DISASTER NURSING

INTRODUCTION:-
Disaster caused by nature’s fury is not uncommon in this planet, earth. In fact, the scientists
believe that the birth of this planet, Earth was the result of explosion that occurred in the solar
system. From time immemorial, this planet had witnessed numerous natural disasters. In the past,
man used to view these natural disasters as the ‘act of god’. Gradually, science opened the doors
of knowledge and enabled man to understand the mysterious occurrence of natural disaster.

DEFINITION OF DISASTER:-
1. “is a situation in which there is sudden massive It disproportion between hospital
element of any kind and the survival resource of that are available to counterbalance
these in the shorter period of time”
American College of Emergency Physicians.
2. “A disaster is any occurrence that cause damage, economic disruption, loss of human
life and property, or deterioration of health and services on scale sufficient to warrant an
extraordinary response from the area or community.

DISASTER alphabetically means

D: Destructions
I: Incidents
S: Sufferings
A: Administrative failures
S: Sentiments
T: Tragedies
E: Eruption of communicable diseases
R: Research program and its implementation.

TYPES OF DISASTERS;
Natural Disaster:
Natural disasters, e.g. natural calamities or climatic hazards, like earthquake, flood, cyclone,
famine, drought, forest, fire, dust storms, sandstorms, landslide, volcanic, etc.
Man-made Disasters:
These include technical disasters like dam failure, nuclear accidents, hazardous waste accidents,
oil spill and leakages, industrial accident and due to fire, social disasters like mass-migration,
riots, etc
 Minor disasters involving approximately 25 victims
 Moderate disasters involving approximately 100 victims
 Major disaster involving more than 100 victims
 Catastrophic disaster when number of injured patients reaches up to 1000 or more.

Disasters Classification (HPC)

Water- and climate-related disasters
- Floods - Cyclones
- Tornadoes - Hailstorms
- Cloud burst - Heat wave and Cold
wave
- Snow avalanches - Droughts
- Sea erosion - Thunder & Lightening
- Tsunami (Added)
Geologically related disasters
- Landslides and mudflows - Earthquakes
- Dam failures/dam bursts - Mine fires
Chemical, industrial and nuclear
- Chemical and industrial disaster
- Nuclear disasters
Accident-related disasters
- Forest fires - Urban fires
- Mine flooding - Oil spills
- Major building collapse - Serial bomb
blasts
- Festival-related disasters - Electrical
disasters and fires
- Air, road and rail accidents - Boat
capsizing
 - Village fire
Biologically related disasters
- Biological disasters and epidemics - Pest attacks
- Cattle epidemics - Food
poisoning

DISASTERS NATURAL
Earthquakes
An earthquake (also known as a quake, tremor or temblor) is the result of a sudden release of
energy in the Earth's crust that creates seismic waves. Earthquakes are recorded with a
seismometer, also known as a seismograph). Intensity of shaking is measured on the modified
Mercalli scale.)
Cyclone
Cyclone is an area of closed, circular fluid motion rotating in the same direction as the earth.
This is usually characterized by inward spiraling winds that rotate counter-clockwise in the
Northern Hemisphere and clockwise in the Southern Hemisphere of the Earth. Most large-scale
cyclonic circulations are centered on the areas of low atmospheric pressure.
Fires
A wildfire is any uncontrolled fire that occurs in the countryside or a wilderness area. .A
wildfire differs from other fires by its extensive size, the speed at which it can spread out from its
original source, and its ability to change direction unexpectedly and to jump gaps, such as roads,
rivers and fire breaks.
Landslides
These include wide range of ground movements such as risk falls, deep failure of slopes and
shallow debris flows which can occur in offshores, costal and onshore environment. The main
causes are ground water pressure acting to destabilize the slope, loss or absence of vertical
vegetative structure, soil nutrients and erosion of toe of a slope by river or ocean waves.
Volcanic Eruptions
A volcano is an opening, or rupture, in a planet's surface or crust, which allows hot magma, ash
and gases to escape from below the surface. The word 'volcano' is derived from the name of
Vulcano Island off Sicily, which in turn, was named after Vulcano the Roman god of fire.
Floods
Water is a source for all life forms. Without water, no life is sustainable. But when water is in the
form of floods, it takes away thousands of human and cattle life. The soil is deposited by
moving water. However, if water remains stagnant for too long, these beneficial floods become a
major disaster. Most vulnerable things which are affected due to floods are homes, buildings, and
huts made from biomass materials like bamboo leaves.
Famines
A famine is a widespread scarcity of food that may apply to any faunal species. This
phenomenon is usually accompanied by regional malnutrition, starvation, epidemic and
increased mortality.
Droughts
A drought is an extended period of months or years when a region notes deficiency in its water
supply.

MAN-MADE DISASTERS
Man-made disasters are human-caused events which, either intentionally or by accident-caused
events which either intentionally or by accident-cause threats to public health and well-being.
Chemical Weapons Chemical
Emergency occurs when a hazardous chemical has been released and the release has potential for
harming people's health.
Radiation Emergency
Emission of radiation from radioactive materials, for example, reactors, radioactive substances
(uranium) and medical supplies (radium)
Bioterrorism
Bioterrorism is terrorism by intentional release or dissemination of biological agents (bacteria,
viruses or toxins); these may be in a naturally-occurring or in a human-modified form.
Pandemics and Disease
 A global disease outbreak
 Influenza virus causes various illnesses
 Spread is from person to person.

Primary Prevention against Man-made Disaster

  Prevention of occurrence of the disaster must be done to prevent not only the
consequences but also the occurrence of fire, explosion crashes and sudden chemical and
radiation exposure.
 These include tighter regulation of chemical plants and other hazardous facilities and
insistence that the chemical plants be built away from the densely populated area.
 Appropriate engineering and technological measures like building codes, dam design
containment of toxic materials Protection against human error.
 The world has turned towards efforts to stop arms race and prevent nuclear war.

DISASTER AGENTs /EPIDEMIOLOGY OF DISASTER;

Agents:
Primary Agents
These include:
 Falling of buildings
 Earthquakes
 Floods
 Hurricanes
 Bomb blasts
 Tsunami

Secondary agents
These include:
 Bacteria and viruses that produce contamination or infection after the primary agent has
caused injury or destruction.
 For example: A hurricane with rising water can cause flooding and high winds. These
are the primary agents.
 The secondary agents would include damaged buildings and bacteria or viruses that
thrive as a result of the disaster

Host Factors :
Host factors include:
 Age
 Immunization status
 Degree of mobility
 Emotional stability
 Environmental Factors
Physical Factors
Weather conditions, the availability of food, time when the disasters occurs, the availability
of water and the functioning of utilities such as electricity and telephone service.
Chemical Factors
Influencing disaster outcome includes leakage of stored chemicals into the air, soil,
groundwater or food supplies. For example: Bhopal Gas Tragedy.
Biological factors
These are those that occur or increase or increase as a 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 caused by illness or death.
Social Factors
These 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.

PHASES OF DISASTER
Warning phase: Some disasters give warning of their approach. In this certain
precautionary measures are undertaken to handle the disaster situation efficiently and
effectively.
Threat phase: This is critical decision-making period when one's activity is directed
towards the survival action.
Impact phase: When disaster strikes, people may at first be stunned.
Then they begin to realize the magnitude of the effects of disaster such as injury, death,
destruction, etc.
Inventory phase: During this phase, one tries to find out what has actually happened to him.
Victim may exhibit fear, anger, sorrow, depression, anxiety and other emotions.
Rescue phase: During this period the victim help each other to cope and begin to help with the
rescue provide comfort to others and to establish shelter and other needs.
Remedy phase: The morale of victim usually picks up during this period as they work together
with rescue personnel to get the community back to its feet. This phases is the longest post
disaster period when reconstruction takes place,
Restoration period: In this phase, the individuals regain the stability that they enjoyed prior to
the disaster. The time required for a community to reach the state of equilibrium depends upon
the nature and intensity of disaster and disaster relief available.

These three aspects of disaster management correspond to different phases in the so-called
disaster cycle as shown in below
 Mitigation
 Preparedness
 Reconstruction
 Rehabilitation
 Response
 Recovery phase after a disaster.

Goal of disaster management:

 The goal of disaster management is the safety and sustainability of human lives.
 Safety is related to avoiding death and injuries to human lives during a disaster.

DISASTER NURSING:

The adaptation of professional nursing knowledge, skills and attitude in recognizing and meeting
the nursing and medical needs of disaster victims.

A NURSE'S RESPONSIBILITIES IN DISASTERS

Prevention and Mitigation
• Preparation for disasters: Disaster planning is essential for a community, business or a hospital;
It involves thinking about details of preparation and management by all involved including
community leaders, health and safety professionals and lay people. A disaster plan need not be
lengthy. Such a concise plan should still contain information on the elements discussed in this
and the following sections.
Personal Preparation
Professional Preparedness
There should be disaster management team of nurse, psychiatric nurses, physician, surgeon,
social workers and psychologists to be active and alert all the time. The team must understand
the disaster plans at their workplace and community and will participate in disaster drills.
Gather Information Through
Shelter Management
Although voluntary health agencies take care of shelter management but the nurses because of
their comfort with delivering aggregate health promotion, disease promotion and emotional
support make ideal shelter management as a team member.
Dealing with Stress
Basic measures while working with victims dealing with stress include
Listening carefully to the victims, and telling and retelling their feelings related to disaster.
Establishing Authority, Communication and Transportation
In addition to community assessment, the effective disaster plan establishes a clear chain of
authority, develops lines of communication and delineates routes of transport. Usually, the chain
is hierarchical for example, at the local hospitals. the hospital administrator may be responsible
for alerting the nurse manager to call in additional personnel flexibility is essential, because key
authority figures may themselves be victims of disaster.

Responding to Disasters
At the disaster site, police, firefighters, nurses and other relief workers develop a coordinative
response to rescue triage and treat disaster victims.
 Rescue: One of the first obligations of response of relief workers is to remove the victim
from the danger site. This job typically all fire fighters and personnel with special
training in search and rescue. Depending upon the disaster agent protective gear heavy
equipment and special vehicles may be needed and dogs trained to locate the dead bodies
may be brought.
 Triage: Whereas emergency nurses daily determine which client require priority care,
triage is the process of sorting multiple causalities in the event of war and major disasters.
It is required when the number of causalities exceeds immediate treatment resources.
Different categories of victims are as follows:
- Red: Urgent/critical
- Victims in this category have injuries or medical problems that will likely lead to
death if not treated immediately. To example, an unconscious victim with the sign
of internal bleeding,
- Yellow: Delayed
 - Victims in this category have injuries that will require medical attention, however,
time to medical treatment is not ye critical. For example, a conscious victim with
a fractured femur.
- Green: Minor/walking wounded
Victims in this category have sustained minor injury or are presenting with minimal
signs of illness. Prolonged delay care most likely will not adversely affect the long-
term outcome. For example, a conscious victim with superficial cut scrapes and
bruises.
Black: Dead
Victims in this category are obviously dead or have suffered mortal wounds, because
of which death is imminent. For example, an unconscious victim with an open skull
fracture with brain matter visible.

Immediate Treatment and Support.

Disaster nurses provide treatment on site at emergency treatment station, in the

shelters or at local hospital and clinics in addition to direct nursing care, onsite
interventions might include arrange for transport once victims are stabilized
managing the procurement, distribution and replenishment of all supplies.

Recovery phase;

 The main objective of disaster management in this stage is to involve all agencies and
resources to restore the economic and civil life of community e.g. construction of
temporary as well as permanent houses and epidemiological services.
 There is continuous threat of communicable disease due to inadequate water supply
and crowded living conditions. The nurse must remain vigilant in teaching proper
hygiene and making sure immunization record up to date.
 The nurse needs to be alert for environmental health hazard during recovery phase of
disaster in the end, all the nurses and organizations in the world can only provide
partnership with the victim of disaster. Ultimately, it is upon an individual to recover
on his/her own.

ROLES OF THE NURSES IN DISASTER

 Nurses have an important role to play during each phase of a disaster. For the
purpose of disaster planning and preparation, it is simpler to categorize nurses as
working in either at the disaster site or hospital setting.

Management and Triage at the Disaster Site

A disaster scene is one of the most challenging environments in which the
nurses have to practice. Most disaster scenes are noisy, dangerous and confusing.
In addition, there are other challenges such as hazardous environment,
miscommunication, and lack of medical/rescue equipment, lack of proper
leadership, inappropriate patient care and improved use of personnel. These
challenges can be met by establishing the following three goals:
 To assure the safety of personnel and patients.
 To organize an effective disaster system.
 To deliver appropriate patient care.

Safety Assurance
All disaster personnel should have, as their foremost consideration, the protection
of:
a) Themselves
b) Their fellow workers
c) Their patients--in that order. Some guidelines to remember before entering
a disaster zone are:
• Quickly assess the scene for danger before rushing in
• Stay at least 100 yards away from fire

Organizing An Effective Disaster System

The nurse must be familiar with the personnel at the disaster scene and their roles and functions.
In addition, she much understand the organizing of the site. A disaster scene is usually broken up
into three zones.
Disaster Zone
It is the actual location of the incident from where patients are to be removed as soon as
possible. Majority of disaster personnel are sent to this zone initially.
Treatment Zone
Nurses spend most of their time in the zone during a disaster, where equipment and personal to
carryout patient care or concentrated. Activities carried out in this zone include:
• Triage of patients into treatment categories
• Through assessment of each patient
• Treatment of injuries
• Preparation for transport.
Transportation Zone
It should be situated directly next to the treatment zone, so that ambulances and other vehicles
can load patients and leave for hospitals.

ROLE OF THE NURSES IN DISASTER AT A HOSPITAL

Disasters which occur in a care facility such as a hospital are known as internal disasters. In
addition, hospitals are often the recipients of casualties from disasters that occur in the
surrounding communities, i.e. external disasters..

Preparation at the Emergency Department

When the emergency department is not emergency department is notified of the disaster, it sets
in motion a series of activities. An assessment of the existing status of patients in the department
is made to take decisions concerning their care and disposition. A waiting room area for family
members is located away from the emergency department so as to avoid congestion of people at
the emergency .The number of patients the department can receive must be determined .
The emergency department is responsible for the following:
• Making sure as many nursing personnel as possible report for duty.
• Assigning them to specific areas/rooms.
• Instructing volunteers and ancillary personnel.
• Providing breaks or periods of rest for triage nurse and those working in resuscitation
and minor treatment areas.
• Commutating the need for additional personnel to whoever concerned.
• Periodic checking of supplies

Emergency department nurses are assigned to work in the following

treatment areas:
• Major (Resuscitation room)
• Minimal (First-aid)
 • Morgue area
• Delayed area

Triage Area
The triage team consists of the team consists of the following personnel: emergency department
physicians, an experienced emergence who is familiar with the disaster plan, an emergency
department admitting clerk, and security personnel of traffic. Responsibilities of this team are:
 Assigning patients to appropriate treatment areas according to severity of their condition
and availability of the department
 Obtaining registration information about the patient
 Transportation of victims onto a stretcher or to wheelchairs.

PREPARATION OF THE INPATIENT AREAS

A. Defined mechanism to alert nursing units to an external disaster must be in place. The
following guidelines can be used for the same:
• Remain calm
• Notify on-duty staff and call in on
• Stop all non-essential functions
Activities at Hospitals or Relief Centers:
• Clearing of the emergency ward or preparing disaster ward. She
• Check the trauma area for the supplies
• Assign one nurse to call back sufficient staff
• Assign one nurse and one doctor for the ambulance to direct to the predetermined
planned areas
• Work with a "Scoop and Run" philosophy
• Assign 2 doctors and 1 nurse for one client in the required cases
• Direct the relatives to a receiving area, where emotional support and continuous relay of
information are to be provided.
• Provide individual attention and prompt treatment.

Activities at Referral Areas:

• Preparation, staffing and supplies method same as above
• Identify the clients if possible
• Check the transport facilities available, make use of all the available recourses for the
transportation of victims to the respective places
 • Put proper identification data while transferring
• Keep the relatives informed.

RESEARCH INPUT:-
Research conduct by Funda Ozpulat and Esma Kabasakal in 2018 :
Aim: aimed to determine nursing students knowledge levels on disaster nursing and their state
of disaster preparedness.
Method: this study include fourth-year nursing students in two universities located in the
Ankara and Konya provinces of Turkey. It was conducted in the second education terms
between 2015-2016 and 2016-2017.for data analysis, this study used frequency values, a chi-
square test to assess students views on disaster nursing courses by their universities ,and an
independent Sample t-test.
Result:51.6% students were nursing students in University A located in Konya, with
48.4%studying at University B in Ankara The mean age of students was 2.14-0.95 years, and
85.5% were female .Most of students studying in University A(67.8%)reported that they had
received education about disaster, and this rose to 83.2% of University B students. This showed
that students disaster education status differed between universities.

SUMMARIZATION:-
Disaster nursing :-.  Disaster nursing are “the adaptation of
professional nursing knowledge, skills and attitude in recognizing and meeting the nursing,
health and emotional needs of disaster victims. “Nurses are often the first medical personnel
on site after disaster strikes. Nurses are at the forefront of disasters and take an active role in
management of the event. Training and disaster drills are two ways to help prepare nurses to
meet the patients and families needs.

CONCLUSION:-
Nurses are at the forefront of caring for individuals and communities in times of
emergency and disaster. ... In disaster recovery and rehabilitation, nurses continue to
provide support to those with long-term care needs, both physical and mental.

BIBLIOGRAPHY:-
1.Brar Kaur Navdeep; Textbook of Advanced Nursing Practice; Jaypee Brothers Medical
Publishers; Page no.1037-1056.
2.K.Park;Textbook of Preventive and Social Medicine; Bhanot Publishers; Page no.795-802.
3. https://onlinelibrary.wiley.com
4.http://collections.unu.edu