DISASTER NURSING

INTRODUCTION
Disaster is an occurrence arising with little or no warning, which causes serious disruption
of life and perhaps death or injury to large number of people. It is may be a man made or
natural event that causes destruction and devastation which cannot be relieved without
assistance. Disaster management is a process or strategy that is implemented when any
type of catastrophic event takes place. Sometimes referred to as disaster
recovery management, the process may be initiated when anything threatens to disrupt
normal operations or puts the lives of human beings at risk. Governments on all levels as
well as many businesses create some sort of disaster plan that make it possible to
overcome the catastrophe and return to normal function as quickly as possible.

DEFINITION
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
LEVELS OF DISASTER
Disaster prevention can be defined as Measures taken to detect, contain, and
forestall events or circumstances which, if left unchecked, could result in a disaster.

 Level iii disaster – considered a minor disaster. These are involves minimal level of
damage
 Level ii disaster- considered a moderate disaster. The local and community
resources has to be mobilized to manage this situation
 Level i disaster- considered a massive disaster- this involves a massive level of
damage with severe impact.

Key organizations and professionals in disaster management

Health care community

 Hospitals
 Health professionals
 Pharmacies
 Public health departments
 Rescue personnel

Non-health care community

 Fire fighters
 Municipal or government officials
 Media
 Medical examiners
 Medical supply manufactures
 Police

PHASES OF DISASTER MANAGEMENT

Mitigation
 Personal mitigation is mainly about knowing and avoiding unnecessary risks. This
includes an assessment of possible risks to personal/family health and to personal
property.
 One example of mitigation would be to avoid buying property that is exposed to
hazards, e.g., in a flood plain, in areas of subsidence or landslides.
  Home owners may not be aware of a property being exposed to a hazard until it
strikes. However, specialists can be hired to conduct risk identification and
assessment surveys.
 Purchase of insurance covering the most prominent identified risks is a common
measure.
 Personal structural mitigation in earthquake prone areas includes installation of
an Earthquake Valve to instantly shut off the natural gas supply to a
property, seismic retrofits of property and the securing of items inside a building to
enhance household seismic safety.
 The latter may include the mounting of furniture, refrigerators, water heaters and
breakables to the walls, and the addition of cabinet latches. In flood prone areas
houses can be built on poles/stilts, as in much of southern Asia.
 In areas prone to prolonged electricity black-outs installation of a generator would
be an example of an optimal structural mitigation measure. The construction
of storm cellars and fallout shelters are further examples of personal mitigative
actions.
Mitigation involves Structural and Non-structural measures taken to limit the impact of
disasters.
Structural Mitigation:-
This involves proper layout of building, particularly to make it resistant to disasters.
Non Structural Mitigation:-
This involves measures taken other than improving the structure of building.
Preparedness
 While preparedness is aimed at preventing a disaster from occurring, personal
preparedness focuses on preparing equipment and procedures for use when a
disaster occurs, i.e., planning.
 Preparedness measures can take many forms including the construction of shelters,
installation of warning devices, creation of back-up life-line services (e.g., power,
water, sewage), and rehearsing evacuation plans.
 Two simple measures can help prepare the individual for sitting out the event or
evacuating, as necessary. For evacuation, a disaster supplies kit may be prepared
and for sheltering purposes a stockpile of supplies may be created.
 The preparation of a survival kit such as a "72-hour kit", is often advocated by
authorities.
 These kits may include food, medicine, flashlights, candles and money. Also, putting
valuable items in safe area is also recommended.
Response
 The response phase of an emergency may commence with search and rescue but in
all cases the focus will quickly turn to fulfilling the basic humanitarian needs of the
affected population.
 This assistance may be provided by national or international agencies and
organisations.
 Effective coordination of disaster assistance is often crucial, particularly when many
organizations respond and local emergency management agency(LEMA) capacity
has been exceeded by the demand or diminished by the disaster itself.
 On a personal level the response can take the shape either of a shelter in place or
an evacuation. In a shelter-in-place scenario, a family would be prepared to fend for
themselves in their home for many days without any form of outside support.
 In an evacuation, a family leaves the area by automobile or other mode
of transportation, taking with them the maximum amount of supplies they can carry,
possibly including a tent for shelter.
 If mechanical transportation is not available, evacuation on foot would ideally
include carrying at least three days of supplies and rain-tight bedding,
a tarpaulin and a bedroll of blankets being the minimum.

Recovery
 The recovery phase starts after the immediate threat to human life has subsided.
 During reconstruction it is recommended to consider the location or construction
material of the property.
 The most extreme home confinement scenarios include war, famine and
severe epidemics and may last a year or more.
 Then recovery will take place inside the home. Planners for these events usually
buy bulk foods and appropriate storage and preparation equipment, and eat the
food as part of normal life.
 A simple balanced diet can be constructed from vitamin pills, whole-meal wheat,
beans, dried milk, corn, and cooking oil.
 One should add vegetables, fruits, spices and meats, both prepared and fresh-
gardened, when possible.

DISASTER RISK REDUCTION (DRR)

 "The conceptual framework of elements considered with the possibilities to minimize
vulnerabilities and disaster risks throughout a society, to avoid (prevention) or to limit
(mitigation and preparedness) the adverse impacts of hazards, within the broad context of
sustainable development."
Disaster Risk Reduction (DRR) is a systematic approach to identifying, assessing and
reducing the risks of disaster. It aims to reduce socio-economic vulnerabilities to disaster
as well as dealing with the environmental and other hazards that trigger them

DISASTER MANAGEMENT CYCLE

PRINCIPLES OF EMERGENCY MANAGEMENT
1. Comprehensive – emergency managers consider and take into account all hazards,
all phases, all stakeholders and all impacts relevant to disasters.
2. Progressive – emergency managers anticipate future disasters and take preventive
and preparatory measures to build disaster-resistant and disaster-resilient
communities.
3. Risk-driven – emergency managers use sound risk management principles (hazard
identification, risk analysis, and impact analysis) in assigning priorities and
resources.
4. Integrated – emergency managers ensure unity of effort among all levels of
government and all elements of a community.
5. Collaborative – emergency managers create and sustain broad and sincere
relationships among individuals and organizations to encourage trust, advocate a
team atmosphere, build consensus, and facilitate communication.
 6. Coordinated – emergency managers synchronize the activities of all relevant
stakeholders to achieve a common purpose.
7. Flexible – emergency managers use creative and innovative approaches in solving
disaster challenges.
8. Professional – emergency managers value a science and knowledge-based approach;
based on education, training, experience, ethical practice, public stewardship and
continuous improvement.

Disaster management plans

Aims of disaster plans

 to provide prompt and effective medical care to the maximum possible in order to
minimize morbidity and mortality

Objectives

 To optimally prepare the staff and institutional  resources for effective performance
in disaster situation
 To make the community aware of the sequential steps that could be taken at
individual and organizational levels

Disaster management committee

The following members would comprise the disaster management committee under the
chairmanship of medical superintendent/ director

 Medical superintendent/ director

 Additional medical superintendent
 Nursing superintendent/ chief nursing officer
 Chief medical officer (casualty)
 Head of departments- surgery, medicine, orthopedics, radiology, anesthesiology,
neurosurgery
 Blood bank in charge
 Security officers
 Transport officer
 Sanitary personnel
Disaster control room

 The existing casualty may be referred as the disaster control room.

Rapid response team

 The medical superintendent will identify various specialists, nurses and

pharmacological staff to respond within a short notice depending up on the time
and type of disaster.
 The list of members and their telephone numbers should be displayed in the
disaster control room.

Information and communication

 The disaster control team would be responsible for collecting, coordinating and
disseminating the information about the disaster situation to the all concerned.

Disaster beds

 Requirement of beds depends up on the magnitude of the disaster.

 Utilization of vacant beds, day care beds, and pre-operative beds
 Convalescing patients, elective surgical cases and patients who can have domiciliary
care or opd management should be discharged
 Utility areas to be converted in to temporary wards such as wards with side rooms,
corridors, seminar rooms etc.
 Creating additional bed capacity by using trolleys, folding beds and floor beds

Logistic support system

 Resuscitation equipments
 Iv sets, iv fluids,
 Disposable needles, syringes and gloves
 Dressing and suturing materials and splints
 Oxygen masks, nasal catheters, suction machine and suction catheters
 Ecg monitors, defibrillators, ventilators
 Cut down sets, tracheostomy sets and lumbar puncture sets
 Linen and blankets
 Keys of these cupboards should be readily available at the time of disaster
Training and drills

 Mock exercise and drills at regular intervals are conducted to ensure that all the
staff in the general and those associated with management of causalities are fully
prepared and aware of their responsibilities. 

Elements of disaster plan

A disaster plan should have the following elements

 Chain of authority
 Lines of communication
 Routes and modes of transport
 Mobilization
 Warning
 Evacuation
 Rescue and recovery
 Triage
 Treatment
 Support of victims and families
 Care of dead bodies
 Disaster worker rehabilitation

Activation of disaster management plans

 Standard operating procedures (SOPs)

 Reception area
 Triage
o Priority one- needing immediate resuscitation, after emergency treatment
shifted to intensive care unit
o Priority two- immediate surgery, transferred immediately to operation
theatre.
o Priority three- needing first aid and possible surgery- give first aid and admit
if bed is available or shift to hospital
o Priority four- needing only first aid-discharge after first aid.
 Documentation

 Public relations.
 Essential services.
 Crowd management/ security arrangement.
Role of Geo informatics for disaster risk
management
GIS and Disaster Management Process

 GIS is a powerful tool that can support decision making in all phases of the disaster
management cycle.
 The focus earlier was primarily on responding to disasters. With the paradigm shift
the role of disaster managers has immensely expanded.
 The process ought to be a seamless one from preparation to mitigation, planning to
prediction and response to recovery. Every activity is directed towards a never-
ending quest for disaster resilience.
 The expanded role also means an integration of a number of disciplines and a
number of expertise drawn from different areas.
 GIS can act as an interface between all these and can support virtually all phases of
the disaster management cycle.
 GIS is known to have been applied to protect life, property, and critical
infrastructure from natural and human-caused disasters; perform vulnerability
analysis, multi hazard risk assessment, evacuation and shelter planning, perform
what if scenarios, modeling and simulation, carry out damage assessment, and a
community’s need assessment.
 Evading disasters begins with identifying the hazards in an area followed by the
vulnerability of people, livestock, structures and assets.
 Knowledge about the physical, human and other asset at risk is imperative. GIS
based thematic mapping of an area's terrain overlaid with its population density,
vulnerable structures, disaster history, climatic information, etc. would determine
who, what and which place is most at risk.
 The GIS capability of mapping hazards with information about its environs reveals a
unique geographical trends and spatial pattern which has more visual clarity, is
more understandable and helps support decision making process. 
 The usage of GIS in disaster risk management ranges from databases creation,
inventory, simple to advanced GIS overlay, risk analysis, cost-benefit analysis,
scenario analysis, probabilistic analysis, decision matrix, sensitivity analysis, geo
processing, spatial statistics, correlation, autocorrelation and many other complex
spatial decision-making tools and algorithms.
 Once it is known which areas are at risk with which hazards, the mitigation process
can begin.
 GIS could be of use in prioritizing areas for defining building codes, for identifying
structures for retrofitting, for carrying out group insurance for people and
structures, for prioritizing locales for mock drills, training and capacity building
 specific to the hazard they face and for identifying areas facing recurrent flood and
in taking decision whom to relocate.
 The most vulnerable areas identified by GIS are the focus for mitigation efforts.
 All steps for eluding disasters when taken, the next step is to prepare for the
situation if disaster strikes.
 What if or the modeling capability of GIS already gives a fair idea of what to expect.
 The GIS for disaster preparedness is effective to earmark shelters outside the
hazard zone, identify alternative evacuation routes based on different disaster
scenarios, best routes to hospitals outside the hazard zone, specialisation and
capacity of hospitals etc. GIS can give an estimate of the amount of food, water,
medicines etc. for stockpiling.

Fig. 2: GIS in all phases of disaster management cycle

 GIS is also suited to respond during disasters. With its capability to analyse real time
satellite imagery a rapid damage assessment is done in the immediate aftermath.
 Prioritising areas for search and rescue, rubble and debris removal, delivery of relief
supplies, prioritizing actions such as areas to be evacuated, identifying roads blocked
with debris or damaged, route planning for emergency supplies entering the disaster
site, route planning for evacuation and medical emergencies exiting the disaster site,
identifying locations and availability of people, equipment, supplies, shelters,
 logistics and other resources necessary to manage the disaster response and
recovery are some of other areas that could utilize GIS effectively. 
 Post disaster recovery phase includes rehabilitation and reconstruction. This is an
ongoing process to restore the vital life-support systems and to rebuild the entire
community. GIS could be utilized in spatial planning incorporating the lessons learnt
in the event of the disaster.
 It includes planning critical infrastructure such as water, electricity, communication,
housing, livelihood, social security, transport, agriculture and monitoring and
evaluating the progress of the recovery activities

Disaster management- nurse’s role in

community
Assess the community

 Assessment - the local climate conducive for disaster occurrence, past history of
disasters in the community, available community disaster plans and resources,
personnel available in the community for the disaster plans and management, local
agencies and organizations involved in the disaster management activities,
availability of health care facilities in the community etc.

Diagnose community disaster threats

 Determine the actual and potential disaster threats (eg; explosions, mass accidents,
tornados, floods, earthquakes etc).

Community disaster planning

 Develop a disaster plan to prevent or deal with identified disaster threats

 Identify local community communication system
 Identify disaster personnel, including private and professional volunteers, local
emergency personnel, agencies and resources
 Identify regional back up agencies and personnel
 Identify specific responsibilities for various personnel involved in the disaster plans
 Set up an emergency medical system and chain for activation
 Identify location and accessibility of equipment and supplies
 Check proper functioning of emergency equipments
 Identify outdated supplies and replenish for appropriate use.
Implement disaster plans

 Focus on primary prevention activities to prevent occurrence of manmade disasters

 Practice community disaster plans with all personnel carrying out their previously
identified responsibilities (eg: emergency triage , providing supplies such as food,
water, medicine, crises and grief counseling)
 Practice using equipment; obtaining and distributing supplies

Evaluate effectiveness of disaster plan

 Critically evaluate all aspects of disaster plans and practice drills for speed,
effectiveness, gaps and revisions.
 Evaluate the disaster impact on community and surrounding regions
 Evaluate the response of personnel involved in disaster relief efforts.

CONCLUSION
Disaster is an emergency situation, therefore coordination of actions and various
departments is an essential requisite for efficient management of mass casualties.A truly
comprehensive disaster management plan will encompass a wide range of possibilities
that can easily be adapted in the event one disaster sets off a chain reaction of other types
of disasters in its wake. Because of the need to continue functioning in emergency
situations, disaster management plans are often multi-layered and can address such
issues as floods, hurricanes, fires, bombings, and even mass failures of utilities or the rapid
spread of disease.