DISASTER NURSING

​ ​ M.C. CAYANAN | 2ND SEM (S.Y. 2024 - 2025)

LECTURE 2: DISASTER NURSING

DISASTER create humans that victims cannot alleviate

●​ Disasters have been an integral part of the without assistance.”
human experience since the beginning of time, ●​ UNDP (2004): “Disaster is a serious disruption
causing premature death, impaired quality of life, triggered by a hazard, causing human, material,
and altered health status economic, or/and environmental losses, which
●​ The risk of a disaster is ubiquitous (being exceed the ability of those affected to cope.”
everywhere at the same time)
●​ On average, one disaster per week that requires MAIN FEATURES OF A DISASTER
international assistance occurs somewhere in the ●​ Unpredictability
world ●​ Unfamiliarity
●​ The word derives from French “désastre” and that ●​ Speed
●​ Urgency
from Old Italian “disastro”, which in turn comes
●​ Uncertainty
from the Green pejorative prefix “dus” = bad + ●​ Threat
“aster” = star.
-​ The root of the word disaster (“bad star” in CLASSIFICATION OF DISASTERS
Greek) comes from an astrological theme in ●​ On the basis of its origin/cause:
which the ancients used to refer the -​ Natural disasters
destruction or deconstruction of a star as a -​ Man-made disasters
disaster
●​ On the basis of speed of onset:
-​ Sudden onset disasters (earthquake)
DEFINITION OF DISASTER -​ Slow onset disasters (typhoon)
●​ A result of vast ecological breakdown in the
relation between humans and their environment, NATURAL DISASTERS
as serious or sudden event on such scale that the A.​ HYDRO METEOROLOGICAL DISASTER
stricken community needs extraordinary efforts to ●​ Natural processes or phenomena of
cope with outside help or international aid atmospheric hydrological or oceanographic
●​ Any catastrophic situation in which the normal nature.
patterns of life (or ecosystems) have been ●​ Phenomena / examples: cyclones, typhoons,
tornados, storms, cold spells, heat waves, and
disrupted and extraordinary, emergency
droughts
interventions are required to save and preserve
human lives and/or the environment B.​ GEOLOGICAL DISASTER
●​ A serious disruption of the functioning of society, ●​ Natural earth processes or phenomena that
causing widespread human, material or include processes of endogenous origin
environmental losses which exceed the ability of (originate inside the surface of the earth) or
the affected society to cope using its own tectonic or exogenous origin (originate above
the surface of the earth)
resources
●​ Mass movements, earthquakes, tsunami,
●​ WHO: “any occurrence that causes damage, volcanic activity, landslides, surface collapse,
ecological disruption, loss of human life, geographical fault activities, etc.
deterioration of health and health services, on a
scale of sufficient to warrant an extraordinary C.​ BIOLOGICAL ORIGINS
response from outside the affected community or ●​ Processes of organic organs or those
area.” conveyed by biological vectors, including
exposure to pathogenic, microorganism,
●​ Red Cross (1975): “an occurrence such as
toxins, and bioactive substances
storm, flood, high water, wind-driven water, tidal ●​ Phenomena / examples: outbreaks of
wave, earthquake, drought, famine, fire, epidemics, diseases, plant, or animal
explosion, building collapse, transportation wreck, contagion and extensive infestation, etc.
or other situations that cause human suffering or

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 HUMAN-INDUCED DISASTERS VULNERABILITY
A.​ TECHNOLOGICAL DISASTER ●​ Condition determined by physical, social,
●​ Danger associated with technological or economic, and environmental factors or
industrial accidents, infrastructure failures or processes, which increase the susceptibility of a
certain human activities which may cause the community to the impact of hazards (UN ISDR
loss of life or injury, property damage, social or 2002)
economic disruption or environmental
degradation, sometimes referred to as an CAPACITY
anthropological hazards ●​ The combination of all the strengths and
●​ Examples: industrial pollution, nuclear release resources available within a community, society,
and radioactivity, toxic waste, dam failure, or organization that can reduce the level of risk,
transport industrial or technological accidents or the effects of a disaster
(explosions fires spills) ●​ Capacity may include physical, institutional, social
or economic means as well as skilled personal or
B.​ ENVIRONMENTAL DEGRADATION collective attributes such as 'leadership' and
●​ Processes induced by human behaviors and 'management.'
activities that damage the natural resources ●​ Capacity may also be described as capability.
based on adversely alter nature processes or (UN ISDR 2002)
ecosystems.
●​ Potential effects are varied and may contribute
to the increase in vulnerability, frequency and RISK
the intensity of natural hazards. ●​ Risk is the probability of harmful consequences,
●​ Examples: land degradation, deforestation, or expected losses (deaths, injuries, property,
wildland fire, loss of biodiversity, land, water livelihoods, economic activity disrupted or
and air pollution climate change, sea level rise environment damaged) resulting from interactions
and ozone depletion. between natural or human-induced hazards and
vulnerable conditions. (UNDP 2004)
●​ Equation: Risk = Hazard x Vulnerability
LEVELS OF DISASTERS
●​ Some professionals:
-​ Risk = (Hazards x Vulnerability) - Capacity
LEVEL I If the organization, agency, or
community is able to contain the event DISASTER NURSING
and respond effectively utilizing its own ●​ Disaster nursing can be defined as “the
resources adaptation of professional nursing knowledge,
skills and attitude in recognizing and meeting the
LEVEL II If the disaster requires assistance from nursing, health and emotional needs of disaster
external sources, but these can be victims.”
obtained from nearby agencies

LEVEL III If the disaster is of a magnitude that GOALS OF DISASTER NURSING

exceeds the capacity of the local The overall goal of disaster nursing is to achieve the
community or region and requires best possible level of health for the people and the
assistance from state-level or even community involved in the disaster.
federal assets
1.​ To meet the immediate basic survival needs of
populations affected by disasters (water, food,
KEY ELEMENTS OF DISASTERS shelter, and security)
●​ Disasters result from the combination of hazards, 2.​ To identify the potential for a secondary disaster
conditions of vulnerability, and insufficient 3.​ To appraise both risks and resources in the
capacity or measures to reduce the potential environment
negative consequences of risk 4.​ To correct inequalities in access to health care or
appropriate resources
5.​ To empower survivors to participate in and
HAZARDS
advocate for their own health and well-being
●​ Phenomena that pose a threat to people, 6.​ To respect cultural, lingual, and religious diversity
structures, or economic assets which may cause in individuals and families and to apply this
a disaster principle in all health promotion activities
●​ Either be manmade or naturally occurring in our 7.​ To promote the highest achievable quality of life
environment for survivors

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 PRINCIPLES OF DISASTER NURSING PHASES OF A DISASTER
1.​ Rapid assessment of the situation and of nursing
care needs PRE-IMPACT PHASE
-​ RDANA: Rapid Damage Assessment and ●​ It is the initial phase of disaster, prior to the actual
Needs Analysis occurrence.
2.​ Triage and initiation of life-saving measures first ●​ A warning is given at the sign of the first possible
3.​ The selected use of essential nursing danger to a community with the aid of weather
interventions and the elimination of non-essential ●​ networks and satellite many meteorological
nursing activities disasters can be predicted.
4.​ Adaptation of necessary nursing skills to disaster
and other emergency situations
-​ The nurse must use imagination and IMPACT PHASE
resourcefulness in dealing with a lack of ●​ Occurs when the disaster actually happens
supplies, equipment, and personnel ●​ Time of enduring hardship or injury end of trying
5.​ Evaluation of the environment and the mitigation to survive
or removal of any health hazards
6.​ Prevention of further injury or illness POST-IMPACT PHASE
7.​ Leadership in coordinating patient triage, care, ●​ Recovery begins during the emergency phase
and transport during times of crisis and ends with the return of normal community
8.​ The teaching, supervision, and utilization of order and functioning
auxiliary medical personnel and volunteers ●​ For persons in the impact area this phase may
9.​ Provision of understanding, compassion, and last a lifetime (e.g. victims of atomic bomb of
emotional support to all victims and their families Hiroshima)

HEALTH EFFECTS OF DISASTERS FOUR STAGES OF EMOTIONAL RESPONSE

●​ Disasters may cause premature deaths, illnesses, (Victims of disaster go through)
and injuries in the affected community, generally 1.​ Denial
exceeding the capacity of the local health care -​ Victims may deny the magnitude of the
system. problem or have not fully registered
●​ Disasters may destroy the local health care -​ Victims may appear usually unconcerned
infrastructure, which will therefore be unable to
respond to the emergency. 2.​ Strong emotional response
-​ Disruption of routine health care services and -​ Person is aware of the problem but regards it
prevention initiatives may lead to long-term as overhwelming and unbearable
consequences in health outcomes in terms of -​ Common reaction: trembling, tightening of
increased morbidity and mortality. muscles, speaking with difficulty, weeping
●​ Disasters may create environmental imbalances, heightened, sensitivity, restlessness, sadness,
increasing the risk of communicable diseases and anger, and passivity
environmental hazards. -​ Victim may want to retell or relieve the disaster
●​ Disasters may affect the psychological, experience over and over
emotional, and social well-being of the population
in the affected community. 3.​ Acceptance
-​ Depending on the specific nature of the -​ Victim begins to accept the problems caused
disaster, responses may range from fear, by the disaster and makes a concentrated
anxiety, and depression to widespread panic effect to solve them
and terror. -​ Important for victims to take specific action to
●​ Disasters may cause shortages of food and help themselves and their families
cause severe nutritional deficiencies.
●​ Disasters may cause large population movements 4.​ Recovery
(refugees) creating a burden on other health care -​ Recovery from the crisis reaction
systems and communities. -​ Victims feel that they are back to normal
-​ Displaced populations and their host -​ A sense of well-being is restored
communities are at increased risk for -​ Victims develop the realistic memory of the
communicable diseases and the health experience
consequences of crowded living conditions.

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 DISASTER MANAGEMENT CYCLE restore minimum services and move towards
long-term restoration.
-​ Debris Removal
-​ Care and Shelter
-​ Damage Assessments
-​ Funding Assistance

EVALUATION / DEVELOPMENT
●​ Often this phase of disaster planning and
response receives the least attention.
●​ After a disaster, employees and the community
are anxious to return to usual operations.
●​ It is essential that a formal evaluation be done to
determine what went well (what really worked)
and what problems were identified.
●​ A specific individual should be charged with the
evaluation and follow-through activities

MITIGATION
●​ These are steps that are taken to lessen the
THE DISASTER EVENT impact of a disaster should one occur and can be
●​ Real-time event of a hazard occurring and considered as prevention and risk reduction
affecting the ‘elements at risk’ measures.
●​ Duration of the event will depend on the type of ●​ Examples of mitigation activities:
threat (ex. Ground shaking may only occur for a -​ installing and maintaining backup generator
few seconds during an earthquake while flooding power to mitigate the effects of a power failure
may take place over a longer period of time) or cross training staff to perform other tasks to
maintain services during a staffing crisis that is
due to a weather emergency.
FIVE BASIC PHASES TO A DISASTER
MANAGEMENT CYCLE
(Kim & Proctor, 2002) PREPAREDNESS / RISK ASSESSMENT
●​ Evaluate the facility’s vulnerabilities or propensity
for disasters.
RESPONSE
●​ Issues to consider include:
●​ The response phase is the actual implementation -​ weather patterns
of the disaster plan. -​ geographic location
●​ The best response plans use an incident -​ expectations related to public events and
command system, are relatively simple, are gatherings
routinely practiced, and are modified when -​ age, condition, and location of the facility
improvements are needed. -​ and industries in close proximity to the hospital
●​ Response activities need to be continually (e.g., nuclear power plant or chemical factory).
monitored and adjusted to the changing situation.
●​ Activities a hospital, healthcare system, or public
health agency take immediately during, and after MANAGEMENT OF MASS CASUALTIES
a disaster or emergency occurs. ●​ Mass Casualty Management is a multi-sectoral
coordination system based on daily utilized
RECOVERY procedures, managed by skilled personnel in
order to maximize the use of existing resources;
●​ Once the incident is over, the organization and
provide prompt and adapted care to the victims;
staff need to recover.
ensure emergency services and hospital return to
●​ Invariably, services have been disrupted and it
routine operations as soon as possible.
takes time to return to routines.
●​ Recovery is usually easier if, during the response,
some of the staff have been assigned to maintain
essential services while others were assigned to
the disaster response.
●​ Activities undertaken by a community and its
components after an emergency or disaster to

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 ADVANTAGES OF TRIAGE
1.​ Helps to bring order and organizations to a
chaotic scene
2.​ It identifies and provides care to those who are in
greatest need
3.​ Helps make the difficult decisions easier
4.​ Assure that resources are used in the most
effective manner
5.​ May take some of the emotional burden away
from those doing triage

TYPES OF TRIAGE

SIMPLE TRIAGE
●​ Simple triage is used in a scene of mass casualty,
in order to sort patients into those who need
critical attention and immediate transport to the
hospital and those with less serious injuries.
●​ This step can be started before transportation
becomes available.
●​ The categorization of patients based on the
OBJECTIVES severity of their injuries can be aided with the use
●​ The application of triage and tagging procedures of printed triage tags or colored flagging.
in the management of mass casualties
●​ Understand the priorities in triage and tagging, ●​ S.T.A.R.T. (Simple Triage and Rapid Treatment)
and orders of evacuation is a simple triage system that can be performed
by lightly trained lay and emergency personnel in
DISASTER TRIAGE emergencies.
●​ The word triage is derived from the French word
●​ Triage separates the injured into four groups:
“trier”, which means, “to sort out or choose”
a.​ 0 - the deceased who are beyond help
b.​ 1 - the injured who can be helped by
NEED OF THE DISASTER TRIAGE immediate transportation
1.​ Inadequate resource to meet immediate needs c.​ 2 - the injured whose transport can be delayed
2.​ Infrastructure limitations d.​ 3 - those with minor injuries, who need help
3.​ Inadequate hazard preparation less urgently
4.​ Limited transport capabilities
5.​ Multiple agencies responding ADVANCED TRIAGE
6.​ Hospital resources overwhelmed
●​ In advanced triage, doctors may decide that
some seriously injured people should not
AIMS OF TRIAGE receive advanced care because they are
1.​ To sort patients based on needs for immediate unlikely to survive.
care
2.​ To recognize futility ●​ Advanced care will be used on patients with
3.​ Medical needs will outstrip the immediately less severe injuries.
available resources -​ Because treatment is intentionally withheld
4.​ Additional resources will become available given from patients with certain injuries,
enough time advanced triage has an ethical implication.

PRINCIPLES OF TRIAGE ●​ It is used to divert scarce resources away from

1.​ Every patient should receive and triaged by patients with little chance of survival in order to
appropriate skilled healthcare professionals increase the chances of survival of others who
2.​ Triage is clinic-managerial decision and must are more likely to survive.
involve collaborative planning
3.​ The triage process should not cause a delay in
the delivery of effective clinical care

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 PRINCIPLES ADVANCED TRIAGE
●​ “Do the greatest good for the greatest number”
●​ Preservation of life takes precedence over preservation of limbs
●​ Immediate threats to life: HEMORRHAGE

ADVANCED TRIAGE CATEGORIES

USING RESPIRATION, PERFUSION, AND MENTAL STATUS (RPM) TO CLASSIFY PATIENTS

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 ROLE OF NURSING IN DISASTERS MAJOR ROLES OF NURSES IN DISASTERS
“Disaster preparedness, including risk assessment and 1.​ Determine magnitude of the event
multi-disciplinary management strategies at all system 2.​ Define health needs of the affected groups
levels, is critical to the delivery of effective responses to 3.​ Establish priorities and objectives
the short, medium, and long-term health needs of a 4.​ Identify actual and potential public health problems
disaster-stricken population.” 5.​ Determine resources needed to respond to the
needs identified
6.​ Collaborate with other professional disciplines,
governmental and non-governmental agencies
7.​ Maintain a unified chain of command
8.​ Communication

DISASTER TIMELINE AND NURSING ACTION / RESPONSIBILITIES

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 CONCLUSION

●​ Disaster is an emergency situation where the

need of the victims mounts over the medical and
nursing resources or services particularly in the
developing countries like India where the
resources are already short the situation
becomes worst;
●​ Therefore coordination of actions and various
departments is an essential requisite for efficient
management of mass casualties.
●​ So, in such a scenario a prudent nurse should be
resourceful, making best use of the available
resources like governmental, nongovernmental
organisations, self-help groups, public, etc. and
should act ethically with best of her knowledge,
patience and judgement to minimize the effect of
disaster.

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