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DISASTER NURSING

INTRODUCTION
The need for professional nurses to be prepared in emergency and disaster nursing is
increasingly evident as the complexity of our lives increases owing to the discovery of new
scientific knowledge and its application to the everyday world. Because nurses represent the
largest group of trained professional health workers available, their awareness and of preparation
for emergency care of the ill and injured are essential.
Such independent nursing function as observation, maintenance of personal health
measures, health teaching, prevention of illness, control of the environment and supervision and
direction of either professional or nonprofessional nursing personnel are already recognized
activities as preparation for providing care in emergency situations. On the other hand, the
administration of medications and treatments, while dependent on others from physicians, is
continually being evaluated and more responsibility for it is being shifted to professional nurses.
Professional nurses, then, need to be prepared to meet everyday emergencies in terms of
first-aid and lifesaving measures. They also need to be prepared to meet emergencies as they
occur on ward nursing units in hospitals and as emergency cases are brought to hospital facilities.
An awareness of the most common emergency cases and their management as found in specific
localities is a professional responsibility nurses must assume.
Nurse’s functions are expanded further in the case of mass disasters either resulting from
natural phenomena or man-made including enemy attack. As the scope of disaster increases,
nurses shift their emphasis of participation from direct, personalized care to patients to the
direction, teaching and supervision of non professional personnel. The professional role is
further expanded in usefulness when the nurse assumes responsibility to be knowledgeable in
citizenship.

DEFINITIONS

1. “A disaster can be defined as any occurrence that cause damage, ecological disruption, loss
of human life, deterioration of health and health services, Vs a scale sufficient to warrant as
extraordinary response from outside the affected community or area.” (W.H.O.)
2. “An occurrence of a severity and magnitude that normally results in death, injuries and
property damage that cannot be managed through the routine procedure and resources of
government.” (FEMA - Federal Emergency Management Agency)
3. “A disaster can be defined as an occurrence either nature or man made that causes human
suffering and creates human needs that victims cannot alleviate without assistance.”(ARC-
American Red Cross)
4.United Nations defines “disaster is the occurrence of a sudden or major misfortune which
disrupts the basic fabric and normal functioning of a society or community.” The Disaster
Relief Act of 1974 defines a major disaster as "any hurricane, tornado, storm, flood, wind-
driven water, tidal wave, earth- quake, volcanic eruption, landslide, mudslide, snowstorm, drought,
fire, explosion, or other catastrophe in any part of the United States [that], in the determination of the
President causes damage of sufficient severity and magnitude to warrant major disaster assistance
above and beyond emergency services by the Federal Government to supplement the efforts and
available resources of the State and Local Governments, and private relief organizations in alleviating
the damages, loss, hardship, and suffering caused by the disaster" (Federal Emergency Management
Agency [FEMA], Washington).

A hazard can be defined as any phenomenon that has the potential to cause disruption or damage to
people and their environment. Disasters are not confined to a particular part of the world, they can
occur anywhere and at any time. Emergencies and disaster do not only affect health and well being of
people, large number of people are displaced, injured, killed or subjected to greater risk of epidemics.
Considerable economic harm is also common. Disasters cause greater harm to existing infrastructure
and threaten the future of sustainable development. Extensive damage to property, roadways, electrical
lines, and other crucial infrastructures limits a region’s ability to respond. Whether the origin of the
disaster is natural or attributable to human causes, the outcomes can be devastating. These events often
leave the local first responders, medical systems, and governmental operations overwhelmed.

A major disaster can create a mass casualty incident or a multiple casualty incident. A multiple casualty incident is one
in which there are more than two but fewer than 100 persons injured. Multiple casualties generally
strain and, in some situations, might overwhelm the available emergency medical services and
resources. A mass casualty incident is a situation with a large number of casualties, usually 100 or
more, that significantly overwhelms available emergency medical services, facilities, and resources.

Disaster management is defined as "the managerial function charged with creating the framework
within which communities reduce vulnerability to hazards and cope with disasters." ( Federal
Emergency Management (FEMA)). Disaster management includes the development of disaster
recovery plans, for minimizing the risk of disasters and for handling them when they do occur, and the
implementation of such plans.

Disaster nursing can be defined as “the adaptation of professional nursing knowledge, skills and
attitude in recognizing and meeting the nursing, health and emotional needs of disaster victims.

“Disaster Nursing is nursing available”practiced in a situation where professional supplies, equipment,
physical facilities and utilities are limited or not
‘DISASTER’ alphabetically means

D - Destructions
I - Incidents
S - Sufferings
A - Administrative, Financial Failures
S - Sentiments
T - Tragedies
E - Eruption of Communicable diseases
R - Research programme and its implementation

" Emergency Nursing is a specialty in which nurses care for patients in the emergency or
critical phase of their illness or injury and are adept at discerning life-threatening problems,
prioritizing the urgency of care, rapidly and effectively carrying out resuscitative measures and
other treatment, acting with a high degree of autonomy and ability to initiate needed measures
without outside direction, educating the patient and his family with the information and
emotional support needed to preserve themselves as they cope with a new reality.”

Types of Disasters:

Category 1- Water and Climate related disasters

a) Flood
b) Drought
c) Costal erosion
d) Thunder and Lightening
e) Cyclone and Storms etc.
Category 2 - Geologically related Disasters
a) Landslides and Mudflows
b) Earthquakes
c) Dam failures
d) Tsunami
e) Dam bursts etc.
Category 3 - Chemical Industrial and Nuclear related disasters
a) Leakage of hazardous materials at the time of their manufacture, processing and
transportation.
b) Disasters due to manufacture, storage, use and transportation of products, pesticides etc
and waster produced during the manufacturing process etc.
Category 4 - Biological related disasters
a) Epidemics
b) Cattle epidemics
c) Food poisoning
d) Pest attacks etc.
Category 5- Man-made disasters
a) Forest fire
b) Urban fire
c) Village fire
d) Festival related disasters
e) Road, Rail and Air Accidents
f) Boat capsizing
g) Oil spill
h) Major building collapse
i) Serial Bomb blast
j) Illicit Liquor Tragedy
k) Drug abuse
l) Drowning
m) Tanker lorry mishaps
n) Pollution (water, air and soil)
o) Family suicides
p) Environmental disasters
q) Communal riots
r) Stamped etc.

Essentially, there are two types of disasters:

natural and man- made. Both types vary in intensity, severity, and impact. Natural

disasters include hurricanes, tornadoes, flash floods, blizzards, slow-rising floods, typhoons,

earthquakes, avalanches, epidemics, and volcanic eruptions. Man-made disasters include war,

chemical and biological terrorism, transportation accidents, food or water contamination, and

building collapse. Fire can be either man-made or naturally occurring.
Epidemiology

Epidemiology is the study of pattern of disease occurrence in human populations 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 outcomes of a disaster. As stated earlier there are two types of disasters: natural and
man-made. Both types will vary in intensity, severity and impact.
Disaster Agent: To apply the epidemiological framework in a disaster situation, the
agent 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 bacterial 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. For example, a
hurricane with rising water can cause flooding and high winds; these are primary agents. The
secondary agents would include damaged buildings and bacteria or viruses that thrive as a result
of the disaster. In an epidemic, the bacteria or virus causing a disease is the primary a disease is
the primary agent rather than the secondary agent.
Host: In the epidemiological frame work as applied to disaster, 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. Individuals most severely affected by a disaster are elderly
persons, who may have trouble leaving the area quickly; young children whose immune systems
are not fully developed and persons with respiratory or cardiac problems. For example, a fire in
a nursing home is potentially more lethal than a fire in a college dormitory. In a fire situation
elderly individuals in the nursing home are at greater risk because they are less physically fire
and more susceptible to smoke and other consequences than are young college students.
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 functioning of utilities
such as electricity and telephone service. Chemical factors influencing disaster outcome include
leakage of stored chemicals into the air, soil, ground water or food supplies. Biological factors
are those that occur or increase as a result of contaminated water, improper food storage, or lack
of or rodent proliferation 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.
Factors affecting Disaster

Host factors
In the epidemiological frame work as applied to disaster the host is a human-kind. Host
factors are those characteristics of humans that influence the severity of the disaster effect. Host
factors include
 Age
 Immunization status
 Degree of mobility
 Emotional stability

Environmental factors:
This includes:
1. Physical factors
Whether conditions, the availability of food, time when the disaster occurs, the
availability of water and the functioning of utilities such as electricity and telephone service.
2. Chemical Factors
Influencing disaster outcome include leakage of stored chemicals into the air, soil, ground
water or food supplies.
Eg: Bhopal Gas Tragedy
3. Biological Factors
Are those that occur or increase as result of contaminated water, improper waste disposal,
insect or rodent proliferations improper food storage or lack of refrigeration due to interrupted
electrical services.
Bioterrorism: Release of viruses, bacteria or other agents cause illness or death.
4. Social Factors
Are those that contribute to the individual 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.
5. Psychological Factors
. Psychological factors are closely related to agents, host and environmental conditions.
The nature and severity of the disaster affect the psychological distress experienced by the
victims

PHASES OF A DISASTER

There are three phases of disaster.
1. Pre-Impact Phase
2. Impact Phase
3. Post – Impact Phase

PRE-IMPACT PHASE

It is the initial phase of disaster, prior to the actual occurrence. A warning is given at the sign of the
first possible danger to a community with the aid of weather networks and satellite many
meteorological disasters can be predicted. The earliest possible warning is crucial in preventing toss
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, detention authority. Communication is a
very important factor during this phase; disaster personnel will call on amateur radio operators,
radio and television stations.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 group.

IMPACT PHASE

The impact phase occurs when the disaster actually happens. It is a time of enduring hardship or
injury end of trying to survive. The impact phase may last for several minutes (e.g. after an
earthquake, plane crash or explosion.) or for days or weeks (eg in a flood, famine or epidemic).
The impact phase continues until the threat of further destruction has passed and emergency plan is in
effect. This is the time when the emergency operation center is established and put in operation. It
serves as the center for communication and other government agencies of health disseminates
healthcare providers to staff shelters. Every shelter has a nurse as a member of disaster action team.
The nurse is responsible for psychological support to victims in the shelter.

POST – IMPACT PHASE
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 lifetime (e.g. – victims of the
atomic bomb of Hiroshima). The victims of disaster in go through four stages of emotional
response.

1. Denial - during the stage the victims may deny the magnitude of the problem or have not fully
registered. The victims may appear usually unconcerned.

2. Strong Emotional Response – in the second stage, the person is aware of the problem but
regards it as overwhelming and unbearable. Common reaction during this stage is trembling,
tightening of muscles, speaking with the difficulty, weeping heightened, sensitivity,
restlessness sadness, anger and passivity. The victim may want to retell or relieve 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 effect to solve them. It is important for victims to take
specific action to help themselves and their families.

4. Recovery - The fourth stage represent a recovery from the crisis reaction. Victims feel that
they are back to normal. A sense of well-being is restored. Victims develop the realistic
memory of the experience.

DISASTER MANAGEMENT

A typical Disaster Management continuum comprising of 4 elements –
1. Response
2. Recovery
3. Mitigation
4. Preparedness in pre-disaster phase

Management sequence of a sudden onset disaster:

Disast
er
Preparedness impac
t
Response
Risk reduction phase
before a disaster

Rehabilitation

Mitigation
Reconstruction - recovery phase after a disaster

I. DISASTER IMPACT AND RESPONSE
The i m p a c t p h a s e 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 might last for several
minutes (e.g., during an earthquake, plane crash, or explosion) or for hours, days, or weeks (e.g., in a
flood, famine, or epidemic). During the impact phase, injured persons are triaged, morgue facilities are
established and coordinated, and search and rescue activities are organized.

Medical treatment for large number of casualties is likely to be needed only after certain types of
disaster. Most injuries are sustained during the impact, and thus, the greatest need for emergency care
occurs in the first few hours. The management of mass casualties can be further divided into search and
rescue, first aid, triage and stabilization of victims, hospital treatment and redistribution of patients to
other hospitals if necessary.

Search, rescue and first-aid:
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 spontaneously to health facilities, using whatever transport is available,
regardless of the facilities, operating status. Providing proper care to casualties requires that the health
service resources be redirected to this new priority. Bed availability and surgical services should be
maximized. Provisions should be made for food and shelter. A centre should be established to respond
to inquiries from patient's relatives and friends. Priority should be given to victim's identification and
adequate mortuary space 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. Higher priority is granted to victims
whose immediate or long-term prognosis can be dramatically affected by simple intensive care.
Moribund patients who require a great deal of attention, with questionable benefit, have the lowest
priority. Triage is the only approach that can provide maximum benefit to the greatest number of
injured in a major disaster situation.
Although different triage systems have been adopted and are still in use in some countries, the most
common classification uses the internationally accepted four color code system. Red indicates high
priority treatment or transfer, yellow signals medium priority; green indicates ambulatory patients and
black for dead or moribund patients.

Triage should be carried out at the site of disaster, in order to determine transportation priority, and
admission to the hospital or treatment centre, where the patient's needs and priority of medical care will
be reassessed. Ideally, local health workers should be taught the principles of triage as part of disaster
training. Persons with minor or moderate injuries should be treated at their own homes to avoid social
dislocation and the added drain on resources of transporting them to central facilities. The seriously
injured should be transported to hospitals with specialized treatment facilities.

Five Category Coding for Triage

1. Red—Most urgent; first priority
First-priority patients have life-threatening injuries and are experiencing hypoxia or nearing hypoxia. Examples of
injuries in this category include shock, chest wounds, internal hemorrhage, head injuries producing increased loss
of consciousness, partial- or full-thickness burns over 20% to 60% of the body surface, and chest pain.

2. Yellow—Urgent; second priority
Second-priority patients have injuries with systemic effects and complications but are not yet hypoxic or in shock.
The patients appear stable enough to withstand up to a 2-hour wait without immediate risk. Examples of injuries in
this category include multiple fractures, open fractures, spinal injuries, large lacerations; partial- or full-thickness
burns over 10% to 20% of the body surface, and medical emergencies, such as diabetic coma, insulin shock, and
epileptic seizure. Patients with second-priority status might need to be observed closely for signs of shock, at which
time they would be re-categorized to first priority.

3. Green—Third priority
Third-priority patients have minimal injuries unaccompanied by systemic complications. Usually these patients
can wait more than 2 hours for treatment without danger. Examples of injuries in this category include closed
fractures, minor bums, minor lacerations, sprains, contusions, and abrasions.

4. Black—Dying or dead
Dying or dead patients are hopelessly injured patients or dead victims. These patients have catastrophic injuries
(e.g., crushing injuries to the head or chest) and would not survive under the best of circumstances. These patients
create the greatest difficulty, because failure to treat patients conflicts with nursing philosophy. In a disaster, triage
must give the chance of survival to the greatest number of victims rather than to one individual. Personnel and
equipment must be reserved for the greatest number of viable patients.

5. Contaminated—Might have a color code or a hazardous material (HAZ MAT) triangle tag
These patients are contaminated with bacteriologic or chemical hazards. They will be routed to a decontamination
sector to eliminate hazards before additional treatment is provided.

Tagging
All patients should be identified with tags stating their name, age, place of origin, triage category,
diagnosis, and initial treatment.
Taking care of dead
Taking care of the dead is an essential part of the disaster management. A large number of dead can
also impede the efficiency of the rescue activities at the site of the disaster. Care of the dead includes:
(1) Removal of the dead from the disaster scene;
(2) Shifting to the mortuary;
(3) Identification;
(4) Reception of bereaved relatives. Proper respect for the dead is of great importance.
The health hazards associated with cadavers are minimal if death results from trauma and corps are
quite unlikely to cause outbreaks of disease such as typhoid fever, cholera or plague. If human bodies
contaminate streams, wells, or other water sources as in floods etc., they may transmit gastroenteritis or
food poisoning to survivors. The dead bodies represent a delicate social problem.

RELIEF PHASE
Immediately following a disaster, the most critical health supplies are those needed for treating
casualties, and preventing the spread of communicable diseases. Following the initial emergency
phase, needed supplies will include food, blankets, clothing, shelter, sanitary engineering equipment
and construction material. A rapid damage assessment must be carried out in order to identify needs
and resources. Disaster managers must be prepared to receive large quantities of donations. There are
four principal components in managing humanitarian supplies
a) Acquisition of supplies;
b) Transportation
c) Storage
d) Distribution.

EPIDEMIOLOGIC SURVEILLANCE AND DISEASE CONTROL
Disasters can increase the transmission of communicable diseases through following mechanisms:

1. Overcrowding and poor sanitation in temporary resettlements. This accounts for the reported
increase in acute respiratory infections etc. following the disasters.
2. Population displacement may lead to introduction of communicable diseases to which either the
migrant or indigenous populations are susceptible.
3. Disruption and the contamination of water supply, damage to sewerage system and power systems
are common in natural disasters.
4. Disruption of routine control programs as funds and personnel are usually diverted to relief work.
5. Ecological changes may favor breeding of vectors and increase the vector population density.
6. Displacement of domestic and wild animals, which carry with them zoonoses that can be
transmitted to humans as well as to other animals. Leptospirosis cases have been reported following
large floods (as in Orissa India, after super cyclone in 1999). Anthrax has been reported
occasionally.
7. Provision of emergency food, water and shelter in disaster situation from different or new source
may itself be a source of infectious disease.

Outbreak of gastroenteritis, which is the most commonly reported disease in the post-disaster period, is
closely related to first three factors mentioned above. Increased incidence of acute respiratory
infections is also common in displaced population. Vector-borne diseases will not appear immediately
but may take several weeks to reach epidemic levels.
Displacement of domesticated and wild animals increases the risk of transmission of zoonoses.
Veterinary services may be needed to evaluate such health risks. Dogs, cats and other domestic animals
are taken by their owners to or near temporary shelters. Some of these animals may be reservoirs of
infections such as leptospirosis, rickettsiosis etc. Wild animals are reservoirs of infections which can be
fatal to man such as equine encephalitis, rabies, and infections still unknown in humans.
The principles of preventing and controlling communicable diseases after a disaster are;

 Implement as soon as possible all public health measures, to reduce the risk of disease
transmission
 Organize a reliable disease reporting system to identify outbreaks and to promptly initiate
control measures
 Investigate all reports of disease outbreaks rapidly
 Vaccination

Health authorities are often under considerable public and political pressure to begin mass
vaccination programmes, usually against typhoid, cholera and tetanus. The pressure may be increased
by the press media and offer of vaccines from abroad.
The WHO does not recommend typhoid and cholera vaccines in routine use in endemic areas. The
newer typhoid and cholera vaccines have increased efficacy, but because they are multi dose vaccines,
compliance is likely to be poor. They have not yet been proven effective, as a large-scale public health
measure. Vaccination programme requires large number of workers who could be better employed
elsewhere. Supervision of sterilization and injection techniques may be impossible, resulting in more
harm than good. And above all, mass vaccination may lead to false sense of security about the risk of
the disease and to the neglect of effective control measures. However, these vaccinations are
recommended for health workers. Supplying safe drinking water and proper disposal of excreta
continue to be the most practical and effective strategy.
Significant increase in tetanus incidence has not occurred after natural disasters. Mass vaccination
of population against tetanus is usually unnecessary. The best protection is maintenance of a high level
of immunity in the general population by routine vaccination before the disaster occurs, and adequate
wound cleaning and treatment.
Natural disasters may negatively affect the maintenance of ongoing national or regional eradication
programmes against polio and measles. Disruption of these programmes should be monitored closely.
If cold-chain facilities are inadequate, they should be requested at the same time as vaccines. The
vaccination policy to be adopted should be decided at senior level only.

NUTRITION
A natural disaster may affect the nutritional status of the population by affecting one or more
components of food chain depending on the type, duration and extent of the disaster, as well as the
food and nutritional conditions existing in the area before the catastrophe. Infants, children, pregnant
women, nursing mothers and sick persons are more prone to nutritional problems after prolonged
drought or after certain types of disasters like hurricanes, floods, land or mudslides, volcanic eruptions
and sea surges involving damage to crops, to stocks or to food distribution systems.
The immediate steps for ensuring that the food relief programme will be effective include : (a)
assessing the food supplies after the disaster ; (b) gauging the nutritional needs of the affected
population ; (c) calculating daily food rations and need for large population groups ; and (d) monitoring
the nutritional status of the affected population.

REHABILITATION
The final phase in a disaster should lead to restoration of the pre-disaster conditions. Rehabilitation
starts from the very first moment of a disaster. Too often, measures decided in a hurry, tend to obstruct
re-establishment of normal conditions of life. Provisions by external agencies of sophisticated medical
care for a temporary period have negative effects. On the withdrawal of such care, the population is left
with a new level of expectation which simply cannot be fulfilled.

In first weeks after disaster, the pattern of health needs will change rapidly, moving from casualty
treatment to more routine primary health care. Services should be reorganized and restructured.
Priorities also will shift from health care towards environmental health measures. Some of them are as
follows :

i. water supply
A survey of all public water supplies should be made. This includes distribution system and water
source. It is essential to determine physical integrity of system components, the remaining capacities,
and bacteriological and chemical quality of water supplied.
The main public safety aspect of water quality is microbial contamination. The first priority of ensuring
water quality in emergency situations is chlorination. It is the best way of disinfecting water. It is
advisable to increase residual chlorine level to about 0.2-0.5 mg / litre. Low water pressure increases
the risk of infiltration of pollutants into water mains. Repaired mains, reservoirs and other units require
cleaning and disinfection.

Chemical contamination and toxicity are a second concern in water quality and potential chemical
contaminants have to be identified and analyzed.
The existing and new water sources require the following protection measures
(1) Restrict access to people and animals, If possible, erect a fence and appoint a guard
(2) Ensure adequate excreta disposal at a safe distance from water source
(3) Prohibit bathing, washing and animal husbandry, upstream of intake points in rivers and streams
(4) Upgrade wells to ensure that they are protected from contamination
(5) Estimate the maximum yield of wells and if necessary, ration the water supply
In many emergency situations, water has to be trucked to disaster site or camps. All water tankers
should be inspected to determine fitness, and should be cleaned and disinfected before transporting
water.

ii. Food safety
Poor hygiene is the major cause of food-borne diseases in disaster situations. Where feeding
programmes are used (as in shelters or camps) kitchen sanitation is of utmost importance. Personal
hygiene should be monitored in individuals involved in food preparation.

iii. Basic sanitation and personal hygiene
Many communicable diseases are spread through faecal contamination of drinking water and food.
Hence, every effort should be made to ensure the sanitary disposal of excreta. Emergency latrines
should be made available to the displaced, where toilet facilities have been destroyed. Washing,
cleaning and bathing facilities should be provided to the displaced persons.

iv. Vector control
Control programme for vector-borne diseases should be intensified in the emergency and rehabilitation
period, especially in areas where such diseases are known to be endemic. Of special concern are
dengue fever and malaria (mosquitoes), Ieptospirosis and rat bite fever (rats), typhus (lice, fleas), and
plague (fleas). Flood water provides ample breeding opportunities for mosquitoes.
A major disaster with high mortality leaves a substantial displaced population, among whom are those
requiring medical treatment and orphaned children. When it is not possible to locate the relatives who
can provide care, orphans may become the responsibility of health and social agencies. Efforts should
be made to reintegrate disaster survivors into the society, as quickly as possible through institutional
programmes coordinated by ministries of health and family welfare, social welfare, education, and
NGOs.

II. RECOVERY PHASE

The aim of the recovery phase is to restore the affected area to its previous state. It differs from the
response phase in its focus; recovery efforts are concerned with issues and decisions that must be made
after immediate needs are addressed. Recovery efforts are primarily concerned with actions that
involve rebuilding destroyed property, re-employment, and the repair of other essential infrastructure.
Efforts should be made to "build back better", aiming to reduce the pre-disaster risks inherent in the
community and infrastructure. An important aspect of effective recovery efforts is taking advantage of
a ‘window of opportunity’ for the implementation of mitigative measures that might otherwise be
unpopular. Citizens of the affected area are more likely to accept more mitigative changes when a
recent disaster is in fresh memory.
This phase begins when assistance from outside starts to reach the disaster area. The type and quantity
of humanitarian relief supplies are usually determined by two main factors:
(1) The type of disaster, since distinct events have different effects on the population
(2) The type and quantity of supplies available locally.

III. MITIGATION

Mitigation efforts are attempts to prevent hazards from developing into disasters altogether or to reduce
the effects of disasters. The mitigation phase differs from the other phases in that it focuses on long-
term measures for reducing or eliminating risk. The implementation of mitigation strategies is a part of
the recovery process if applied after a disaster occurs. Mitigation measures can be structural or non-
structural. Structural measures use technological solutions like flood levees. Non-structural measures
include legislation, land-use planning (e.g. the designation of nonessential land like parks to be used as
flood zones), and insurance. Mitigation is the most cost-efficient method for reducing the affect of
hazards although not always the most suitable. Mitigation includes providing regulations regarding
evacuation, sanctions against those who refuse to obey the regulations (such as mandatory
evacuations), and communication of risks to the public. Some structural mitigation measures may harm
the ecosystem.

A precursor to mitigation is the identification of risks. Physical risk assessment refers to identifying
and evaluating hazards. The hazard-specific risk (Rh) combines a hazard's probability and affects. The
higher the risk, the more urgent that the vulnerabilities to the hazard are targeted by mitigation and
preparedness. If, however, there is no vulnerability then there will be no risk, e.g. an earthquake
occurring in a desert where nobody lives.
Based on risk assessment, specific action plans should be designed to reduce the effects of predicted
disasters. Mitigation might involve legislating specific building codes and land-use restrictions. As-
sessment and inventory of resources for special equipment, «applies, and personnel necessary to
support an emergency response is essential. Planning activities should be coordinated by the
emergency management agency and involve all appropriate government agencies, public safety,
private organizations, and health care entities. Disaster plans and personnel training must be reviewed
and tested on a regular basis. % critical component of the pre-disaster phase preparation is education
of the public to encourage individual preparedness. Examples of public education are the hurricane
watch preparation and evacuation procedures for communities in the Southeast hurricane belt.

IV. DISASTER PREPAREDNESS
Emergency preparedness is "a programme of long term development activities whose goals are to
strengthen the overall capacity and capability of a country to manage efficiently all types of
emergency. It should bring about an orderly transition from relief through recovery, and back to
sustained development”.
The objective of disaster preparedness is to ensure that appropriate systems, procedures and resources
are in place to provide prompt effective assistance to disaster victims, thus facilitating relief measures
and rehabilitation of services.The individuals are responsible for maintaining their well- being.
Community members, resources, organizations, and administration should be the cornerstone of an
emergency preparedness programme. The reasons of community preparedness are:
(a) Members of the community have the most to lose from being vulnerable to disasters and the most
to gain from an effective and appropriate emergency preparedness program
(b) Those who first respond to an emergency come from within the community. When transport and
communications are disrupted, an external emergency response may not arrive for days
(c) Resources is most easily pooled at the community level and every community possesses
capabilities. Failure to exploit these capabilities is poor resource management
(d) Sustained development is best achieved by allowing emergency-affected communities to design,
manage, and implement internal and external assistance programme
Disaster preparedness is an ongoing multi sectoral activity. It forms an integral part of the national
system responsible for developing plans and programmes for disaster management, prevention,
mitigation, preparedness, response, rehabilitation and reconstruction. The system, known by a variety
of names depending on the country, depends on the coordination of a variety of sectors to carry out the
following tasks
 Evaluate the risk of the country or particular region to disaster;
 Adopt standards and regulations ;
 Organize communication, information and warning systems ;
 Ensure coordination and response mechanisms ;
 Adopt measures to ensure that financial and other resources are available for increased
readiness and can be mobilized in disaster situation ;
 Develop public education programmes ;
 Coordinate information sessions with news media ; and
 Organize disaster simulation exercises that test response mechanisms.
Policy development:
The policy development is "the formal statement of a course of actionn. Policy is strategic in nature and
performs the following functions:
 establish long - term goals;
 assign responsibilities for achieving goals;
 establish recommended work practice; and
 Determine criteria for decision making.
While policies tend to be “top - down" that is authorized by higher levels, implementation of the
strategies that arise from a policy tend to be "bottom-up", with the higher levels assisting lower levels.
The form of emergency preparedness policy varies from country to country. Six sectors are required for
response and recovery strategies. These sectors are communication, health, social welfare, police and
security search and rescue and transport.

Role of nurse in disaster recovery:

1. Primary prevention :
participate in developing disaster management plan for the community.

2. Secondary prevention: assess the disaster victims and triage for a care.

3. Tertiary prevention: participate in home visits to uncover danger that may cause additional
injury to victims or instigate other problems. For example: house fires from faulty wiring.

Role of nurse in disaster response:
1 .Nurse as first responder
2.Nurses as epidemiologists
3.Nurse as communicator
4.Nurse in action

1. Nurse as a first responder:

The nurse is the first to arrive on the scene.Once the rescue workers begin to arrive at the
scene plan for triage should begin immediately. Although valued for their expertise in
community assessment, care findings, and referring, and working with the aggregates.
2. Nurse as a epidemiologists:
Detecting the outbreak
Determine the cause
Identify factor that place people at risk
Implementing measures to control outbreak
Informing the medical and public communities about treatment.

3. Nurse as communicator:
Nurse working as a member of an assessment team need to return accurate information to
relief managers to facilitate rapid rescue and recovery.
Lack of or inaccurate information regarding the scope of the disaster.
The objective in emergency communication are to identify and respond to the barriers or
reestablish trust.

4. Nurse in action:
Determine the magnitude of the event.
Define health needs of affected group.
Establishes priorities and objectives.
Collaborate with other professional, governmental and non-governmental agencies.
Maintain unified chain of command.
BIBLIOGRAPHY :

1. Basavanthappa, Community Health Nursing Paperback – 2008 , By JPB; 2 edition

2. Tener Goodwin Veenema , Disaster Nursing and Emergency Preparedness: for
Chemical, Biological, and Radiological Terrorism and Other Hazards, Third
Edition 3rd Editio by Springer Publishing

3. Deborah S Adelman, Disaster Nursing: A Handbook for Practice 1st Edition by
Bartlett Learning

4. Gail A. Harkness DrPH ,Community and Public Health Nursing: Evidence for
Practice Second, North American Edition .

5. Park, Textbook of Preventive and Social Medicine, 23rd edition, M/S Banarsidas
Bhanot Publishers; 23 edition (2015)

6. Ray Suresh, Nurse's Role in Disaster Management30 January 2010 by Paperback
CBS; 1st edition

7. Loretta Malm Garcia, Disaster Nursing: Planning, Assesment and Intervention
Hardcover 1985 by Lippincott Williams and Wilkins

8. Michael Beach, Disaster Preparedness and Management 1st Edition,
by F A Davis.