SEMINAR ON DISASTER NURSING

SUBMITTED TO: BY:

SUBMITTED

GENERAL OBJECTIVE At the end of the seminar the group will be able to understand about the Disaster Nursing and apply it in daily practice.

SPECIFIC OBJECTIVE At the end of seminar, the group will be able to;1. Meaning of disaster and hazard. 2. Explain the types of disaster. 3. Discuss the phases of disaster. 4. Explain the dimensions of disaster. 5. Describe the triage system of disaster management. 6. Explain stages of disaster and the role of nurse in disaster management. 7. Describe role of Community Health Nurse in Disaster Response. 8. Explain role of Community Health Nurse in Disaster Recovery.

INTRODUCTION Presently at the global level, there has been considerable concern over natural disasters. Even as substantial scientific and material progress is made, the loss of lives and property due to disasters has not decreased. In fact, the human toll and economic losses have mounted. There has been an increase in the number of natural disasters over the past years and with it, increasing losses on account of urbanization and population growth, as a result of which the impact of natural disasters is now felt to a larger extent. According to the United Nations, in 2001 alone, natural disasters of medium to high range caused at least 25,000 deaths around the world, more than double the previous year and economic losses of around US $36 billion. These figures would be much higher, if the consequences of the many smaller and unrecorded disasters that cause significant losses at the local community level were to be taken into account. Natural disasters are not bound by political boundaries and have no social or economic considerations. They are borderless as they affect both developing and developed countries. They are also merciless and as such the vulnerable tend to suffer more at the impact of natural disasters. For example, the developing countries are much more seriously affected in terms of the loss of lives, hardship borne by population and the percentage of their GNP lost. Since 1991, two-third of the victims of natural disasters was from developing countries, while just 2 percent were from highly developed nations. Those living in developing countries and especially those with limited resources tend to be more adversely affected. With the alarming rise in the natural disasters and vulnerability per se, the world community is strengthening its efforts to cope with it.

MEANING Disaster means that any occurrence that causes damage, ecological disruption, loss of human life or deterioration of health and health services on a scale sufficient to warrant and extraordinary response from outside the affected community or area (WHO, 1995). TYPES Disaster is an occurrence, either natural or man-made that causes human suffering and creates human needs that victims cannot alleviate without assistance. Disasters can be natural & man-made. Natural disasters include droughts, earthquakes, tsunamis, forest fires,

landslides and mudslides, blizzards, hurricanes, tornadoes, floods and volcanic disruptions.

Man-made disasters includes hazardous substance accidents (e.g.,

chemicals, toxic gases), radiologic accidents, dam failures, resource shortage (e.g., food, electricity and water), structural fire and explosions and domestic disturbances (e.g., terrorism, bombing and riots), Bioterrorism. DISASTER FACTORS Agent

It is the physical item that actually causes the injury or destruction. Primary

agents include falling buildings, heat, wind, rising water and smoke. Secondary agents include bacteria and viruses that produce contamination or infection after the primary agent has caused injury or destruction. Primary and secondary agents will vary according to the type of disaster. Host:

The host is human kind. Host factors are those characteristics of humans that

influence the severity of the disaster's effect. Host factors include age, immunization status, pre-existing health status, degree of mobility and emotional stability. Environment: Environmental factors that affect the outcome of a disaster include physical, chemical, biological and social factors.

Physical factors include the time when the disaster occurs, weather

conditions, the availability of food and water and the functioning of utilities such as electricity and telephone service.

Chemical factors influencing disaster outcome include leakage of stored Biological factors are those that occur or increase as a result of

chemicals into the air, soil, ground water or food supplies.

contaminated water, improper waste disposal, insect or rodent proliferation, improper food storage, or lack of refrigeration owing to interrupted electrical services.

Social factors are those that contribute to the individual's social support

systems. Loss of family members, changes in roles, and the questioning of religious beliefs are social factors to be examined after a disaster.

Psychological factors contribute to the effect of the disaster on individuals.

Psychological factors are closely related to agent, host and environmental conditions. The nature and severity of the disaster affect the psychological distress experienced by victims. The existence and length of a warning period and physical proximity to the actual site of the disaster influence the amount of psychological distress experienced by victims. The closer an individual is to the actual site of the disaster and the longer the individual is exposed to the immediate site of the disaster, the greater the psychological distress that individual will experience.

 Individuals may suffer impaired intellectual functioning, have difficulty concentrating, or making decisions and experience impaired memory. Psychosomatic complaints and mental illness are also responses to disaster situations and are evidenced by loss of appetite, fatigue, intestinal upset, sleep disorders and muscular weakness. PHASES OF A DISASTER Pre-Impact Phase: The pre-impact phase is the initial phase of the disaster, prior to the actual occurrence. A warning is given at the sign of the first possible danger to a community. Many times there is no warning, but with the aid of weather networks and satellites, many metrological disasters can be predicted. The earliest possible warning is crucial in preventing loss 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 Defense Authority. Communication is a very important factor during this phase; disaster personnel will call on amateur radio operators, radio and television stations and any available method to alert the community and keep it informed. The community must be educated to recognize the threat as serious. When communities experience false alarms several times, members may not take future warnings very seriously. 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 groups. Impact Phase: The impact phase occurs when the disaster actually happens. It is a time of enduring hardship or injury and of trying to survive. This is a time when individuals help neighbors and families at the scene, a time of "holding on"

until outside help arrives. The impact phase may last for several minutes or for days or weeks (e.g., in a flood, famine or epidemic). This phase must provide for preliminary assessment of the nature, extend and geographical area of the disaster. The number of persons requiring shelter, the type and number of needed disaster health services anticipated and the general health status and needs of the community must be evaluated. The impact phase continues until the threat of further destructions has passed and the emergency plan is in effect. If there has been no warning, this is the time when the Emergency Operation Center (EOC) is established and put in operation. The EOC is the operating center for the local chapter of the American Red Cross. It serves as the center for communication with other government agencies, the center for recruitment of health care providers to staff shelters

Post impact Phase:

Recovery beings during the emergency phase and end 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 bombing of Hiroshima). The victims of a disaster go through four stages of emotional response: 1. Denial: During the first stage, the victim may deny the magnitude of the problem or, more likely, will understand the problem but may seem unaffected emotionally. The problems created by the disaster are being denied or have not fully "registered." The victim may appear unusually unconcerned. 2. Strong emotional response: In the second stage, the person is aware of the problem but regards it as overwhelming and unbearable. Common reactions during this stage are trembling, tightening of the muscles, sweating, speaking with difficulty, weeping, heightened sensitivity, restlessness, sadness, anger, and passivity. The victim may want to retell or relive 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 effort to solve them. He or she feels more hopeful and confident. It is especially important for victims to take specific actions to help themselves and their families. 4. Recover: The fourth stage represents a recovery from the crisis reaction. Victims feels that they are back to normal. Routines become important again. A sense of well-being is restored. The ability to make decisions and carry out plans returns. Victims develop a realistic memory of the experience. DIMENSIONS OF A DISASTER Disasters have a number of dimensions in which they may differ: predictability, frequency, controllability, time and scope or intensity. These dimensions influence the nature and possibility of preparation planning, as well as response to the actual event. Predictability: Some events are more easily predicated then others. Advances in meteorology, for example, have made it more feasible to accurately predict the probability of certain types of natural, weather-related disasters (e.g., tornadoes, floods, and hurricanes), while others, such as earthquakes, are not as easily predicted. Man-made disasters, such as explosions or weeks, are also less predictable. Whenever an event is predictable, authorities and emergency personnel have more time to prepare for situation than when an event is not foreseeable (i.e., spontaneous). Frequency: Although natural disasters are relatively rare, they appear more often in certain geographical locations. Residents of the coastal area live in what is commonly referred to as cyclone are at greater risk for experiencing later greater risk for earthquakes, and people who live near large river systems are at greater risk for

flooding than people who live elsewhere Controllability: Some situations allow for pre warning and control measures that can reduce the impact of the disaster; others do not. Emergency planners were able to control some of the effects of the flooding by sandbagging levees and river or sea banks to reduce the effects of water damage, and by deliberately blasting dikes and dams to divert flood waters to less populated areas. The immediate impact on people was reduced by the ability of emergency personnel to organize evacuations and reduce the risk of injury and death. Time: There are several characteristics of time as it relates to the impact of a disaster; the speed of onset of the disaster, the time available for warning the population, and the actual length of time of the impact phase. Scope and Intensity: A disaster may be concentrated in a very small area or involve a very large geographical region, usually affecting many more people. A disaster can be very intense and highly destructive, causing many injuries, deaths, and property damage, or less intense, with relatively little damage done to property or individuals. THE NURSING ROLE IN DISASTERS Disaster nurses play key leadership and service provision roles in planning and implementing disaster relief efforts, preventing technologic disasters, and addressing problems that occur during a disaster, such as the physical and emotional stress of disaster victims. During a disaster many environmental health problems emerge. The scope and magnitude of these problems determines the nursing role. Nurses

collaborate with community agencies and officials to recognize and reduce disaster risks and maximize the health and safety of individuals involved in disaster crises.

Following a disaster, nurses make numerous referrals to community agencies for a variety of needs including psychologic care, emotional support services, and treatment for victims and their families. Recovery encompassed dealing with many disaster effects such as loss of life, income, and home. The communicable disease implications of disasters are also immense:

Assess the Community Is there a current community disaster plan in place? What previous disaster experiences has the community been involved with locally, statewide, nationally? How is the local climate conducive to disaster formation (e.g., hurricanes, tornadoes, blizzards)? How is the local terrain conducive to disaster formation (e.g., earthquakes, flooding, forest fires, avalanches, mudslides)? What are the local industries? Are there any community hazards (e.g., toxic waste and chemical spills, industrial or agricultural pollutants, mass transportation problems)? What personnel are available for disaster interventions (e.g., nurses, doctors, dentists, pharmacists, clergy, volunteers, emergency medical teams)? What are the locally available disaster resources (e.g., food, clothing, shelter, pharmaceutical)? What are the local agencies and organizations (e.g., hospitals, schools, churches, emergency medical, Red Cross)? What is immediately available for infant care (e.g., formula, diapers) and care

of the elderly and disabled? What are the most salient chronic illnesses in the community that will need immediate attention (e.g., diabetes, arthritis, cardiovascular)? Diagnose Community Disaster Threats Determine actual and potential disaster threats (e.g., toxic waste spills, explosions, mass transit accidents, hurricanes, tornadoes, blizzards, floods, earthquakes). Community Disaster Planning Develop a disaster plan to prevent or deal with identified disaster threats. Identify a local community communication system. Identify disaster personnel, including private and professional volunteers, local emergency personnel, agencies, and resources. Identify regional backup agencies, personnel. Identify specific responsibilities for various personnel involved in disaster coping and establish a disaster chain of command. Set up an emergency medical system and chain for activation. Identify location and accessibility of equipment and supplies. Check proper functioning emergency equipment. Identify outdated supplies and replenish for appropriate readiness. Implement Disaster Plan Focus on primary prevention activities to prevent occurrence of man-made disasters. Practice community disaster plans with all personnel carrying out their previously identified responsibilities (e.g., emergency triage, providing supplies such as food, water, medicine, crises and grief counselling). Practice using equipment, obtaining and distributing supplies. Evaluate Effectiveness of Disaster Plan

 Critically evaluate all aspects of disaster plans and practice drills for speed, effectiveness, gaps, and revisions. Evaluate the disaster impact on community and surrounding regions. Evaluate response of personnel involved in disaster relief efforts. PHASES OF DISASTER MANAGEMENT It has been identified that there are four phases of disaster management which include:- mitigation, preparedness, response, and recovery, which serve as a model for community disaster preparations and nursing interventions. Mitigation Mitigation includes my activities that prevent a disaster, reduce the chance of a disaster happening, or reduce the damaging effects of unavoidable disasters. Nurses have a key role in disaster mitigation by working with local, state and federal agencies in identifying disaster risks and developing disaster prevention strategies through extensive public education in disaster prevention and readiness. Effective mitigation includes recognizing and preventing potential technologic disasters and being adequately prepared should such events occur. To plan effectively for disaster prevention the nurse needs to have community assessment information, including knowledge of community resources (e.g., emergency services, hospitals, and clinics), community health personnel (e.g., nurses, doctors, pharmacists, emergency medical teams, dentists, and volunteers), community government officials, and local industry. Disasters such as floods, tornadoes, hurricanes, and Early warning systems alert the public to the probability of immediate danger and help to reduce the impact of predictable disaster such as hurricanes or tornadoes. They may also provide information on an evacuation plan or other immediate actions that improve the chance of survival and reduce the probability of injures. The primary goals of disaster management are to prevent or minimize death,

disability, suffering and loss on the part of disaster victims. Preparedness PRINCIPLES OF DISASTER MANAGEMENT There are eight fundamental principles that should be followed by all who have a responsibility for helping the victims of a disaster. It is critical that rescue workers use these principles in proper sequence, or they will be ineffective and possibly detrimental a disaster victims. The eight basic principles are as follows (Grab and Eng 1969): Prevent the occurrence of the disaster whenever possible. Minimize the number of casualties if the disaster cannot be prevented. Prevent further casualties from occurring after the initial impact of the disaster. Rescue the victims. Provide first aid to the injured. Evacuate the injured to medical facilities. Provide definitive medical care. Promote reconstruction of lives. TRIAGE There are several times during the emergency response in which triage may be necessary to best determine the needs of injured victims. Triage is a French word meaning "sorting" or "categorizing." The term first came into use during World War 1 when casualties were sorted during battle. During a disaster, the goal is to maximize the number of survivors by sorting the treatable from the untreatable victims. In a disaster, the potential for survival and the availability of resources are the primary criteria used to determine which patients receive immediate treatment. In a disaster situation, saving the greatest number of lives is the most important goal. Triage may take place during the rescue operation at the scene of the disaster,

and again at each stage of transport for the disaster victims. Prioritising of victims for treatment can be done in many ways; some communities use color coding. Probably the best and most easily understood four-category system is the first-priority, second-priority, third-priority, and dying-or-dead system: Red - most urgent, first priority Yellow - urgent, second priority Green - third priority Black - dying/dead

STAGES OF DISASTER AND THE ROLE OF NURSES 1. Preparedness Personal Preparedness Great stress is placed on the nurse with client responsibilities who also becomes a disaster victim. Conflicts arise between family and work-related responsibilities. In addition, the community health nurse who will be assisting in disaster relief efforts must be as healthy as possible, both physically and mentally. A disaster worker who is not well is of little service to his or her family, clients, and other disaster victims. Personal preparedness can help case some of the conflicts that will arise and allows nurses to attend to client needs sooner that one may anticipate. Professional Preparedness Professional preparedness requires that nurses become aware of and understand the disaster plans at their workplace and community. Nurses who take disaster preparation seriously will take the time to read and understand workplace and community disaster plans and will participate in disaster drills and community

mock disasters. The more adequately prepared nurses are, the more they will be able to function in a leadership capacity and assist others toward a smoother recovery phase. 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 a stethoscope A flashlight and extra batteries Cash Warm clothing and a heavy jacket (or weather-appropriate clothing) Record-keeping materials Pocket-sized reference books Community Preparedness The level of community preparedness for a disaster is only as good as the people and organisations in the community make it. Some communities remain vigilant as to the possibility of a disaster hitting their community and stay prepared by having a solid disaster plan on paper and by participating in yearly mock disaster drills

ROLE OF THE COMMUNITY HEALTH NURSE IN DISASTER RESPONSE

The role of the community health nurse during disaster depends greatly on the nurse's past experience, role in the institutions and community's preparedness, specialized training, and special interest. The most important attribute for anyone working in a disaster, however, is flexibility. One certain factor about disaster is that change is a constant.

Although valued for their expertise in community assessment, case finding and

referring, prevention, health education, surveillance, and working with aggregates, at times the community health nurse is the first to arrive on the scene and must respond accordingly. Community health nurses working as members of an assessment team have the responsibility of feeding back accurate information to relief managers to facilitate rapid rescue and recovery. Many times nurses are required to make home visits to gather needed information, a task that comes quite naturally to the community health nurse. Types of information included in initial assessment reports include the following: Geographical extent of disaster's impact Population at risk or affected Presence of continuing hazards Injuries and deaths Availability of shelter Current level of sanitation Status of health care infrastructure. . ROLE OF THE COMMUNITY HEALTH NURSE IN DISASTER RECOVERY The role of the community health nurse in the recovery phase is as varied as in the preparedness and response phases of a disaster. Flexibility remains an important component of a successful recovery operation. Community cleanup efforts can incur a host of physical and psychological problems. For example, the physical stress of moving heavy objects can cause back injury, severe fatigue, and even death from heart attacks. In addition, the continuing threat of communicable disease will continue as long as the water supply remains threatened and the living conditions remain crowded. Community health nurses

must remain vigilant in teaching proper hygiene and making sure immunization records are up to date.

Acute and chronic illnesses can be exacerbated by the prolonged effects of

disaster. The psychological stress of cleanup and moving can bring about feelings of severe hopelessness, depression, and grief. Recovery can be impeded by short-term psychological effects eventually merging with the longterm results of living in adverse circumstances. In some cases, stress can lead to suicide and domestic abuse. In addition, although most people eventually recover from disasters, mental distress may persist in these valuable populations who continue to live in chronic adversity. Referrals to mental health professional should continue as long as the need exists. The community health nurse must also remain alert for environmental health hazards during the recovery phase of a disaster. Home visits may lead the nurse to uncover situations such as a faulty housing structure. Lack of water supply, or lack of electricity.

BIBLIOGRAPHY:-

1.

Basvantappa B.T. textbook of Community Health Nursing, 7 th edition, Jaypee Brothers, New Delhi pp 953-961.

2.

Gulani K Community Health Nursing, 1 st edition, kumar publishing services New Delhi

3.

Kamalan, Essentials of Community Health Nursing, 1 st edition, Jaypee brothers New Delhi.

4.

Park K Preventive And Social Medicine, 19 th edition, Banarasidas Publishers Jabalpur Pp 600.

5. Tener Goodwin, Venera, Disaster Nursing, Spring Publication Company New York,

HANDOUT SUBMITTED TO BY Mrs. Priya D Jadhao TOPIC: - DISASTER NURSING INTRODUCTION MEANING Disaster means that any occurrence that causes damage, ecological disruption, loss of human life or deterioration of health and health services on a scale sufficient to warrant and extraordinary response from outside the affected community or area (WHO, 1995). TYPES 1) Man-made disasters 2) Natural disasters DISASTER AGENT Agent Host: Primary and secondary agents will vary according to the type of disaster Environment: Ms. Namita SUBMITTED

Physical factors Chemical factors Biological factors Social factors Psychological factors PHASES OF A DISASTER

Pre-Impact Phase Impact Phase Post impact Phase . Denial . Strong emotional response . Acceptance Recover DIMENSIONS OF A DISASTER Predictability: Frequency: Controllability: Scope and Intensity Time: THE NURSING ROLE IN DISASTERS Disaster nurses play key leadership and service provision roles in planning and implementing disaster relief efforts, preventing technologic disasters, and addressing problems that occur during a disaster, such as the physical and emotional stress of disaster victims. During a disaster many environmental health problems emerge. The scope and magnitude of these problems determines the nursing role. Nurses collaborate with community agencies and officials to recognize and reduce disaster risks and maximize the health and safety of individuals involved in disaster crises. Following a disaster, nurses make numerous referrals to community agencies for a variety of needs including psychologic care, emotional support services, and treatment for victims and their families. Recovery

encompassed dealing with many disaster effects such as loss of life, income, and home. The communicable disease implications of disasters are also immense: THE NURSING ROLE IN DISASTERS ASSESS THE COMMUNITY Community Disaster Planning THE NURSING ROLE IN DISASTERS THE NURSING ROLE IN DISASTERS Mitigation PRINCIPLES OF DISASTER MANAGEMENT PRINCIPLES OF DISASTER MANAGEMENT TRIAGE Red - most urgent, first priority Yellow - urgent, second priority Green - third priority Black - dying/dead STAGES OF DISASTER AND THE ROLE OF NURSES 1. Preparedness Personal Preparedness Professional Preparedness Community Preparedness ROLE OF THE COMMUNITY HEALTH NURSE IN DISASTER RECOVERY ROLE OF THE COMMUNITY HEALTH NURSE IN DISASTER RESPONSE BIBLIOGRAPHY:1. Basvantappa B.T. textbook of Community Health Nursing, 7 th edition,

Jaypee Brothers, New Delhi pp 953-961.

2.

Gulani K Community Health Nursing, 1 st edition, kumar publishing services New Delhi

3.

Kamalan, Essentials of Community Health Nursing, 1 st edition, Jaypee brothers New Delhi.

4.

Park K Preventive And Social Medicine, 19 th edition, Banarasidas Publishers Jabalpur Pp 600.

5. Tener Goodwin, Venera, Disaster Nursing, Spring Publication Company New York