Disasters are a primary cause of morbidity and mortality. Nurses can play an important role in disaster mitigation, but they receive very little training. This lecture is designed to help to introduce to nursing the concepts of disasters and disaster mitigation. We propose that you teach this lecture to your nursing students to build awareness world wide.

1. Define a disaster2. Discuss patterns of mortality and injury3. Understand impact of disasters on health 4. Describe the factors that contribute to

disasters severity5. Discuss role of nursing in disasters 6. Apply principles of triage in disaster7. Analyze the WHO components of effective

disaster nursing

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.

NaturalPandemicsTransportationTechnological Terrorism

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.

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 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.

A significant global concernThe primary health concern:

• Injuries arising from structural collapse• Most injuries occur amongst individuals

trapped at the time of the earthquakeWell known prevention strategy is to prevent

buildings from collapsingThere is a recognized need to develop better

rescue strategies for retrieving individuals from collapsed buildings

Rare, but can be catastrophic when they occurOver 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

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Conflict Natural Disasters

Unpredictable ChallengesDisruptive UnexpectedTargeting weaknesses Very rare, impossible to conceive before event Threats to Civilians, Information Infrastructure

Building DebrisHousehold DebrisVegetative DebrisProblem Waste Streams

Any kind of assistance needed in disasters A response not based on impartial evaluation

contributes to chaosEpidemics and plagues are inevitable after every

disaster Epidemics rarely ever occur after a disaster Dead bodies will not lead to catastrophic outbreaks of

exotic disease Proper resumption of public health services will ensure

the public’s safety (sanitation, waste disposal, water quality, and food safety)

Disasters bring out the worst in human behavior The majority responses spontaneous and generous

The community is too shocked and helpless Cross-cultural dedication to common good is most

common response to natural disasters

Disaster events that involve water are the most significant in terms of mortality

Floods, storm surges, and tsunamis all have a higher proportion of deaths relative to injuries

Earthquakes and events associated with high winds tend to exhibit more injuries than deaths

The risk of injury and death is much higher in developing countries – at least 10 times higher because of little preparedness, poorer infrastructure.

Mass SheltersShelter management:

• Organized team (chain)• Sleeping area and necessities• Water and food handling• Sanitation (toilets, showers,..) • Special care to children and elderly • Health services (physical, mental)

In a major disaster water treatment plants,storage & pumping facilities, & distributionlines could be damaged, interrupted orcontaminated.Communicable diseases outbreak due to:

Changes affecting vector populations (increase vector),

Flooded sewer systems,The destruction of the health care infrastructure,

andThe interruption of normal health services geared

towards communicable diseases

Injuries from the eventEnvironmental exposure after the event

(no shelter)Malnutrition after the event (feeding the

population affected)Excess NCD mortality following a disasterMental health (disaster

syndrome)

Little attention is paid to the childrenListen attentively to children without denying

their feelingsGive easy-to-understand answers to their

questionsIn the shelter, create an environment in

which children can feel safe and secure (e.g. play area)

In any major disaster, people want to know where their loved ones are, nurses can assist in making links.

In case of loss, people need to mourn:• Give them space, • Find family friends or local healers to

encourage and support them• Most are back to normal within 2 weeks•  About1% to 3%, may need additional help

Mitigation:Lessen the impact of a disaster before it strikes

Preparedness:Activities undertaken to handle a disaster when it

strikesResponse:

Search and rescue, clearing debris, and feeding and sheltering victims (and responders if necessary).

Recovery:Getting a community back to its pre-disaster

status

Activities that reduce or eliminate a hazardPrevention Risk reduction

ExamplesImmunization programsPublic education

Activities that are taken to build capacity and identify resources that may be usedKnow evacuation sheltersEmergency communication planPreventive measures to prevent spread of

diseasePublic Education

Activities a hospital, healthcare system, or public health agency take immediately before, during, and after a disaster or emergency occurs

Activities undertaken by a community and its components after an emergency or disaster to restore minimum services and move towards long-term restoration.Debris RemovalCare and ShelterDamage AssessmentsFunding Assistance

French verb “trier” means to sort

Assigns priorities when resources limited

Do the best for the greatest number of patients

Inadequate resource to meet immediate needs

Infrastructure limitationsInadequate hazard preparationLimited transport capabilitiesMultiple agencies respondingHospital Resources Overwhelmed

Helps to bring order and organization to a chaotic scene.

It identifies and provides care to those who are in greatest need

Helps make the difficult decisions easierAssure that resources are used in the most

effective mannerMay take some of the emotional burden away

from those doing triage

Nurses don’t act for legal fears of being blamed for deaths, and lack of clarity on where they fit in the command structure

Nurses function to the level of their training and experience.

If nurses they are the most trained personnel the site, they are in charge.

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Disaster preparedness, including risk assessment and multi-disciplinary management strategies at all system levels, is critical to the delivery of effective responses to the short, medium, and long-term health needs of a disaster-stricken population.

International Council of Nurses (2006)

Determine magnitude of the eventDefine health needs of the affected groupsEstablish priorities and objectives Identify actual and potential public health

problemsDetermine resources needed to respond to

the needs identifiedCollaborate with other professional

disciplines, governmental and non-governmental agencies

Maintain a unified chain of commandCommunication

Nursing organizations must have a comprehensive and accurate registry for all members

Have a structured plan:• Collaborate and coordinate with local authorities • Have a hotline 24x7• Inform nurses where to report and how (keep

records)• Make sure have a coordinator to prevent chaos• Ensure ways to maintain communication

between nurses and their families

11 million nurses world wide:• Form the backbone of the health care system• Are the frontline health care workers who are

in direct contact with the public• Contribute to health of individuals, families,

communities, and the globeSchools of nursing offer little or no

information on disaster nursing (WHO, 2008)Shortage of trained instructors/faculty (WHO,

2008)

Ethical and legal issues, and decision making;Care principles;Nursing care; Needs assessment and planning; Safety and security; Communication and interpersonal relationships; Public health; and Health care systems and policies in emergency

situations(WHO, 2008)

Basic life supportSystem and planning for settings where

nurses workCommunications (what to report and to

whom)Working in the damaged facilities and with

damaged equipmentSafety of clients and practitionersWorking within a team (understand each

member’s role and responsibility)Infection controlMental and psychosocial support

(WHO, 2006)

“Most of all, if gains in health and nutrition during emergencies are to be sustained, graduates need to understand the importance of capacity building of national staff and institutions.”

Salama et al, Lessons Learned from Complex Emergencies

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lec35051/index.htm

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