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Objectives
Unit III (a) Disaster
Management ❖ Introduction to disaster
1 ❖ Enlist types of disaster
Acknowledgement : ❖ Discuss its epidemiology
Dr. Ain Ul Momina
Mr SohailAhmed
❖ Various phases of disaster
Tanzeel Ul Rahman ❖ Characteristics of disaster

Edition : ❖ Post disaster effects

Akash Samuel
BSN, RN
❖ Nursing role in disaster management
❖ Discuss rehabilitation

Definition What is Disaster?

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A disaster can be defined as any occurrence that can
cause any damage ,ecological disruption ,loss of
human life and deteriotion of health and health
services on a sufficient scale
( W.H.O )
Disaster is any occurrence ether natural or man-
made, that can cause human suffering and create
human needs that victim cannot alleviate without
assistance.
( American red cross)
A catastrophe, sudden, calamitous event bringing great
damage, loss, destruction and devastation to life and
property by natural or man-made causes
According to United Nations International Strategy for
Disaster Reduction;
‘A serious disruption of the functioning of a community or
a society involving widespread human, material, economic
or environmental losses and impacts, which exceeds the
ability of the affected community or society to cope using
its own resources’
Disasters can be broadly classified as Natural or
Manmade

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Natural Disaster: Man-made Disaster:

This is caused due to activities7undertaken by Man or Group of People
This is some times called as Act6s of God and may be
caused by one or more of the following Natural Events: ranging from one or more of the following:
Terrorist Activities
Earthquakes Fire
Floods Wars & Riots
Cyclones & Storms Vehicular Accidents
Tsunami Pollution – Air, Water, Noise, etc
Drought
Fog SabotageActivities
Lightning Many of similar activities
Heat & Cold waves Bio-terrorisim
NaturalFires Dam failure
River & SeaErosion
Hazardous substance accident
Land Slides etc.
Explosions

Phases of disaster
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❖ Pre-impact phase :
It is the initial phase of disaster,
prior to the actual occurrence . A warning is given at the
sign of first possible danger.

❖ Impact phase :
This phase occurs when actual disaster
happens . It is time of enduring hardships injuries and
try for survival. In this phases individual helps nebulous
and families until the help is not arrived from outside:
✓ lasts for several minutes e:g earthquakes ,explosions
and plane crashes .

Copyright © 2017 by Tanzeel Ul Rahman

9/21/2017

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Cont.. Characteristics of disaster

✓ Last for several days and weeks e:g floods , epidemics,
terrorist attack . ❖ Predictability
❖ Controllability
❖ Post impact phase :
❖ Length of forewarning
Recovery is began during this
emergency phase and end with the return of normal ❖ Duration of impact
community functioning and order. ❖ Scope and intensity of impact
Victims goes through four stages
✓ Denial
✓ Strong emotional response
✓ Acceptance
✓ Recovery

Disaster effects Major roles of a nurses in disaster

❖ Determine the magnitude of a event

❖ Death
❖ Identify need of effected group
❖ Disability
❖ Establishing priorities and objective
❖ Increase in communicable diseases
❖ Identify the actual and potential health problem
❖ Psychological problems
❖ Determine the recourses needed to respond
❖ Water and food shortage
❖ Collaborative work with other professionals,
❖ Social and economies losses
governmental and non governmental organization .
❖ Shortage of drug and medical supplies
❖ Maintain a unified chain of command
❖ Skilled Communication

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What is Disaster Management

Role Players in Disasters
Community 15

NGOs
Like any other Management activity or National Red Cross
process, Disaster Management is also a
Media
management activity or process undertaken
Fire Services
by various segments of the society - public,
governmental, NGOs, etc. with an aim to Police and Para-Military Forc e
s
minimize or avoid occurrence of disaster Civil Defence

and to provide relief to the affected people Armed Forces

and rehabilitate them. Public Sector & Private Sector

Disaster management

There are four phases of disaster management :

1. Mitigation :
It includes an activity that reduce
the chance of a disaster , to prevent disaster or
reduce the damaging effect .
The role of a nurse is very important because
working with the local and state to identify
the disaster risk and developing a disaster
planning strategies .

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Disaster management 2. Preparation

Mitigation measures include building codes;
vulnerability analyses updates; zoning and land use
management; building use regulations and safety
codes; preventive health care; and public education
Spatial Planning:
The methods used by the public sector to influence the
distribution of people and activities in spaces of
various scales.
Spatial planning include land use planning, urban
planning, regional planning, transport planning and
environmental planning
Strengthen the technica19l and managerial
capacity of governments, organizations and
communities
Response mechanisms and procedures, rehearsals,
developing long-term and short-term strategies,
public education and building early warning systems
Preparedness measures include preparedness plans;
emergency exercises/training; warning systems;
emergency communications systems; evacuations
plans and training; resource inventories; emergency
personnel/contact lists; mutual aid agreements; and
public information/education

Cont… Cont…
3. Response :

▪ To provide immediate assistance to maintain life,
improve health and support the morale of the affected
population
▪ Such assistance may range from providing specific but
limited aid, such as assisting refugees with transport,
temporary shelter and food, to establishing semi-
permanent settlement in camps and other locations.
▪ It also may involve initial repairs to damaged
infrastructure
▪ The focus in the response phase is on meeting the basic
needs of the people until more permanent and
sustainable solutions can be found
The response is determine by the level of a
disaster , and disaster is not determine by the
no of causality but the amount of recourses
need .
Level 1:
if the organization agency or community
is able to manage the event and response
effectively , utilizing its own recourses e:g one
family fire explosion.

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4.Recovery
Cont…
(Rehabilitation/Reconstruction) 23

▪ Returning the community to normal

Level 2 : ▪ Essential services such as providing drinking water,
if the disaster require any assistance transport, electricity, etc. are restored
from outside source but they can be obtain ▪ The people are taught how to follow healthy and safety
from nearby agency . measures
▪ The victims are provided with temporary
Level 3: accommodation, financial assistance and employment
if the disaster magnitude is exceeded from opportunities
the capacity of the local community or region ▪ Those who have lost their family members are consoled
and require assistance from state level or even ▪ If there is a danger of epidemics, vaccination
federal asset programme are to be undertaken

Psychological Responses to
Disaster
Signs and symptoms of emotional shock Stages
• Impact stage.Survivors are stunned,
apathic and disorganized. For several hours after the
initial event, they may have difficulty following directions
and will need strong support and firm guidance.
• Heroic stage. Individuals want to be helpful, and may
minimize or ignore their own injuries and demonstrate
rescue behavior that is risky to self.
• Honeymoon stage. Survivors are grateful that they
are still alive. There is a strong sense of brotherhood and
community spirit.
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• Disillusionment stage. Reality of loss occurs.
Ongoing physical and emotional fatigue can result in
substance abuse and discouragement. Survivors feel
abandoned and ignored by the larger community
because of the gap between resources and need.
• Reconstruction stage. This stage may continue for
years as people rebuild lives and even begin to see the
crisis, in retrospect, as a growth and opportunity
period.

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Triage Disaster Triage System

The sorting of patients to determine priority Class I: Emergent (red)

health care needs and the proper site of Class II: Urgent (yellow)
treatment
Class III: Nonurgent (green)
In non disaster situations, health care workers
assign highest priority and allocate most Class IV: Minor (white)
resources to the most critically ill patients. Class V: Dead or expected to die (black)
In disaster situations with large numbers of
casualties, decisions are based on the likelihood
of survival and the consumption of resources.

Triage During Disasters

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Victims with life-threatening conditions and a

good chance of survival are cared for first
When there are more victims of a disaster than
medical personnel to treat them, those who are
likely to survive are treated first; these patients
are given green tags
The mortally wounded and those who are not
expected to survive are attended later, and
these patients are issued a black tag

Copyright © 2017 by Tanzeel Ul Rahman

9/21/2017

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Chemical Disaster
Indications that a chemical attack has
occurred might include
 Fog-like or low-lying cloud suddenly
appearing in the atmosphere
 Many dead birds, domestic animals, or
insects within a particular area
 Many dead, dying, or sick people in an area
or downwind from a suspicious cloud or fog
 An atypical, unexplained odor for the location
Vesicants
Lewisite, sulfur mustard, nitrogen
mustard, phosgene
Cause blistering and burning
Respiratory effects can be serious and cause death
Decontamination with soap and water; do not
scrub or use hypochlorite solutions
Eye exposure requires copious irrigation
Treatment for lewisite exposure: dimercaprol IV
or topically
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Chemical Weapons
Chemical substances that quickly cause injury or death
and cause panic and social disruption
Agents
 Vesicants
 Nerve agents
 Blood agents
 Pulmonary agents
Agents vary in volatility, persistence, toxicity,
period of latency, and exposure length
Limitation of exposure is essential with evacuation and
decontamination as soon possible and as close to the
scene of the incident as possible
Nerve Agents
Sarin, soman organophosphates
Inhibit cholinesterase, causing cholinergic
symptoms progressing to loss of consciousness,
seizures, copious secretions, apnea, and death
Treatment: supportive care,
atropine, benzodiazepine and
pralidoxime
Decontaminate with copious amounts of soap
and water or saline for at least
20 minutes
Plastic equipment will absorb sarin gas
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Radiation Exposure
Radiation Exposure
Radiation exposure may occur because of nuclear weapon,
nuclear reactor incidents, or exposure to radioactive Amount of damage to each person
samples Decontamination
Exposure to radiation is affected by time distance and
shielding Acute radiation sickness syndrome
Types of radiation exposure  Bone marrow syndrome
 External radiation: all or part of the body is exposed to  Gastrointestinal syndrome
radiation; decontamination is not necessary; not a  Cardiovascular/central nervous system syndrome
medical emergency Treatment of particulate radiation exposure
 Contamination: exposure to radioactive gases, liquids, or
solids; requires immediate medical management to  Chelating agents
prevent incorporation  Isotope-specific blocking agents
 Incorporation: uptake of the radioactive material into  Excretion agents
the  Diluting agents
body

Radiation Decontamination (cont’d)

Radiation Decontamination
Patients are surveyed for radiation and directed
to the decontamination area.
Triage outside the hospital. Decontaminate each patient outside the ED
Cover floor and use strict isolation with a shower.
precautions to prevent the tracking of Water, tarps, towels, soap, gowns, all patient belongings, and so
contaminants. on must be collected and contained.
Waste is double bagged and labeled Patients are resurveyed and reshowered as necessary.
“radiation waste.” Showering should be performed to not
Staff protection contaminate clean areas with runoff from the
showering.
 Water-resistant gowns, two pairs of gloves,
Biologic samples: nasal and throat swabs, blood
caps, goggles, masks, and booties
Internal contamination requires additional
 Dosimetry devices : to measure radiation dose
treatment— catharsis and gastric lavage with
chelating agents.

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Decontamination Drill Decontamination Drill (cont.)

Biologic Disaster Isolation Precautions for Biological

Terrorism Agents

Anthrax
Biological agents may be delivered or spread
Botulism in a number of ways.
Because off modern travel, spread of infection may occur
Plague in areas thousands of miles apart
Health care providers need to be aware of potential
Smallpox signs of biological weapon
dissemination. Signs and symptoms are
Tularemia similar to those of common disease process.
Isolation practices depend on the infecting agent.
Viral hemorrhagic fevers
Always use standard precautions.
Some agents require transmission-based precautions.
Terminal disinfection and disposal of wastes depend on the
infecting agent.

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Recognizing a Bioterrorism Event Recognizing a Bioterrorism Event

(cont.)
Certain signs or events may present a warning Unusual or extensive rashes, especially if
that a bioterrorism attack has occurred. Some of preceded by flu-like symptoms
the signs include (Peterman, 2010) Flaccid muscle paralysis
Rapidly progressing flu-like illness, particularly Severe bleeding disorders
in the young and among those previously
A large group of patients with food-borne illness
healthy
Sudden death of many animals in the community
Rapidly progressive respiratory illness,
especially in young, previously healthy people

Personal Protective Equipment Bioterrorism

Purpose: to shield the health care provider from chemical, Nursing management
physical, biological, and radiological hazards that may exist
when caring for contaminated patients  Strict adherence to infection control procedures and

Categories of protective equipment policies

 Level A: Self-contained breathing apparatus (SCBA) and  Debriefing
vapor-tight chemical resistant suit, gloves, and boots
 Level B: High level of respiratory protection (SCBA) but
lesser skin and eye protection; chemical-resistant suit
 Level C: Air-purified respirator, coverall with
splash hood, chemical-resistant gloves and boots
 Level D: Typical work uniform

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Pandemic (Airborne Respiratory)

Biologic Agents Infection
• Category A agents: Easily disseminated, and some may be
transmitted from person to person as well. These could cause Teach people to be prepared to stay at home for at
mass casualties and require a well-organized and extensive
health care system response for management least two weeks
• Category B agents: Delivered through water and food sources. Reassure people that basic measures for
These produce moderate amounts of illness and low death prevention of respiratory infection can be
rates. Public health department action is needed for
management. Examples are Q fever, brucellosis, glanders, ricin effective
toxin, epsilon toxin of Clostridium perfringens, and  Healthy lifestyle to support the immune system
Staphylococcus aureus enterotoxin B.
 Washing hands and covering the mouth during
• Category C: Agents that have not been weaponized as yet, but
have the potential for high morbidity and mortality. These coughing or sneezing, disposing of tissues, and
agents are plentiful and easy to produce and disseminate. staying away from public places if at all possible
Examples include Hantavirus, tick-borne encephalitis, yellow
fever, and multidrug-resistant tuberculosis.

Any Question????
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