Disaster Nursing

Objectives
• Define a disaster
• Discuss patterns of mortality and injury
• Understand the impact of disasters on health
• Describe the factors that contribute to disasters severity
• Discuss role of nursing in disasters
• Apply principles of triage in disaster
• Analyze the WHO components of disaster nursing
 What is disaster?
• Is a result of vast ecological breakdown in
the relation between humans and their
environment, a serious or sudden event
that the stricken community needs
extraordinary efforts from outside help or
international help to cope with the
devastation.
 The United Nation Office for
Disaster risk reduction
• Defines disaster as a serious disruption of
the functioning of community or society
involving human, material, economic or
environmental losses and impacts, which
exceeds the ability of the affected
community and society to cope using its
own resources.
What are the types of
disaster?
 Types of Disasters
• Natural

• Man-made

• Natural Hazards Triggering Technological Disasters’ or

Natech refers to the interaction between natural
disasters and industrial accidents. Natech accidents
are technological side effects of natural disasters.
 Natural
• Typhoons
• Primary health hazard lies in the risk of drowning from
the storm surge associated with the landfall of the
storm.
• Most deaths associated with Typhoons are drowning
deaths.
 Natural
• Typhoons
• 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.
• Ex. Cardio Pulmonary Resuscitation, Wound dressing.
 Floods
• Floods may originate very quickly after a rain storm, or
they may develop over a short period following an
extended period of rain.
• The primary hazard from flooding is drowning.
• The longer term health concerns are development of
diseases from contaminated water and lack of hygiene.
 Tornadoes
• Primary hazard is also 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
structural collapse.
• May be injured while on the ground or lifted into the air
and dropped at a different location.
 Earthquakes
• A significant global concern
• The primary health concerns are injuries arising from
structural collapse
• Most injuries occur amongst individual trapped at the
time of the earthquake.
• Well known prevention strategy is to prevent the
buildings from collapsing with “Earthquake resistant
materials”
 Earthquake Magnitude Scale
• Magnitude Earthquake Effects

• 2.5 to 5.4 Often felt, but only causes minor

damage.

• 5.5 to 6.0 Slight damage to buildings and other

structures.

• 6.1 to 6.9 May cause a lot of damage in very

populated areas.

• 7.0 to 7.9 Major earthquake. Serious damage.

Tsunami
• A tsunami is a series of waves in a water body
caused by the displacement of a large volume of
water, generally in an ocean or a large lake.
Earthquakes, volcanic eruptions and other
underwater explosions above or below water all
have the potential to generate a tsunami.
• Main health concern is drowning due to being
engulfed by the strong waves
Volcanic eruptions
 Volcanic eruption
• Rare, but can catastrophic when they occur.
• Health concerns are:
• Respiratory illnesses from inhalation of ash also known
as Pneumonoultramicroscopicsilicovolcanoconiosis or
for its shorter term as silicosis. Exposure to particles
causes permanent lung scarring.
• For individuals close to the volcano, some danger exists
from lava flows as shown in the next two slides
 Man-made threat
• Explosives- Materials that can cause massive explosions

• Fire/arson

• Biological Terrorism- intentional release of viruses,

bacteria, or other germs that can sicken or kill people,
livestock, or crops.

• Biochemical terrorism- intentional release of , harmful

chemicals that can sicken or kill people, livestock, or
crops.
Man-made threat

• Transportation

• Chemical spills

• Acts of war.
 Competencies for Registered
Nurses responding to mass
casualty incidents
• a. Critical thinking assessment
• The ability to analyze the situation to better respond
to an emergency/ life-threatening circumstance.
• b. Technical skill
• Specialized knowledge and expertise needed to be
performed in an emergency. Life saving techniques
such as CPR, wound dressing, etc.
• c. Communication
• Proper and tactful communication to victims, and
other members of the disaster response team.
Nursing role in Mass Casualty
Incidents
• It includes to determining the magnitude
of the event, define & understand the
health needs of the affected groups,
prepare the priorities and objectives,
Identify actual and potential public health
problems at the earliest & estimate
resources needed to respond to the needs
Natural Hazards Triggering
Technological Disasters’ or Natech
• Refers to the series of unwanted interaction between
natural disasters and industrial accidents. Natech
accidents are technological side effects of natural
disasters: a natural disaster leads to a cascading
technological disaster, accumulating its consequences.
• Multi-hazard: earthquake, lighting, forest fire,
landslides, flooding, lightning
• Equipment-specific: pipelines; LPG tanks; categories of
buildings; nuclear power plant
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
Phases of a Disaster
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.
Phases of a Disaster
• POST – IMPACT PHASE
• Recovery begins during the emergency phase
ends with the return of normal community order
and functioning.
 Patterns of Mortality and
Injury
• Disaster events 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
• The risk of injury and death is much higher in
developing countries- at least 10 times higher
because of little preparedness, and poorer
infrastructure.
 DISASTER MANAGEMENT
CYCLE
• RESPONSE The response phase is the actual implementation of the
disaster plan. response activities need to be continually monitored
and adjusted to the changing situation. • A hospital, healthcare
system, or public health agency take immediately during, and after a
disaster or emergency occurs.
• RECOVERY Once the incident is over, the organization and staff needs
to recover. Invariably, services have been disrupted and it takes time
to return to routines. • 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
• Evaluation/ Development Often this phase of disaster planning and
response receives the least attention. After a disaster, employees and
the community are anxious to return to usual operations. It is
essential that a formal evaluation be done to determine what went
well (what really worked) and what problems were identified. A
specific individual should be charged with the evaluation and follow-
through activities.
 DISASTER MANAGEMENT
CYCLE
• Mitigation These are steps that are taken to lessen the impact of a
disaster should one occur and can be considered as prevention and
risk reduction measures. Examples of mitigation activities include
installing and maintaining backup generator power to mitigate the
effects of a power failure
• Preparedness/Risk assessment Evaluate the facility’s vulnerabilities
or propensity for disasters. Issues to consider include: weather
patterns; geographic location; expectations related to public events
and gatherings; age, condition, and location of the facility; and
industries in close proximity to the hospital (e.g., nuclear power plant
or chemical factory)
What is triage?
• From French verb “Trier” means to sort
• Assigns priorities when resources are limited
• Do the best for the greatest number of patients
 Triage
• 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”
 Triage
• 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”
 Triage
• 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”
 Triage
• 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”
 The victims of disaster in goes
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.
• 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.
 Mental Wellness
• 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. Ex play area
• In any major disaster people are distressed because of
missing loved one, nurses can assist in making links.
Ex. Social media.
• In case of loss, people need to mourn:
• Give them space
• Allow verbalization of feelings and emotions
• Try to assist to look for family/friends for encouragement
and support.