NURSING MANAGEMENT IN

DISASTER
 A. BASIC PRINCIPLES FOR DISASTERS RESPONSE

Super acute
DISASTER phase 72
hours

acute phase
72 hours-1
week

Chronic phase
(reintegration/rec
onstruction
phase 1-3 month

SILENT PHASE : PHASE FOR CHORONIC PHASE

PREPAREDNESS (BEFORE (REINTEGRATION/RECONST
DISASTER) RUCTION PHASE) 1-3 MONTH
 Disaster cycle and role of nurses
PHASES
Super-Acute phase ; 72 hours
after disasters
Acute phase ; 72 hours-1 week
Semi-Acute phase 0,5-1 month
Chronic phase
(reintegration/reconstruction
phase) 1-3 month
Silent phase / preparedness phase
(before next disaster)
ROLE OF NURSES (ACTUAL NURSING CARE)
Traige and life saving medical care by DMAT (disasters
medical assistance team), transfer patients. Mental care by
medical team, assistence for first aide reliefe station
In addition to above works, assistance for disasters site,
prevention for economic seat syndrome and infection,
public hygiene education, assistence for evacuation center
Assistence for evacuation center and hospital in disaster
site, home visit nursing care and home based helath
education, care for patients with chronic disease, infection
control and mental care
In addition to above works, provide guidence for helath
management and heart caring for PTSD (post traumatic
syndrome)
Dissemination for disaster mitigation activities and
training and disaster training for medical personel, self
training for disaster prevention training and
implementation)
MEANING OF CSCATTT
PRINCIPLE OF DISASTER
RESPONSE
C Command & control
S Safety (3 S)
C Communication
A assasement
T Triage
T Treatment
IMPLICATION / MEANING
Command means vertical instruction, control means horizontal
linkage with other organizatitions. Head of nursing Dep. Takes the
roll
At first, protect yourself. Next, protect the field/or disaster site
(hospital wards, orevent fire, prevent the leak of medical gas).
Lastly, protect staff, patients and visitors of the hospital
(survivors).
Information is important to make assasement. Following point
must be decided.
Who collect information? (responsible person)
What kind of information must be collected? (contents of
information)
Where are those information reported? ( flow of information)
How we get information? (by walkie-talkie, internal phones, PHS :
personal handphone system or a massenger)
How we transmit information? (must decide methode)
Filed sittuatin of disaster site ( acces status, injured persons,
dangerous area), hospital condition (damage of the ward and
operation rooms by fire on so on), ruined area, condition and
safety of materials, medical instrument and equipment with time
progress, possibility of eccaptance of patients or not must be
assesed and report the way forward to disaster response.
Do traige pf patients in disaster site, at arrival of hospital, also at
the time of trasnportations of the patients, triage is to decide
priority of emergency treatment and transportation
Provide proper medical treatment according to priority of triage

T Transport
B. DISASTER MEDICINE
1. DISASTER BASE HOSPITAL
Function and role of disaster base hospital
1. To be able to save lives of seriously ill/injured patients. (necessary to be
equiped with highly advanced medical equipment)

2. To be able to accept injured patients and/or transfer them to refferal hospital.

(need the function for transfer)

3. To be able to dispatch disaster relife medical team. (need to have disaster

relief dispatch

4. To be able to land materials and equipment for first aid treatment to the
hospital in disaster side

5. To be able to do training of disaster relife activities for doctorsand nurses.

(need enough manpower, facilities and teaching kids)
 2. CHECK ITEMS TO ACCEPT PATIENTS
• Availability of the staff who can do traige properly
• The hospital must have the defenite medical care course according to triage
• To have more doctors and nurses than caring admitted patients and can set up disaster
response sections as below
a. head office (quarter)
b. Triage area (red area, yellow, green and black)
c. volunteer section
d. family related section
e. Press release section
f. SCU (staging care unit) section
g. staff coordination section
h. patients transfer section
i. reception of regritration of the victims
j. DMAT (disaster medicine assistence team)/medical relief team section
k. decontamination section
• Life lines must be secured
• Medical goods, materials and drugs
 `3. ASSESSMENT OF HOSPITAL FUNCTIN
S
afety
o
f
ho
S
afetL
yifeosp
ofaciltes,fhitalb
C
oqsileou
ndup
itopalsfdn
eg
m
nem
na(
ofliet,gd
linm
eecm
esdicalonag
godited
odnc
so
nd
it
on
)

P
a
t
i
e
n
t
s

l
i
v
e
s
/
d
i
s
a
s
t
e
r

c
o
n
d
i
t
i
o
n
ASSESSMENT/JUDGMENT
4. ROLE OF HEAD OFFICE OF THE HOSPITAL IN DISASTER

1. To inform as head office for disaster counter measures

2. To notofy the method of communication
3. To collect information, analyze information and make
assessment for counter meassures
4. To discuss about principles and policy for disaster and
notofy to relevant personnel and organization
5. To give instruction to solve problems
6. To confirm the condition with time
7. To make records of process after disaster happened
 t
n
s
i
a
C. Response
tn
f 0f Hospital at The Time of Disaster Happening
g
o
e
tP Flow chart of instruction at the hospital
o
h
y
ref
ea
o
p
d
fa
i
ro
s
se
fa
t
fs
a
eit
f
v
ce
fa
er
c
&
u
a
tp
a
i
t
o
in
e
n
Confirmation of safety staff and patients

• Confirm safety of the staff

• Confirm safety of the facility
• Confirm safety of admitted patients

(existence and safety)

• Observe wards and whole hospital
• Report to disaster head office according to items of repots
sheet
 Prepare evacuation

• Bring patients to safety area of the ward and wait for the
next instructions
• Patients who can walk : bring them near the exit
• Patients who need assisstance : after patients move on to
wheel chairs and/or beds, draw them to safety area
• Patients who are in the beds: patients who can breath
even after removed artificial respirator and IV line, their
bed will be carried to safety area
D. Preparedness for disaster
• List of necessary items
• Preparedness as a nursing manager
a. understand earthquake resistance strenght of hospital buliding in advanced
b. Decide standard ruleof nursing staff to come to the hospital by free will in
disaster
c. Do survey of communiting time of each nursing staff from their houses in
advance
d. Provide disaster training regularly
e. Practice disaster simulation training in a short time every day
f. Secure and check necessary disaster goods
g. Set up disaster response team
h. Provide leaders
• Evacuation and guidance of patients in disasters
• Disaster drill
No Injuries (text on patient Palpable radial Number of Triage
artery palse
1 Middle aged man. Trapped in the wreck.
Penetrating abdominal injury. HR 130.
breathing forced
2 Middle aged woman, traumatic amputation
lower limb. HR 116. pale. Severe pain
3 Young girl, soft tissue injuries in face and
ahands. Crying. HR 80. breathing OK
4 Small boy, severely trapped. Abdominal pain,
pre shock. HR 140. breathing weak
5 Middle aged woman, open fracktur left femur,
severe pain. HR 116. breathing OK
6 Eldery man with severe multiple maxillofacial
injuries with fractures. HR 180. breathing
forced
7 Young man, open fracture left lower arm. HR
104. peripheral circulation OK. Breathing OK
8 Old man with chest pain and a big haematoma
on the right side of the chest. HR 88. breathing
forced. coughing
9 Old man, fracture of the left neck of the femur.
Chest pain. HR 100. breathing OK
10 Old man, soft tissue injury ear and face.
Fracture of the radius. Hr 84. breathing Ok
11 Young woman, no visible injuries. Very pale.
Freezing but awake. HR 124., weak. Breathing
OK
12 Middle age woman. Soft tissue injuries in
face. HR 88. breathing Ok
13 Young man, open frackture of the skull.
Responds weakly to talk. Hr 84. breathing Ok
Thank you