DISASTER

NURSING
NURSES AND EDUCATION

 Education is the most powerful weapon

which you can use to change the
world.
Nelson Mandela
MISSION STATEMENT
 Disasters are a primary cause of morbidity and
mortality. Nurses can play an important role in
disaster mitigation, but they receive very little
training. This lecture is designed to help to
introduce to nursing the concepts of disasters and
disaster mitigation. We propose that you teach this
lecture to your nursing students to build awareness
world wide.
 OBJECTIVES
1. Define a disaster
2. Discuss patterns of mortality and injury
3. Understand impact of disasters on health
4. Describe the factors that contribute to disasters
severity
5. Discuss role of nursing in disasters
6. Apply principles of triage in disaster
7. Analyze the WHO components of effective
disaster nursing
WHAT IS DISASTER
 Is a result of vast ecological breakdown in the
relation between humans and their environment, as
serious or sudden event on such scale that the
stricken community needs extraordinary efforts to
cope with outside help or international aid.
TYPES

 Natural
 Pandemics

 Transportation

 Technological

 Terrorism
 HURRICANES

 The primary health hazard from hurricanes or

cyclones lies in the risk of drowning from the storm
surge associated with the landfall of the storm.
Most deaths associated with hurricanes are
drowning deaths.
 Secondarily, a hazard exists for injuries from flying
debris due to the high winds.
 Nurses can be instrumental in providing direct
emergency care to drowning and head injuries.
TORNADOES

 The primary hazard from a health perspective in a

tornado is the risk for injuries from flying debris. The
high winds and circular nature of a tornado leads to
the elevation and transport of anything that is not
fastened down. Most victims of tornadoes are
affected by head and chest trauma due to being
struck by debris or from a structural collapse. Some
individuals are injured while on the ground. Others
are lifted into the air by the tornado and dropped at
another location.
 FLOODS

 Floods may originate very quickly following a quick rain

storm, or they may develop over a short period following
an extended period of rain or quick snow melt
 The primary hazard from flooding is drowning

 Longer term health concerns from flooding is the

development of disease from contaminated water and
lack of hygiene.
EARTHQUAKES

 A significant global concern

 The primary health concern:

• Injuries arising from structural collapse

• Most injuries occur amongst individuals trapped at the
time of the earthquake
 Well known prevention strategy is to prevent buildings
from collapsing
 There is a recognized need to develop better rescue
strategies for retrieving individuals from collapsed
buildings
 VOLCANOES

 Rare, but can be catastrophic when they occur

 Over the 25 year period (1972-1996), there was an
average of 6 eruptions per year, causing an
average of 1017 deaths and 285 injuries
 Health outcomes are associated with volcanic
eruptions:
• Respiratory illnesses from the inhalation of ash
• For individuals close to the volcano, some
danger exists from lava flows, or more likely mud
flows
VULNERABILITIES, NEEDS, AND ABILITIES VARY
10000000

9000000

8000000

7000000

6000000

5000000

4000000

3000000

2000000

1000000

0 1960

1985
1900
1905
1910
1915
1920
1925
1930
1935
1940
1945
1950
1955

1965
1970
1975
1980

1990
1995
2000
Conflict Natural Disasters
MAN-MADE THREAT
Unpredictable Challenges
Disruptive
Unexpected
Targeting weaknesses
Very rare, impossible to conceive before event
Threats to Civilians, Information
Infrastructure
COMPONENTS OF DISASTER DEBRIS
 Building Debris
 Household Debris

 Vegetative Debris

 Problem Waste Streams

MYTHS ASSOCIATED WITH DISASTERS
 Any kind of assistance needed in disasters
 A response not based on impartial evaluation contributes to
chaos
 Epidemics and plagues are inevitable after every
disaster
 Epidemics rarely ever occur after a disaster
 Dead bodies will not lead to catastrophic outbreaks of exotic
disease
 Proper resumption of public health services will ensure the
public’s safety (sanitation, waste disposal, water quality, and
food safety)
 Disasters bring out the worst in human behavior
 The majority responses spontaneous and generous
 The community is too shocked and helpless
 Cross-cultural dedication to common good is most common
response to natural disasters
 PATTERNS OF MORTALITY AND INJURY

 Disaster events that involve water are

the most significant in terms of mortality
 Floods, storm surges, and tsunamis all
have a higher proportion of deaths
relative to injuries
 Earthquakes and events associated with high
winds tend to exhibit more injuries than
deaths
 The risk of injury and death is much
higher in developing countries – at least
10 times higher because of little
preparedness, poorer infrastructure.
DISPLACEMENT OF DISASTER VICTIMS
 Mass Shelters
 Shelter management:
• Organized team (chain)
• Sleeping area and necessities
• Water and food handling
• Sanitation (toilets, showers,..)
• Special care to children and elderly
• Health services (physical, mental)
DISASTER AND HEALTH
In a major disaster water treatment plants,
storage & pumping facilities, & distribution
lines could be damaged, interrupted or
contaminated.
 Communicable diseases outbreak due to:
⚫ Changes affecting vector populations (increase vector),
⚫ Flooded sewer systems,
⚫ The destruction of the health care infrastructure, and
⚫ The interruption of normal health services geared
towards communicable diseases
DISASTER AND HEALTH

 Injuries from the event

 Environmental exposure after the event (no shelter)

 Malnutrition after the event (feeding the population

affected)
 Excess NCD mortality following a disaster

 Mental health (disaster

syndrome)
MENTAL WELLNESS
 Little attention is paid to the children
 Listen attentively to children without denying their
feelings
 Give easy-to-understand answers to their questions

 In the shelter, create an environment in which

children can feel safe and secure (e.g. play area)
MENTAL WELLNESS
 In any major disaster, people want to know where their
loved ones are, nurses can assist in making links.
 In case of loss, people need to mourn:

• Give them space,

• Find family friends or local healers to encourage

and support them

• Most are back to normal within 2 weeks

• About1% to 3%, may need additional help

THE MOST VULNERABLE
THE PHASES OF DISASTER

 Mitigation:
⚫ Lessen the impact of a disaster before it strikes
 Preparedness:
⚫ Activities undertaken to handle a disaster when it strikes
 Response:
⚫ Search and rescue, clearing debris, and feeding and
sheltering victims (and responders if necessary).
 Recovery:
⚫ Getting a community back to its pre-disaster status
MITIGATION
 Activities that reduce or eliminate a hazard
⚫ Prevention
⚫ Risk reduction

 Examples
⚫ Immunization programs
⚫ Public education
PREPAREDNESS
 Activities that are taken to build capacity and
identify resources that may be used
⚫ Know evacuation shelters
⚫ Emergency communication plan
⚫ Preventive measures to prevent spread of disease
⚫ Public Education
RESPONSE
 Activities a hospital, healthcare system, or public
health agency take immediately before, during, and
after a disaster or emergency occurs
RECOVERY
 Activities undertaken by a community and its
components after an emergency or disaster to
restore minimum services and move towards long-
term restoration.
⚫ Debris Removal
⚫ Care and Shelter
⚫ Damage Assessments
⚫ Funding Assistance
WHAT IS TRIAGE?
 French verb “trier” means to sort
 Assigns priorities when resources
limited
 Do the best for the greatest
number of patients
WHY IS DISASTER TRIAGE NEEDED
 Inadequate resource to meet immediate needs
 Infrastructure limitations
 Inadequate hazard preparation
 Limited transport capabilities
 Multiple agencies responding
 Hospital Resources Overwhelmed
 ADVANTAGES OF TRIAGE

 Helps to bring order and organization to a chaotic

scene.
 It identifies and provides care to those who are in
greatest need
 Helps make the difficult decisions easier

 Assure that resources are used in the most

effective manner
 May take some of the emotional burden away from
those doing triage
WHO DECIDES IN TRIAGE
 Nurses don’t act for legal fears of being blamed for
deaths, and lack of clarity on where they fit in the
command structure
 Nurses function to the level of their training and
experience.
 If nurses they are the most trained personnel the
site, they are in charge.
ARE NURSES PREPARED??
ROLE OF NURSING IN DISASTERS

Disaster preparedness, including risk assessment and

multi-disciplinary management strategies at all
system levels, is critical to the delivery of effective
responses to the short, medium, and long-term health
needs of a disaster-stricken population.
International Council of Nurses (2006)
NURSES’ ROLES IN DISASTERS

 Determine magnitude of the event

 Define health needs of the affected groups
 Establish priorities and objectives
 Identify actual and potential public health problems
 Determine resources needed to respond to the
needs identified
 Collaborate with other professional disciplines,
governmental and non-governmental agencies
 Maintain a unified chain of command
 Communication
COMMUNICATION IS A SUCCESS KEY
 Nursing organizations must have a comprehensive
and accurate registry for all members
 Have a structured plan:
• Collaborate and coordinate with local authorities
• Have a hotline 24/7
• Inform nurses where to report and how (keep records)
• Make sure have a coordinator to prevent chaos
• Ensure ways to maintain communication between
nurses and their families
THE NEED FOR DISASTER NURSING TRAINING
 11 million nurses world wide:
• Form the backbone of the health care system
• Are the frontline health care workers who are in
direct contact with the public
• Contribute to health of individuals, families,
communities, and the globe
 Schools of nursing offer little or no information on
disaster nursing (WHO, 2008)
 Shortage of trained instructors/faculty (WHO, 2008)
CORE COMPETENCIES IN DISASTER NURSING
TRAINING

 Ethical and legal issues, and decision making;

 Care principles;

 Nursing care;

 Needs assessment and planning;

 Safety and security;

 Communication and interpersonal relationships;

 Public health; and

 Health care systems and policies in emergency

situations
(WHO, 2008)
TOPICS THAT MUST BE COVERED BY DISASTER
NURSING TRAINING

 Basic life support

 System and planning for settings where nurses
work
 Communications (what to report and to whom)

 Working in the damaged facilities and with

damaged equipment
 Safety of clients and practitioners

 Working within a team (understand each member’s

role and responsibility)
 Infection control

 Mental and psychosocial support

(WHO, 2006)