DISASTER MANAGEMENT

Introduction

Disasters are a major global issue because they cause a lot of harm to people, communities, and

the environment. The number of disasters is increasing, and their impact on public health is huge.

Examples include: Airplane crashes, Terrorist attacks, Building collapses, Erosion.

Definition of Terms

What is a Disaster?

A disaster is a sudden and unexpected event that causes serious damage to property, disrupts the

environment, and results in loss of lives and health problems. These events often need help from

outside the affected area.

Characteristics of Disasters

Disasters are events that happen suddenly.

They harm people, property, and the environment.

They disrupt daily life.

They often require outside help.

They usually happen without warning.

Classification of Disasters

Disasters can be divided into different types:

Natural Disasters (Sudden): Earthquakes, hurricanes, volcanic eruptions, tsunamis, landslides,

etc.

Man-made Disasters (Sudden): Fires, toxic waste spills, transport accidents, wars, etc.

Natural Disasters (Slow): Droughts, desertification, famines, and floods.

Man-made Disasters (Slow): Environmental pollution, civil wars, and economic crises.

Epidemics: Diseases like cholera or meningitis.

Effects of Disasters

Disasters lead to:

Loss of lives.

Health issues (temporary or permanent).

Destruction of infrastructure and social services.

Economic losses, like damage to property.

Injuries (e.g., burns or fractures).

Spread of diseases due to poor sanitation and overcrowding.

Other effects:

Mental health issues (e.g., anxiety, depression).

Loss of homes, leading to exposure to extreme weather.

Poverty and frustration among survivors.

NATURAL DISASTERS

Earthquakes

An earthquake (also known as a quake, tremor or temblor) is the result of a sudden release of

energy in the Earth's crust that creates seismic waves. Earthquakes are recorded with a

seismometer, also known as a seismograph). Intensity of shaking is measured on the modified

Mercalli scale.)

Cyclone

Cyclone is an area of closed, circular fluid motion rotating in the same direction as the earth.

This is usually characterized by inward spiraling winds that rotate counter-clockwise in the

Northern Hemisphere and clockwise in the Southern Hemisphere of the Earth. Most large-scale

cyclonic circulations are centered on the areas of low atmospheric pressure.

Fires

A wildfire is any uncontrolled fire that occurs in the countryside or a wilderness area. .A

wildfire differs from other fires by its extensive size, the speed at which it can spread out from its

original source, and its ability to change direction unexpectedly and to jump gaps, such as roads,

rivers and fire breaks.

Landslides

These include wide range of ground movements such as risk falls, deep failure of slopes and

shallow debris flows which can occur in offshores, costal and onshore environment. The main
causes are ground water pressure acting to destabilize the slope, loss or absence of vertical

vegetative structure, soil nutrients and erosion of toe of a slope by river or ocean waves.

Volcanic Eruptions

A volcano is an opening, or rupture, in a planet's surface or crust, which allows hot magma, ash

and gases to escape from below the surface. The word 'volcano' is derived from the name of

Vulcano Island off Sicily, which in turn, was named after Vulcano the Roman god of fire.

Floods

Water is a source for all life forms. Without water, no life is sustainable. But when water is in the

form of floods, it takes away thousands of human and cattle life. The soil is deposited by

moving water. However, if water remains stagnant for too long, these beneficial floods become a

major disaster. Most vulnerable things which are affected due to floods are homes, buildings, and

huts made from biomass materials like bamboo leaves.

Famines

A famine is a widespread scarcity of food that may apply to any faunal species. This

phenomenon is usually accompanied by regional malnutrition, starvation, epidemic and

increased mortality.

Droughts

A drought is an extended period of months or years when a region notes deficiency in its water

supply.
MAN-MADE DISASTERS

Man-made disasters are human-caused events which, either intentionally or by accident-caused

events which either intentionally or by accident-cause threats to public health and well-being.

Chemical Weapons Chemical

Emergency occurs when a hazardous chemical has been released and the release has potential for

harming people's health.

Radiation Emergency

Emission of radiation from radioactive materials, for example, reactors, radioactive substances

(uranium) and medical supplies (radium)

Bioterrorism

Bioterrorism is terrorism by intentional release or dissemination of biological agents (bacteria,

viruses or toxins); these may be in a naturally-occurring or in a human-modified form.

Pandemics and Disease

 A global disease outbreak

 Influenza virus causes various illnesses

 Spread is from person to person.

Primary Prevention against Man-made Disaster

  Prevention of occurrence of the disaster must be done to prevent not only the

consequences but also the occurrence of fire, explosion crashes and sudden chemical and

radiation exposure.

 These include tighter regulation of chemical plants and other hazardous facilities and

insistence that the chemical plants be built away from the densely populated area.

 Appropriate engineering and technological measures like building codes, dam design

containment of toxic materials Protection against human error.

 The world has turned towards efforts to stop arms race and prevent nuclear war.

DISASTER AGENTs /EPIDEMIOLOGY OF DISASTER;

Agents:

Primary Agents

These include:

 Falling of buildings

 Earthquakes

 Floods

 Hurricanes

 Bomb blasts

 Tsunami

Secondary agents
 These include:

 Bacteria and viruses that produce contamination or infection after the primary agent has

caused injury or destruction.

 For example: A hurricane with rising water can cause flooding and high winds. These

are the primary agents.

 The secondary agents would include damaged buildings and bacteria or viruses that

thrive as a result of the disaster

Host Factors :

Host factors include:

 Age

 Immunization status

 Degree of mobility

 Emotional stability

Environmental Factors

Physical Factors

Weather conditions, the availability of food, time when the disasters occurs, the availability

of water and the functioning of utilities such as electricity and telephone service.

Chemical Factors
 Influencing disaster outcome includes leakage of stored chemicals into the air, soil,

groundwater or food supplies. For example: Bhopal Gas Tragedy.

Biological factors

These are those that occur or increase or increase as a result of contaminated water, improper

waste disposal, insect or rodent proliferations, improper food storage or lack of refrigeration

due to interrupted electrical services.

Bioterrorism: Release of viruses, bacteria or other agents caused by illness or death.

Social Factors

These are those that contribute to the individual social support systems. Loss of family

members, changes in roles and the questioning of religious beliefs are social factors to be

examined after a disaster.

PHASES OF DISASTER

Warning phase: Some disasters give warning of their approach. In this certain

precautionary measures are undertaken to handle the disaster situation efficiently and

effectively.

Threat phase: This is critical decision-making period when one's activity is directed

towards the survival action.

Impact phase: When disaster strikes, people may at first be stunned.

Then they begin to realize the magnitude of the effects of disaster such as injury, death,

destruction, etc.
Inventory phase: During this phase, one tries to find out what has actually happened to him.

Victim may exhibit fear, anger, sorrow, depression, anxiety and other emotions.

Rescue phase: During this period the victim help each other to cope and begin to help with the

rescue provide comfort to others and to establish shelter and other needs.

Remedy phase: The morale of victim usually picks up during this period as they work together

with rescue personnel to get the community back to its feet. This phases is the longest post

disaster period when reconstruction takes place,

Restoration period: In this phase, the individuals regain the stability that they enjoyed prior to

the disaster. The time required for a community to reach the state of equilibrium depends upon

the nature and intensity of disaster and disaster relief available.

Goal of disaster management:

 The goal of disaster management is the safety and sustainability of human lives.

 Safety is related to avoiding death and injuries to human lives during a disaster.

PHASES OF DISASTER MANAGEMENT

 PREVENTION AND MITIGATION

 PREPAREDNESS

 RESPONSE

 RECOVERY

DISASTER NURSING:
The adaptation of professional nursing knowledge, skills and attitude in recognizing and meeting

the nursing and medical needs of disaster victims.

A NURSE'S RESPONSIBILITIES IN DISASTERS

PREVENTION AND MITIGATION

• Preparation for disasters: Disaster planning is essential for a community, business or a hospital;

It involves thinking about details of preparation and management by all involved including

community leaders, health and safety professionals and lay people. A disaster plan need not be

lengthy. Such a concise plan should still contain information on the elements discussed in this

and the following sections.

Personal Preparation

Professional Preparedness

There should be disaster management team of nurse, psychiatric nurses, physician, surgeon,

social workers and psychologists to be active and alert all the time. The team must understand

the disaster plans at their workplace and community and will participate in disaster drills.

Gather Information Through

Shelter Management

Although voluntary health agencies take care of shelter management but the nurses because of

their comfort with delivering aggregate health promotion, disease promotion and emotional

support make ideal shelter management as a team member.

Dealing with Stress

Basic measures while working with victims dealing with stress include
Listening carefully to the victims, and telling and retelling their feelings related to disaster.

Establishing Authority, Communication and Transportation

In addition to community assessment, the effective disaster plan establishes a clear chain of

authority, develops lines of communication and delineates routes of transport. Usually, the chain

is hierarchical for example, at the local hospitals. the hospital administrator may be responsible

for alerting the nurse manager to call in additional personnel flexibility is essential, because key

authority figures may themselves be victims of disaster.

RESPONDING TO DISASTERS

At the disaster site, police, firefighters, nurses and other relief workers develop a coordinative

response to rescue triage and treat disaster victims.

 Rescue: One of the first obligations of response of relief workers is to remove the victim

from the danger site. This job typically all fire fighters and personnel with special

training in search and rescue. Depending upon the disaster agent protective gear heavy

equipment and special vehicles may be needed and dogs trained to locate the dead bodies

may be brought.

 Triage: Whereas emergency nurses daily determine which client require priority care,

triage is the process of sorting multiple causalities in the event of war and major disasters.

It is required when the number of causalities exceeds immediate treatment resources.

Different categories of victims are as follows:

Universal colors are used (Color Coding)

Triage Category (Triage Tag) Color Code

Level I Red

Level II Yellow

Level III Green

Level IV Black

Level V White

LEVEL 1 (highest priority)

Immediate or Critical Care

Life-threatening

Delay of a few minutes Fatal

Immediate degree of urgency

Examples include; Respiratory Arrest, Airway Obstruction, Sucking Chest Wound, Cardiac

Arrest, Severe bleeding, Shock, Respiratory tract burns, Acute Coronary Syndromes.

LEVEL 2: Delayed (second priority)

 Delayed, acute or non-ambulatory care

 Serious but stable

 Delay of few hours: no impact

 Secondary degree of Urgency

 Depends on patient’s condition vs. resources

Examples: Open thoracic wound, Penetrating abdominal wound, Severe eye injury, Avascular

limb, Significant burns other than face, neck, or perineum, Moderate bleeding, Multiple

fractures, Conscious with head injury, Anxiety states.

LEVEL 3: Minor (third priority)

 Victims who do not require hospitalization

 Delay: no impact

 Much delayed degree of urgency

 Disposition depends on space availability

Examples: Minor bleeding, Minor soft tissue injuries, Contusions, sprains, Superficial burns,

Partial-thickness burns of <20% BSA

LEVEL 4: Expectant or Pending Care

 Dead and Dying

 Delay, no impact

 Much delayed degree of urgency

 When to classify a victim dead and dying

Level V - WHITE

 No care

 Unaffected person

 Delay; no impact

 No degree of urgency

 Disposition: Safe evacuation

EXAMPLES: Evacuees, Relatives of victims, Onlookers, Press

Immediate Treatment and Support.

Disaster nurses provide treatment on site at emergency treatment station, in the shelters or at

local hospital and clinics in addition to direct nursing care, onsite interventions might include

arrange for transport once victims are stabilized managing the procurement, distribution and

replenishment of all supplies.

RECOVERY PHASE;

 The main objective of disaster management in this stage is to involve all agencies and

resources to restore the economic and civil life of community e.g. construction of

temporary as well as permanent houses and epidemiological services.

 There is continuous threat of communicable disease due to inadequate water supply

and crowded living conditions. The nurse must remain vigilant in teaching proper

hygiene and making sure immunization record up to date.

 The nurse needs to be alert for environmental health hazard during recovery phase of

disaster in the end, all the nurses and organizations in the world can only provide

partnership with the victim of disaster. Ultimately, it is upon an individual to recover

on his/her own.
 ROLES OF THE NURSES IN DISASTER

Nurses have an important role to play during each phase of a disaster. For the purpose of

disaster planning and preparation, it is simpler to categorize nurses as working in either at the

disaster site or hospital setting.

Management and Triage at the Disaster Site

A disaster scene is one of the most challenging environments in which the nurses have to

practice. Most disaster scenes are noisy, dangerous and confusing. In addition, there are other

challenges such as hazardous environment, miscommunication, and lack of medical/rescue

equipment, lack of proper leadership, inappropriate patient care and improved use of personnel.

These challenges can be met by establishing the following three goals:

 To assure the safety of personnel and patients.

  To organize an effective disaster system.

 To deliver appropriate patient care.

Safety Assurance

All disaster personnel should have, as their foremost consideration, the protection of:

a) Themselves

b) Their fellow workers

c) Their patients--in that order. Some guidelines to remember before entering

a disaster zone are:

• Quickly assess the scene for danger before rushing in

• Stay at least 100 yards away from fire

Organizing An Effective Disaster System

The nurse must be familiar with the personnel at the disaster scene and their roles and functions.

In addition, she much understand the organizing of the site. A disaster scene is usually broken up

into three zones.

Disaster Zone

It is the actual location of the incident from where patients are to be removed as soon as

possible. Majority of disaster personnel are sent to this zone initially.

Treatment Zone
Nurses spend most of their time in the zone during a disaster, where equipment and personal to

carryout patient care or concentrated. Activities carried out in this zone include:

• Triage of patients into treatment categories

• Through assessment of each patient

• Treatment of injuries

• Preparation for transport.

Transportation Zone

It should be situated directly next to the treatment zone, so that ambulances and other vehicles

can load patients and leave for hospitals.

ROLE OF THE NURSES IN DISASTER AT A HOSPITAL

Disasters which occur in a care facility such as a hospital are known as internal disasters. In

addition, hospitals are often the recipients of casualties from disasters that occur in the

surrounding communities, i.e. external disasters..

Preparation at the Emergency Department

When the emergency department is not emergency department is notified of the disaster, it sets

in motion a series of activities. An assessment of the existing status of patients in the department

is made to take decisions concerning their care and disposition. A waiting room area for family

members is located away from the emergency department so as to avoid congestion of people at

the emergency. The number of patients the department can receive must be determined.
 The emergency department is responsible for the following:

• Making sure as many nursing personnel as possible report for duty.

• Assigning them to specific areas/rooms.

• Instructing volunteers and ancillary personnel.

• Providing breaks or periods of rest for triage nurse and those working in resuscitation

and minor treatment areas.

• Commutating the need for additional personnel to whoever concerned.

• Periodic checking of supplies

Emergency department nurses are assigned to work in the following treatment areas:

• Major (Resuscitation room)

• Minimal (First-aid)

• Morgue area

• Delayed area

Triage Area

The triage team consists of the team consists of the following personnel: emergency department

physicians, an experienced emergence who is familiar with the disaster plan, an emergency

department admitting clerk, and security personnel of traffic. Responsibilities of this team are:

 Assigning patients to appropriate treatment areas according to severity of their condition

and availability of the department

  Obtaining registration information about the patient

 Transportation of victims onto a stretcher or to wheelchairs.

FIRST AID EMERGENCY ACTION PRINCIPLES

1. Survey the Scene

Once you recognize that an emergency has occurred and decided to act, you must make sure that

emergency scene is safe for you and any bystanders. Take time to survey the scene and answer

these questions:

 Is this scene safe?

When you survey the scene, look for anything that may threaten your safety and that of the

victim and bystanders.

 What happened?

Find out what happened. Look around for clues about what caused the emergency and the type

and extent of the victim's injuries.

 How many people are injured?

Know how many persons are injured so you will know how to manage your time.

 Are there companions that can help?

If you find more than one victim, ask bystanders for help.

Look for bystanders who can help or who can help or who may be able to tell you what

happened or help in other ways.

2. Activate Medical Assistance

In some emergencies, you will have enough time to call for specific medical advice before

administering first aid. But in some situations, you will need to attend to the victim first.

 Call First

If the victim is not in a life threatening situation and there is plenty of time to first aid.

 First Aid First

If the victim is in a life threatening situation.

Information to be remembered in Activating Medical Assistance:

-What happened?

-Location.

-Number of persons injured.

-Extent of injury and first aid given.

-The telephone number from where you are calling.

-Identify yourself.

3. Initial Assesment of the Victim

 In every emergency situation, you must first find out if there are conditions that are

immediate threat to the victim’s life.

Check for CONSCIOUSNESS:

 Alert-The patient is fully awake (although not necessarily oriented). This patient will

have spontaneously open eyes, will respond to voice (although may be confused) and

will have bodily motor function.

 Verbal-The patient makes some kind of response when you talk to them, which could

be in any of the three component measures of eyes, voice or motor - e.g. patient's eyes

open on being asked "Are you OK?". The response could be as little as a grunt, moan,

or slight move of a limb when prompted by the voice of the rescuer.

 Painful-The patient makes a response on any of the three component measures on the

application of pain stimulus, such as a central pain stimulus like a sternal rubor a

peripheral stimulus such as squeezing the fingers. A patient with some level of

consciousness (a fully conscious patient would not require a pain stimulus) may

respond by using their voice, moving their eyes, or moving part of their body

(including abnormal posturing).

 Unresponsive- Sometimes seen noted as 'Unconscious', this outcome is recorded if the

patient does not give any eye, voice or motor response to voice or pain.

4. Primary Survey of the Victim

 is a quick way for you to find out if someone has any injuries or conditions which are life-

threatening. If you follow each step methodically, you can identify each life-threatening

condition and deal with it in order of priority.

Check for:

 Airway: Is it open? Minimize neck movement as much as possible; apply cervical

collar if available

 Breathing: Is the victim breathing? Look, listen, feel. Rescue breathing if necessary.

 Circulation: Is there a carotid pulse? Is there severe bleeding? CPR if necessary

5. Do a Secondary Survey of the Victim

It is a systematic method of gathering additional information about the injuries or condition that

may need care.

 Interview the Victim (SAMPLE)

Check for:

 S-signs and symptoms

 A-allergies

 M-medications

 P-past medical history

 L-last meal taken

 E-events prior to injury

 Do a head to toe Examination:

  D-deformity

 C-contusion

 A-abrasion

 P-puncture

 B-burn

 T-tenderness

 L-laceration

 S-swelling

 Check the victim’s vital signs

 Skin temperature, moisture, and color: Examination of the skin furnishes

important clues regarding oxygenation, general body stress, and the status of

circulation to the skin. However, in dark-skinned people, skin pigment may mask

color changes, and examination of the whites of the eyes or the nailbeds may be

Field Manual for the U.S. Antarctic Program 278 more reliable. Red skin can be a

sign of high altitude problems or advanced carbon monoxide poisoning.

Hypothermia may produce pale or bluish, cold, dry skin. Bluish skin (cyanosis) is

a sign of inadequate oxygen in the blood. An illness or injury that stimulates a

stress response from the sympathetic nervous system leading to increased heart

rate and increased sweating is indicated by pale, clammy, cold skin.

 Capillary refill: Using the thumb and forefinger, squeeze a finger or tip of toe

until the nail blanches, then release the pressure. The tissue under the nail should

return to their normal pink color within two seconds.

 Reaction of the pupils: The pupils are normally round and equal to each other in

diameter. Unequal pupils (one pupil normal while the other is dilated) frequently

indicates a serious injury involving the brain on the same side as the dilated pupil.

However, it is normal for some individuals, so if you see it in a victim ask them if

this is normal. The pupils are the “windows to the brain.” Patients who are in

cardiac arrest generally have dilated pupils that do not constrict in response to

bright light. The pupillary response to light is also lost after death.