Introduction:

Disaster Drill

Disaster drill provides an excellent means of testing plans for their completeness and
effectiveness. frequent drill will assure that knowledge and skills are current.

 Effective features of all disaster drills are the inclusion of all individuals and
agencies likely to be involved in the disaster response.

 The news media has a vital role in disasters and failure to involve the media in
planning activities can lead to dysfunctional response.

 Any modification made to disaster plans or response procedures must to be

communicated to all groups involved.

 Periodic evaluation of disaster plans are essential to ensure that personnel have
adequate familiarity with their role in disaster situations, as well as to
accommodate in the population demographics.
 Definitions of Disaster

A disaster can be defined as any occurrence that cause damage, ecological disruption,
loss of human life, deterioration of health and health services, Vs a scale sufficient to
warrant as extraordinary response from outside the affected community or area.
(W.H.O.)

An occurrence of a severity and magnitude that normally results in death, injuries and
property damage that cannot be managed through the routine procedure and resources of
government.
- FEMA (Federal Emergency Management Agency)

A disaster can be defined as an occurrence either nature or man made that causes human
suffering and creates human needs that victims cannot alleviate without assistance.
- American Red Cross (ARC)

Definition“Disaster Nursing is nursing practiced in a situation where professional

supplies, equipment, physical facilities and utilities are limited or not available”.
‘DISASTER’ alphabetically means:

D – Destructions

I – Incidents

S – Sufferings

A - Administrative, Financial Failures.

S – Sentiments

T – Tragedies

E - Eruption of Communicable diseases.

R - Research programme and its implementation

 Disaster Nursing

Disaster Nursing can be defined as the adaptation of professional nursing skills in

recognizing and meeting the nursing physical and emotional needs resulting from a
disaster. The overall goal of disaster nursing is to achieve the best possible level of health
for the people and the community involved in the disaster.

Impact of natural disaster in the last 30 years.

Ø Death of 3 million people

Ø Economic loss increased due to disaster like flood

Ø In Indian scenario, 34jmijlion people affected per year and 5116 death per year.

Ø In US, economic loss is 400 million dollar and 3 million people died.

Classification of Disaster
Natural disaster:

Flood
Cyclone
Drought
Earthquake
Tornadoes hurricane
Tsunami
Sea erosion
Cattle Epidemic
Forest fire
Volcano Eruption

Manmade Disaster :

Drowning
Oil spill
Urban fires, Village fires
Festival Related Disaster
Serial bomb Blasts
Major Building Collapse
Mine flooding
Road, Rail and other transportation accidents including water ways
Environmental pollution
Deforestation
Nuclear disaster
Chemical and industrial Disaster
Gas leak
TYPES OF DISASTER ON THE LOCATION OF IMPACT

Land Related disaster eg: Earthquake,

Environmental Disaster eg:Vterolcano eruption

Technological disaster eg:Engineering failure

Industrial Disaster eg: Gas leak

Socilogical Disaster eg: Criminal act

There are several hazard type for which there is widespread concern

1)SUDDEN ONSET DISASTER:

Earhquake,Tsunami,floods,tropical storms,volcanic eruption,landslides

2)SLOW ONSET HAZARDUS

Famine,deforestation,drouht,environmental,degradation.

3)INDUSTRIAL SYSTEM:

Accidents,Spillages,fires,gas leak

4)WARS AND CIVIL STRIFE

Terrorism and other action leading to persons and refugees

5)EPIDEMICS :

Water or food borne disease, person to person disease,Vector borne

disease & complication from wounds
 FACTORS CAUSING DISASTER:

Earthquake: It is sudden rapid shaking of the earth caused breaking & shifting of rock
beneath the earths surface.
Chemical: Influencing disaster outcome include leakage of stored chemicals into the air,
soil, ground water or food supplies.
Eg: - Bhopal Gas Tragedy

Biological:Are those that occur or increase as 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 illness or death.
Cyclones:Mixture of heat and moisture from low center pressure over oceans in tropical
latitudes where water temperature are over 26 degree cell wind pressure and organize low
pressure towards the center.
Tsunamis:
Faulty movement on sea floor, accompanied by an earthquake.

Droughts: Immediate cause is rainfall deficit human induced changes in ground surface
and soil.
 FEATURES OF DISASTER:

UNPREDICTIBILITY: We cannot predict about when the disaster is going to come. It

may be sudden effect; an earthquake is quick and sudden event which can cause direct
effect of human life, economical etc.

UNFAMIALIRITY: The management of certain type of disaster is not known like E.g.
when Tsunami occurs for first time we are not knowing the management of the tsunami.

SPEED: There is sudden onset of the disaster without any warning signs E.g. Tsunami,
Earthquake

URGENCY: When there is disaster which occurs uncertainly, the disaster management
should be able to mange the emergency situation.

THREAT: The environmental disasters are sudden threat to the public health or
wellbeing of the environment. It causes lack of economic resources, epidemic disease,
loss of life poverty. impact on capital stock, loss of production.
 PHASES IN THE DISASTER
1) Disaster Prevention:

2) Disaster Mitigation

3) Disaster Preparedness

1) IMPACT PHASE:

a. Warning (Beginning before the actual phase_

b. Evacuation, Search,and rescues

c.Emergency assistance(Relief)-Food, Shelter, medical Etc.

2) POST IMPACT PHASE:

a.Repair and reconstruction of life lines

b.Reclaim and clear land

c.Resume services.

3) REHABLITATION PHASE:

a.Replace phase

b.Restore service system

c.Restore occupation.
 EFFECTS OF DISASTER

A) PHYSICAL:

Loss of the human life

Severe physical injuries

Damage to health facilities

Food Shortage

Damage to safe water facilities

Major population movement

Communicable disease (TB,Diarrohea,malaria)

B) ECONOMICAL:

Major Business or economic loss

Property damage

Industrial damage

C) SOCIOLOGICAL:

Complete disruption of normal day life-

Isolation

Disrupt the functioning

D) ENVIORNMENTAL :
 Deforestation

Death of the animal

Major loss in farming field

Geographical changes in the map of village ,city & country

E) PSYCHOLOGICAL:

Post traumatic disorders

Psychological trauma

Acute mental illness

Anxiety neurosis

F) HEALTH & POLITICAL SYSTEM:

New health planning policies

Major changes in political background

Formulation of legislation criteria’s

 DISASTER MANAGEMENT

The purpose of the disaster management in any health care facility is to maintain a safe
environment and continue to provide essential service to the patients during the time of
the disaster.

OBJECTIVE OF THE DISASTER MANAGEMENT

1.To ensure that appropriate,procedures,resources and systems are in place to
prompt, effective assistance to disaster victims,thus facilitating relief measures and
rehabilitation services.

2.To reduce the impact on the life of the individuals and health through
emergencies services.

3.To participate in the disaster team efforts to minimize the loss of life,damage to
property,social and economical disruption.

4.To make initiation of psychological rehabilitation.

PRNCIPLES OF DISASTER MANAGEMENT

 Prevent the occurance of the disaster whenever possible
 Minimize the number of casualties if disaster cannot be prevented.
 Prevent further casualties from occurring the initial impact of the disaster.
 Rescue victims
 Provide first aid to the injured
 Use of the referral services
 Evacuate the injured
 Provide definitive medical care
 Promote reconstruction of life
 DISASTER MANAGEMENT CYCLE

Disaster
impact
C C
R R
I Prepadness
Responce I
S
S
I
S
I
M S
Mitigation
A Rehablitation
M
N A
A N
prevention Developement
A
Reconstruction

There are three fundamental aspects of disaster management:

a)Disaster Response

b) Disaster preparedness

c) Disaster mitigation
 DISASTER PREVENTION

Disaster prevention, mitigation and preparedness are better than disaster response in
achieving goals and objectives of vulnerability reduction .the government of India has
adopted mitigation and prevention as essential components of their development strategy.
Prevention include developing and implementing strategies for reducing losses of
lives by incorporating safety in to public and private decisions.
Public awareness camps should be conducted.
 Movement / or relocation of at risk population.
 Establishment of early warning systems.
 Perform diasater drill
 Develop disaster nursing database for notification,mobilization and triage of
emergency nurse staffing resources.
 The national center for Disaster management at the national level has been
upgraded and designated..they provide information based on disaster
management policies, prevention mechanisms, mitigation measure.
 A sterromg committee on mass media campaign has been constituted for
this purpose.The poster are displayed at building like primary health centers,
schools and other places where villages are normally congregate for
community activity.
 Disaster management as a subject in a social sciences has been introduced in
the school curriculum for class 8th in central board of secondary education.

Disaster impact and response:

Medical treatment for large number of casualties is likely to be needed only after certain
types of disaster. Most injuries are sustained during the impact, and thus, the greatest
need for emergency care occurs in the first few hours. The management of mass
casualties can be further divided into search and rescue, first aid, triage and stabilization
of victims, hospital treatment and redistribution of patients to other hospitals if necessary.

Field care Search, rescue and first aid:

1)After a major disaster, the need for search, rescue and first aid is likely to be so great
that organized relief services will be able to meet only a small fraction of the demand.
Most immediate help comes from the uninjured survivors.

2) Most injured persons converge spontaneously to health facilities, using whatever

tansport is available, regardless of the facilities, operating status. Providing proper care to
casualties requires, that the health service resources be redirected to this new priority.

3) Bed availability and surgical services should be maximized. Provisions should be

made for food and shelter. A centre should be established to respond to inquiries from
patient's relatives and friends. Priority should be given to victim's identification and
adequate mortuary space should be provided.

TRIAGE (To Sort out or to choose)

1)Triage consists of rapidly classifying the injured on the basis of the severity of their
injuries and the likelyhood of their survival with prompt medical intervention.

SIGNIFICANCE:

1) . Higher priority is granted to victims whose immediate or long-term prognosis can

be dramatically affected by simple intensive care.
2) . Moribund patients who require a great deal of attention, with questionable
benefit, have the lowest priority.
3) Triage is the only approach that can provide maximum benefit to the greatest
number of injured in a major disaster situation.
 TRIAGE SYSTEM ; 4 Colour system.

Red indicates high priority treatment or transfer.

yellow signals medium priority.

green indicates ambulatory patients.

black for dead or moribund patients.

Tagging

All patients should be identified with tags stating their name, age, place of origin, triage
category, diagnosis, and initial treatment.

Identification of dead

Taking care of the dead is an essential part of the disaster management.

Care of the dead includes :

(1) removal of the dead from the disaster scene;

(2) shifting to the mortuary;

(3) identification;

(4) reception of bereaved relatives.

(5)Proper respect for the dead is of great importance.

Relief phase

1) This phase begins when assistance from outside starts to reach the disaster area.

2) The type and quantity of humanitarian relief supplies are usually determined by
two main factors : (a) the type of disaster, since distinct events have different
effects on the population, and (b) the type and quantity of supplies available
locally.

Epidemiologic surveillance and disease control

Disasters can increase the transmission of communicable diseases through

following mechanisms :

1. Overcrowding and poor sanitation in temporary resettlements. This accounts in

part, for the reported increase in acute respiratory infections etc. following the
disasters.
 2. Population displacement may lead to introduction of communicable diseases to
which either the migrant or indigenous populations are susceptible.

3. Disruption and the contamination of water supply, damage to sewerage system

and power systems are common in natural disasters.

4. Provision of emergency food, water and shelter in disaster situation from different
or new source may itself be a source of infectious disease.

The type and quantity of humanitarian relief supplies are usually determined
by two main factors

(1) the type of disaster, since distinct events have different effects on the population

(2) the type and quantity of supplies

There are four principal components in managing humanitarian supplies:

(a) acquisition of supplies

(b) transportation

(c) storage

(d) distribution.

Epidemiologic surveillance and disease control:

Prevention and controll of communicable disease can be achived by

1. Overcrowding and poor sanitation in temporary resettlements. This accounts in

part, for the reported increase in acute respiratory infections etc. following the
disasters.

2. Population displacement may lead to introduction of communicable diseases to

which either the migrant or indigenous populations are susceptible.

3. Provision of emergency food, water and shelter in disaster situation from different or
new source may itself be a source of infectious disease.
4. Disruption and the contamination of water supply, damage to sewerage system and
power systems are common in natural disasters.

5.Organize a reliable disease reporting system.

6.Arrange control measure to reduce breeding of vectors.

Rehabilitation Phase:

The final phase in a disaster should lead to restoration of the pre-disaster conditions.
Rehabilitation starts from the very first moment of a disaster. Too often, measures
decided in a hurry, tend to obstruct establishment of normal conditions of life.

In first weeks after disaster, the pattern of health needs, will change rapidly, moving from
casualty treatment to more routine primary health care.

Water supplay

1.A survey of all public water supplies should be made. This includes distribution system
and water source.

2.Determine bacteriological and chemical quality of water supplied.

3.The first priority of ensuring water quality in emergency situations is chlorination. It is

the best way of disinfecting' water. It is advisable to increase residual chlorine level to
about 0.2-0.5 mg / litre.

4.Protection of new water resources.

5.Ensure adequate excreta disposal at a safe distance from water resources

6.Prohibit bathing, washing, animal husbandry upstream of intake point in rivers and
streams.

7.Prevent contamination of wells.

Food safety
Poor hygiene is the major cause of food-borne diseases in disaster situations. Where
feeding programmes are used (as in shelters or camps) kitchen sanitation is of utmost
importance. Personal hygiene should be monitored in individuals involved in food
preparation.

Basic sanitation and personal hygiene

Many communicable diseases are spread through faecal contamination of drinking water
and food. Hence, every effort should be made to ensure the sanitary disposal of excreta.
Emergency latrines should be made available to the displaced, where toilet facilities have
been destroyed. Washing, cleaning and bathing facilities should be provided to the
displaced persons.

Vector control

1. Control programme for vector-borne diseases should be intensified in the emergency

and rehabilitation period, especially in areas where such diseases are known to be
endemic. Of special concern are dengue fever and malaria (mosquitoes), leptospirosis and
rat bite fever (rats), typhus (lice, fleas), and plague (fleas). Flood water provides ample
breeding opportunities for mosquitoes.

2.Enviornmental sanitation e.g.clean house and surroundindeg

3.Stop open airdefecation

4. Use insecticides and larvicides.

Mosquito

 Sourse reduction i.e. Filing,leveling and drainage of breeding places.

 Application of soils in water.

 Paris green micro crystalline powder kills mainly anopheles larvae because they
are surface feeders.

 Use of larvicides
 Use of small fish sewage oxidation ponds
  Use of DDT,Use of mosquito nets

Disaster mitigation in health sector

1.Medical casualties can be drastically reduced by improving the structural quality of

houses, schools and other public and private buildings.

2.To prevent hazards causing emergency.

3.Mitigate all ongoing hazards.

4.Activate agency disaster plans.

5.Lessn the possible effect of emergencies

6.Interagte state and federal resources.

7.Establish vector control.

Disaster preparedness

 .Emergency preparedness is “a programme of long term development activities

whose goals are to strengthen the overall capacity and capability of a country to
manage efficiently all types of emergency.

 .To ensure that appropriate systems, procedures and resources are in place to
provide prompt effective assistance to disaster victims, thus facilitating relief
measures and rehabilitation of services.

 .The disaster planning is broad in scope and must address collaboration across
agencies and organizations,advance preprations, as well as needs assessment event
management and recovery effects.

 .Desccribe the role of emergency agencies in responding to a range of emergencies

that might arise.
  The staff in any health care organization should be fully conversant with
emergency response plans.

 Employes should be fully conversant with their emergency response functional

roles, and these should have been practiced before hand.

 The staff should participate in continuing education to maintain up to date

knowledge in relevant areas.

 Effective communication regarding potential risk

 Advance warning system and the the use of evacuation from areas of danger save
lives should be included in community disaster plans.
Warning

A warning is a risk communication about an imminent event and has intended to produce
an approaite disastrer response.

1)RISK IDENTIFICATION:

Decosion about hoe to respond to a hazard begin with the risk identification.th most
important source of risk identification are warning message from authorities the media
and peers.

Risk assessment involves evaluating the personal consequences if the disaster

occurs.Ppeoles personal risk assessment should be done.

2).PROTECTIVE ACTION SEARCH:

The primary question in protective action search is “how can I protect my self”
People are likely to recall action yhey have taken on previous occasion if they have had
experiencr with the Hazards.
 3).PROTECTIVE ACTION ASSESSMENT:

At this point the best question is”What is the best method of protection”?
E.g If the flood is forecast to arrive within a few hours people could perform emergency
flood proofing by placing sand bags around the builidings they can evacuate the family
members before the flood water reaches dangerous level.

NURSES RESPONCIBILITY
OPPORTUNITIES AND CHALLENGES FOR NURSES IN DISASTR
MANAGEMENT:

LEADERSHIP:

Nursing As a profession has a long history of being creative and visionary in its
continuous efforts to meet the needs of the patient and their families.

1. Leadership is a important in forging links and creating connections among

organization and their members to promote high level of performance, qulity
outcomes, and the accomplishment of goals.
2. Nurses need to get into leadership positions in all types of health care and public
health care organization to assists with the design of disaster response plansd and
the development of future changes in these organization.
3. Nurse can serve as advocates for communities,and in particular for vulnerable
populations such as infant and children, the elderly, the disabled,the mentally ill
and for safety of other nurses in disaster response.
4. Nursing knowledge of the health care process,diagnosis, planning, treatment and
evaluation is an asset.
5. Effective leadership in disaster management requires personal integrity, strength,
Flexibility, creativity,and use of collaborative approaches

ROLES & FUNCTION:

1. Nurses need to define what their roles will be across the disaster management and
many types of organizations
2. Clinician, scientists, educator, and colleagues to public health,these roles must be
defined by nursing
3. Supportive work environment must be created that has been evident in the past
decade nursing has major undergone changes in its role and function
4. Disaster nursing will also require new strategies and interventions to render care in
non-traditional care setting.
HEALTH PROMOTION AND DISEASE PREVENTION:

1. The importance of health promotion and healthy life style choices is a corner stone
of the health people 2010 compaign.
2. Disease surveillance and containment are interventions designed to prevent or
mitigate consequence of disease.
3. Disaster nursing will demand close collaboration with public health colleagues in
areas where health promotion and disease prevention strategies will play a critical
role in achieving health out comes for population affected by disaster.
4. Nursing needs educational programmes that are unique providing knowledge and
skills regarding health promotion and technology and leadership in complex health
care system.

QUALITY CARE:

1. Disaster response is not different.Staffing is a major prediction quality of care and

issue of adequate nurses during a disaster response must be addressed.
2. There must be balance between quality and cost containment,because both are
important.
3. Nurses play major role in this process in order to contribute to the process of
quality care.

POLICEY DEVELOPMENT:

1. Health care provides a direction and standard with regard to health care delivery,
evaluation and education of health care professionals.
2. Globalization is frequently discussed in all areas of health care today,including
disaster relief.
3. Nurses have been involved in international policy development through world
health organization.this will become more important as bounrarioes that separate
country from another.

EVIDENCED BASE PRACTISE:

1. The evaluation of health care out come has been important for a long time, yet
the empirical evidence supporting disaster nursing is minimal.much of the lack
of the evidences is due to challenging nature of research conducted under
disaster condition.
CRITICAL THINKING SKILLS:

1. The inherent nature of the disaster condition mandates that providers are critical
thinkers who can remain calm, rapidly asses situation and enact the emergency
responace plans.
2. New problems that have not been confronted in the past will need to be
addressed.
3. An ability to triage at situations as well as patient and delegated limited
resources are also key components of the role.
ROLE OF TEAM MEMBERS IN DISASTER MANAGEMENT
PHYSICIAN:

The role of the physician is to identify the victims condition disgnose the
condition and transfer the victims to the hospital through medical services.careful,
rapid medical evaluation is done prevent outbreaks of the diseases;

SURGEONS:

Surgeon will play a major role in cleaning and dressing the wounds, suturing of
the wounds of the patient.

PSCHOLOGIST:

The psychologist will play a major role in giving psychological support to the
patient.th psychologist will treat the patient post traumatic stress disorder.

NURSES:

The nurse is the person who assists all the other healthy personnels in recovery of
the victims she manages the triage system.
 Listen carefully of the victims allow them to express their feelings..
 Provide facilities for basic needs.
 Keep record of the dead person.
 Arrange counseling programs.

SOCIAL WORKER:

They help in counseling of the assisted victims.Provide facilities for basic

needs.they help in financial assistance of the affected victims.
 ROLE OF INDIAN RED CROSS SOCIETY :

It helps in prevention of disease and mitigation of health

Disaster services comprise distribution of milk, medicines, Vitamin tablets
and cod liver oil and 100 other items to the famine stricken people and to those
who have been struck by the floods..it is associated with activities like village
uplift, anti-epidemic work etc.

EFFECTS OF DISATER:

ON INDIVIDUAL:
 It causes damage of an individual’s health
 Loss of human life
 Emotional stress
 Economic decay
 Loss of employment

ON FAMILY:
 Leads to poverty
 Scarcity of food and water supply
 Stress disorders
 Loss of shelter
 Affected by diseases

ON COMMUNITY:
 Absence of clean water, food, sanitation and shelter
 Community is affected by outbreaks of certain disease
 Poor sanitation which leads to various disease.
 Grieving over loss of loved ones

ON COUNTRY:
 Outbreaks of diseases
 Increased poverty
 Loss of safe water supply
 Difficulty in meeting the basic needs of the population ie. food, clothing and
shelter
 Risk of social or economic disruption.