nuclear, chemical and biological).
 Civil disasters: riots and demonstration.
 Accidents: transportation (planes, trucks, automobiles, trains and ships);
structural collapse (building, dams, bridges, mines and other structures);
explosions and fires.
 Technological failures: A mishap at a nuclear power station, leak at a
chemical plant causing pollution of atmosphere or the breakdown of a
public sanitation.
 Chemical weapons: Chemical emergency occurs when hazardous
chemical has been released and the release has potential for harming
people’s health
 War: In all wars the groups experiencing the need to dominate other
groups are unable and unwilling to accept or permit the possibility of
relationship of fundamental equality to exist between the groups who
have opted for group violence.
Disaster Classification
 Water and climate-related disasters
 Floods
 Cloud burst
 Sea erosion
 Tsunami
 Cyclones
 Droughts
 Thunder and lightning

 Geologically related disasters

 Earthquakes
 Mine fires
 Dam failures
 Chemical industrial and nuclear
 Chemical and industrial disasters
 Nuclear disasters
 Accident ~-related disasters
 Forest fires
 Flooding
 Air, road and rail accidents
 Urban fires
 Serial bomb blasts
 Electrical disaster
 Biologically related disasters
 Biological disasters and epidemics
 Cattle epidemics
 Food poisoning

DISASTER AGENTS/EPIDEMIOLOGY OF DISASTER AGENTS

PRIMARY AGENTS
 Falling of buildings
 Earthquakes
 Floods
 Hurricanes
 Bomb blasts
  Tsunami
 Automobile accidents
 Epidemic outbreaks
 Draughts
SECONDARY AGENTS :Bacteria and viruses that produces contamination
or infection after primary agent has caused injury or destruction.It would be
include damaged buildings and bacteria or viruses that thrives as a result of the
disaster.
HOST FACTORS
 Age
 Immunisation status
 Degree of mobility
 Emotional stability
ENVIRONMENTAL FACTORS
 PHYSICAL FACTORS: Weather conditions, the availability of foods,
tame when the disaster occurs, the availability of water and functioning of
utilities sack as electricity and telephone services.
 CHEMICAL FACTORS: It includes leakage of store chemicals in to
the air, soil groundwater or food supplies. E.g.: Bhopal gas tragedy

LEVELS OF DISASTER

Goolsby and Kulkarni (2006) further classify disasters according to the

magnitude of the disaster in relation to the ability of the agency or community
to respond. Disasters are classified by the following levels:
1) Level I: If the organization, agency, or community is able to contain the
event and respond effectively utilizing its own resources.

2) Level II: If the disaster requires assistance from external sources,

but these can be obtained from nearby agencies.

3) Level III: If the disaster is of a magnitude that exceeds the capacity

of the local community or region and requires assistance from state-level
or even federal assets.
KEY ELEMENTS OF DISASTERS

Disasters result from the combination of hazards, conditions of

vulnerability and insufficient capacity or measures to reduce the potential
negative consequences of risk.

Hazards

Hazards are defined as “Phenomena that pose a threat to people,

structures, or economic assets and which may cause a disaster. They
could be either manmade or naturally occurring in our environment.”

Hazard is a potentially damaging physical event, phenomenon or human

activity that may cause the loss of life or injury, property damage, social
and economic disruption or environmental degradation. (UN ISDR 2002)

Vulnerability

Vulnerability is the condition determined by physical, social, economic

and environmental factors or processes, which increase the susceptibility
of a community to the impact of hazards. (UN ISDR 2002)

Capacity

Capacity is the combination of all the strengths and resources available

within a community, society or organization that can reduce the level of
risk, or the effects of a disaster. Capacity may include physical,
institutional, social or economic means as well as skilled personal or
collective attributes such as 'leadership' and 'management.' Capacity may
also be described as capability. (UN ISDR 2002)

Risk

Risk is the probability of harmful consequences, or expected losses

(deaths, injuries, property, livelihoods, economic activity disrupted or
environment damaged) resulting from interactions between natural or
human-induced hazards and vulnerable conditions. (UNDP 2004)

Risk is conventionally expressed by the equation:

Risk = Hazard x Vulnerability

Some professionals use the notation:

Risk = (Hazards x Vulnerability) - Capacity

They identify capacity as an element that can drastically reduce the

effects of hazards, and vulnerabilities and thus reduce risk.

For example, an earthquake hazard of the same magnitude in a sparsely

populated village of Rajasthan and in the densely populated city of Delhi
will cause different levels of damage to human lives, property and
economic activities.

GOALS OF THE DISASTER NURSING

The overall goal of disaster nursing is to achieve the best possible level of
health for the people and the community involved in the disaster.

Other goals of disaster nursing are the following:

1. To meet the immediate basic survival needs of populations affected

by disasters (water, food, shelter, and security).

2. To identify the potential for a secondary disaster.

3. To appraise both risks and resources in the environment.

4. To correct inequalities in access to health care or appropriate

resources.

5. To empower survivors to participate in and advocate for their own

health and well-being.

6. To respect cultural, lingual, and religious diversity in individuals

and families and to apply this principle in all health promotion activities.

7. To promote the highest achievable quality of life for survivors.

PRINCIPLES OF DISASTER NURSING

The basic principles of nursing during special (events) circumstances and
disaster conditions include:

1. Rapid assessment of the situation and of nursing care needs.

2. Triage and initiation of life-saving measures first.

3. The selected use of essential nursing interventions and the

elimination of nonessential nursing activities.

4. Adaptation of necessary nursing skills to disaster and other

emergency situations. The nurse must use imagination and
resourcefulness in dealing with a lack of supplies, equipment, and
personnel.

5. Evaluation of the environment and the mitigation or removal of any

health hazards.

6. Prevention of further injury or illness.

7. Leadership in coordinating patient triage, care, and transport during

times of crisis.

8. The teaching, supervision, and utilization of auxiliary medical

personnel and volunteers.

9. Provision of understanding, compassion, and emotional support to

all victims and their families.

HEALTH EFFECTS OF DISASTERS

The health effects of disasters may be extensive and broad in their

distribution across populations. In addition to causing illness and injury,
disasters disrupt access to primary care and preventive services.
Depending on the nature and location of the disaster, its effects on the
short- and long-term health of a population may be difficult to measure.

Disasters affect the health status of a community in the following ways: -

 · Disasters may cause premature deaths, illnesses, and injuries in the
affected community, generally exceeding the capacity of the local health
care system.

· Disasters may destroy the local health care infrastructure, which

will therefore be unable to respond to the emergency. Disruption of
routine health care services and prevention initiatives may lead to long-
term consequences in health outcomes in terms of increased morbidity
and mortality.

· Disasters may create environmental imbalances, increasing the risk

of communicable diseases and environmental hazards.

· Disasters may affect the psychological, emotional, and social well-

being of the population in the affected community. Depending on the
specific nature of the disaster, responses may range from fear, anxiety,
and depression to widespread panic and terror.

· Disasters may cause shortages of food and cause severe nutritional

deficiencies.

· Disasters may cause large population movements (refugees)

creating a burden on other health care systems and communities.
Displaced populations and their host communities are at increased risk for
communicable diseases and the health consequences of crowded living
conditions.

PHASES OF A DISASTER

There are three phases of 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 earliest possible warning is crucial in preventing toss of life and minimizing
damage. This is the period when the emergency preparedness plan is put into
effect emergency centers are opened by the local civil, detention authority.
Communication is a very important factor during this phase; disaster personnel
will call on amateur radio operators, radio and television stations.

The role of 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.

The impact phase may last for several minutes (e.g. after an earthquake, plane
crash or explosion.) or for days or weeks (eg in a flood, famine or epidemic).

The impact phase continues until the threat of further destruction has passed and
emergency plan is in effect. 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 and ends with the return of
normal community order and functioning. For persons in the impact area this
phase may last a lifetime (e.g. - victims of the atomic bomb of Hiroshima). 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. The victims may appear usually
unconcerned.

2. Strong Emotional Response - in the second stage, the person is aware of

the problem but regards it as overwhelming and unbearable. Common reaction
during this stage is trembling, tightening of muscles, speaking with the
difficulty, weeping heightened, sensitivity, restlessness sadness, anger and
passivity. The victim may want to retell or relieve the disaster experience over
and over.

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.
It is important for victims to take specific action to help themselves and their
families.

4.Recovery - The fourth stage represent a recovery from the crisis reaction.
Victims feel that they are back to normal. A sense of well-being is restored.
Victims develop the realistic memory of the experience.

DISASTER MANAGEMENT

Principles of Disaster Management

SANDFORD in 1984 listed pnnciples of disasi«r management. They ae

1. Prevent the occurrence of disaster whenever possible
2. Minimize the number of casualues if the disaster cannot be prev ented
3. Prevent further casualties from occurnng after imtal impact of the disaster
4. Rescue the victims
5. Evacuate the injured to the medical facilities
6. Provide definitive medical care
7. Promote reconstruction of resources

STAGES OF DISASTER MANAGEMENT

Preparedness

/ a / Mitigation DISASTER Response IMPACT ” wd Recovery -~_.

4 DISASTER M ANAGEMENT PHASES

1. MITIGATION
2. PREPAREDNESS
3. RESPONSE
4. RECOVERY PHASE
MITIGATION
It means prevent a disaster or emergency; minimize the vulnerability to effects
of an event. It includes any of the activities that prevent disaster, reduces the
chance of disaster happening or reduce the damaging the effects of unavoidable
disaster.
Mitigation complements the disaster preparedness and disaster response
activity. It includes appropriate planning, reduction or protection of vulnerable
population and structures etc.
Emergency prevention and mitigation involves measures designed either to
prevent hazards from causing emergency or to lessen the likely effect of
emergencies.These measures include:
1. Flood mitigation works
2. Appropriate land use planning
3. Improved building codes
4.Reduction or protection of vulnerable population and structures.

In most cases mitigation measures aim to reduce the vulnerability of the

system.Medical casualties can be drastically reduced by improving the
structural quality of houses, schools, and other public and private buildings.
Although mitigation in these sectors has clear health implications, the direct
responsibility of the health sector is limited to ensuring the safety of health
facilities and public health services, including water supply and sewerage
systems. When water supplies are contaminated or interrupted, in addition to the
social cost of such damage, the cost of rehabilitation and reconstruction are
severely strains the economy. Mitigation complements the disaster preparedness
and disaster response activities.
DISASTER PREPAREDNESS

Assure capability to respond effectively to disaster. It is a continuous process

Objective of the disaster preparedness is to ensure that appropriate systems
procedures and resources are in place to provide prompt effective assistance to
disaster victim. It involves the following elements:
1. Education & training of health personnel
2. Evaluate the risk of the country or particular region to disaster
3. Organize communication, information and warming system
4. Adapt measures to ensure that financial and other resources are available
for increased readiness and can be mobilized in disaster situation.
Recent Trends Shift From Disaster Response To Disaster Preparedness

The UN General Assembly Resolution of 1989 launched the international

decade for National Disaster Reduction (IDNDR 1992-2000) that effectively set
the trends in shifting the .focus of attention from the rescue and relief to
preparedness and mitigation
Personal Preparedness
The nurses assisting in disaster relief efforts must be as healthy as possible both
mentally and physically. Personal and family preparation can help some of the
conflicts that arise and will allow nurses to attend to clients need sooner than
one may anticipate.
Professional Preparedness
 It requires that the nurses become aware of and understand the disaster
plans at their work place and community. Nurses who take disaster
preparation seriously will take the time to read and understand workplace
and the community disaster plans and will participate in disaster drill.
Personal items that are recommended for any nurse preparing to help in a
disaster include the following:
 a copy of their professional license
 personal equipment, such as stethoscope
 a flashlight and extra batteries
 cash
 warm clothing or heavy jackets (or weather appropriate clothing)
 record keeping materials
 pocket sized reference books
It is recommended that all workers be certified in first aid and cardiopulmonary
resuscitation
Community Preparation
The level of the community preparedness for a disaster is only as good people
and organization in the community make it. The community should have a solid
disaster plan on paper and participation in the disaster drills. A solid disaster
plan requires the multidisciplinary talents, coordination and cooperation of
many different organization

RESPONSE PHASE
The response phase begins immediately after the onset of the disastrous event.
Activities during this phase include:
1.Rescue
2.Triage
3.Onsite stabilization
4.Transportation of victim
 5.Treatment at local hospital
6.Supportwe Care-Food, water, shelter

SEARCH, RFSCUE, FIRST AID

After a mayor disaster, the need for search, rescue, first aid 1s likely to be so
great that organized relief services will be able to meet only a small fraction of
the demand. Most immediate help comes from the injured survivors.
TRIAGE

Triage is a French word meaning-“categorizing”. The principle of “first come

firs treated’ is not followed but according to the severity of injury and likely
hood of survival care is provided When several injured persons are received at
the same time in the incident triage is initiated,
Triage means picking, sorting, and choice.
Triage means: when several people are involved in the same accident, the
patients with certain conditions or injuries are sorted out or picked up and
separated into priorities.
Aims
At separating the victims into those who are so hopelessly (injured) and require
urgent treatment and those whose injuries do not immediately endanger the life
or organ.
Priorities Of Treatment
immediate Priority
Airway, breathing, restoration of blood volume and arrest of bleeding.
Urgent
Relief of cerebral compression, assisted respiration if relief of obstruction and
or embarrassed mechanisms of breathing has proved.
High Priority
Laprotomy and thoracotomy for internal injuries. Exploration of mayor blood
vessels or organs.
Later Priority
Fractured long bones injuries to joints, tendons, lacerations.
Immediate aftercare
» Continued care for fractures
» Wounds
» Burns
» Infections
The Four Color Code System
Red: It indicates first priority treatment or transfer. Immediate injuries are life
threatening but survival with minimal intervention e.g. asphyxia, shock,
hemothorax etc.
Yellow: Delayed, injuries are significant and require medical care, but can wait
hours without threat to life. Eg. soft tissue injury with collateral circulation,
abdominal injury,fracture
Green: Injuries are minor and treatment can be delayed hours to days. E.g.
minor injury, minor burn, sprain etc.
Black: It indicates dead or morbid patients. Injuries are extensive and chances
of survival are unlikely even definitive care. E.g. profound shock with injury,
multiple organ wounds, spinal cord injury etc.The local health should be taught
the principles of triage as part of disaster training and should be carried out at
site of disaster.

TAGGING
All patients should be identified with tags stating their name, age, place of
origin,
triage category, diagnosis and initial treatment.
IDENTIFICATION OF DEAD
Taking care of the dead is an essential part of the disaster management. A large
number of dead can impede the efficiency of the rescue activities at the site of
the disaster,
Care of the dead includes:
1.removal of the dead from the disaster scene
 2. shifting to mortuary
3.identification
4. reception of bereaved relatives
if human bodies contaminate streams, wells or other water sources as in floods,
they may transmit gastroenteritis or food poisoning to survivors. The dead
bodics represent a delicate social problem.

STABILIZATION & TRANSPORTATION

Triage should be carried out at the field only. Patient should be treated by
following triage principle and transportation to central facilities to be done as
soon as possible.

RECOVERY PHASE
This means restore systems to functional level. This phase begins when
communities start the process of healing, reconstruction and rehabilitation
optimally restores the community to pre disaster condition. It is the time for
evaluation and reflection by disaster team member and community officials.
Prevention and control of communicable disease, nutrition, and vaccination are
some relief work

REHABILITATION

The final phase of disaster should lead to restoration of the pre-disaster

condition. Rehabilitation starts from every first moment of a disaster. Too often
measures decided in hurry, tends to obstruct re-establishment of normal
conditions of life. In the first week after the disaster, the pattern of health needs,
will change rapidly, moving from casualty treatment to more routine primary
health care. Services should be reorganized and restructured. priorities also will
shift from health care towards environmental health measures. Some of them
are as follows:
Water supply: survey of all public water supplies should be made. this includes
distribution system and water source. the main public safety aspect of water
quality is the microbial contamination. The first priority is chlorination,the best
way of disinfecting water. It is advisable to increase residual chlorine level to
about 0.2-0.5 mg/liter
Nutrition:The immediate steps for ensuring that the food relief program will be
effective include:
a. Assessing food supply after disaster.
b. Gauging the nutritional needs of the affected population.
c. Calculating daily food rations and need for large population groups
d. Monitoring nutritional status of affected people.
Food Hygiene: Poor hygiene is the main cause of food-borne diseases in
disaster situation. Personal hygiene should be monitored in individuals involved
in food preparation
Basic Sanitation & Personal Hygiene: Many communicable diseases spread
through fecal transmission. So every measure is to be taken to ensure the
sanitary disposal of excreta. Emergency latrine should be made available to
displaced, where toilet facilities have been destroyed. Washing, cleaning and
bathing facilities should be provided to the displaced person.
Vector Control: Control program me for vector borne diseases should be
intensified in the emergency and rehabilitation period, especially in areas where
such diseases are known to be endemic. Of special concern are dengue fever
malaria, plague, typhus. Flood water provides ample breeding opportunities for
mosquitoes.

EPIDEMIOLOGIC SURVEILLANCE AND DISEASE CONTROL:

Disasters can increase the transmission of communicable disease through
following mechanisms:
1. Overcrowding and poor sanitation in temporary resettlements.
2. Population displacement may lead to introduction of communicable diseases.
3. Disruption of water supply, damage to sewerage system.
4. Disruption of routine control programmes as funds and personnel are usually
diverted to relief work.
5. Ecological changes favour vector breeding,
6.Provision of emergency services from different or new source may itself be a
source of infectious diseases.
RESOURCES FOR DISASTER:
 Local governments and communities
 Volunteer organizations
 State governments
 Federal governments
RESOURCE MANAGEMENT
 Personnel and supplies
 Bioethical concern
 Disaster alert and notification network
 Directing flow of traffic and patients
 De contamination
 Patient tracking
 Providing shelter
 Volunteer
 Education
 Transportation
HOSPITAL DISASTER PLAN
The hospital is an integral part of the society and it has great role to play in the
disaster management. Every hospital big or small, public or private has to
prepare a disaster plan, and must learn to activate the disaster plan at the hour of
need. Disasters in the hospital perspective can be grouped into two categories:
1. Internal Hospital disasters like fire, building collapse, terrorism, etc
2. External disasters like earthquakes, floods, etc

OBJECTIVES OF HOSPITAL DISASTER PLAN

1. Preparedness of staff, optimizing of resources and mobilization of the
logistics and supplies within short notice
2. To make community aware about the hospital disaster plan and benefits of
plan
3. Training and motivation of the staff
4. To carry out mock drills
5. Documentation of the plan and making hospital staff aware about the various
steps of the plan
DESIGNING OF HOSPITAL DISASTER PLAN
Disaster Management Committee
The hospital disaster management committee is the decision making body for
formulation of the policy and plan for disaster management. It constitutes the
following members.
 Director of the hospital
 HOD of accidents and emergency services
 Nursing superintendent
 Hospital administrator
 Representatives of the staff
Functions Of The Disaster Management Committee
The functions of the committee are:
 To prepare a hospital disaster plan for the hospital
 To prepare departmental plan in support of the hospital plan
 Assign duties to the staff Establishment of criteria for emergency care
 To conduct, supervise and evaluate the training programs
 Updating of plans as need arises
 To supervise the mock drills
 Organize community awareness programs, through mass media
 Assist in information, education, and communication (IEC) programs
in respect of the disaster preparedness, prevention and management.
ROLE AND FUNCTIONS
The effective implementation of the programme will depend upon clarity of
the plan, role and functions of the different members and the staff. They are :
Disaster coordinator: the coordinator role will be:
 Organizing
 Communicating
 Assigning duties
 Deployment of staff
 Taking key decisions

Nursing superintendent :
Medical staff: specific role of rendering medical care both pre-hospital and
hospital care

Nursing staff: nursing care and support critical care

Important Departments

The important department of the hospital have to play a key role in the disaster

Management.

> Accident and emergency department

> Operating department

> Dietary department

> Housekeeping Services

> Medical records Public relations Communications

Transportation

Mortuary

Engineering department Security and safety services

>>

>

>

> Medic-social worker >

>

> Media relations

DISASTER NURSING The adaptations of professional nursing knowledge

,skills and attitudes in recognizing

and meeting the nursing and medical needs of disaster victims.

Roles and responsibilties of a Disaster nurse

ental hazards. D: Disseminate information on the prevention and control of

environm

I: Interpret health laws and regulations S: Serve yourself of self -survival A:

Accept directions and take orders from an organised authority S: Serve as the
best of the MOST T: Teach the meaning of warning signals E: Exercise
leadership R: Refer to appropriate agencies NURSES ‘S RESPONSIBILITIES
IN DISASTERS
1. Prevention and mitigation

Disaster planning is essential for a community ,buisness or a hospital.It involves

thinking about details of preparation and management by all involved including
community leaders ,health and saftey professionals and lay people.A disaster
plan need not be lengthy.

2. Personal preparation

3. Professional prepardeness

> There should be disaster management team of nurse,psychiatric nurses,

physician,surgeon,social workers and psychologists. > The disasters which are
not preventable,their impact can be mitigated by

public education to the people stayingin disaster prone areas.

>» Community health nurses is uniquely qualified to perform a community

assessment for risk factors that inay contributes to disasters. Gather information
through

Shelter management

Although voluntry health agencies take careof shelter managementbut the

nurses because of their comfort with delivering aggregate health promotion
,disease promotion and emotional support make ideal shelter management as a
team member.

6. Dealing with stress

Basic measures while working with victims dealing with stress includes,
listening carefully to the victims, and telling and retelling their feelings related
to

disaster.

7. Establishing authority, communication and transportation The effective

disaster plan establishes a clear chain of authority, develops lines of
communication and delineates routes of transport. For example, at the local
hospital, the hospital administrator may be responsible for alerting the nurse
manager to call in additional personnel.

8. Warning and evacuating

Disaster plan must be specify the means of communicating warning to public,

as well as the precise information that should be included in warning.

9. Responding to disaster At the disaster site,police,fire-fighters,nurses,and

other relief workers develop

a coordinative response to rescue, triage and disaster victims.

10. Immediate treatment and support ‘N

Disaster nurses provide treatment on site at emergency treatment stations, in

shelters or at local hospitals and clinics. In addition to direct nursing care, onsite

interventions might include arranging for transport once victims are stabilized
and
managing the procurement, distributions and replenishment of all supplies.

11. Care of bodies and notification of families

Identification and transport of the dead bodies should be done. Records of

deaths must be made and maintained and family members should be notified of
their loved ones deaths as quickly and compassionately as possible.

12. Recovery phase > The main objective of disaster management is in this
stage is to involve all agencies and resources to restore the economic and civil
life of community.

> The nurse need to be alert for environmental health hazards during recovery

phase of disaster.

> All the nurses and organizations in the world can only provide partnership

with the victim of disaster.

ROLE OF NURSE

The nursing disaster plan should have features such as

1. Simple, Understandable 2. Flexible 3. Clear, Concise 4. Adaptable 5.

Over Time
ROLE OF NURSE IN DISASTER

1.

Helping patient to maintain a safe environment and advocating for

environmental safety in community.

The nurse must her unique ability of motivating communities in planning for
disaster relief efforts and addressing problem that occur during a disaster.

The nurse must be alert for environmental health hazards during the recovery
phase of

a disaster

In recovery phase, if the nurse finds any critical case, she should refer to higher
medical centre and facility wherever possible

Health education on maintaining good hygiene habit, services available at

disaster centres, , stress reducing factors and technique , and psychological
support must be given

Nurse have a unique skills for assisting communities in planning for disaster
relief

efforts and addressing problems that occurs during disaster.

Management and Triage at the Disaster Site

A disaster scene is one of the most challenging environments in which the
nurses have

to practice. There are other challenges such as hazardous environment,

miscommunication,

lack of medical /rescue equipment, lack of proper leadership, inappropriate

patient care and

improved use of personnel.

To assure the safety of personnel and patients To organize an effective disaster

system

To deliver appropriate patient care

Safety Assurance

All disaster personnel should have, as their foremost considerations, the

protection of:

© Themselves ® Ther follow workers

e Their patients Organizing an Effective Disaster System

The nurse must be familiar with personnel at the disaster scene and their roles
and

functions. In addition she much understand the organizing of the site. A disaster
scene is
usually broken up to three zones. DISASTER ZONES: It is the actual location
of the incident from where patients are to be removed as soon possible.

TREATMENT ZONE: Nurses spend most of their time in this zone during a
disaster.

Where equipment and personnel to carry out patient care. Activities carried out
in this zones are:

Triage of patients into treatment categories

Through assessment of each patient

» Treatment of injuries

>» Preparation for transport

TRANSPORTATION ZONE: It should be situated directly next to the

treatment zone, so

that ambulances and other vehicles can load patients and leave from hospitals.

DISASTER MANAGEMENT IN INDIA India 1s the vast country, with 24% of

worlds land mass and 15% of world's
pepulanon The common natural disasters seen in India are:

1 Floods. India is one of the most flood prone countries in the world. About 9
milhon

hectares are attected by flood every year.

2. Earth quake Cyclones: India has a very long coast line of 5700 kilometres,
which is vulnerable to

‘od

tropical cyclones arising in the Bay of Bengal and Arabian Sea.

Manmade disasters-Bhopal gas tragedy on 3 December 1984 when chemical

gases

leak killed 2500 people.

NATIONAL LEVEL In the federal setup both the central and state governments
share the responsibility for

disaster management. The basic role of the central government is supportive in

providing information, financial, technical and material support. Contingency
action plan for natural

calamities issued by the ministry of health and home affairs government of

India is the basic
document guiding the disaster management in India. This document provides a
policy

statement and response mechanism.

STATE LEVEL

The policies, organisational structure and functions at central government level

are reflected in the state government. There is no standard organisation, policies
or functional arrangements. As each state government has its own organization
patterns and policies. The

primary responsibility of disaster managerrent of state government is relief

operations,