TOPIC : DISASTER MANAGEMENT

INTRODUCTION

Disaster, caused by nature’s fury is not uncommon in this

planet, Earth. In fact, scientists believe that the birth of this
planet Earth was the result of explosion that occurred in
the solar system. In the past men used to view these
natural disasters as the ‘Act of God’. Gradually they
understand the mysteries of nature. Disaster has the
adverse effects on health in terms of variety of disease,
injuries and health problems, etc.,so nurses have an
important role to play during a disaster to save the lives
and to provide health care to the victims.
DEFINITIONS
1. Disaster as “any occurrence that causes damage,
economic disruption, loss of human life and
deterioration of health and health service on a scale
sufficient to warrant an extraordinary response from
outside the affected community or area”. (WHO)
2. Disaster as “An occurrence such as hurricane,
tornado, storm, flood, high water, wind-driven
water, tidal wave, earthquake, drought, blizzard,
pestilence, famine, fire, explosion, building collapse,
transportation wreck, or other situation that causes
human suffering or creates human that the victims
cannot alleviate without assistance”.-RED CROSS
 3. “Disaster can be defined as an overwhelming
ecological disruption, which exceeds the capacity of a
community to adjust and consequently requires
assistance from outside.-Pan American Health
Organisation(PAHO)
4. “Disaster is an event, natural or manmade, sudden or
progressive, which impacts with such severity that
the affected community has to respond by taking
exceptional measures.-W. Nick Carter
TYPES OF DISASTER
Disasters are commonly divided according to their
causes into two distinct categories :
 Natural disaster
 Man-made disaster

i. Natural disasters: natural disaster include

the following types:
 Metrological disaster: Storms(Cyclones, typhoons,
hurricanes, tornados, hailstorms, snowstorms),cold
spells, heat waves and droughts.
 Typological Disaster: landslides, avalanches,
mudflows and floods.
 Telluric and Teutonic (Disaster originate
underground): Earthquake, volcanic eruptions and
tsunamis (seismic sea waves).
 Biological Disaster: communicable disease,
epidemics and insect swarms (locusts).
ii. Man Made Disasters
 Warfare: conventional warfare (bombardment,
blockade and singe) and non-conventional warfare
(nuclear, chemical and biological).
 Civil disasters: riots and demonstration.
 Accidents: transpotation (planes, trucks,
automobiles, trains and ships); structural collapse
(building, dams, bridges, mines and other
structures); explosions : fires; chemical (topic waste
and pollution ), and biological(sanitation).
 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.

IMPACT OF DISASTER
Disaster has two types of impact:
a) Direct impact: It includes damage to
property , loss of lives both human and
animal, home and crops may be destroyed,
disruption of food and water supply.
b)Indirect impact: this includes great
emotional and psychological illness due to
loss of family members, relatives,
neighbours, people suffer and die from
diseases caused by unhygienic conditions.
Recognising the importance of action and
relief to reduce the impact of disaster, the
 WHO has declared the decade 1990-2000 as
the international decade for natural disaster
reduction, The theme was “should disaster
strike, be prepared”.

READINESS FOR DISASTER

Readiness for disaster involves two aspects:
 Resource for readiness .
 Disaster pre planning.
Resources for readiness:
 RED CROSS: Its primary concern in a disaster situation is
to provide relief for human suffering in the form of food,
shelter, clothing, medical care, and occupational
rehabilitation of victims.
 COMMUNITY AND LOCAL GOVERNMENT: It share the
responsibility in clearing rubble, maintaing law and
order, determining the safety of a structure of
habitation, repairing bridges, resuming transpotation,
maintaining sanitation, providing safe food and drinking
water, etc.
 CIVIL DEFENCE SERVICES: The civil defence and its
medical facility programmers provide for shelters,
establishing communication linkage, post disaster
services, assistance to affected community in the area of
health, sanitation, maintaining law and order, fire
 fighting, clearing debris, prevention and control of
epidemic of various diseases etc.
DISASTER PRE-PLANING: It is important to make the
best possible use of the resources. Some of the pre-
planing aspects for disaster related to medical care as
follows:
 HOSPITAL DISASTER PLANING: Depending upon the
hospital’s , location and size, it mobilizes its resources to
manage any disaster. It should provide for immediate
action in the event of:
i. An internal disaster in hospital itself e.gfire ,
explosion, etc.
ii. Some minor external disaster.
iii. Major external disaster.
iv. Threat of disaster.
v. Disaster in neighbouring communities/country.
 EVACUATION: There is usually a system which on order
of the medical superintendent, is activated e.g :
 Percentage of evacuation (discharge) of the patient from
the hospital.
 Addition of extra beds.
 Prepration of emergency ward.
 Such facilities should be near to X-ray, operation
theatre, central supply, medical store, etc.
 ORDERLY FLOW OF CASUALITY: It is important to
minimize confusion in receiving causalities. A team of
well qualified physician and nurses at the reception it
 self sorts out causalities and make quick decisions of the
treatment.
 additional nursing staff volunteers may be called and
posted.
 Services of all departments of the hospital should be
well integrated in the disaster plan vizdieatery
department, laundry, public works department (PWD),
engineering unit, etc.
 The planning should also take into consideration other
aspects like traffic control, types of medical records to
be maintained, standardization of emergency medical
tags, public information centers, controlled
dissemination of information without or with minimum
distortion, preparation of emergency supplies kept
ready, all ambulance kept ready, arrangement of
additional vehicles.
 Communication system: Additional communicaton
system should be planned. It is also important to keep
the hospital informed about the inflow of the casualties
from the scene.
 CASUALITY FLOWCHART

DISASTER SITE TRIAGE HOSPITAL

IDENTIFICATION

 TRIAGE MORGUE
 SORTING
 TAGGING
 INITIATE
DISASTERING

EMERGENCY NON-URGENT DISCHARGE

DEPARTMENT

O.T I.C.U.

WARDS
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THE DISASTER MANAGEMENT CYCLE

1. DISASTER EVENT: This refers to the “REAL TIME” event

of the hazard occurring and affecting elements of risk.
2. RESPONSE AND RELEIF: This refers to the first stage
response to any calamity, which include setting up
control rooms, putting the contingency plan in action,
issue warnings, evacuating people to safe areas,
rendering medical aid to the needy, etc.
 3. RECOVERY: It has three overlapping phases of
emergency relief rehabilitation and reconstructing.
4. DEVELOPMENT: Evolving economy and long-term
prevention/disaster reduction measures like
construction of houses capable of withstanding the on
slought of heavy rains, wind speeds and shocks of
earthquakes.
5. REDUCTION AND MITIGATION: Protective or preventing
actions that lessons the scale of impact.  Minimizing the
effects of disaster.Examples: building codes and zoning;
vulnerability analyses; public education.
6. PREPAREDNESS: Includes the formulation and
development of viable emergency plans, of the warning
system, the maintenance of inventories and the training
of personnel.
Principle of Triage
The word triage is derived from French word “trier”
which means sorting or choosing.
Fitzgerald developed a scale for the triage which is
commonly known as “Ispwich Scale”. The scale due to its
characteristics feature of utility, reliability is adopted in
emergency medical services worldwide according to this
scale colour in brackets depicts the colour code
allocated to patients.

ISPWICH TRIAGE SCALE

 This patient should wait for medical care no longer than:

TIME COLOUR NUMERIC CATEGORY

AND TAG CODE

Seconds Red 1 Resuscitaton

Minute Yellow 2 Emergency

An hour Green 3 Urgent

Hours Blue 4 Semi-urgent

Day White 5 Non-urgent

- Black 6 Dead

PRINCIPLES OF TRIAGE
The main principles of triage are as follows :
 Every patient should received and triaged by
appropriate skilled health-care professionals.
 Triage is a clinic-managerial decision and must involve
collaborative planning.
 The triage process should not cause a delay in the
delivery of effective clinical care.
OBJECTIVES OF TRIAGE
 An effective triage system should be able to achieve the
following:
 Ensure immediate medical intervention in life
threatening situations.
 Expedite the care of patents through a systematic
initial assessment.
 Ensure that patients are prioritised for treatment in
accordance with the severity of their medical
condition.
 Reduce morbidity through early medical
intervention.
 Improve public relations by communicating
appropriate information to friends and relatives
who accompany patients.
 Improve patients flow within emergency
departments and/or disaster management
situation.
 Provide supervised learning for appropriate
personnel.

Role of nurses

As we have already studied, there are varieties of

disasters either natural or man-made. But to
discuss the role of nurses I would prefer to discuss
the Role of Nurses in Earthquake.
 1. Safety Assurance
All personnel in earthquake site should have as their
foremost consideration the protection of: (a) themselves ;
(b)their fellow workers ;(c)their patients.
 Quickly assess the scene of danger before rushing in.
 Stay at least 100 yards away from a danger structure.
 Never enter a burning structure an area containing toxic
gases.

2. Organizing an effective Disaster system

Nurse must be familiar with the personnel at the disaster

scene and their roles and function. In addition, she must
understand the roles and function; she must understand
organizing of sites.

A disaster scene is usually broken-up into three zone:

Disaster zone Treatment zone Transportation zone

a) Disaster zone
 Start resque operation as soon possible.
 Locate trapped victims by shouting the rubble
 Follow certain elementary rules:
- Do not trample over the ruins.
 - Do not move rubble before being sure of not causing
further collapses of building or falls of material.
- Use manual methods preferably.
 Give necessary first to victim after they have been
rescued
- Maintain an easy respiration.
- Clear the victim’s airways by using fingers to clean
the mouth and throat.
- Take out dentures; loosen collars, belts and clothing.
- Using blankets to prevent the victims catching cold
- Transfer to treatment zone.
b) Treatment zone
 Triage of patient in the treatment categories.
 Thorough assessment of each patient
 Treatment of injuries.
 Preparation for transport.

c) Transportation zone

While transportation the victims certain rules must be

followed.
 Movement must be calm and coordinated and carried
out in accordance with the instructions of rescue
worker.
 The injured person must be moved as little as possible.
  The victims head, neck and trunk must be kept in the
same axis.

3. Delivering appropriate patient care

Normal priorities change in a disaster. For e.g. –a critical
patient may have to be placed in a low priority category in
order to save the patient with better prognosis in a disaster
situation . The types of patients found in a disaster and their
position in priority categories are follow:
Probable fatal : these are the patients with injuries or
likeness which probably fatal regardless of the care they
receive – e.g. massive head injuries, patient in cardiac arrest,
extensive chest trauma. These are placed in one of the
lowest priority categories during a disaster.
Critical: patients who may have life threatening conditions,
but they receive hospital care within 30 to 60 minutes they
have a good prognosis, if transported and treated at a
hospital quickly they fit in high priority category.
Serious: the patients with best prognosis in a disaster are the
patients in serious condition, e.g patients with multiple
fracture or pneumothorax death is not imminent. This type of
patient is placed in higher priority.
Stable: Patients who do not have life threatening conditions
(e.g. closed leg fracture), patients with abrasions and
confusion etc. are placed in a lower middle category.
Fatal: A patient who has died at the scene should be placed
in the lowest priority category.
Health services for the Non-Injured Dislocated Population
1. Public education and setting up of reception
centres.
2. Standing medical orders.
3. Prevention of epidemics.
4. Control of communicable diseases.

CONCLUSION
A disaster is a situation where the need of the
public victims mounts over the medical and
nursing resources or services available
particularly in the developing countries like India
where the resources are already short the
situation becomes worst. So, in such a scenario a
prudent nurse should be resourceful, making
best use of the available resources like
governmental , nongovernmental organisations,
self help groups, public, etc. and should act
ethically with best of her knowledge, patience
and judgement to minimize the effect of disaster.
BIBLIOGRPHY
Dave, P.K. Emergency Medical Services and
Disater Management : A Holistic Approch. New
Delhi: Jaypee brothers Medical Publishers (p)
Ltd; 2001