PRACTICE TEACHING ON

“DISASTER NURSING”

SUBMITTED TO SUBMITTED BY
Madam Krishna Sen Swaramita ghosh
Assistant professor Msc.1st year
Apollo Gleneagles Nursing college
INTRODUCTION
The word disaster is composed of ‘dis’ which means bad and ‘aster’ means star. Disaster is a sudden,
calamities event bringing great damage, loss and destruction and devastation to life and property. There are
many types of disaster such as earthquakes, cyclone, floods, tidal curves, landslides, volcanic eruption,
tornados, hurricane, war, acts of aggression and the incidence of terrorist attack. The damage caused by
disasters is immeasurable and varies with geographical location, climate and the type of earth surface or
degree of vulnerability. This influences the mental, socioeconomic, political and cultural state of the affected
area. Generally, disaster has the following effects in concerned areas-
1. It completely disrupts the normal day to day life.
2. It negatively influences the emergency systems.
3. Normal needs and process like food, shelter, health etc. are affected and deteriorate depending on the
intensity and severity of disaster.
DEFINITION
Definition of disaster
“Disaster is any occurrence that causes damage ecological disruption, loss of human life, deterioration of
health and health services, on a scale sufficient to warrant an extraordinary response from outside the
affected community or area” (WHO)
“A disaster can be defined as an occurrence, either natural or man-made, that causes human suffering and
creates human needs that victims cannot alleviate without assistance.” (American Red Cross [ARC])
Definition of disaster nursing
Disaster nursing can be defined as “the adaption of professional nursing knowledge, skills and attitude in
recognizing and meeting the nursing physical and emotional needs resulting from disaster. The overall goal
of disaster nursing is to achieve the best possible level of health for the people and the community involved
in the disaster.”
“Disaster” alphabetically means:
 D-destruction
 I-incidents
 S-suffering
 A-administrative
 S-sentiment
 T-tragedies
 E-eruption of communicable disease
 R-research program and its implementation
INCIDENCE
The incidence of natural disaster worldwide has steadily increased, especially since the 1970’s according to
a report from the New England journal of medicine since 1990 natural disaster have affected about 217
million, people every year.
PRINCIPLE OF DISASTER NURSING
The basic principles of nursing during special circumstances and disaster conditions include-
1. Rapid assessment of the situation and of nursing care needs.
2. Triage and initiation of live saving measures first.
3. The selected use of essential nursing interventions and the elimination of non-essential nursing
activities.
4. Adaption of necessary nursing skills to disaster and other emergency situation. The nurse must use
imagination and resourcefulness in dealing with a lack of supplies, equipment and personnel.
5. Evaluation of the environment and the mitigation or removal of any health hazards.
6. Prevention of further injury.
 7. Leadership in coordinating patient triage, care and transport during times of crisis.
8. The teaching, supervision and utilization of auxiliary medical personnel and volunteers.
9. Provision of understanding, compassion and emotional support to all victims and their families.
TYPES OF DISASTER
There are two types of disaster.
ON THE BASIS OF ORIGIN
MAN MADE DISASTER
 Major Manmade disaster-deforestation, chemical pollution,wars,fires.
 Minor manmade disaster-food poisoning, environmental pollution, road accidents, industrial crisis.
NATURAL DISATER
 Major natural disaster-cyclone, flood, earthquake,
 Minor natural disaster-cold wave, thunder storm, storms.
ON THE BASIS OF BASIS OF SPEED OF ONSET
 Sudden on of disaster- Bhopal gas tragedy
 Slow onset of disaster-global warming

Disaster

On the basis of On the basis of

origin/causes speed of onset

man made
Natural disaster Sudden onset Slow onset
disaster disaster disaster
Fig no: 1
CAUSES OF DISASTER
 Hydrometeorological disaster- Natural process or phenomenon of atmosphere or iconographic
nature.
e.g.-cyclones, typhoons, tornados etc.
 Geographical disaster-Natural earth processes or phenomena that include endogenous origin,
exogenous origin.
e.g.-earthquake, tsunamic, volcanic activity.
 Biologic disaster-Processes of organic organs or those conveyed by biological vectors including
exposure to pathogenic, microorganism, toxins and bioactive substances
e.g.-outbreaks of epidemic diseases
 Technological disaster-Damage associated with technological or industrial accidents, infrastructural
failures or certain human activities which may cause the loss of life or injury, property damage etc.
e.g.-industrial pollution, nuclear release and radioactivity technological accidents.
 Environmental degradation-processes induced by human behaviours and activities that damage the
natural resources base and adversely affect the ecosystem.
e.g.-deforestation, wild land fire, water and air pollution.
 War and civil conflicts-Wars and terrorism
 e.g.-the attack on twin buildings of world trade centre in New York in which about 6000 people lost
their lives and thousands are injured.
PHASES OF DISASTER
There are three phases to any disaster.
1. Preimpact 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. Many times there is no warning, but with aid
of weather networks and satellites, many meteorological disaster can be predicted. This is the period
when the emergency preparedness plan is put into the effect.
2. Impact phase- This 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 individual help the neighbour and
families at the scene, a time of holding on until outside help arrives. It may last for several minute,
days, or weeks.
3. Postimpact phase-recovery begin 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.

PREIMPACT POSTIMPACT
IMPACT PHASAE
PHASE PHASE

Fig no: 2
The victim of a disaster go through four stages of emotional response during postimpact phase.
1. Denial
2. Strong emotional response
3. Acceptance
4. Receiver
From the mental health view point, work with victim of disaster has suggested the following classifications
related to emotional reactions:
I. Heroic phase- this phase appears at the time of the disaster and is characterized by people working
together to save each other and their property. Excitement is intense and people are concerned with
their survival.
II. Honeymoon phase- this is a relatively short (2weeks to 2 months) post disaster period in which the
victims feel buoyed and supported by the promises of governmental and communal help. Losses are
counted and plans to re-establish are made.
III. Disillusionment phase- lasting anywhere from several months to a year or more, this phase contains
unexpected delays and failures, which emphasize the frustration from confusion. Victims turn to
rebuilding their own lives and solving their own individual problems.
IV. Reconstruction phase- this phase may last for several years. It is characterized by a coordinated
individual community effort to rebuild and re-establish normal functioning. Environmental health
remains a major, worldwide public health concern.
DISASTER MANAGEMENT
Disaster leaves a permanent mark on a community, destroying lives and property and forever changing
the area. Disaster management is designed to either prepare a community for a disaster, respond to the
immediate needs of a community during a disaster or to help rebuild and avoid future disasters.
PRINCIPLE 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 in disaster victims.
 The eight basic principles are as follows:
1) Prevent the occurrence of the disaster whenever possible.
2) Minimise the number of casualties if the disaster cannot be prevented.
3) Prevent further casualties occurring after the initial impact of the disaster.
4) Rescue the victims.
5) Provide first aid to the injured.
6) Evacuate the individual to medical facilities.
7) Provide definitive medical care.
8) Promote reconstructive of lives.
PHASES OF DISASTER MANAGEMENT
There are five phases of disaster management sequence of a sudden onset disaster, which serve as a mood
for community disaster preparation and nursing intervention. These phases are as follows:
1) Mitigation
2) Preparedness
3) Response
4) Rehabilitation
5) Reconstruction

Fig no:3 disaster management cycle

MITIGATION
1. Mitigation include all activities that prevent a disaster, reduce the chance of a disaster happening or
reduce the damaging effect of unavoidable disasters.
2. Effective mitigation includes recognizing and preventing potential technological disasters and being
adequately prepared should such events occur.
3. Disaster such as floods, hurricanes, and earthquakes can have devastating effects, so before a striking
of such disasters, communicates need to have disaster prevention measures in place.
4. Goal of mitigation is to prevent or minimize death, disability, suffering and loss on the part of
disaster victims.
Mitigation can be done by:
a) Enforcement of good building code or by proper land and water management.
b) Observing proper safety precaution, including regular equipment maintenance, especially for the
prevention of manmade disaster.
c) Public education, especially in areas that are prone to certain types of disaster situation, alert the
public on how best to prepare for such situations in advance of an actual event.
d) Early warning systems alert the public to the probability of immediate danger such as hurricanes.
Role of nurse in mitigation phase of disaster management
1. Identifies disaster risks and develops disaster prevention strategies through extensive public
education in disaster prevention and readiness.
2. For effective planning a nurse needs to have community assessment information including
knowledge of community resource, community health personnel, community government officials
and local industry.
3. Nurse needs to be prepared to mobilize resources, provide care and minimize confusion.
4. Nurse can be involved in all such efforts, which may include instruction regarding proper safety
precautions, proper manage of emergency supplies and first aid courses to prepare the public to care
for injuries in the event of an actual emergency.
PREPARDENESS
This phase involves the development of awareness among the population on the general aspects of disaster
and how to behave in the face of a future disaster. This includes education on warning sign of disasters,
method of safe and successful evacuation and first aid measures. It is further divided into three stages.
1. Personal preparedness-Great stress is placed on the nurse with patient responsibilities who also
becomes a disaster victim. For example, a mother whose child care needs go unmet will not be able
to participate fully in disaster relief efforts. The community health nurse who will be assisting
in disaster relief efforts must be healthy as possible, both physically and mentally. Personal
preparedness allows a nurse to attend to the patient needs sooner than once may anticipate.
2. Professional preparedness- It requires that nurse become aware of and understand the disaster plans
at their workplace and community. The more adequately prepared nurses are the more they will be
able function in a leadership capacity and assist others towards a smoother recovery phase.
Personal items that are recommended for nurses preparing to help in a disaster include the following:
a. A copy of their professional license
b. Personal equipment such as stethoscope
c. A flashlight and extra bacteria’s
d. Cash
e. Warm clothing and a heavy jacket for weather appropriate clothing
f. Record keeping materials
g. Pocket sized reference book
3. Community preparedness- the level of community preparedness for a disaster is only as good as the
people and organizations in community make it. A solid disaster plan requires the multidisciplinary
talents, coordination and cooperates of many different organizations. Many community organization
and professionals are involved in disaster work including the clergy, morticians, Police, fire and
rescue, the mayor and other city officials and media. It must be assured that the community has an
adequate warning system as well as a backup evacuation plan to remove individual who hesitate to
leave their homes from areas of danger. Individual may refuse to leave their homes because they are
fearful of personnel possessions becoming lost or destroyed from the disaster and from post disaster
looting. A face to face encounter with law-enforcement personnel or orders is often necessary to
convince individuals to leave their homes and retreat to safer quarters.

PERSONAL PREAPREDNESS PROFFESONAL PREPARDNESS

COMMUNITY PREPARDNESS
Fig no: 4
ROLE OF NURSE IN PREAREDNESS PHASE OF DISASTER MANAGEMENT
1. A nurse should facilitate preparation within the community.
 2. A nurse should provide a n updated record of vulnerable population within the community.
3. A nurse should have flexibility, decisiveness, stamina, endurance and emotional stability.
4. A nurse should assist in recruiting others within the organisation who help if and when the response
is required,
5. As a leader, she or he should also possess an intimate knowledge of the as a community advocate,
she or he should always seek to keep a safe environment.
6. After several hours of disaster training, the nurses may want to take the following steps:
a. Place themselves on a local disaster action team.
b. Act as a liaison , with local hospitals, Determine health related appropriateness for shelter
sites. Plan with various specialists’ pharmacies and other health personnel to facilitate
services for disaster victims.
c. Plan for and retain needed supplies.
d. Teach disaster nursing in the community.
7. Another important role of the nurse in disaster management is to keep the nursing and medical
protocols and intervention standards up to date and consistent with local public health standards.
RESPONSE
The response is determined by the level of disaster. Levels are not determined by the number of causualties
but by the amount of resource needed. These levels are as follows:
1. Level I disaster- it requires activation by the local emergency medical system in cooperation with local
community organization such as police and good Samaritans.
2. Level II disaster- This requires more of a regional response necessitating several causal protocols.
3. Level III disaster- this level is one in which a federal emergency has been declared because of
widespread destruction.
Common reactions to disaster by adults and children include the following:
1. Adults
a. Extreme sense of urgency
b. Panic and fear
c. Disbelief
d. Disorientation and numbing
e. Reductance to abandon property
f. Difficulty in making decisions
g. Need to help others
h. Anger and blaming
i. Delayed reactions
j. Insomnia
k. Headaches
l. Apathy and depression
m. Sense of powerlessness
n. Guilt
o. Moodiness and resentment
p. Jealousy and resentment
q. Domestic violence
2. Children
a. Regration behaviour
b. Fantasies that disaster never occurred
c. Nightmares
d. School-related problems, including inability as concentrate and refusal to go back to school.
ROLE OF NURSE IN RESPONSE PHASE OF DISASTER MANAGEMENT
1. In India the nurse may provide information of a disaster as the National Disaster Management
Centre, Ministry of Home welfares, Government of India, on a toll free no 1070.
2. Nurses have skills on triage and crisis intervention and are involved in acute care, triage, first aid,
rescue and evacuation procedures, and preventing communicable illness and assessing and providing
immediate health care needs during disaster impact.
3. A primary concern for nurses in disaster response in safety for themselves, the rescue team and
victims.
4. The nurse works to reduce fear, panic and hysteria by aging victims to express their feeling and
providing emotional supports to the victims and their families.
5. Community health nurses working as members of a assessment team have a responsibility of feeding
back accurate information to relief managers for rapid rescue and recovery.
Types of information included in initial assessment include the following:
a. Geographic extent of disaster impact
b. Population at risk or affected.
c. Presence of continuing hazards
d. Injuries and deaths
e. Availability of shelter
f. Current level of sanitation
g. Status of health care infrastructure.
REHABILITATION
Rehabilitation starts from the very first moment of a disaster to the first weeks after disaster, the pattern of
health needs with change rapidly, moving from casualty treatment to move routine primary health Care
services should be recognised and rescued victims will also shift from health care toward environmental
health measures.
RECONSTRUCTION
The phase disaster known as recovery occurs as all involved agencies pull together to restore the economic
and civic life of the community.
1. Many religious organizations also help with the rebuilding efforts.
2. The internal revenue Service educates victims as to how to write off losses and department of
housing and urban development provides grants for temporary housing.
3. Voluntary agencies continue to assess individual and community needs and meet those needs as they
are able.
ROLE OF NURSE IN REHABILITATION AND RECONSTRUCTION PHASE OF DISASTER
MANAGEMENT
1. Nurse must remain vigilant in teaching proper hygiene and making sure immunization records are up
to date.
2. Nurse must also remain alert for environmental health hazards during the recovery phase of disaster.
3. The role of nurse in case finding and referral remains critical during the recovery phase.
4. The main goal of nurse in this phase is to prevent debilitating effects and restore personal, economic
and environmental health and stability to the community.
TRIAGE
Triage is a French word “sorting” or “categorizing’’. The process of sorting people based on their need for
immediate medical treatment as compared to their chance of benefiting from such care. Triage is done in
emergency rooms, disasters, and wars, when limited medical resources must be allocated to maximize the
number of survivors. Triage in this sense originated in World War I. Wounded soldiers were classified into
one of three groups: those who could be expected to live without medical care, those who would likely die
even with care, and those who could survive if they received care.
Prioritizing of victims is done by using color coding.
 Red-(immediate) are used to label those who cannot survive without immediate treatment but who
have a chance of survival.
 Yellow-(observation) for those who require observation (and possible later re-triage). Their condition
is stable for the moment and, they are not in immediate danger of death. These victims will still need
hospital care and would be treated immediately under normal circumstances.
 Green- (wait) are reserved for the "walking wounded" who will need medical care at some point,
after more critical injuries have been treated.
 White- (dismiss) are given to those with minor injuries for whom a doctor's care is not required.
 Black- (expectant) are used for the deceased and for those whose injuries are so extensive that they
will not be able to survive given the care that is available.

ROLE OF NURSES IN DISASTER

 Disaster nurses play key leadership and service provision roles in planning implementing disaster
relief efforts, preventing technological disaster and addressing problems that occur during a disaster.
 During a disaster many environmental health problem emerge. The scope and the magnitude of these
problems determine 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 , nurse make numerous referrals to community agencies for a variety of needs
including psychological care, emotional support services and treatment for victims and their families.
The communicable disease implication of disaster are also immense. Nurses need to realize that the
emotional effects of disasters any persist for many years and that a person’s initial response to the
traumatic event is often predictive of future response.
 Nurses work in all phases of disaster management. Following are some community disaster
strategies for nurses:
1. Assess the community
a. In there a current community disaster plan in place.
b. What previous disaster experiences has the community been involved with locally,
state-wide and nationally.
c. How is the local climate conducive to disaster formation (e.g. hurricanes, tornado)
d. What are the local industry?
e. Are there any community hazards (toxic waste, chemical spills, agriculter pollution
etc.)
f. What personnel are available for disaster intervention (e.g. nurses, doctors,
pharmacist, dieticians etc.)
g. What are the local agencies and organization (e.g. churches, hospitals, school etc)
h. What is immediately available for infants’ care (e.g. diapers) and care of elderly and
disabled.
i. What are the most salient chronic illnesses in the community that will need immediate
attentions( e.g. diabetes, arthritis, cardiovascular disorder)
2. Diagnose community disaster threats
a. Determine actual and potential disaster threats (toxic waste spills, explosion, floods,
earthquakes)
3. Community disaster planning
a. Develop a disaster plan to prevent or deal with identified disaster threats.
b. Identify a local community communication system.
 c. Identify disaster personnel, including private and professional volunteers, local
emergency personnel, agencies and resources.
d. Identify regional backup agencies and personnel.
e. Identify specific responsibilities for various personnel involved in disaster coping, and
established a disaster chain of command.
4. Implement disaster plan
a. Focus on primary prevention activities to prevent occurrence of man-made disaster.
b. Practice community disaster plans with all personnel carrying out their previously
identified responsibilities, for example providing food and medicines.
c. Practice using equipment and obtaining and disturbing supplies.
5. Evaluate effectiveness of disaster plan
a. Critically evaluate all aspects of disaster plans and practice drills for speed,
effectiveness, gaps, and revisions.
b. Evaluate the disaster impact on community and surrounding regions.
c. Evaluate response of personnel involved in disaster relief efforts.
CONCLUSION
Hardly a day now passess without news about a major or complex emergency happening in some part of the
world . Disaster continue to strike and cause destruction in developing and developed countries about their
vulnerability to occurrences that can gravely affect their day to day life and their future. Nurses in any
location will be on the frontline as care giver and managers in the event of damaging disaster.

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