Module 4 : Emergency &

Disaster Nursing
 Disaster Nursing
Disaster Nursing can be defined as the adaptation of
professional nursing knowledge, skills and attitude in
recognizing and meeting the nursing, health and
emotional needs of disaster victims.
Disaster - Any destructive events that disrupts the normal
functioning of a community.
- Ecologic disruptions or emergencies of a severity and
magnitude that result in deaths, injuries, illness and property
damage that cannot be effectively managed using routine
procedures or resources that require outside assistance.
 Goals of 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 a disaster.
 Other Goals:

• To meet the basic survival needs

• To identify the potential for a secondary disaster
• To appraise both risks and resources
• To correct inequalities in access to healthcare
• To empower survivors to participate
• To respect cultural, lingual and religious diversity
• To promote highest quality of life
 Types of Disaster

• Natural - cause by natural or environmental forces.

• Man Made/Human Generated - The principal direct causes are

identifiable human actions, deliberate or otherwise.

• Medical Disaster- Is a catastrophic event that results in casualties that

overwhelm the health care resources in that community.
Natural Disaster
Man-made or human generated disaster
 Other Natural Disaster

• Hurricanes
• Tornados • Mudslides
• Floods • Volcanic Eruption
• Earth quakes • Communicable Disease
• Blizzards epidemics
• Cyclones
• Tsunami
• Drought
 Man-made disaster

• Conventional Warfare
• Explosions
• Toxic Materials
• Civil Unrest
• Transportation Accidents
• Fires
• Pollution
• Terrorist Attacks
 Phases of Disaster
Pre-impact phase

- Prior to the actual occurrence a warning is given at the sign of the first possible danger
to the community

Impact Phase
- It is the time of enduring hardships or injury and of trying to survive. Time when the
individuals help neighbors and families at the scene a time of holding on until help
arrives. This phase may last for several minutes or several days or weeks.

Post Impact Phase

- Recovery begins during the emnergency phase and ends with both the return of normal
community order and functioning. This phase can even last for life.
 Principles of Disaster Nursing
• Rapid assessment of situation
• Triage and initiation of life saving measures
• Selected use of essential nursing interventions
• Adaptation of necessary nursing skills
• Evaluation of environment
• Prevention of further injury
• Leadership in coordinating patient triage etc
• Teaching, supervision, and utilization of auxillary medical personnel
• Provision of understanding, compassion, and emotional support
Disaster phases and Management

1. Preparedness phase

2. response

3. Recovery

4. Mitigation
1.Preparedness phase

- Activities prior to a disaster

- It is an ongoing multi sectoral activity

2.Response Phase

- Activities during a disaster

Search, rescuer and first aid:

The most immediate help comes from the uninjured persons

Field Care:

Most injured person converge spontaneously to health facilities.

Bed availability and surgical services should be maximized.
Provision makes for food and shelter.
 Triage
It is an rapidly classifying the injured on the basis of their injuries.

Is the only approach that can provide maximum benefit to the greatest
number of injured in a major disaster situation

Triage Colour coding system:

1. Red
2. Yellow
3. Green
4. Black
1. DAILY TRIAGE

2. INCIDENT TRIAGE

3. DISASTER TRIAGE

4. TACTICAL TRIAGE

5. SPECIAL CONDITIONS TRIAGE

6. TRIAGE DURING AN EPIDEMIC

I. In-Hospital Triage Systems

Emergent

Urgent

Non-urgent
II. Disaster Triage System

• Simple Triage and Rapid Treatment System (START)

- ADULT PRE-HOSPITAL TRIAGE
- It is based on the person’s ability to respond verbally and ambulate
and their respirations, perfusion, and mental status (RPM).
The system work as follows:
All patients who can walk are categorized as GREEN and asked to move
away from incident area to a specific location.
The next group of patients is assessed quickly (30-60sec/pt) by
evaluation RPM
• JumpSTART system

Created to meet needs of children below 8y0.

Should be used if the victim looks like a child and START should be
sued whenever victim looks like a young child or older.

Objectives:
To optimize the primary triage of injured children
To enhance the effectiveness of resources
To reduce emotional burden on triage personnel who may have to
make rapid life or death decision about injured children in chaotic
circumstances
 Triage area must be equipped with the following

• Wheelchairs • Pens
• Stretchers • Adhesives
• Backboards • Oral airway
• IV poles • Scissors
• Splints, bandages • Blankets
• Emesis Basin • Steth
• Disaster tags • Emergency trolley/cart
3. Recovery Phase

Activities following a disaster

4. Prevention / Mitigation Phase

Activities that reduces the effects of disaster

 Nursing Role in Disaster Management
• Assess the community

• Diagnose Community disaster threats

• Evaluate Effectiveness of Disaster Plan

• Community Disaster Planning

• Implementation of Disaster Plan

 The Nursing Role in Disaster Management

Assess the Community

- Is there a current community disaster plan in place?

- Previous disaster experience?
- How is the local terrain conductive to disaster formation
- What are local industry?
- What personnel are available for disaster interventions
- What are local agencies and organization?
2. Diagnose the community

Determine actual and potential disaster threats

3. Community disaster planning

Develop a disaster plan to prevent or deal with identified disaster threats

Identify a local community communicable system

Set up of an emergency medical systems and chain for activation

4. Implement disaster plan

Focus on primary prevention activities to prevent occurrence of man made disaster

Practice using equipments, obtaining and distributing supplies
5. Evaluate effectiveness of disaster plan

Critically evaluate all aspects of disaster plan and practical drills for speed,
effectiveness, gaps and revision.

Evaluate the disaster impact on community and surrounding regions

Evaluate response of personnel involved in disaster relief efforts

 Disaster Nursing

▪Objectives
▪Emergency vs. Disasters
vs. Mass Casualty
▪Roles of Nurses/Health
care workers
▪Core competencies of
Nurses
 ICN Framework of Disaster Nursing
Competencies
A. Prevention Competencies
1. Risk reduction, disease prevention
and health promotion
2. Policy Development and planning

B. Preparedness competencies
1. Ethical practices , legal practice and
accountability
2. Communication and information
sharing
3. Education and preparedness
 Prevention Competencies
RISK REDUCTION
How can Nurses actively engage on disaster risk reduction and
disaster risk management policy?

Nurses Engaging and leading Nationally

• Advocacy with government (national and local)
Actively engaging with governments so that they develop a binding
strategy
• Encouraging governments to plan for responding to the basic
needs of nurses in the event of a disater.

Evidenced based policy Making

• Facilitating the development and implementation of relevant
policies and procedures.
• Promoting nursing and health research on disaster reduction,
preparedness, mitigation, response, and recovery
• Conducting research that addresses key evidence gaps, including
disaster health risk profiling of vulnerable groups
Collaborating and partnering
• Actively participating in supporting institutions and gov ernments to prepare
in advance for disaster by assessing potential hazards and vulnerabilities, and
by increasing their ability to predict, warn, and respond to disaster
• Actively participating in strategic planning and implemen tation of disaster
plans ensuring nursing input
• Networking with other professional disciplines, governmental and
nongovernmental agencies at local, regional, national, and international
levels
• Partnering with independent, objective media, local and national branches of
government, international agencies, and nongovernmental organizations

Training/competency development in disasters

• Systematically training nursing personnel to be effective in a
crisis/emergency situation
• Ensuring a register is maintained of trained nurses

Disaster response
• in the short term, assisting in efforts to mobilize the necessary resources
including helping with emergency medical assistance, giving special attention
to vulnerable groups.
• In the long term , assisting with resettlement programs,
psychosocial, economic, and legal needs
• For those nurses working in disaster settings, providing as well as
being provided with support that meets resilience, daily physical
and emotional needs

Disease prevention

Food safety is essential for Disease Prevention in the Aftermath of a

disaster
WHO has issued the following recommendations for ensuring the
safety of food supplies following a disaster event (WHO 2005)
KEY 1 KEEP CLEAN (Prevent the growth and spread of Microorganisms)
• Wash hands
• Avoid preparing food directly in surroundings flooded with water
• Wash/sanitize all surfaces and equipment
• Protect kitchen areas and food from insects, pest and other animals
• Keep persons with diarrhea away from food preparation areas
• Keep fecal material way from food preparation areas
• Avoid eating food raw if they may have been flooded
KEY 2: Separate rawe and cooked foods
• Separate raw meat , poultry and seafood from ready to eat foods
• Separate animal slaughtering and food preparation areas
• Treat utensils and equipment used for raw foods as contaminated –
wash and sanitize before other use.
• Store separately raw and prepared foods
• Avoid contamination with unsafe water
• Peel fresh fruits before eating

Key 3: Cook thoroughly

• cook food thoroughly, especially meat, poultry, eggs, and seafood,
until it is steaming hot throughout
• For cooked meat and poultry to be safe, their juices must run clear
and no parts of the meat should be red or pink.
• bring g foods like soups and stews to boiling and continue to boil for
at least 15 minutes to make sure all parts of the food have reached
at least 70°C (158°F)
• . Although cooked food should generally be e aten immedi ately, if
necessary, thoroughly reheat cooked food until it is steaming hot
throughout.
KEY 4 keep food at safe temperatures

■ Eat cooked food immediately and do not leave cooked

food at room temperature longer than 2 hours.
■ Keep cooked food steaming hot (more than 60°C or
140°F) prior to serving.
■ Cooked and perishable food that cannot be kept
refrigerated (below 5°C or 41°F) should be discarded

KEY 5 Use safe water and raw materials

• Use safe water or treat it to make it safe through boiling
• Wash or preferably cook vegetables and peel fruits that
are eaten raw
• Use clean containers to collect and store water and clean
utensils to dispense stored water
• Select fresh and wholesome foods
• Breastfeed infants and young children at least up to the
age of 6 months
 Health Promotion
“Health promotion” is the process of enabling people to increase control
over, and to improve, their health (WHO, 1986, 2009). Pender, Murdaugh,
and Parsons (2010) describe health promotion as behavior motivated by
the desire to increase well-being and actualize human health potential.

• To meet the basic survival needs

• To identify the potential for a secondary
disaster
• To appraise both risks and resources
• To correct inequalities in access to healthcare
• To empower survivors to participate
• To respect cultural, lingual and religious
diversity
• To promote highest quality of life
Maslow’s hierarchy of needs.
 1. Risk reduction, disease prevention and health promotion
• Using epidemiological data evaluates the risks and effects of
specific disasters on the community and the population and
determines the implications for nursing.
• Collaborates with other health care professionals, community
organizations, government and community leaders to develop
risk reduction measures to reduce the vulnerability of the
populations.
• Participates in planning to meet health care needs in a
disaster.
• Identifies challenges to the health care system and works
with the multidisciplinary team to mitigate the challenges.
• Identifies vulnerable populations and coordinates activities to
reduce risk.
• Understands the principles and process of isolation,
quarantine, containment and decontamination and assists in
developing a plan for implementation in the community.
• Collaborates with organizations and governments to build the
capacity of the community to prepare for and respond to a
disaster.
Health Promotion

• Participates in community education activities related to disaster

preparedness.
• Assesses the community to determine pre-existing health issues,
prevalence of disease, chronic illness and disability and the health
care resources in the community.
• Partners with others to implement measures that will reduce risks
related to person-to-person transmission of disease, sanitation and
foodborne illness.
• Participates in planning to meet the health care needs of the
community such as, mass immunization and medication
administration programmes.
• Works with the community to strengthen the health care system’s
ability to respond to and recover from a disaster.
 2. Policy Development and Planning
• Demonstrates an understanding of relevant disaster
terminology
• Describes the phases of disaster management
• Describes the role of government and organization in
disaster
• Understands the community disaster plan and how it
relates to the national response plans.
• Recognizes the disaster plan in the workplace
• Participates in disaster planning and policy
development
• Contributes to the development of the community
• Ensures that the needs of vulnerable populations are
included in the community disaster plan
• Interprets roles of nurses in relation to other members
 2. Policy Development and Planning
• Participates politically and
legislatively in the
development of policies
related to disaster
preparedness and response
• Describes the role of public
health in disaster and how it
relates to nurses role
 Preparedness Competencies
Ethical practices/issues in Disaster Nursing
- Awareness of the ethical underpinnings of aid relief is
critical if nurses wish to participate in such work and be
effective in the long term either as practitioners in
disaster relief healthcare or as advocates for individuals
and communities who experience disaster.

5 moral hazards aid relief workers should be aware of:

• Complicity in abuses
• Legitimizing violations
• Aid’s negative effect
• Targeting and triage
• Advocacy or access
 3. Ethical Practice, Legal Practice and
Accountability
Ethical Practice
• Collaborates with others to identify and address ethical
challenges.
• Applies the national approved ethical framework to support
decision-making and prioritizing.
• Protects the rights, values and dignity of individuals and
communities.
• Practises in accordance with the cultural, social and spiritual
beliefs of individuals and communities.
• Maintains confidentiality in communication and documentation.
• Understands one’s own personal beliefs and how those beliefs
impact on disaster response.
• Describes how security issues and ethics may conflict.
 Ethical Practice, Legal Practice and Accountability
Legal practice
• Practices in accordance with local, state, national
and international applicable laws.
• Understands how laws and regulations specific to
disaster impact on nursing practices and disaster
survivors.
• Recognizes the legal role of public health to protect
the community in a disaster.
• Understands the legal implications of disasters and
emergency
• Describes the legal and regulatory issues related to
issues such as: y working as a volunteer; y roles and
responsibilities of volunteers; y abandonment of
patients; y adaptation of standards of care; y role and
responsibility to an employer; and y delegation
 Accountability
• Accepts accountability and responsibility for one’s own
actions.
• Delegates to others in accordance with professional
practice, applicable laws and regulations and the disaster
situation.
• Identifies the limits of one’s own knowledge, skills and
abilities in disaster and practises in accordance with them.
• Practises in accordance with the laws and regulations
governing nurses and nursing practice.
• Advocates for the provision of safe and appropriate
care.
 Communication & Information Sharing
• Describes the chain of command and the nurse’s role within the system.
• Communicates in a manner that reflects sensitivity to the diversity of the population.
• Describes the principles of crisis communication in crisis intervention and risk
management.
• Identifies and communicates important information immediately to appropriate
authorities.
• Utilizes a variety of communication tools to reduce language barriers.
• Coordinates information with other members of the disaster response team.
• Provides up-to-date information to the disaster response
• team regarding the health care issues and resource needs.
• Works with the disaster response team to determine the nurse’s
• role in working with the media and others interested in the disaster. a
• Understands the process of health information management in a disaster.
• Demonstrates an ability to use specialized communication equipment.
• Maintains records and documentation and provides reports as required.
• Communicates identified or suspected health and/or environment risks to
appropriate authorities
 Education and Preparedness
• Maintains knowledge in areas relevant to
disaster
• and disaster nursing.
• Participates in drills in the workplace
• and community.
• Seeks to acquire new knowledge and maintain
expertise in disaster nursing.
• Facilitates research in disaster.
• Evaluates the need for additional training
• and obtains required training.
• Develops and maintains a personal and family
preparedness plan.
• Describes the nurse’s role in various disaster
assignments.
• Maintains a personal disaster/emergency kit
• Implements preparedness activities as part of a
multidisciplinary team.
• Assists in developing systems to addres
nursing and health care personnel capacity-building
for disaster response.
• Takes on a leadership role in the
development and implementation of training
programmes
for nurses and other health care providers.
• Evaluates community readiness and takes actions to
increase readiness where needed.