Natural Disaster

Heat WaVe
Mortality and morbidity rise when
daytime temperatures remain unusually high several
days in a row and nighttime temperatures do not
drop significantly.
Deaths occur more commonly during heat waves
where there is little cooling at night, and taper off
to baseline levels if a heat wave is sustained
(Federal Emergency Management Agency [FEMA],
2006b).
Risk of Morbidity and
Mortality
Heat kills by pushing the human body beyond its limits.
The heat index (HI) is the temperature the body feels when heat and
humidity are combined.
Most heat disorders occur because the victim has been overexposed to
heat or has over-exercised for his or her age and physical condition.
Other conditions that can induce heat-related illnesses include stagnant
atmospheric conditions and poor air quality (FEMA, 2006b).
Adverse health outcomes associated with high environmental
temperatures include heatstroke, heat exhaustion, heat syncope, and heat
cramps.
Heatstroke: is the most serious of these conditions and is characterized by
rapid progression of lethargy, confusion, and unconsciousness; it is often
fatal despite medical care directed at lowering body temperature.
Heat Syncope and Heat Cramps: usually related to physical exertion during
hot weather.
PREVENTION:
Basic behavioral and environmental measures are essential for
preventing heat-related illness and death. Personal prevention strategies
should include increasing time spent in air-conditioned environments,
intake of nonalcoholic beverages, and incorporation of cool baths into a
daily routine.
Sun exposure should be minimized, and light, loose, cotton clothing
should be worn.
NURSES ROLES:
Nurses and other health care providers can assist in preventing
heat-related illnesses and deaths by disseminating community
prevention messages to persons at high risk (e.g., the elderly
and persons with preexisting medical conditions) using a variety
of communication techniques.
CYClONes aND HurriCaNes
Cyclones are large-scale storms characterized by low pressure in the
center surrounded by circular wind motion.
A hurricane is a tropical storm with winds that have reached a constant
speed of 74 miles per hour or more. Hurricane winds blow in a large
spiral around a relatively calm center known as the eye. The eye is
generally 20 to 30 miles wide, and the storm may extend outward 400
miles.
A distinctive characteristic of hurricanes is the increase in sea level,
often referred to as storm surge. This increase in sea level is the
result of the low-pressure central area of the storm creating suction,
the storm winds piling up water, and the tremendous speed of the
storm. Rare storm surges have risen as much as 14 meters above
normal sea level.
Risk of Morbidity and
Mortality
Deaths and injuries from hurricanes occur because victims fail
to evacuate the affected area or take shelter, do not take precautions
in securing their property, and do not follow guidelines on food and
water safety or injury prevention during recovery (FEMA, 2006f).

Nurses need to be familiar with the commonly used definitions for

severe weather watches and storm warnings in order to assist with
timely evacuation or finding shelter for affected populations
Morbidity during and after the storm itself results from drowning, electrocution,
lacerations, or punctures from flying debris, and blunt trauma or bone
fractures from falling trees or other objects.
Heart attacks and stress-related disorders can arise during the storm or its
aftermath.
Gastrointestinal, respiratory, vector-borne disease, and skin disease as well as
accidental pediatric poisoning can all occur during the period immediately
following a storm.
Injuries from improper use of chain saws or other power equipment, disrupted
wildlife (e.g., bites from animals, snakes, or insects), and fires are common.
DrOugHt
Drought affects more people than any other environmental
hazard, yet it is perhaps the most complex and least
understood of this type of event. Drought is often seen as the
result of too little rain and is often synonymous with famine.
Fluctuation in rainfall alone does not cause a famine.
The ecosystem changes leading to desertification are all attributed to
human activities, such as overcultivation, deforestation, overgrazing,
and unskilled irrigation. Each of these activities is exacerbated by
increasing human population size. The first three activities strip the
soil of vegetation and deplete its organic and nutrient content. This
leaves the soil exposed to the eroding forces of the sun and wind. The
subsoil that is left can become so hard that it no longer absorbs rain.
Risk of Morbidity and
Mortality
Morbidity and mortality can result from diarrheal disease,
respiratory disease, and malnutrition. Mortality exceeding a
baseline rate of one death per 10,000 people per day is the
index of concern.
eartHQuaKe
An earthquake, generally considered to be
the most destructive and frightening of all
forces of nature, is a sudden, rapid
shaking of the Earth caused by the
breaking and shifting of rock beneath the
Earth’s surface.
This shaking can cause buildings and bridges
to collapse; disrupt gas, electric, and
phone service; and sometimes trigger
landslides, avalanches, flash floods, fires,
andhuge, destructive ocean waves
(tsunamis).
Risk of Morbidity and
Mortality
Deaths and injuries from earthquakes vary according to the type of
housing available, time of day of occurrence, and population
density. Common injuries include cuts, broken bones, crush
injuries, and dehydration from being trapped in rubble. Stress
reactions are also common.
PREVENTION/MITIGATION
Mitigation involves developing and implementing strategies for reducing
losses from earthquakes by incorporating principles of seismic safety
into public and private decisions regarding the setting, design, and
construction of structures (i.e., updating building and zoning codes and
ordinances to enhance seismic safety), and regarding buildings’
nonstructural elements, contents, and furnishings.
ePiDeMiCs
An epidemic is an outbreak or occurrence
of one specific disease from a single
source in a group, population,
community, or geographic area, in
excess of the usual or expected level.
An epidemic exists when new cases
exceed the prevalence of a disease.
An acute outbreak—a sharp increase of
new cases that affect a significant
group—is generally considered
an epidemic (Merrill & Timmereck,
2006).
The spread of infectious disease depends on preexisting
levels of the disease, ecological changes resulting
from disaster, population displacement, changes in
density of population, disruption of public utilities,
interruption of basic public health services, and
compromises to sanitation and hygiene.
Not every characteristic need be present and each must be
assessed with regard to its relative importance locally:
■ Risk of introduction to and spread of the disease in the population.
■ Large number of cases may reasonably be expected to occur.
■ Disease involved is of such severity as to lead to serious disability or death.
■ Risk of social or economic disruption resulting from the presence of the
disease.
■ Inability of authorities to cope adequately with the situation because of
insufficient technical or professional personnel, organizational
experience, and necessary supplies or equipment (e.g., drugs, vaccines,
laboratory diagnostic materials, vector control materials).
■ Risk of international transmission.
FlOOD
Prolonged rainfall over several
days can cause a river or
stream to overflow and flood
surrounding areas. A flash
flood from a broken dam or
levee or after intense rainfall of
1 inch (or more) per hour often
catches people unprepared.
Except for flash floods, flooding directly causes few deaths.
Instead, widespread and long-lasting detrimental effects
include damage to homes and mass homelessness,
disruption of communications and health care systems,
and heavy loss of business, livestock, crops, and grain,
particularly in densely populated, low-lying areas.
RISK OF MORTALITY AND
MORBIDITY
Flood-related morbidity and mortality vary from country
to country. Flash flooding, such as from
excessive rainfall or sudden release of water from a
dam, is the cause of most flood-related deaths.
Many victims become trapped in their cars and drown
when attempting to drive through rising or swiftly
moving water. Other deaths have been caused by
wading, bicycling, or other recreational activities in
flooded areas.
Injured and frightened animals, hazardous waste contamination, molds and
mildew, and dislodging of graves pose additional risks in the period following a
flood (FEMA, 2006d).
Food shortages that are due to water-damaged stocks may occur because of
flooding and sea surges.
The stress and exertion required for cleanup following a flood also cause
significant morbidity (mental and physical) and mortality (e.g., myocardial
infarction). Fires, explosions from gas leaks, downed live wires, and debris can
all cause significant injury.
tOrNaDO
Tornadoes are rapidly whirling, funnel-shaped air spirals
that emerge from a violent thunderstorm and reach
the ground. Tornadoes can have a wind velocity of up
to 200 miles per hour and generate sufficient force
to destroy even massive buildings.
The extent of damage depends on updrafts within
the tornado funnel, the tornado’s atmospheric
pressure (which is often lower than the
surrounding barometric pressure), and the
effects of flying debris.
RISK OF MORTALITY AND
MORBIDITY
Certain geographic areas are at greater risk because of
recurrent weather patterns; tornadoes most frequently
occur in the midwestern and southeastern states.
Injuries from tornadoes occur from flying debris or people
being thrown by the high winds (e.g.,head injuries, soft
tissue injury, secondary wound infection).
Stress-related disorders are more common, as is disease
related to loss of utilities, potable water, or shelter.
PREVENTION AND MITIGATION
Because tornadoes can occur so quickly, communities
should develop redundant warning systems (e.g.,
media alerts and automated telephone warnings),
establish protective shelters to reduce tornado-related
injuries, and practice tornado shelter drills.
In the event of a tornado, the residents should take shelter
in a basement if possible, away from windows, while
protecting their heads.
tHuNDerstOrM
A thunderstorm is formed from a combination of moisture,
rapidly rising warm air, and a force capable of lifting air such
as a warm and cold front, a sea breeze, or a mountain. All
thunderstorms contain lightning.
Thus, it is possible for several thunderstorms to affect one
location in the course of a few hours.
Thunderstorms can bring heavy rains (which can cause flash
flooding), strong winds, hail, lightning, and tornadoes.
Severe thunderstorms can cause extensive damage to homes
and property (FEMA, 2006f).
Lightning is a major threat during a
thunderstorm.
Lightning is an electrical discharge that results
from the buildup of positive and negative
charges within a thunderstorm. When the
buildup becomes strong enough, lightning
appears as a bolt.
RISK OF MORTALITY AND
MORBIDITY
Morbidity is reduced if, when caught outdoors,
individuals avoid natural lightning rods such as tall,
isolated trees in an open area or on top of a hill and
metal objects such as wire fences, golf clubs, and metal
tools.
It is a myth that lightning never strikes twice in the same
place. In fact, lightning will strike several times in the
same place in the course of one discharge (FEMA,
2006f).
tsuNaMi
Tsunamis, a series of waves usually
generated by large earthquakes
under or near the ocean occur
when a body of water is rapidly
displaced on a massive scale.
Submarine landslides and volcanic
eruptions beneath the sea or on
small islands can also be
responsible for tsunami, but their
effects are usually limited to
smaller areas.
PREVENTION AND MITIGATION
Tsunami waves can be described by their wave-length
(measured in feet or miles), period (minutes or
hours it takes one wavelength to pass a fixed
point), speed (miles per hour), and height.
Tsunamis may travel long distances, increasing in
height abruptly when they reach shallow water,
causing great devastation far away from the source.
Any of the following events may signal an approaching tsunami:
■ A recent submarine earthquake.
■ The sea appears to be boiling, as large quantities of gas rise to the
surface of the water.
■ The water is hot, smells of rotten eggs, or stings the skin.
■ There is an audible thunder or booming sound followed by a roaring or
whistling sound.
■ The water may recede a great distance from the coast.
■ Red light might be visible near the horizon and, as the wave approaches,
the top of the wave may glow red.
RISK OF MORTALITY AND
MORBIDITY
In the immediate aftermath of a tsunami, the first health
interventions are to rescue survivors and provide medical
care for any injuries.
For people caught in the waves, the force of the water
pushes people into debris, resulting in the broadest range
of injuries, such as broken limbs and head injuries. Most
deaths from tsunamis are related to drowning.
The floods that accompany a tsunami result in potential
health risks from contaminated water and food supplies.
Loss of shelter leaves people vulnerable to exposure to
insects, heat, and other environmental hazards.
Tsunamis have long-lasting effects and recovery necessitates
long-term surveillance of infectious and water- or insect-
transmitted diseases, an infusion of medical supplies and
medical personnel, and the provision of mental health and
social support services.
Potential waterborne diseases that follow tsunamis include
cholera; diarrheal or fecal-oral diseases, such as
amebiasis, cryptosporidiosis, cyclosporiasis, giardia-sis,
hepatitis A and E, leptospirosis, parasitic infections,
rotavirus, shigellosis, and typhoid fever; animal-
or mosquito-borne illness, such as plague, rabies, malaria,
Japanese encephalitis, and dengue fever (and the
potentially fatal complication dengue hemorrhagic
shock syndrome); and wound associated infections and
diseases, such as tetanus.
 WiNter/iCe stOrMs
A major winter storm can be lethal.
Winter storms bring ice, snow, cold
temperatures, and often dangerous
driving conditions.
Nurses need to be familiar with winter
storm warning messages, such as wind
chill, winter storm watch, winter storm
warning, and blizzard warning.
Wind chill is a calculation of how cold it feels outside when the effects of
temperature and wind speed are combined. On November 1, 2001, the
National Weather Service implemented a replacement wind chill
temperature index for the 2001/2002 winter season.
A winter storm watch indicates that severe winter weather may affect your
area.
A winter storm warning indicates that severe winter weather conditions are
definitely on the way and emergency preparedness plans should be
activated.
A blizzard warning means that large amounts of falling or blowing snow and
sustained winds of at least 35 miles per hour are expected for several
hours.
RISK OF MORTALITY AND
MORBIDITY
Transportation accidents are the leading cause of death
during winter storms. Preparing vehicles for the winter
season and knowing how to react if stranded or lost on the
road are the keys to safe winter driving.
Morbidity and mortality associated with winter storms
include frostbite and hypothermia, carbon monoxide
poisoning, blunt trauma from falling objects, penetrating
trauma from the use of mechanical snow blowers,
and cardiovascular events usually associated with snow
removal.
Frostbite is a severe reaction to cold exposure that can
permanently damage its victims. A loss of feeling and a
light or pale appearance in fingers, toes, nose, or earlobes
are symptoms of frostbite.
Hypothermia is a condition brought on when the body
temperature drops to less than 90 ◦F. Symptoms of
hypothermia include uncontrollable shivering, slow speech,
memory lapses, frequent stumbling, drowsiness, and
exhaustion.
PREVENTION AND MITIGATION
Winter storm preparation activities should include the following:
■ Collecting winter clothing and supplies such as ex- tra blankets, warm
coats and clothes, water-resistant boots, hats, and mittens.
■ Assembling a disaster supplies kit containing a first aid kit, battery
powered weather radio, flashlight, and extra batteries.
■ Stocking canned food, a nonelectric can opener, and bottled water.
■ Winterizing vehicles, keeping gas tanks full, and as-sembling a disaster
supply car kit.
■ Ensuring an adequate supply of any medications needed during and
immediately following the storm.
WilDFires
More and more people are
making their homes in woodland
settings in or near forests, rural
areas, or remote mountain sites.
As residential areas expand into
relatively untouched wildlands,
people living in these
communities are increasingly
threatened by forest fires.
There are three different classes of wildfires
A surface fire, the most common type, burns along the
floor of a forest, moving slowly and killing or damaging
trees.
A ground fire is usually started by lightning and burns on
or below the forest floor in the humus layer down to
the mineral soil.
Crown fires spread rapidly by wind and move quickly by
jumping along the tops of trees.
RISK OF MORTALITY AND
MORBIDITY
Morbidity and mortality associated with
wildfires include burns, inhalation injuries,
respiratory complications, and stress-related
cardiovascular events (exhaustion and
myocardial infarction while fighting or fleeing
the fire).
PREVENTION AND MITIGATION
Prevention efforts include encouraging people to do the following:
■ Build fires away from nearby trees or bushes. Ash and cinders lighter than air
float and may be blown into areas with heavy fuel load, starting wildfires.
■ Be prepared to extinguish the fire quickly and completely. If the fire becomes
threatening, someone will need to extinguish it immediately.
■ Never leave a fire—even a cigarette—burning unattended. Fire can quickly
spread out of control.
■ Find out whether the area where people live is at risk for wildfire and develop
a family wildfire evacuation plan (FEMA, 2006c).
Natural and environmental disasters result in significant losses,
physical destruction of dwellings, social and economic disruption,
human pain and suffering, and significant injury and loss of life.
Nurses should be familiar
with the types and
consequences of
frequently occurring
natural disasters, in order
to contribute to public
health efforts to prevent,
mitigate, and recover
from these events.