Iii

agcment necessitates a multi-institutional approach . Jt demands e ·

· aster man . . . . mergency or casualty
Dis f the hospital, and that th1s department should function well if disaster 1·5 to be managed
services o
effecdvely.

~ otFINITIONS (?F HAZARUm~s~stER. - -~ .. .

1. Hazard is a rare or ext~e~e event m the natura~ or man-made environment that adversely
affects human life or activity to the extent of causmg a disaster.
disruption , loss of human life and deterioration
2_ Any occurrence that cau~es damage, economic
of health and health services on a scale sufficient to warrant an extraordinary response from the
outside of the affected community or area is a disaster.
3. Disaster is disruption of human ecology, which cannot be absorbed by the affected community
within its own resources.
(4.A. disaster is an~ man-ma~e or natural event that causes destruction and devastation that cannot
L --be alleviated without ass1sta~
5. Disaster is a catastrophe causin ~ and illness to 25 or more people, whom the normal system
of a hospital or an organization cannot bear and due to which the equilibrium of the hospital system
is disturbed.
6. Disaster is a sudden massive disproportion between hostile elements of any kind and survival
resources that are available to counterbalance these in the shortest period of time.
7. Disaster is defined as an act of nature or man that may mean a menace serious or great enough
to justify emergency aid, and in which extensive material damage is followed by a tragic loss
of human lives and large numbers of injured victims.

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1. Sudden-onset hazard (geological and climatic hazards): Earthquakes, tsunamis, floods,

tropical storms, volcanic eruptions, landslides, etc.
2· Slow-onset hazards (environmental hazards): Droughts, famine, environmental degradation,
desertification, deforestation, pest infestation, etc.

Sudden-onset hazards

Slow-onset hazards
~
"'
~

;a Industrial/technological
4a ~---- . system failure
"'
Cl)

~ Wars and civil strifes

Epidemics

Figure 11.4 Types of Disasters .

 . t s· System failure/accidents, spillages expJo .
I ical d1sas er . . , s1ons fi
3. Industrial/techno ~g d ggression, insurgency, terronsm and other acti , res,t,,
4 Wars and civil strifes: Anne a ons leadini'
. and refugees. . !
displaced persons d b e diseases, AIDS, vector-borne diseases, etc.
. · • Water and foo - om
5. Ep1dem1cs. -

st
Natural Disa ers h ki of earth's surface caused by individual plates movin
h ke· Violent s a ng gagai .
I. Eart qua. · th . ke These plates make up the outermost shell of the earth' ~!
h other 1s known as ear qua · h • . sc¾
eac . h other and to the earth's movement. T e mtens1ty of an earth
and move relative to eac . d qu~,
.1s measuredbYthe R1'chter scale' where an earthquake of a magmtu e of 2.5 representsa•"•/i
. d 11lu

'ttl d age while an earthquake of magmtu e 7.0 or greater represents ama·

tremor and l1 e am . 101
tremor, where changes to the earth's surface occur and vast damage IS e~pe~ted.
2. Floods: Among all natural disasters, floods are regarded as most da~ag1~g m tenns of human
lives and property. The flood is an annual feature in r~spect _of maJor nvers a~d tributariei
during the monsoon season. Populations living on alluvial plams prone to floodmg arewo111
affected. Mortality is high in case of sudden flooding. Besides :fracture injuries and bruim.
cases of accidental hypothennia also occur during cold weather. Deaths. due to poisonou1
snakes and insects are also common.
3. Drought: Factors responsible for drought are low rainfall, reduction in vegetation, soil
erosion and surface evaporation. In rural communities, economic factors (agronomy) ana
sociocultural factors cause migration. This affects the health and survival of families. Famine
and desertification are their most fearsome consequences. Draughts cause protein-energy
m~lnutrition (~EM), vitamin A deficiency, measles, acute respiratory infection (ARJ), diarrhoea
with ~ehydra_t1_on, etc. Drought-affected populations who migrate and settle down on the
outskirts of cities and towns face the problem of poor hygiene and sanitation. Overcrowding
furthe.r exposes them to communicable diseases like diarrhoea TB parasitic infestations all<l
malana. ' '
4. Volcanic eruptions· A I h . . .
t t · vo cano as a vent m the earth 's surface and the cone formed by it. T1us
ven ex ends to the layers of m It • d;r;
and is formed by the t . ohren matenal called magma. The cone is called volcanic e u,ce
. ma ena1t own from the vent
5. Tropical cyclones: They are al kn · t
powerful and destructive ma . soh own as typhoons and hurricanes. Tsunamis are the mos
. nne azards.
The impact of tsunamis and c 1
ye ones o h di · n
to the public health and medic I n uman health cannot be underestimated. In ad uo
.
. impact oftsua consequences
. · natural calamities the social,
0 f th ese · cuJtura1
and psycholog1cal
nam1s and cy I h ' . · act
across the world, and a direct imp· cones ave an enormous and Iong-lastmg tmP
act on huma d I
Drowning that takes place during the . n eve opment in general. .
majority of deaths from tsunamis and impact phase of the disaster causes the overwbellll1ng
. cyclones p l b it)g
close to low-lymg areas and the coastline In.u · .eop e are at risk of death simply by ~
cyclones. ' · J ry Is the major cause of morbidity for tropical
Man~Made Disasters
l. Nuclear warfare: When a nuclear bomb is exploded in the air it causes blast heat and radiation.
a. Blast: It is the sudden huge increase in air pressure, which bursts out all at once from
the bomb just as waves from a stone dropped in a still water. The blast waves knock
down buildings, shatter window panes and hurl around debris of all sorts. People are
hurt by falling buildings or struck by flying glass and rubble. Victims suffer burns, cuts,
bruises, sprains and fractures of exactly the same types as the ones that occur in peace-time
accidents.
b. Heat: A flash of intense heat lasting only a few seconds is capable of scorching the exposed
skin of persons up to several miles away from the exploding bomb.
c. Radiation: Atomic explosion produces an instantaneous discharge of radiation similar
to X-rays. These rays are capable of producing a serious degree or radiation sickness in
exposed people up to a mile from the bomb centre. The vast majority of nuclear bomb
casualties suffer from blast injuries or bums.
2. Biological warfare: One possible method of enemy attack is to introduce diseases that affect
humans, domestic animals or food crops. Either germs or toxins (poisons) produced by germs
may be spread by bombs or aerial sprays or by saboteurs who add the dangerous organisms
directly to food or water supplies.
3. Chemical warfare: In case of massive attacks on civilian population, the most likely chemical
agents are nerve gas and mustard gas. Nerve gases are a group of highly poisonous chemicals
that are colourless and odourless. They are likely to be introduced in the form of a liquid spray
from planes, bombs or shells. The liquid can quickly penetrate clothing and get absorbed through
the skin. Speed is essential in dealing with the nerve gas, since even in low concentration, they
can produce serious illness or death within a few minutes. ·
Mustard gas: It is a group of oily liquids ranging in colour from yellow to brown and smelling
like garlic, shoe polish or rotten fish. It is used in the form of liquid spray from aircraft, bombs
or shells. Drops on the skin quickly produce blisters that are very slow to heal. The liquid
slowly evaporates, producing a gas that is very harmful to the eyes, causing redness, soreness
and ulceration. If the vapour is inhaled, it affects the lungs, leading to coughing, difficulty in
breathing and fever.
4· Conventional warfare: Conventional arms have been used for a long time, and include
explosives and fire bombs. They produce the following effects:
a. Wounds and fractures caused by flying splinters of the explosives.
b. Rupture of ear drums, lungs and small intestines.
c. Falling buildings may cause multiple injuries and fractures.
d. Fire caused by the destroyed buildings_may cause severe bums.

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People of · ,~,. '-"-"'"'~-~ ,
different age groups tend to react to a disaster d'ffi althouah loss of appetit
and, seep
1 ct· · I erent ways,
m·
0

incl d th isturba~ces are common at all ages. Other c t. ons in different . e

u e e following: · ommon reac 1 , age groups
 ( 1 - 5 ye ars)
l,ool
Presc
lness
I. Fearfu
. Nightznares
2 rents
n g to pa d k
3. Clingi
-1 1 y ears)
chi ld hood (5
es, ar o f th e ar
Early ght1na r fe
-/ Jt ten·or s, n1· o r a t s c hool
I Nio
·
0
b 0ur a m e
ehav1• th0
e ss iv e
2·. · Aggr a nd h eadaches
to m ac h aches
3. S
o r w he ezing
ng
4. Clingi atio n in school
o or c o ncentr
s. P
1 - 14 yea rs)
ores
.

en ce ( 1 -- o do c h
Preadole
s c -as-refusal t
u ch
-in~ the .home, s hes
bellion
J. Re ach aches or headac
eha viour
2. Stom est in frie
nds e k i n g b
finter tio n se
3. Loss o
terest o r atten
l o ss o fi n
uc h a s
o o l
( p
1 r
4 o
- b
J leymesasrs)
8
Scnhce ...,.-,
Ado4l.esce atin g ..,
o f in te r est in d haViour
1. Loss u e n t be
le a nd /o r de,,l,i-n-q
onsib
2. Iroroerspconcentratio
n
3. P r ia /
cho nd
4. llYJJo
d
Adulthoo
n d de p r ession
ss a
1. Dirsutrseive •

I 2. Int
1h

o f the d isaster
,.,em oneest feelings
s h b a c k s o f ups
3. Fla se d' t inders
4. Inten es s a t r em
. i,s brJu f
5. lm ta b iJ itY
J n g o ff eelings . . .
La c k o f . , snt in Ple le a ctivities
6 inte r e
. asur ab ratioo
. re a a d co ncent
ling d
llls, inso .
mni an Poor
7. Troub
11.tf' HEALTH SECTOR INVOLVEMENT IN DISASTER MANAGEMENT
1. Nationa_l . ~rga~izations: Under the ~~ federal system, disaster management is a
~ bthty of state governments. ;Research survey guidelines and provisions for financial
assistance to ~ e state are the responsibilities of the central government. There is a crisis
management o-r u hEaded by the cabinet secre~ which consists of nodal ministers for
natura 1sasters. In such cases, a multidisciplinary central government team, at the invitation of
the affected state, conducts a disaster assessment and makes recommendation for assistance .
.~
2. State-level organiz!'tion: 12._isaster preparedness and response is usually delegated to the relief
ana r~hap_ilita~.oi_1....~ e n t, which i~ hea~ed by the chief seg = ?f the goyernmenLwith
participation of all other related agenc1e_s and degartments.
3. Dist~ic~:le_yelm:ganiliation: A district-level coordination and review c~ tttee is con~~tuted;
it is headed by the collector as chaiiman with participation of all other re ated agencies and
departments.

National
organization

( \
Health sector
District-level disaster State-level
organization management organization

CommWlity-level
helpers
/
Figure 11.5 Disaster Managemen t

4. Co~unity~lev~!..!1!JP'tPS (rLHs): Any community when faced with a disaster displays a

response to the situation by the local people who immediately come forward to help. They ~e
called community-level helpers (CLHs). They are a vital link betw@en t!ie affected population
and the helping agencies (individuals, nongovernmental organizations and g?vemmental
organizations) Community-level helpers can provide psychological intervention ~ough
daily visits. Durino such visits they talk to the survivors about their feelings and expenences,
~mpart healt~duc~t ion, discuss health problems, motivate indiviElJ_als,to hold group meetingS,
and organize educationala cfiVities~_CQmmunity-level helpe~therefore have to educate the
Survivors about common stress reactions followino a disaster and ways to cope with stress ao<l
0
the available resources.
 -
• .o i .. .i G J
1 1i1
. t)1 U l' > l~ )JSAS'fi\lS
~ O 1. ,
121tOLJ:J F
tSE 1) to
. rease the pro fe
,n
ra ges nurses c ssion ·s .ib .· ,
11. Cu se s (l
~ ) encou
C i,, · ter urs .
by t h ~ . •.
nci\ of N~ ft.e r a d i§ occ ~ r j K ll)J
The Jnt~r natidoenal O _1t h 5erv~r bef ~ n d - l ! . - ~ · ~ . dis aster . tt or, .
pre d . .
pare ne ~~ mc.
quate hei:uw -d i s role in
- li ef opera· n•o 5 fhe co
1 ·•

to pro v1. de apre an n .

t:l,:
revenuon, p are d n ess re
Pb fonowing·.
.
. are pro v·d d in the chaotic pastdisaste
t e
. . \ irnrnediate · e P L ¢ . fi 1 e tion s an d ·
r ~ n\X.
l Ensunng th at cruc1a re d as the basis reli ef opera co ntmgenc~ pb:-.,
. lCN urges tha \istic scenafl.os be use or
t rea

1mmediate
reli ef service
s

Accountabilit
y
system

Relief
development

Nurse's
role (ICN )

Figure 1 .6
1 Nurse's Role
in Disasters
2. Condemn
ing violation .
s o f human n d
g h ts that oft
recovery .
3 . Strongly re en o c c u r u . o d a f te r dis a s te rs
rmo an , th rea ten in~
inforcing the
4. Establishin . link between
g credible a
cc
. . relief a n d d e v e lo p m
resources in o u ntability syste e n t p la n n in
relief operati ms to p re v g.
5. Calling on ons. e n t th e a b u
governments s e o f finan . l nd hum,·\1'
an d relief organ c1a a
address the h izations to
ealth care ne e s ta b li s h s
6. Actively eds of relief u p p o rt s y s . d ll,•
assisting · cou workers as te m s re q uir
ntr ie s in their pla w e ll a s d is as te r v ic ti m e
reductio~ wit nning to in s.
hin the existi te
so that disast n g machinery a g ra te d is a s te r
er-prone area nd strategie p re v e n ti o n
7· Pro~o s have faster s , w h il e e s
ta a nd i.rnP 3~~
ting strategie a c c e s s to altern ativ b li s h in g c o n ti n g e
~ rv1ces. s that support e c a re s e rv n c y p\ 311'
social justic ic e s .
e and e quity
o f a c c e s s to
needed h ea
lth an d so ci.il
 Em e rg e n c y a nd D is a st e r M a na g e m e nt I 161

Nun-cs with their technical skill~ an~ kn?wledg e of ~pi~em~ology, physiology, pharmaco logy,
,. . ral familial structures and physiological issues can assist m disaster preparedness programm es as
~u1tu . d fd.
well as during the per10 o. 1sasters. N urs~s as _te~m _members can play a strategic role by cooperating
.th health and community groups, social d1sc1plmes, governme nt bodies and nongovern mental
WI . . • .
agenc•1·1.:,_,., . including humamtan an orgamzatt
•
ons. •
Care and support must also be provided for rehefwork ers who are experienc ing human tragedy and
may be stressed, fatigued and ~ing to provide _services ":ith to~ !ittl~ resources in physically unsafe
circumstances. Nurses have a vital role to play m prevention , mitigation , preparedness and relief.

Prevention, Mitigation and Prepare dness Activitie s

It is necessary to
l. be familiar with methods of raising public awareness of those natural disasters that the region
and country are most likely to experience.
2. be infonned of disease and social behaviour patterns associated with disasters that may be
exacerbated by deteriorated living conditions .
3. be aware of associated physical and mental health, and socioecon omic and nursing needs.
4. lobby institutions and governme nts to prepare in advance for disaster by information on
potential hazards and vulnerabilities and by increasing the ability to predict and respond to the
situation.
5. actively participate in strategic planning and implemen ting of disaster plans ensuring nursing
input.
6. support the developm ent of an accountable chain of command within the network or relief
organizations (e.g. governme nt or designated expert organization) and the division of the
affected area.
7. urge the development and implementation of relevant policies, procedures (e.g. disaster
simulation exercise, mobilization teams, etc.) and legislation.
8. cerebrate World Disaster Reduction Day every October.

Relief Response
A nurse should also do the following:
1. In the short te1m assist in efforts to mobilize the necessary resources (e.g. food, water, sanitation ,
shelter, etc.), including emergenc y medical assistance, giving special attention to vulnerable
groups such as the sick, handicapped, children, women and the elderly.
2. Work with existing capacities, skills, resources and organizational structures .
3. In the long term, assist with resettlement programme , psychosocial, economic and legal needs
(e.g. counselling, documentation, mobility)
4. Partner with independent, objective media, local and national branches of governme nt,
international agencies and nongovernmental organization.
5. Provide care for those who are providing direct services.