DISASTURE
MANAGEMENT
SUBMITTED TO,
Mrs.P
INDEX
1 Introduction 3
2 Definition 3
3 Disaster nursing 3
3
4 Classification
4
5 Natural disaster 4
7
10 Phases of disaster
7-9
11 Community’s relation to disaster 7-13
19
14 Principles
20
15 Steps of disaster management
16 Role of voluntary agencies
17 Role of nurse
18 Conclusion
19 bibliography
DISASTER MANAGEMENT
INTRODUCTION
Disaster is unexpected events that usually occur all of a sudden. Disasters have been integral
parts of the human experience since the beginning of time. Causing premature death, impaired
quality of life, and altered health status. The disasters unfolding in this century are frequently
associated with global instability, economic decay, political upheaval and collapse of
government structure, violence and civil conflicts, famine and mass population and
displacements. The increased incidence of disasters and the growing complexity of the nature of
disasters create considerable challenges to those responsible for disaster planning.
DEFINITIONS:
WHO defines disaster as any occurrence that causes damage, ecological disruption, loss of
human life or deterioration of health and health services on a scale sufficient to cause an extra
ordinary response from outside the affected community or area.
Disasters may be defined as any destructive event that disrupts the normal functioning of a
community.
Disasters are exceptional events that suddenly kill or injure large number of people.
DISASTER NURSING
Disaster nursing can be defined as the adaptation of professional nursing skills in recognizing
and meeting the nursing, physical and emotional needs resulting from a disaster.
The overall goal of disaster nursing is to achieve the best possible level of health for the
people and the community involved in the disaster.
CLASSIFICATION OF DISASTERS
o Natural Disasters.
o Manmade Disasters.
NATURAL DISASTERS
WHO define natural disaster as “the result of an ecological disruption or threat that
exceeds the adjustment capacity of the affected community.”
o Hurricanes
o Tornados
o Hair storms
o Tsunami
o Cyclone
o Blizzards
o Drought
o Floods
o Mudslides
o Earthquakes
o Volcanic eruptions
o Communicable disease epidemics
MANMADE DISASTERS
Disasters or emergency situations caused by people are those in which the principal direct
causes are identifiable human actions, deliberate or otherwise.
o Conventional warfare
o Non conventional warfare (eg. Nuclear, Chemical)
o Transportation accidents
o Structural collapse
o Explosions
o Fires
o Toxic materials
o Pollution
o Civil unrest
o Terrorist attack
o Complex emergencies
o Technologic disasters
o Disasters that are not caused by natural hazards but occur in human
settlements.
o Disasters that are not caused by natural hazards but occur in human settlements is
the result or weakness in the human environment. An example of this is a
chemical plant explosion following an earth quake.
EPIDEMIOLOGY OF DISASTER
Epidemiology is the study of pattern of disease occurrence in human population and the
factors that influence these patterns. Disaster may be studied and analyzed using the
epidemiological frame work of agent, host, and environment in an attempt to predict, prevent or
control the outcome of a disaster.
DISASTER AGENT:
Agent is the physical item that causes 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
vary according to type of disaster.
DISASTER HOST:
o In the epidemiological frame work, host is human kind and as a matter any living
organisms.
o Host factors include age, immunization status, pre disaster health status, degree of
mobility and emotional stability.
o Individuals most severely affected by a disaster are elderly persons, young
children, person with respiratory and cardiac problems etc., for eg – a fire in a
nursing home is potentially more lethal than a fire in a college dormitory.
ENVIRONMENT:
Florence Nightingale did one of the earliest attempts at research during a disaster during
the Crimean war & she emphasized the importance of a healthy environment for
maintaining optimum health
Disasters affect community and population in many different ways. The health effects of the
disaster may be extensive and broad in their distribution across, population. In addition to
causing illness and injury, disasters disrupt access to primary care & preventive services.
Depending upon the nature and location of disaster, its effects on short and long term health of a
population may be difficult to measure.
o Disasters may cause premature deaths, illnesses and injuries in the affected
community, generally exceeding the capacity of the local health care system.
o Disasters may destroy the local health care infrastructure, which will therefore be
unable to respond to the emergency. Disruption of routine health care service
and prevention initiatives may lead to long term consequences in health
outcomes in terms of increased morbidity & mortality.
o Disasters may create environmental imbalances, increasing the risk of
communicable diseases and environmental hazards.
o Disasters may affect the psychological, emotional and social well being of the
population in the affected community.
o Disasters may cause shortages of food and cause severe nutritional deficiencies.
o Disasters may cause large population movements creating a burden on other
health care systems & communities
PHASES OF DISASTER
o The Pre impact phase is the initial phase of the disaster, prior to the actual
occurrence.
o A warning is given at the sign of the first possible danger to a community.
o Many times there is no warning, but with the aid of weather networks and
satellites, many meteorological disasters can be predicted.
o The earliest possible warning is crucial in preventing loss of life and minimizing
damage. 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.
o The role of the nurse during this phase is to assist in preparing shelters and
emergency aid stations and establishing contact with other emergency service
groups.
Impact phase
o The impact phase occurs when the disaster actually happens. It is a time of
enduring hardship or injury and of trying to service. The impact phase may last
for several minutes.
o This phase must provide for preliminary assessment of 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.
o The impact phase continues until the threat of further destruction has passed and
the emergency plan is in effect.
Recovery begins during the emergency phase and ends with the return of normal
community order and functioning. For persons in the impact area this phase may last a
life time. (eg. Victims of the atomic bombing of Hiroshima).
Heroic phase
This phase appears at the time of the disaster and is characterized by people working
together to save each other and their property.
Honeymoon phase
This is a relatively short (2 wk – 2 month) post disaster period in which the victims feel
buoyed and supported by the promises of governmental and communal help and see an
opportunity to reconstitute quickly.
Disillusionment phase
Lasting anywhere from several months to a year or more, this phase contains
unexpected delays of failures, which emphasize, the frustration from bureaucratic
confusion, victims turn to re building their own lives and solving their own individual
problems.
Reconstruction phase
This phase may last for several years. It is characterized by a co-ordinated individual
community effort to rebuild and reestablish normal functioning.
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.
In this stage, the person is aware of the problem that but regards it as over whelming 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.
3Acceptance
During the 3rd stage, the victim begins to accept the problems caused by the disaster and
makes a concentrated effort to solve them.
4. Recovery
4th stage represents a recovery from the crisis reaction. Victim feels that they are back to
normal. Routines are established. A sense of well-being is restored.
DISASTER MANAGEMENT
The primary goals of Disaster management are to Prevent or minimize death disability,
suffering & loss on the part of disaster victims.
There are 8 fundamental principles that should be followed by all who have a responsibility
for helping the victims of a disaster.
o The first two actions are designed to control or mitigate the results of the disaster
and have already been addressed. Preventing further casualties after initial
impact depends on evaluating and lessening any unsafe conditions present after
the disaster.
o Rescue involves locating and freeing trapped victims and then evaluating them to
a safe place. An effective rescue and evaluation term with good leadership skills
is essential for saving life after a disaster.
o First aid must be provided to victims with life threatening injuries to prevent
death.
o Evacuation or victims must be done in an orderly but timely fashion. Many
factors will affect evacuation and they are availability of transport vehicles,
condition of roads leading to advanced care facilities, time between disaster
impact and arrival at hospital.
o Provision of definitive medical care depends on an existing disaster plan and
adequately trained disaster personnel. Hospitals must have well -honed disaster
plans to meet the needs of large groups of victims in a short time.
o Reconstruction of the victim’s life begins with initial care and continues until the
victim has recovered. This may take days, months or years. This is a slow and
long term phase. It aims at getting the community/ Victim back in to the groove.
o Disaster response
o Disaster Preparedness
o Disaster Mitigations
The 3 aspects of the disaster management correspond to different phases in the ‘disaster
cycle.
DISASTER CYCLE
It is the immediate response once the disaster strikes. A number of causalities may be seen
immediately after an disaster Thus immediate care is needed at this phase. The management of
mass causalities include following steps
After a major disaster the need for search, rescue and first aid is likely to be so great that
organized relief services will be able to meet only a small fraction of the demand. Most
immediate help comes from the uninjured survivors.
Field care
Most injured persons converge to health facilities using whatever transport is available,
regardless of the facilities operating status. Proper care to casualties requires that the
health services resources to be redirected to this new priority Bed availability and
surgical services should be maximized. Provision for food & shelter should be
provided.
Triage
Triage consists of rapidly classifying the injured on the basis of the severity of their
injuries and the likelihood of their survival with prompt medical intervention. It is the
most important step in planning for management of mass causalities.
Aim of triage is:
Sorting is done on the site or disaster itself. The most common classification uses the
internationally accepted four-color code system.
This group consist or patients requiring immediate care. They need short procedures to save life.
This group is likely to constitute 20% of total causalities.
This group also consists of 20% of total causalities. This group includes:
This group include patients whose treatment could be delayed. They would require
technically complicated & time-consuming procedures. Treatment would basically
consist of resuscitation and emergent medical treatment. This group also consists of
20% of total injured. This include
a. Critical injures of CNS and respiratory tract.
b. Penetrating abdominal injuries
This group would constitute up to 40% of total injured .these causalities require minor
treatment and when first seen and dispatched to minimal treatment facility area.
Tagging
All patents should be identified with tags stating their name, age, place of origin,
triage, category, diagnosis and initial treatment.
Identification of dead
The health hazards associated with cadavers are minimal if death results from trauma
and if corps are contaminating streams, wells or other sources as in flood etc they may
transmit gastroenteritis, food poisoning etc.
Relief phase
This phase begin when assistance from outside starts to reach the disaster area.
The type and quantity of humanitarian relief supplies are usually determined by
Immediately following a disaster, the most critical health supplies are those needed for
treating causalities and preventing the spread of communicable disease. Following initial
emergency phase the needed supplies include food, blanket, clothing’s, shelters, sanitary
engineering equipment and nonstructural material.
Disaster managers must be prepared to receive large quantities of donations. There are 4
prenatal components in managing humanitarian supplies.
a. Acquisition of supplies
b. Transportation
c. Storage
d. Distribution
Disease control
a. Implement as soon as possible all public health measures to reduce the risk of disease
transmission.
b. Organize a reliable disease reporting system.
c. Investigate full reports of disease outbreak.
Supply of safe drinking water and proper disposal of concreter continue to be the most practical
method of disease prevention.
Nutrition
A natural disaster may affect nutritional status of the population by affecting one or
more components of food chain. Infants, children, pregnant women, nursing mothers
and sick persons are more prone to nutritional problems. The immediate steps for
ensuring food relief are:-
Rehabilitation
In first weeks after disaster the pattern of health needs will change rapidly, moving from
causality treatment to more routine primary health care.
Priorities also will shift from health care towards environmental health measures.
Water supply
The existing and new water sources require protection measures like.
Food safety
Paw hygiene is the major cause of food borne diseases. Kitchen sanitation and personal
hygiene should be monitored.
Many communicable diseases are spread through fecal contamination of drinking water and
food. Hence ensure sanitary disposal of excreta. Emergency latrine should be made available.
Washing, cleaning and bathing facilities should be provided.
Vector control
Control programme for vector borne disease should be intensified in the emergency and
rehabilitation period.
2. DISASTER PREPAREDNESS
o It is a programme of long term development activities whose goals are to
strengthen the overall capacity and capability of a country to manage effectively
all types of emergency, bring about an orderly transition from relief through
recovery and back to sustained development.
o The objective of disaster preparedness is to ensure that appropriate systems,
procedures and resources are in place to provide prompt and effective assistance
to disaster victims, thus facilitating relief measures and rehabilitation of services.
Members of community have the most to lose from being vulnerable to disasters and the
most to gain from effective and appropriate disaster management programmes.
Resources are most easily pooled at community level and every community possesses
capabilities.
Those who first respond to disaster come from the same community and so they can
manage situation effectively.
Sustained development is best achieved by allowing emergency affected communities to
design manage and implement internal & external assistance programs.
3 DISASTER MITIGATION
Disaster mitigation involves measures designed either to prevent hazards or to lessen the
likely effects of disaster.
These measures include flood mitigation works, appropriate land using techniques and
protection of vulnerable population and structures.
E.g.: improving the structural quality of houses, schools and other public and private
buildings.
a. Community Awareness
The voluntary agencies can ensure community participation by helping the community
in:-
The disaster preparedness programme would require the government agencies, volunteer
groups or NGOs from outside and local NGOs to co-ordinate among themselves as well
as the community. There is a greater need for co-ordination, regarding mitigation
actions, research, resource mobilization and utilization and networking among various
factors involved in disaster management at local and outside levels.
NGOs and CBOs are for more acceptable and effective at the grass root level than
government. In times of disaster, they can exercise first aid; search and rescue
operations promptly and efficiently compared to the government agencies. On the other
hand, the Government has more resources, equipment and transport required to
implement these activities. Thus there is a felt need & or an affective co-ordination
between manpower and organizing capability of NGOs, and resources and initiatives of
the Government.
Women and children are the first and foremost victims of natural disasters. During
disaster period they have to still perform their normal domestic functions. Some may be
pregnant. Some may deliver at this period. For successful implementation, formulation
of local plans has to lay special emphasis on women to make significant contribution
towards it.
The local community has developed if own coping mechanism strategies to deal with
the disasters. These can be better understood by the people and can prove to be
beneficial in minimizing the loss of life & property in the wake of disasters.
The needs of the community in respect to disaster management are divided into three
phase’s viz. pre-disaster, during disaster and post disaster.
1. Hazard analysis
2. Risk analysis
3. Vulnerability analysis
4. Resource analysis
5. Communication
6. Storage of essential items
7. Health facilities
8. Construction of shelter for victims
9. Evacuation plans
10. Emergency operation centre
11. Disaster task force
12. Education in schools
13. Enforcement of rules and regulations
14. Strengthening of building
Search, Rescue, Evaluation, Treating & taking care of victims, shelter, food, communication,
water and power supplies, health & sanitation, public information, security.
hAdvocacy
Along with relief the victims’ needs advocacy for better preparedness, increasing self
help capacity and developing own coping mechanism by the community. Thus there is
an urgent need for generating and sustaining community awareness on disaster.
i. Preventing disaster
ii. Preparing people to accept and to respond positively to any kind of disaster.
iii. Support people to recover from disaster situation
The nurse in the disaster team has an important role in dealing with psychosocial
problems of victims, there by prevents stress, and promotes mental health.
Initially she has to assess any physical problems and to treat them appropriately.
Assessment
Nurses need assess the victims who are at high risk for developing mental disturbances and
their need for crisis intervention as follows.
Those victims who have lost their home or possession, who have lost one or more family
members, who have suffered serious injuries
Victims with history of psychiatric disorder.
Those who do not have adequate support systems.
Elderly people.
Planning
It includes
Personal preparation
Establishing authority, communication and transportation.
Mobilizing, warning & evacuating
Rescue and recovery of victim triage.
Immediate treatment and support of victims and families
Identifying dead bodies.
Disaster worker rehabilitation
INTERVENTIONS
General interventions
Specific intervention.
Group work
Education about coping strategies
Crisis intervention
Problem solving
Advocacy
Appropriate referral service
Debriefing and counseling
Transportation
Communications
Fire fighting
Mass care
Resource support
Hazardous materials
Food
Energy
Among these most important emergency support service unit is health and medical
services, which provides co-ordinated federal assistance to communities following a
major disease or emergency the purpose of this unit is
Assist in establishing surveillance systems to monitor the general population and special high
risk population segments; carry out field studies and investigations, monitor injury and disease
patterns and potential disease out breaks and provide technical assistance and consultation on
disease and injury prevention and precautions.
They assist in providing care for ill or injured victims at the location of a disaster or
emergency.
Provide health and medical equipment and supplies, including pharmaceuticals, biologic
products and blood & blood products in an area affected by a major disaster or emergency.
Victim Evacuation
Provide for movement of seriously ill or injured patients from the area affected by a major
disaster or emergency to locations, where definitive medical care is available.
Hazards Consultation
Assist in assessing health and medical effects of radiological chemical and biological
exposure on the general population and on high risk population groups; conduct field
investigation, including collection and analysis of relevant samples
Vector Control
Assist in assessing the threat of vector borne diseases following a major disaster or
emergency. Provide victor control equipments and supplies technical assistance and consultation
on protective actions regarding vector – borne diseases.
Assist in providing victim identification and mortuary services, including temporary morgue
facilities, victim identification by fingerprint, forensic dental & or forensic pathology /
anthropology methods & processing, preparation, disposition of remains.
Food/Drug Safety
Ensure safety and efficacy of regulated foods, drugs, biologic products and medical devices
following a major disaster or emergency.
Assist by providing public health and disease and injury prevention information that can be
transmitted to members of the general public who are located in or near areas affected by a major
disaster.
In Hospital Care
Provide definitive medical care to victims who become seriously ill or injured as a result of a
major disaster or emergency.
CONCLUSION
Disaster may be sudden and can occur at any time, which cause, damage to community on
large scale. It may be loss of lives, economic loss that disrupt the existing infrastructure of that
community or it may threaten the future existence and survival of the community. Disasters can
occur anywhere at any time, not related to development of the community. However natural
disorders are inevitable and can only be anticipated but manmade disasters are to an extend
avoidable if proper care is taken to avoid it.
BIBLIOGRAPHY:
1. B.T Basavanthappa, Text book of community health nursing”. (2008) Jaypee brothers
New Delhi.
2. T. Bhaskara Rao “Text book of community medicine”. (2006) paras. New Delhi.
3. K. Park – “Textbook of preventive & social medicine” (2005) Bhanot.
4. Tener Goodwin veenema, “Disaster nursing” (2006). Springs – New York.
5. Indian journal of holistic nursing. vol (4) no June 2008.
6. http://www.stonybrookmedicalcentre.orgl.