NURSING ROLE(S) IN

EMERGENCY AND
DISASTER
Saifudin Zukhri
 CONTENT
DEFINITION AND PHASE OF
DISASTER
DISASTER MANAGEMENT PHASE
INDONESIAS DISASTER
MANAGEMENT SYSTEM
NURSING ROLE IN DISASTER
MANGEMENT
PROBLEM RELATED TO NURSING
ROLE IN DISASTER
Definition of Disaster
A sudden calamitous event bringing great
damage, loss, or destruction;
broadly : a sudden or great misfortune or
failure
An occurrence causing widespread
disruption, destruction and distress
requiring external assistance;
Events that inflict significant damage to life
or property and that substantially
overwhelm the local communitys resources
 DISASTER ?
A disaster is present when need
exceeds resources !

DISASTER = NEED >

RESOURCES
DISATER VS ACCIDENT/EMERGENCY

EMERGENCY DISASTER
: the local emergency
resources, though : A response NEED
potentially that is greater than
overwhelmed initially, the RESOURCES that
are able to quickly are available
manage the situation (Requiring resources
without requiring from other
resources from other communities)
communities
Type Of Disasters
HUMAN MADE
EVENTS NATURAL DISATERS
Warfare, Earthquake: collision
Transportation accidents,
Bombing,
of tectonic plates
Structural collapse, Drought
Fires, Flood
Pollution,
Hazardous Materials Heat wave
Incident (Oil Spill), Hurricane
Civil unrest,
Terrorism (CBRNE incidents),
Thunderstorm
Cyber attacks, Tornado
Airplane crash,
Water supply contamination
Volcano
 Infectious Disasters
Epidemic: the rates exceed the
normal incidents
Endemic: the rates are consistent
within a certain range (example:
tuberculosis in the U.S.)
Pandemic: global outbreak
(example : Hong Kong flu of 1968:
killed 1 million peopleglobally)
 DISASTER PHASES
Pre-Impact Phase

Impact Phase

Post-Impact Phase: includes emergency

response and recovery
COMMUNITY RESPONSES TO DISASTERS

Heroic Phase
Active rescure Adrenalin

Honeymoon Phaes
Community pulls together

Disillusionment phase
delays in assistance leads to disappointment

Reconstruction phase
: rebuilding of infrastructure, the return of a new a new form of
normalcy
DISASTER MANAGEMENT

Encompasses the efforts to

deal with hazards and the
disasters they may produce
 The 8 Principles Of Disaster
Management
1. Prevention
2. Minimize casualties from primary agent of
harm
3. Minimize casualties fromsecondaryagents or
sourcesof harm
4. Rescue victims
5. First aid and triage
6. Evacuation
7. Definitive medical treatment
8. Reconstruction
INDONESIAS DISASTER
MANAGEMENT SYSTEM
Indonesia : The Laboratory for
Disaster expert
Volcanoes
Earthquake and Tsunami (tectonic plate
lines, archipilago country)
Fload (deforesstation, climates))
Terorism (radicalism)
Social conflict (multi etnis)
Comunicable diseases
(global,economic status)
 INDONESIAS DISASTER
MANAGEMENT SYSTEM
Legal Standing : Government Law No : 24/2007 : the National System for
Disaster Management
The regulations providing a clear outline and role of central and local
governments up to village levels, including the role of community, private
sectors, and international partners in disaster management.
Formal Board:
Centraly by National Agency for Disaster Management (Badan Nasional
Penanggulangan Bencana (BNPB)
Localy (Provincial and Distric) by Local Board of Disater Mangement (BPBD)
Informal Central Board : National Platform (Planas) yang terdiri unsur
masyarakat sipil, dunia usaha, perguruan tinggi, media dan lembaga
internasional.
Local Level : Forum PRB Yogyakarta dan Forum PRB Nusa Tenggara Timur
The big picture that covers all management plans is reflected in the Five Year
National Action Plan for Disaster Risk Reduction (DDR) and the National Plan
on Disaster Management.
 Facility to enhance National
capacity to cope to disaster
Early Warning System,
Disaster Information Database (DiBi)
and
Standard in Risk Assessment
(PARBA).
 Rapid Disaster Response and
Assistance delivery
Stand-by force for emergency
management or Indonesian Rapid
Response and Assistance (INDRRA)
a combined civil-military forces from
various relevant line ministries/agencies
This force is stand-by ready to assist the
disaster-affected local government in
undertaking emergency activities in its
area in a timely and integrated manner
 The Chain of Comand
When a disaster strikes, a chain of command starts
from the Head of National Agency and Local Agency
who should coordinate other institutions and agencies
related to disaster management system to dispatch
and mobilize human resources, equipments, and
logistic needed to the disaster affected area.
In emergency situation, the Head of National Agency
will give recommendation for foreign logistic and
equipment assistance to be facilitated with custom
duty, tax, and quarantine exemption, except for
equipment and logistics with potential hazard with
coordination with other related Ministries.
NURSING ROLE IN
DISASTER ?
Nurses have consistently shown to be
reliable responders in disaster
the largest healthcare workgroup in
most countries
have a commpassionate nature
ingrained desire to help others
Historically are linked to the provision
of care during crise (Florence N in the
Crimean War)
Unique skill sets
Must understand the disaster cycle and
be able to be integrated at every phase
 Nurses posses skill and knowledge

comunication
Coordination and delegation
Care giver
Understanidng of the community
NURSING DISASTER GOAL
Ensuring that the highest achievable
level of care is delivered through
identifying, advocating, and caring for
all impacted population throughout all
phases of a disaster event, including
active participation in all levels of
disaster planning and preparedness.
THE CHARACTERISTICS OF NURSING
IN DISASTER
Caring of the community during of disaster :
must be aware of the potential hindrances in
delivering care and the modifications necessary to
provide this care.
Personal impact : loses of their own, not know
the status of the family, increase physical demand,
long shift
Adverse Conditions :The nature of a disaster can
cause adverse environmental conditions ; structural
damage, un safe environment, clossing medical
centre, dificulties in rceieving and evaciating
patients.
 The Character of Nursing In Disater
(contd)
Lack of recognition : nurses are not allowed to voice
their ideas nor are they allowed to participate in
administrative decision-making.
Critical Thinking : Critical thinking and problem-
solving are crucial skills in managing the effects of a
disaster.
Adaptibility :Because of the rapidly changing
circumstances during a disaster, flexibility and
adaptability increase the nurses capacity to function
efficiently and effectively during disaster events.
Leadership : Nurses must fully utilize their leadership
abilities to coordinate and organize efforts during all
stages of a disaster
Principles Of Nursing in Disaster
1. Services provided should be consistent with the
scope of practice
2. The components of the nursing process align
with the phases of disaster management
3. Competencies provide a framework for defining
nurses role and standards of practice across
the disaster cycle
4. Public health nurses bring leadership, policy,
planning, and practice expertise to disaster
preparedness, response, and recovery.
 4 Area of Nursing competencies in
disaster
1) Mitigation and prevention;
2) preparedness;
3) response;
4) recovery/rehabilitation
The competency domain :

1. Risk reduction, disease prevention and health

promotion
2. Policy development and planning
3. Ethical practice, legal practice andaccountability
4. Communication and information sharing
5. Education and preparedness
6. Care of the community
7. Care of individuals and family
8. Psychological care
9. Care of vulnerable populations
10. Long-term recoveryof individuals, families and
communities
 The Nurses 5 of Primary Roles in
Disasters
1. Planning and prevention
2. Emergency care
3. Triage of victims
4. Direct care of victims
5. Recovery and revitalization of
communities
 Prevention and Planning
1. Personal protection of the self and family
members
2. Prevention of disaster, whenever plausible
3. Planning for disaster management before one
occurs;
4. When disaster strikes, the nurse is involved in
developing a response plan
As a nurse in a disaster, your first role is
tosave yourself and your family first; after
all, you must help yourself before you can
help others
 Prevention Measures
All-hazards mitigation
Structural & Nonstructural
Deter potential threats
Take action to eliminate threats
 Example of Prevention
Activities
Hazard vulnerability assessment/risk
assessment
Increase security
Increase testing specific to the event;
increased surveillance
Mass prophylaxis/immunization
Assessment & identification of potential
hazards/vulnerabilities
Isolation & quarantine
Halting of CBRNE threats
 RESPONSE : Emergency
Care
National Frame Work
First responders
Preparing for care through a disaster
assessment
First aid to community members
Risk comunication
 Triage of Victims
Triage involvespreservation of the
most lives possibleby prioritizing
to determine theimmediacy of care
The need to allocate
limitedresources and determining
whocan besaved can be emotionally
and spirituallychallenging
A color coding system is used to
organize care management
 Direct care
Provide direct care of victims
Perform care of victims in an unified
and collaborative manner with other
rescue workers
Most hospitals have an emergency
planin place for a variety of potential
disasters
 Recovery Action
Nurses work with other recovery coordinators to
restore, redevelop and revitalize communities
impacted by disaster
Nurses assist in policy development to prevent
future disasters or implement quality control in
response
Flexibility is important; attempt to return to
usual operations.
Community assessment
Psychological support
Community and client advocate
 Preparedness
Personal
Profesional : disaster competencies
Community
Training, Drill, and Excercise
PARTNERSHIP & TEAM
WORK
public

nation nursi privat

al ng e

Local
 PROBLEMS RELATED TO NURSING
ROLE IN DISASTER
Safety issues
Ethic and
Legal issues
 CONCLUSSION
If nurses c annot convey their disaster practice
expertise to others, they will most likely be
underused, misused, and/or unable to participate
in the leadership that they employ for community
advocacy.
Nurses remain the largest health care provider
group available for preparedness, response, and
recovery.
It is important that nurses understand and
promote their disaster capabilities as members of
the publi chealth and health care team before,
during, and after the incident.
 REFERENCES
American Nurses Association (ANA). 2008. Adapting standards of care under
extremeconditions: Guidance for professionals during disasters, pandemics, and other
extreme emergencies. http://
www.wsna.org/Topics/Emergencypreparedness/documents/ASCEC_WhitePaper031008FINAL.pd
f
American Nurses Association (ANA). 2010. ANA issues brief: Who will be there? Ethics,
the law and a nurses duty to respond in disaster.
http://nursingworld.org/MainMenuCategories/WorkplaceSafety/Healthy-
orkEnvironment/DPR/Disaster-Preparedness.pdf
Centers for Disease Control and Prevention (CDC). 2012. Public health preparedness: 2012
state-by-state report on laboratory, emergency operations coordination, and emergency
public information and warning capabilities. http://www.cdc.gov/phpr/pubs-
links/2012/documents/2012%20State -ByState_Preparedness_Report.pdf

International Council of Nurses (ICN) and World Health Organization (WHO). 2009. ICN
framework of disaster nursing competencies. http://
www.icn.ch/images/stories/documents/networks/DisasterPreparednessNetwork/Disaster_Nursi
ng_Competencies_lite.pdf
Association of Public Health Nurses, 2014, The Role of the Public Health Nurse In Disaster
Preparedness, Response, and Recovery, A Position Paper.
Robert Powers, 2010, Introduction To disaster and Disater Nursing, in International Disater
Nuring
Badan Nasional Penanggualnagan Bencana (BNPB)
TANK YOU