Disaster Nursing and Management

By: Bryan Mae H. Degorio

Disaster

- is an event that inflicts significant damage to life and property and that substantially overwhelm the community’s resources.

- unplanned natural or man-madeincident whichsignificantly impacts the public and support capabilities of a location

Types of Disaster:

1. Natural: Earthquake, flood, hurricane, tsunami and volcanic eruption

2. Man-made: Nuclear explosion, industrial accident and fire

3. Terrorism and bioterrorism

Vulnerability assessment:

- is a structured data collection geared towards understanding the levels of potential threat, needs and immediate available resources.- 2 basic categories:

a.Relatively static infrastructuresb.Relatively dynamic socioeconomic

data

Importance of vulnerability assessment1. To inform the decision makers2. To give an actual picture of the

vulnerability3. For continuous habit of monitoring

Principles of disaster management: Prevent the disaster Minimize the casualties Prevent further casualties Rescue the victims First aid Evacuate Medical care Reconstruction

Roles of the nurse in the different phases of disaster:

a.Preparednessb.Mitigationc.Responsed.Recovery e.Evaluation

A. Preparedness AKA: pre-impact, or pre-disaster It focuses on prevention, protection

and preparedness. common activities:

a. Hazard-vulnerability assessmentb. Preparing a well organized disaster

response planc. Training and practices:

Drills, education and practical training

B. Impact Phase Period of time when disaster occurs,

continuing immediately following the disaster.This can be brief when the disaster strike

suddenly and is over in minutes or lengthy as incident continues

Inventory and recue perioda. Assessment of extent of losses.b. Identification of remaining resources.c. Planning for:

- use of resources, rescue victim and minimize further injuries and property damage

C. Post-Impact Phase

occurs when majority of the rescue

operation is completed.Remedy and recovery period.Lengthy phase may last for years.

D.Rehabilitation restoration to pre-disaster

condition. health needs will change from casualty

treatment to primary healthcare.

Disaster Cycle and Management

Mitigation and Preventionrefers to action or measures that can

either prevent the occurrence of the disaster or reduce the severity of its effect.

It aims to reduce the vulnerability of the system.

Examples:a. Voiding property that are prone to hazard (personal non-structural mitigation)b. Installation of earthquake valve, alarm

systemc. Improved building codes

PreparednessIs a program of long term development

activities which goals are strengthened to overall capacity of a country or manage efficiently all types of emergency.

Objective:- to ensure appropriate systems,

procedures and resources are in place to provide prompt effective assistant.

Note:- COMMUNITY members, resources,

organization and administration should be the cornerstone of emergency preparedness program.

WAYS TO ENHANCE PREPAREDNESS:a. It is an ongoing multisectoral

activity and an integral part of the national system responsible for developing plans and programmes for all phases of disaster managementResponsibilities in the national level:

1. Evaluate the risk of the country

2. Adopt standard and regulation3. Organize communication,

information and warning system

4. Ensure coordination and response mechanism.

5. Adopt measures to ensure financial and other resources available.

6. Develop public education program7. Coordinate information session with

media8. Organize disaster stimulation

exercises

b.Policy development- the formal statement of action which

includes long term goal, assign responsibilities and recommend work practice and determine criteria for decision making

c. Personal protection- people must be aware of what is

expected of them in case of emergency.

- Basic measures:1. Do not use the telephone

2. Listen to messages broadcasted by the radio and the various media

3. Carry out official instruction given by the media

4. Keep family emergency kit ready

Response includes the mobilization of the

necessary emergency services and first responders in the disaster area.

Basic activities:a. Search, rescue and first aidb. Field carec. Triaged. Tagging/identification of dead

a. Search/Rescue and First Aid- in some countries, specialized search- and-rescue teams is an integral part of the national disaster plan- the members received specialized

training in “confined space environments”- Members of the team:

A cadre of medical specialist Technical specialist Trained canines and

their handlers

b. Field care:- casualty collection site should

be located close enough to the disaster site to offer rapid treatment but far enough to

be safe.1. proximity to disaster site

2. safety from the hazard and upwind location from contaminated

environment

3. protection form climatic condition

4. easy visibility for disaster victims

5. convenient exit routes for air and land evacuation

c. Triage- is the rapid classifying of the injured on

the basis of severity of their injuries and the likelihood of their survival.

- goal: “To do the greatest good to the greatest number of people.”

Different types of Triage:1.Simple triage and Rapid Treatment

System (START) - performed by lightly trained emergency

personnel- it separates the injured into 4 groups:

The expectant who are beyond help The injured who can be helped by 

immediate transportation The injured whose transport can be delayed Those with minor injuries, who need help less

urgently

2. Color Coding Triage

- usually used by expert personnel

- knowledge of medical consequences of various injuries ( e.g., burn, blast, or

crush injuries pr exposure to chemical, biological or nuclear weapon) is critical.

RED URGENT

Casualties who require immediate lifesaving interventions (airway, breathing,circulation)

YELLOW

DELAYEDOR

EXPECTANT

Casualties who do not require immediatelife-saving interventions and for whomtreatment can be delayed

Casualties who are not expected to survivedue to the severity of injuries complicatedby the conditions and lack of resources

GREEN MINORIndividuals who require minimal or nomedical care

BLACK DECEASED

1. IMMEDIATE (Red): Highest priority 3. MINOR (Green): Third priority2. DELAYED (Yellow): Second priority 4. DEAD/DYING (Black): Lowest priority

Evacuating patients after triage:A.Modes of evacuation:

- ground transport, helicopter or large fix wing aircraft

b.Indications for evacuation: The decompress the area To improve care for most critical casualties by

removal to off-site medical facilities To provide specialized care for casualties such

as those with burns and crush injuries

c. Reasons to delay/defer evacuation: Contaminated casualties, transmissible

diseases and unstable casualties

Principles to follow when evacuating patients:

a.Survey the scene for potential hazard, # of patients and need for specialized help

b.Call for medical or technical back-up as needed.

c.Protect rescuers first: treat gas spills, remove power lines, etc…

d.Implement hazardous material management protocol

e.Stabilize vehicle before entryf. Triage patients and assign to available

medical personnel

g. Perform primary survey and treat airway difficulties and severe bleeding first.

h.If patient has no pulse or respiration and extrication is necessary before CPR is provided, the patient should be considered dead.

i. Apply cervical collar , immobilize spine prior to extrication.

j. Perform quick secondary survey, splint extremities with fractures.

k. Expedite safe extrication by specialist.l. Perform a complete secondary survey.

c. Tagging of patients- patients should be identified

with tags stating their name, age, place of origin, triage category, diagnosis and initial treatment.

d. Identification of dead- care of dead includes:

Removal of the dead from the disaster scene.

Shifting to the mortuary. Identification Reception for the bereaved relatives

Recovery Phase- recovery efforts are concerned with issued and decisions that must be made after immediate needs are addressed.- it differs from the response phase in its focus.- 4 R’s are usually followed:

a. RESCUE, RELIEF, REHABILITATION, and RECONSTRUCTION

a. Rescue operations- it usually starts with local

residents and is usually supported by trained

and skilled staff. This is usually complemented by

NGO- lasts for 48-72 hours when

the rate of survival of trapped victims is high

- after 3 days, other priorities are taking over

b. Relief operation- begins when the assistance from the outside starts to reach the disaster area.- it includes food, water, shelter and sanitary equipments- things to consider:

Acquisition of supplies Transportations Storage Distribution

Lifeline services minimum requirements:

Water- Potable: 20L/day/person

(increased by 20% for increased temperature and physical exertion)

- Sanitation: 5L/day/personFood

- Adult: 1900 kcal/person/day- children varies by age

Emergency/Temporary shelter- 3.5 m²/person

c. Rehabilitation/Reconstruction - it aims to restore the communities to the pre-earthquake status.- social and other infrastructure is restored and the economy is revitalized.- this may last for several years.- long term objectives is to build a safer and sustainable livelihood.

Psychological Response to Disaster

this is common sequellae after a disaster.

it is important that planners, and policy makers understand the importance of psychological issues.

Characteristics of disaster that affects mental health:a. Little or no warningb. Serious threat to personal safety.c. Potential unknown health effects.

d. Uncertain duration of event.e. Human error or malicious intent.f. Symbolism related to terrorist target

Factors affecting individual response to disaster:

a. Physical and psychological proximity to the eventb. Exposure to gruesome or grotesque

situation.c. Diminish health status prior to or as a

result of the disasterd. Magnitude of loss.e. Trauma history.

Factors affecting the collective response to disaster:a. Degree of community disruptionb. Pre-disaster family and community stability.c. Community leadership.d. Cultural sensitivity of recovery efforts.

Psychological Sequelae of Disaster:a. Mild stress response to full blown post-traumatic stress disorder (PTSD)b. Major depression to acute stress disorder.

Note: 15-25% of those directly impacted will subsequently develop diagnosable mental disorder

Interventions:a. In cases of no diagnosed mental disorder, educational materials that help people understand what they and their families are experiencingb. Brief crises counseling should be provided, followed by referral treatment is indicated.