SEMINAR

ON
DISASTER NURSING

SUBMITTED TO: SUBMITTED

BY:
GENERAL OBJECTIVE

At the end of the seminar the group will be able to understand about the Disaster

Nursing and apply it in daily practice.

SPECIFIC OBJECTIVE

At the end of seminar, the group will be able to;-

1. Meaning of disaster and hazard.

2. Explain the types of disaster.

3. Discuss the phases of disaster.

4. Explain the dimensions of disaster.

5. Describe the triage system of disaster management.

6. Explain stages of disaster and the role of nurse in disaster management.

7. Describe role of Community Health Nurse in Disaster Response.

8. Explain role of Community Health Nurse in Disaster Recovery.

INTRODUCTION

Presently at the global level, there has been considerable concern over natural
disasters. Even as substantial scientific and material progress is made, the loss of
lives and property due to disasters has not decreased. In fact, the human toll and
economic losses have mounted. There has been an increase in the number of
natural disasters over the past years and with it, increasing losses on account of
urbanization and population growth, as a result of which the impact of natural
disasters is now felt to a larger extent. According to the United Nations, in 2001
alone, natural disasters of medium to high range caused at least 25,000 deaths
around the world, more than double the previous year and economic losses of
around US $36 billion. These figures would be much higher, if the consequences
of the many smaller and unrecorded disasters that cause significant losses at the
local community level were to be taken into account.
Natural disasters are not bound by political boundaries and have no social or
economic considerations. They are borderless as they affect both developing and
developed countries. They are also merciless and as such the vulnerable tend to
suffer more at the impact of natural disasters. For example, the developing
countries
are much more seriously affected in terms of the loss of lives, hardship borne by
population and the percentage of their GNP lost. Since 1991, two-third of the
victims of natural disasters was from developing countries, while just 2 percent
were from highly developed nations. Those living in developing countries and
especially those with limited resources tend to be more adversely affected. With
the alarming rise in the natural disasters and vulnerability per se, the world
community is strengthening its efforts to cope with it.
MEANING
Disaster means that any occurrence that causes damage, ecological disruption, loss
of human life or deterioration of health and health services on a scale sufficient to
warrant and extraordinary response from outside the affected community or area
(WHO, 1995).

TYPES
Disaster is an occurrence, either natural or man-made that causes human suffering
and creates human needs that victims cannot alleviate without assistance.
Disasters can be natural & man-made.

• Natural disasters include droughts, earthquakes, tsunamis, forest fires,

landslides and mudslides, blizzards, hurricanes, tornadoes, floods and volcanic
disruptions.
• Man-made disasters includes hazardous substance accidents (e.g.,
chemicals, toxic gases), radiologic accidents, dam failures, resource shortage
(e.g., food, electricity and water), structural fire and explosions and domestic
disturbances (e.g., terrorism, bombing and riots), Bioterrorism.

DISASTER FACTORS
• Agent
• It 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 bacteria 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.
• Host:
• 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, immuni-
zation status, pre-existing health status, degree of mobility and emotional
stability.
• 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 the 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 waste disposal, insect or rodent proliferation,
improper food storage, or lack of refrigeration 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.
• Psychological factors contribute to the effect of the disaster on individuals.
Psychological factors are closely related to agent, host and environmental
conditions. The nature and severity of the disaster affect the psychological
distress experienced by victims. The existence and length of a warning period
and physical proximity to the actual site of the disaster influence the amount of
psychological distress experienced by victims. The closer an individual is to the
actual site of the disaster and the longer the individual is exposed to the
immediate site of the disaster, the greater the psychological distress that
individual will experience.
 • Individuals may suffer impaired intellectual functioning, have difficulty
concentrating, or making decisions and experience impaired memory. Psycho-
somatic complaints and mental illness are also responses to disaster situations
and are evidenced by loss of appetite, fatigue, intestinal upset, sleep disorders
and muscular weakness.

PHASES OF A DISASTER
• Pre-Impact Phase:
The pre-impact phase is the initial phase of the disaster, prior to the actual
occurrence. A warning is given at the sign of the first possible danger to a
community. Many times there is no warning, but with the aid of weather
networks and satellites, many metrological disasters can be predicted. The
earliest possible warning is crucial in preventing loss 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 Defense Authority.
Communication is a very important factor during this phase; disaster personnel
will call on amateur radio operators, radio and television stations and any
available method to alert the community and keep it informed. 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. 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 groups.
• Impact Phase:
The impact phase 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 may last for several minutes or for
days or weeks (e.g., in a flood, famine or
epidemic).
This phase must provide for preliminary assessment of the 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. The impact phase
continues until the threat of further destructions has passed and the emergency
plan is in effect. If there has been no warning, this is the time when the
Emergency Operation Center (EOC) is established and put in operation. The
EOC is the operating center for the local chapter of the American Red Cross. It
serves as the center for communication with other government agencies, the
center for recruitment of health care providers to staff shelters
• Post impact Phase:
Recovery beings during the emergency phase and end 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 bombing of Hiroshima).
The victims of a disaster go through four stages of emotional response:
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. The problems created by the disaster are being denied or have not
fully "registered." The victim may appear unusually unconcerned.
2. Strong emotional response: In the second stage, the person is aware of the
problem but regards it as overwhelming 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. The victim may want to retell or relive 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 effort to solve them. He or she
feels more hopeful and confident. It is especially important for victims to take
specific actions to help themselves and their families.
4. Recover: The fourth stage represents a recovery from the crisis reaction.
Victims feels that they are back to normal. Routines become important again. A
sense of well-being is restored. The ability to make decisions and carry out plans
returns. Victims develop a realistic memory of the experience.

DIMENSIONS OF A DISASTER

Disasters have a number of dimensions in which they may differ: predictability,

frequency, controllability, time and scope or intensity. These dimensions influence
the nature and possibility of preparation planning, as well as response to the actual
event.
Predictability:
Some events are more easily predicated then others. Advances in meteorology, for
example, have made it more feasible to accurately predict the probability of certain
types of natural, weather-related disasters (e.g., tornadoes, floods, and hurricanes),
while others, such as earthquakes, are not as easily predicted. Man-made disasters,
such as explosions or weeks, are also less predictable. Whenever an event is
predictable, authorities and emergency personnel have more time to prepare for
situation than when an event is not foreseeable (i.e., spontaneous).
Frequency:
Although natural disasters are relatively rare, they appear more often in certain
geographical locations. Residents of the coastal area live in what is commonly
referred to as cyclone are at greater risk for experiencing later greater risk for
earthquakes, and people who live near large river systems are at greater risk for
flooding than people who live elsewhere
Controllability:
Some situations allow for pre warning and control measures that can reduce the
impact of the disaster; others do not. Emergency planners were able to control
some of the effects of the flooding by sandbagging levees and river or sea banks to
reduce the effects of water damage, and by deliberately blasting dikes and dams to
divert flood waters to less populated areas. The immediate impact on people was
reduced by the ability of emergency personnel to organize evacuations and reduce
the risk of injury and death.
Time:
There are several characteristics of time as it relates to the impact of a disaster; the
speed of onset of the disaster, the time available for warning the population, and
the actual length of time of the impact phase.
Scope and Intensity:
A disaster may be concentrated in a very small area or involve a very large
geographical region, usually affecting many more people. A disaster can be very
intense and highly destructive, causing many injuries, deaths, and property
damage, or less intense, with relatively little damage done to property or
individuals.

THE NURSING ROLE IN DISASTERS

• Disaster nurses play key leadership and service provision roles in planning
and implementing disaster relief efforts, preventing technologic disasters,
and addressing problems that occur during a disaster, such as the physical
and emotional stress of disaster victims.
• During a disaster many environmental health problems emerge. The scope
and magnitude of these problems determines the nursing role. Nurses
 collaborate with community agencies and officials to recognize and reduce
disaster risks and maximize the health and safety of individuals involved in
disaster crises.
• Following a disaster, nurses make numerous referrals to community
agencies for a variety of needs including psychologic care, emotional
support services, and treatment for victims and their families. Recovery
encompassed dealing with many disaster effects such as loss of life, income,
and home. The communicable disease implications of disasters are also
immense:
Assess the Community
• Is there a current community disaster plan in place?
• What previous disaster experiences has the community been involved with
locally, statewide, nationally?
• How is the local climate conducive to disaster formation (e.g., hurricanes,
tornadoes, blizzards)?
• How is the local terrain conducive to disaster formation (e.g., earthquakes,
flooding, forest fires, avalanches, mudslides)?
• What are the local industries?
• Are there any community hazards (e.g., toxic waste and chemical spills,
industrial or agricultural pollutants, mass transportation problems)?
• What personnel are available for disaster interventions (e.g., nurses, doctors,
dentists, pharmacists, clergy, volunteers, emergency medical teams)?
• What are the locally available disaster resources (e.g., food, clothing, shelter,
pharmaceutical)?
• What are the local agencies and organizations (e.g., hospitals, schools,
churches, emergency medical, Red Cross)?
• What is immediately available for infant care (e.g., formula, diapers) and care
 of the elderly and disabled?
• What are the most salient chronic illnesses in the community that will need
immediate attention (e.g., diabetes, arthritis, cardiovascular)?
• Diagnose Community Disaster Threats
• Determine actual and potential disaster threats (e.g., toxic waste spills,
explosions, mass transit accidents, hurricanes, tornadoes, blizzards, floods,
earthquakes).
Community Disaster Planning
• Develop a disaster plan to prevent or deal with identified disaster threats.
• Identify a local community communication system.
• Identify disaster personnel, including private and professional volunteers, local
emergency personnel, agencies, and resources.
• Identify regional backup agencies, personnel.
• Identify specific responsibilities for various personnel involved in disaster
coping and establish a disaster chain of command.
• Set up an emergency medical system and chain for activation. Identify location
and accessibility of equipment and supplies. Check proper functioning
emergency equipment. Identify outdated supplies and replenish for appropriate
readiness.
Implement Disaster Plan
• Focus on primary prevention activities to prevent occurrence of man-made
disasters.
• Practice community disaster plans with all personnel carrying out their
previously identified responsibilities (e.g., emergency triage, providing supplies
such as food, water, medicine, crises and grief counselling).
• Practice using equipment, obtaining and distributing supplies.
• 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 response of personnel involved in disaster relief efforts.

PHASES OF DISASTER MANAGEMENT

It has been identified that there are four phases of disaster management which
include:- mitigation, preparedness, response, and recovery, which serve as a model
for community disaster preparations and nursing interventions.
Mitigation
Mitigation includes my activities that prevent a disaster, reduce the chance of a
disaster happening, or reduce the damaging effects of unavoidable disasters.
Nurses have a key role in disaster mitigation by working with local, state and
federal agencies in identifying disaster risks and developing disaster prevention
strategies through extensive public education in disaster prevention and readiness.
Effective mitigation includes recognizing and preventing potential technologic
disasters and being adequately prepared should such events occur.
To plan effectively for disaster prevention the nurse needs to have community
assessment information, including knowledge of community resources (e.g.,
emergency services, hospitals, and clinics), community health personnel (e.g.,
nurses, doctors, pharmacists, emergency medical teams, dentists, and volunteers),
community government officials, and local industry. Disasters such as floods,
tornadoes, hurricanes, and
Early warning systems alert the public to the probability of immediate danger and
help to reduce the impact of predictable disaster such as hurricanes or tornadoes.
They may also provide information on an evacuation plan or other immediate
actions that improve the chance of survival and reduce the probability of injures.
The primary goals of disaster management are to prevent or minimize death,
disability, suffering and loss on the part of disaster victims.
Preparedness

PRINCIPLES OF DISASTER MANAGEMENT

There are eight fundamental principles that should be followed by all who have a
responsibility for helping the victims of a disaster. It is critical that rescue workers
use these principles in proper sequence, or they will be ineffective and possibly
detrimental a disaster victims. The eight basic principles are as follows (Grab and
Eng 1969):
Prevent the occurrence of the disaster whenever possible.
Minimize the number of casualties if the disaster cannot be prevented.
Prevent further casualties from occurring after the initial impact of the disaster.
Rescue the victims.
Provide first aid to the injured.
Evacuate the injured to medical facilities.
Provide definitive medical care.
Promote reconstruction of lives.

TRIAGE
There are several times during the emergency response in which triage may be
necessary to best determine the needs of injured victims. Triage is a French word
meaning "sorting" or "categorizing." The term first came into use during World
War 1 when casualties were sorted during battle. During a disaster, the goal is to
maximize the number of survivors by sorting the treatable from the untreatable
victims. In a disaster, the potential for survival and the availability of resources are
the primary criteria used to determine which patients receive immediate treatment.
In a disaster situation, saving the greatest number of lives is the most important
goal. Triage may take place during the rescue operation at the scene of the disaster,
and again at each stage of transport for the disaster victims.
Prioritising of victims for treatment can be done in many ways; some communities
use color coding. Probably the best and most easily understood four-category
system is the first-priority, second-priority, third-priority, and dying-or-dead
system:
Red - most urgent, first priority
Yellow - urgent, second priority
Green - third priority
Black - dying/dead

STAGES OF DISASTER AND THE ROLE OF NURSES

1. Preparedness
Personal Preparedness
Great stress is placed on the nurse with client responsibilities who also becomes a
disaster victim. Conflicts arise between family and work-related responsibilities. In
addition, the community health nurse who will be assisting in disaster relief efforts
must be as healthy as possible, both physically and mentally. A disaster worker
who is not well is of little service to his or her family, clients, and other disaster
victims. Personal preparedness can help case some of the conflicts that will arise
and allows nurses to attend to client needs sooner that one may anticipate.
Professional Preparedness
• Professional preparedness requires that nurses become aware of and understand
the disaster plans at their workplace and community. Nurses who take disaster
preparation seriously will take the time to read and understand workplace and
community disaster plans and will participate in disaster drills and community
 mock disasters. The more adequately prepared nurses are, the more they will be
able to function in a leadership capacity and assist others toward a smoother
recovery phase. Personal items that are recommended for any nurse preparing
to help in a disaster include the following
• A copy of their professional license
• Personal equipment, such as a stethoscope
• A flashlight and extra batteries
• Cash
• Warm clothing and a heavy jacket (or weather-appropriate clothing)
• Record-keeping materials
• Pocket-sized reference books
Community Preparedness
The level of community preparedness for a disaster is only as good as the people
and organisations in the community make it. Some communities remain vigilant as
to the possibility of a disaster hitting their community and stay prepared by having
a solid disaster plan on paper and by participating in yearly mock disaster drills

ROLE OF THE COMMUNITY HEALTH NURSE IN DISASTER

RESPONSE
• The role of the community health nurse during disaster depends greatly on the
nurse's past experience, role in the institutions and community's preparedness,
specialized training, and special interest. The most important attribute for
anyone working in a disaster, however, is flexibility. One certain factor about
disaster is that change is a constant.
• Although valued for their expertise in community assessment, case finding and
 referring, prevention, health education, surveillance, and working with
aggregates, at times the community health nurse is the first to arrive on the
scene and must respond accordingly.
• Community health nurses working as members of an assessment team have the
responsibility of feeding back accurate information to relief managers to
facilitate rapid rescue and recovery. Many times nurses are required to make
home visits to gather needed information, a task that comes quite naturally to
the community health nurse. Types of information included in initial
assessment reports include the following:
• Geographical extent of disaster's impact
• Population at risk or affected
• Presence of continuing hazards
• Injuries and deaths
• Availability of shelter
• Current level of sanitation
• Status of health care infrastructure.
.
ROLE OF THE COMMUNITY HEALTH NURSE IN DISASTER
RECOVERY
• The role of the community health nurse in the recovery phase is as varied as
in the preparedness and response phases of a disaster. Flexibility remains an
important component of a successful recovery operation. Community cleanup
efforts can incur a host of physical and psychological problems. For example,
the physical stress of moving heavy objects can cause back injury, severe
fatigue, and even death from heart attacks. In addition, the continuing threat of
communicable disease will continue as long as the water supply remains
threatened and the living conditions remain crowded. Community health nurses
must remain vigilant in teaching proper hygiene and making sure immunization
records are up to date.
• Acute and chronic illnesses can be exacerbated by the prolonged effects of
disaster. The psychological stress of cleanup and moving can bring about
feelings of severe hopelessness, depression, and grief. Recovery can be
impeded by short-term psychological effects eventually merging with the long-
term results of living in adverse circumstances. In some cases, stress can lead to
suicide and domestic abuse. In addition, although most people eventually
recover from disasters, mental distress may persist in these valuable
populations who continue to live in chronic adversity. Referrals to mental
health professional should continue as long as the need exists.
• The community health nurse must also remain alert for environmental health
hazards during the recovery phase of a disaster. Home visits may lead the nurse
to uncover situations such as a faulty housing structure. Lack of water supply,
or lack of electricity.
BIBLIOGRAPHY:-

1. Basvantappa B.T. textbook of Community Health Nursing, 7 th edition,

Jaypee Brothers, New Delhi pp 953-961.

2. Gulani K Community Health Nursing, 1 st edition, kumar publishing

services New Delhi

3. Kamalan, Essentials of Community Health Nursing, 1 st edition, Jaypee

brothers New Delhi.

4. Park K Preventive And Social Medicine, 19 th edition, Banarasidas

Publishers Jabalpur Pp 600.

5. Tener Goodwin, Venera, Disaster Nursing, Spring Publication

Company New York,

 HANDOUT

SUBMITTED TO SUBMITTED
BY
Mrs. Priya D Ms. Namita
Jadhao
TOPIC: - DISASTER NURSING

INTRODUCTION
MEANING
Disaster means that any occurrence that causes damage, ecological disruption, loss
of human life or deterioration of health and health services on a scale sufficient to
warrant and extraordinary response from outside the affected community or area
(WHO, 1995).
TYPES
1) Man-made disasters
2) Natural disasters
DISASTER AGENT
• Agent
• Host:
• Primary and secondary agents will vary according to the type of disaster
• Environment:
 •Physical factors
• Chemical factors
• Biological factors
• Social factors
• Psychological factors
PHASES OF A DISASTER
• Pre-Impact Phase
• Impact Phase
• Post impact Phase
. Denial
. Strong emotional response
. Acceptance
• Recover
DIMENSIONS OF A DISASTER
Predictability:
Frequency:
Controllability:
Scope and Intensity
Time:
THE NURSING ROLE IN DISASTERS
• Disaster nurses play key leadership and service provision roles in planning
and implementing disaster relief efforts, preventing technologic disasters,
and addressing problems that occur during a disaster, such as the physical
and emotional stress of disaster victims.
• During a disaster many environmental health problems emerge. The scope
and magnitude of these problems determines the nursing role. Nurses
collaborate with community agencies and officials to recognize and reduce
disaster risks and maximize the health and safety of individuals involved in
disaster crises.
• Following a disaster, nurses make numerous referrals to community
agencies for a variety of needs including psychologic care, emotional
support services, and treatment for victims and their families. Recovery
 encompassed dealing with many disaster effects such as loss of life, income,
and home. The communicable disease implications of disasters are also
immense:
THE NURSING ROLE IN DISASTERS
ASSESS THE COMMUNITY
Community Disaster Planning
THE NURSING ROLE IN DISASTERS
THE NURSING ROLE IN DISASTERS
Mitigation
PRINCIPLES OF DISASTER MANAGEMENT
PRINCIPLES OF DISASTER MANAGEMENT
TRIAGE
Red - most urgent, first priority
Yellow - urgent, second priority
Green - third priority
Black - dying/dead
STAGES OF DISASTER AND THE ROLE OF NURSES
1. Preparedness
Personal Preparedness
Professional Preparedness
Community Preparedness
ROLE OF THE COMMUNITY HEALTH NURSE IN DISASTER
RECOVERY
ROLE OF THE COMMUNITY HEALTH NURSE IN DISASTER
RESPONSE
BIBLIOGRAPHY:-

1. Basvantappa B.T. textbook of Community Health Nursing, 7 th edition,

 Jaypee Brothers, New Delhi pp 953-961.

2. Gulani K Community Health Nursing, 1 st edition, kumar publishing

services New Delhi

3. Kamalan, Essentials of Community Health Nursing, 1 st edition, Jaypee

brothers New Delhi.

4. Park K Preventive And Social Medicine, 19 th edition, Banarasidas

Publishers Jabalpur Pp 600.

5. Tener Goodwin, Venera, Disaster Nursing, Spring Publication

Company New York