Disaster Nursing ----------------------------------------------------------------------------------------------Introduction Disaster is an occurrence arising with little or no warning, which causes serious disruption of life and

perhaps death or injury to large number of people. It is any man made or natural event that causes destruction and devastation which cannot be relieved without assistance. Natural disasters are catastrophic events with atmospheric, geologic, and hydrologic origins. Natural disasters can have rapid or slow onset, with serious health, social, and economic consequences. Developing countries are disproportionately affected because they may lack resources, infrastructure, and disaster-preparedness systems. India has been traditionally vulnerable to natural disasters on account of its unique geoclimatic conditions. Types of disaster Natural. Eg : earthquake, floods, hurricane, tsunami. Manmade.Eg: nuclear accidents, industrial accidents Hybrid Eg: spread of disease in community, global warming. Levels of disaster Level iii disaster considered a minor disaster. These are involves minimal level of damage Level ii disaster- considered a moderate disaster. The local and community resources has to be mobilized to manage this situation Level i disaster- considered a massive disaster- this involves a massive level of damage with severe impact. Disaster mitigation Disaster mitigation refers to actions or measures that can either prevent the occurrence of a disaster or reduce the severity of its effects. (American Red Cross). Mitigation activities include: Awareness and education, such as holding community meetings on disaster preparedness Disaster prevention-such as building a retaining wall to prevent flood water from the residences Advocacy such as supporting actions and efforts for effective building codes or proper land use. Disaster management Phases of disaster management Prevention phase Preparedness phase Response phase Recovery phase Prevention phase The task during this phase is to identify community risk factors and to develop and implement programs to prevent disasters from occurring. Programs developed during this phase may also focus on strategies to mitigate the effects of disaster that cannot be prevented such as earth quakes, cyclones etc. Task force includes are local and national government, social service providers, police & fire department, major industries, local medias etc. Preparedness phase Personal preparedness:Health care professionals with client responsibilities can also become disaster victims. Conflicts arise between client related and work related responsibilities. Personal and family preparation can help to ease of some of the conflicts. Professional preparedness: Professional preparedness requires that health care professionals become aware of and understand the disaster plans at their work place and community. Adequately prepared professionals can function as leaders in the disaster management areas. Personal items that are recommended for a professional to keep for the disaster management are- copy of professional license, personal equipments such as stethoscope, flash light and extra batteries, cellular phone, warm clothing or heavy jackets, protective shoes, pocket sized reference books, watch etc.

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Key organizations and professionals in disaster management Health care communityhospitals Mental health professionals Pharmacies Public health departments Rescue personnel Non health care community Clergy Fire fighters Municipal or government officials Media Medical examiners Medical supply manufactures Police Community preparedness The level of community preparedness for a disaster is only as high as the people and organization in the community make it. Some communities stay prepare for disaster with written plans and by participating in disaster drills. Community must have adequate warning system and a back up evaluation plan to remove people from the area of danger Response phase The level of disaster varies and the management plans mainly based on the severity or extent of the disaster. Level iii disaster- considered a minor disaster. The disaster is classifies as one that involves a minimal level of damage Level ii disaster- considered a moderate disaster that is likely to result in major disaster. Mobilizations of support system are necessary at this level. Level i disaster- considered a massive disaster. This disaster involves a massive damage to lives and property. Recovery phase During this phase the community take actions to repair, rebuilt, or reallocate damaged homes and businesses and restore health and economic vitality to the community. Psychological recovery must be addressed. The emotional scars of witnessing a disaster may persist for long duration. Both victims and relief workers should be offered mental health activities and services. Disaster management cycle Prevention ------> I Recovery <---------

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preparedness v response

Disaster management plans Although no disaster management plans can be made to fit every emergency but protocols and chronological action plans to prove to deal emergency situation efficiently if executed in coordinated manner. Aims of disaster plans to provide prompt and effective medical care to the maximum possible in order to minimize morbidity and mortality ObjectivesTo optimally prepare the staff and institutional resources for effective performance in disaster situation To make the community aware of the sequential steps that could be taken at individual and organizational levels

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Constitution of disaster management committee The following members would comprise the disaster management committee under the chairmanship of medical superintendent/ director Medical superintendent/ director Additional medical superintendent Nursing superintendent/ chief nursing officer Chief medical officer (casualty) Head of departments- surgery, medicine, orthopedics, radiology, anesthesiology, neurosurgery Blood bank in charge Security officers Dietitian Transport officer Sanitary personnel The disaster management committee is overall responsible for managing the disaster situation, take administrative decisions, review the disaster plans and inform authorities. Disaster control room In the eventuality of a disaster the existing casualty would be referred as the disaster control room. It would be managed round the clock. Rapid response team The medical superintendent will identify various specialists, nurses and pharmacological staff to respond within a short notice depending up on the time and type of disaster. The list of members and their telephone numbers should be displayed in the disaster control room. Information and communication- the disaster control team would be responsible for collecting, coordinating and disseminating the information about the disaster situation to the all concerned. Information would be sort on time, place and nature of the disaster, approximate number of the causalities. Disaster beds Requirement of beds depends up on the magnitude of the disaster. Some beds can ear marked as disaster beds. The efforts should be created to allocate additional beds byUtilization of vacant beds, day care beds, and pre-operative beds Convalescing patients, elective surgical cases and patients who can have domiciliary care or opd management should be discharged Utility areas to be converted in to temporary wards such as wards with side rooms, corridors, seminar rooms etc. Creating additional bed capacity by using trolleys, folding beds and floor beds Logistic support system Separate cupboards marked as disaster shelf and should be kept in disaster control rooms, equipped with all essential medicines and surgical supplies. The disaster cupboard should containResuscitation equipments Iv sets, iv fluids, Disposable needles, syringes and gloves Dressing and suturing materials and splints Oxygen masks, nasal catheters, suction machine and suction catheters Ecg monitors, defibrillators, ventilators Cut down sets, tracheostomy sets and lumbar puncture sets Linen and blankets Keys of these cupboards should be readily available at the time of disaster Training and drills Mock exercise and drills at regular intervals to ensure that all the staff in the general and those associated with management of causalities are fully prepared and aware of their responsibilities. Elements of disaster plan A disaster plan should have the following elements Chain of authority Lines of communication

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Routes and modes of transport Mobilization Warning Evacuation Rescue and recovery Triage Treatment Support of victims and families Care of dead bodies Disaster worker rehabilitation Activation of disaster management plans A standard operating procedure should be developed that defines how each task would be accomplished. As soon as the information regarding disaster is received emergency control room officer on duty in consultation with ms/ director would activate the disaster plan. Reception area- the disaster control room will act as the reception area to receive the causalities and to screen them. Triage- a predetermined triage should be undertaken to classify the causalities. For large number of casualties the triage team should incorporate a surgeon, an orthopedic surgeon, physician and an anesthesiologist. Priority one- needing immediate resuscitation, after emergency treatment shifted to intensive care unit Priority two- immediate surgery, transferred immediately to operation theatre. Priority three- needing first aid and possible surgery- give first aid and admit if bed is available or shift to hospital Priority four- needing only first aid-discharge after first aid. Documentation-A comprehensive documentation is essential. Documentation will be done at the casualty by cmo and attending health care professionals. All mlcs will be recorded as per the institutional policy. However the treatment of patients will get priority over the paper work. Public relations- the identified officer would liaison with relatives of the victims to inform them on their clinical status. The list of casualties along with their status displayed at prominent place outside casualty in both english and local language and should be update regularly. The ms or the authorized person should brief the media (press, radio, tv). Essential services- adequate provision should be made to meet additional requirement of water & power supply and other services prominent to patient care. Crowd management/ security arrangement- immediate mobilization of security staff available within the hospital campus to ensure security of admitted patients, their belongings, hospital staff equipments and crowd management. The local police station should be informed to provide assistance in managing the crowd. Disaster management- nurses role in community Assess the community Assess the local climate conducive for disaster occurrence, past history of disasters in the community, available community disaster plans and resources, personnel available in the community for the disaster plans and management, local agencies and organizations involved in the disaster management activities, availability of health care facilities in the community etc. Diagnose community disaster threats Determine the actual and potential disaster threats (eg; explosions, mass accidents, tornados, floods, earthquakes etc). Community disaster planning Develop a disaster plan to prevent or deal with identified disaster threats Identify local community communication system

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Identify disaster personnel, including private and professional volunteers, local emergency personnel, agencies and resources Identify regional back up agencies and personnel Identify specific responsibilities for various personnel involved in the disaster plans Set up an emergency medical system and chain for activation Identify location and accessibility of equipment and supplies Check proper functioning of emergency equipments Identify outdated supplies and replenish for appropriate use. Implement disaster plans Focus on primary prevention activities to prevent occurrence of manmade disasters Practice community disaster plans with all personnel carrying out their previously identified responsibilities (eg: emergency triage , providing supplies such as food, water, medicine, crises and grief counseling) Practice using equipment; obtaining and distributing supplies Shelter management plans nurses can act as shelter managers listen to the victims and retell their feelings related to disaster encourage victims to share their feelings help victims to over come the crisis delegate tasks to team members and coordinate activities provide the basic necessities(food, water, shelter etc) provide compassion and dignity to the victim 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 the response of personnel involved in disaster relief efforts. Conclusion Disaster is an emergency situation, therefore coordination of actions and various departments is an essential requisite for efficient management of mass casualties. References Stanhope m, lancaster j. Community health nursing- process and practice for promoting health. 3rd edn. Mosby year book. St.louis. 1992. Allender j a, spradly bw. Community health nursing- promoting and practicing the publics health. 6th edn. Lippincott williams and wilkins. London. 2005 Clemenstone s, mcguire sl, eigsti dg. Comprehensive community health nursing- family aggregate and community practice. 6th edn. Mosby publishers. St louis. 2002 Stanhope m, lancaster j. Community and public health nursing. 6th edn. Mosby publishers. London. 2004. Lewis sl, heitkemper mm. Medical surgical nursing- assessment and management of problems. Mosby publishers. Philadelphia. 2007. Taylor c, lillis c, lemone p. Fundamentals of nursing- the art and science of nursing care. 5th edn. Lippincott williams and wilkins. London. 2006.

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