Education

1. Disaster Management
Presented by:
Mr. Umar Hayat
Nursing Instructor SNC

2. Objectives
 Introduction to disaster
 Enlist types of disaster
 Various phases of disaster
 Disaster effects
 Nursing role in disaster management
 Discuss rehabilitation

3. Definition
A disaster can be defined as any occurrence that can cause any
damage ,ecological disruption ,loss of human life and
deteriotion of health and health services on a sufficient scale
( W.H.O )
Disaster is any occurrence ether natural or man-made, that can
cause human suffering and create human needs that victim
cannot alleviate without assistance.
( American red cross)

4. What is Disaster?
 A catastrophe, sudden, calamitous event bringing great
damage, loss, destruction and devastation to life and
property by natural or man-made causes.
 According to United Nations International Strategy for
Disaster Reduction;
 'A serious disruption in the functioning of a
community or society resulting in widespread human,
material, economic, or environmental losses and
impacts that exceed the affected community's or
society's ability to cope using its own resources.'
 Disasters can be broadly classified as
Natural or Manmade

5. Natural Disaster:
This is some times called as Act s of God and may be caused
by one or more of the following Natural Events:
Earthquakes
Floods
Cyclones & Storms
Tsunami
Drought
Fog
Lightning
Heat & Cold waves
Natural Fires
River & Sea Erosion
Land Slides etc.

6. Man-made Disaster:
9/21/2017
This is caused due to activities undertaken by Man or Group of
People ranging from one or more of the following:
Terrorist Activities
Fire
Wars & Riots
Vehicular Accidents
Pollution – Air, Water, Noise, etc
Sabotage Activities
Bio-terrorisim
Dam failure
Hazardous substance accident
Explosions

7. Pre-impact phase :
It is the initial phase of disaster, prior to the actual occurrence
. A warning is given at the sign of first possible danger.
Impact phase :
This phase occurs when actual disaster happens . It is time of
enduring hardships injuries and try for survival. In this
phases individual helps families until the help is not arrived
from outside:
 lasts for several minutes e:g
earthquakes ,explosions and plane crashes .
Phases of disaster

8.  Last for several days and weeks e:g
floods , epidemics, terrorist attack .
Post impact phase :
Recovery is began during this emergency phase and end with
the return of normal community functioning and order.
Victims goes through four stages
 Denial
 Strong emotional response
 Acceptance
 Recovery

9. Disaster effects
 Death
 Disability
 Increase in communicable diseases
 Psychological problems
 Water and food shortage
 Social and economies losses
 Shortage of drug and medical supplies

10. Major roles of a nurses in disaster
 Determine the magnitude of a event
 Identify need of effected group
 Establishing priorities and objective
 Identify the actual and potential health problem
 Determine the resourse needed to respond
 Collaborative work with other professionals, governmental
and non governmental organization .
 Maintain a unified chain of command
 Skilled Communication

11. What is Disaster Management
Like any other Management activity or process, Disaster
Management is also a management activity or process
undertaken by various segments of the society - public,
governmental, NGOs, etc. with an aim to minimize or avoid
occurrence of disaster and to provide relief to the affected
people and rehabilitate them.

12. Role Players in Disasters
 Community
 NGOs
 National Red Cross
 Media
 Fire Services
 Police and Para-Military Forc
 Civil Defence
 Armed Forces
 Public Sector & Private Sector

14. Disaster management
9/21/2017
There are four phases of disaster management :
1) Mitigation,
2) Preparation,
3) Response,
4) Recovery Rehabilitation/Reconstruction
1. Mitigation :
It includes an activity that reduce the chance of a disaster ,
to prevent disaster or reduce the damaging effect .
The role of a nurse is very important because
working with the local and state to identify the
disaster risk and developing a disaster planning
strategies .

15. Disaster management
Mitigation measures include building codes, zoning and land
use management; building use regulations and safety
codes; preventive health care, and public education.
Spatial Planning:
The methods used by the public sector to influence the
distribution of people and activities in spaces of various
scales.
Spatial planning include land use planning, urban planning
or regional planning, transport planning
and environmental planning

16. 2. Preparation
Strengthen the technical and managerial capacity of
governments, organizations and communities
 Response mechanisms and procedures, rehearsals,
developing long-term and short-term strategies, public
education and building early warning systems.
Preparedness measures include preparedness plans;
emergency exercises/training; warning systems; emergency
communications systems; evacuations plans and training;
resource inventories; emergency personnel/contact lists;
mutual aid agreements; and public information/education

17.  To provide immediate assistance to maintain life, improve
health and support the morale of the affected population
 Such assistance may range from providing specific but
limited aid, such as assisting refugees with transport,
temporary shelter and food, to establishing semi-
permanent settlement in camps and other locations.
 It also may involve initial repairs to damaged
infrastructure.
 The focus in the response phase is on meeting the basic
needs of the people until more permanent and
sustainable solutions can be found.
3. Response :

18. • The response is determine by the level of a disaster , and
disaster is not determine by the no of causality but the
amount of recourses need .
• Level 1:
• if the organization agency or community is able to manage
the event and response effectively , utilizing its own
recourses
• Example : one family fire explosion.

19. Level 2 :
if the disaster require any assistance from outside source
they can be obtain from nearby agency .
Level 3:
if the disaster magnitude is exceeded from the capacity of
the local community or region and require assistance from
state level or even federal asset

20.  Returning the community to normal (Resilience)
 Essential services such as providing drinking water,
transport, electricity, etc. are restored
 The people are taught how to follow healthy and safety
measures.
 The victims are provided with temporary
accommodation, financial assistance and employment
opportunities
 Those who have lost their family members are consoled
 If there is a danger of epidemics, vaccination
programme are to be undertaken
4.Recovery
(Rehabilitation/Reconstruction)

21. Psychological Responses to Disaster
Signs and symptoms of emotional shock
Stages
•Impact stage. Survivors are stunned, apathetic, and
disorganized. For several hours after the initial event, they
may have difficulty following directions and will need strong
support and firm guidance.
• Heroic stage. Individuals want to be helpful, and may
minimize or ignore their own injuries and demonstrate
rescue behavior that is risky to self.
• Honeymoon stage. Survivors are grateful that they are still
alive. There is a strong sense of brotherhood and
community spirit.

22. • Disillusionment stage. Reality of loss occurs. Ongoing
physical and emotional fatigue can result in substance
abuse and discouragement. Survivors feel abandoned
and ignored by the larger community because of the gap
between resources and need.
• Reconstruction stage. This stage may continue for years
as people rebuild lives and even begin to see the crisis,
in retrospect, as a growth and opportunity period.

23. The sorting of patients to determine priority health care
needs and the proper site of treatment.
In non disaster situations, health care workers assign
highest priority and allocate most resources to the most
critically ill patients.
In disaster situations with large numbers of casualties,
decisions are based on the likelihood of survival and the
consumption of resources.
Triage

24. Disaster Triage System
Class I: Emergent (red)
Class II: Urgent (yellow)
Class III: Nonurgent (green)
Class IV: Minor (white)
Class V: Dead or expected to die (black)

25. 28
Copyright © 2017 by Tanzeel Ul Rahman

26. Triage During Disasters
 Victims with life-threatening conditions and a good chance of
survival are cared for first
 When there are more victims of a disaster than medical
personnel to treat them, those who are likely to survive are
treated first; these patients are given green tags
 The mortally wounded and those who are not expected to
survive are attended later, and these patients are issued a
black tag.

27. Chemical Disaster
Indications that a chemical attack has occurred might
include
 Fog-like or low-lying cloud suddenly appearing in the
atmosphere.
 Many dead birds, domestic animals, or insects within
a particular area.
 Many dead, dying, or sick people in an area or
downwind from a suspicious cloud or fog
 An atypical, unexplained odor for the location

28. Chemical Weapons
 Chemical substances that quickly cause injury or death
and cause panic and social disruption
Agents
 Vesicants
 Nerve agents
 Limitation of exposure is essential with evacuation and
decontamination as soon possible and as close to the
scene of the incident as possible

29. Vesicants
(Agent that causes blistering)
9/21/2017
 Lewisite, sulfur mustard, nitrogen mustard,
phosgene
 Cause blistering and burning
 Respiratory effects can be serious and cause death
 Decontamination with soap and water; do not scrub or use
hypochlorite solutions
 Eye exposure requires copious irrigation
 Treatment for lewisite exposure: Dimercaprol IV or
topically

30. Nerve Agents
(Chemicals that affect the nervous system)
9/21/2017
 Sarin, soman,organophosphates
 Inhibit cholinesterase, causing cholinergic symptoms
progressing to loss of consciousness, seizures, copious
secretions, apnea, and death
 Treatment: supportive care, atropine, benzodiazepine and
pralidoxime chloride .
 Decontaminate with copious amounts of soap and water or
saline for at least 20 minutes

31. Radiation Exposure
 Radiation exposure may occur because of nuclear weapon,
nuclear reactor incidents, or exposure to radioactive
samples
 Exposure to radiation is affected by time distance and
shielding
 Types of radiation exposure
 External radiation: all or part of the body is exposed to
radiation; decontamination is not necessary; not a
medical emergency
 Contamination: exposure to radioactive gases, liquids, or
solids; requires immediate medical management to
prevent incorporation
 Incorporation: uptake of the radioactive material into the
body

32. Radiation Exposure
 Treatment of particulate radiation exposure
 Chelating agents (removing heavy metals from the bloodstream, in treating lead or mercury poisoning
 Isotope-specific blocking agents
 Excretion agents
 Diluting agents

33. Radiation Decontamination
 Triage outside the hospital.
 Cover floor and use strict isolation precautions to
prevent the tracking of contaminants.
 Waste is double bagged and labeled “radiation waste.”
 Staff protection
 Water-resistant gowns, two pairs of gloves, caps,
goggles, masks, and boot
 Dosimetry devices : to measure radiation dose

34. Radiation Decontamination
9/21/2017
 Patients are surveyed for radiation and directed to the
decontamination area.
 Decontaminate each patient outside the ED with a shower.
 Water, tarps, towels, soap, gowns, all patient belongings, and
so on must be collected and contained.
 Patients are resurveyed and reshowered as necessary.
 Showering should be performed to not contaminate clean
areas with runoff from the showering.
 Samples: nasal and throat swabs, blood.
 Internal contamination requires additional treatment—
(gastric lavage with chelating agents)

35. Biologic Disaster
 Anthrax (gram-positive, rod-shaped bacteria known as Bacillus anthracis)
 Botulism (serious illness caused by a toxin that attacks the body's nerves
and causes difficulty breathing, muscle paralysis, and even death, toxin is
made by Clostridium botulinum )
 Plague (It is caused by the bacterium, Yersinia pestis)
 Smallpox
 Tularemia( known as rabbit fever or deer fly fever, it typically attacks the
skin, eyes, lymph nodes and lungs. caused by the bacterium Francisella
tularensis.
 Viral hemorrhagic fevers (Ebola)

36. Isolation Precautions for Biological
Terrorism Agents
 Biological agents may be delivered or spread
in a number of ways.
 Because off modern travel, spread of
infection may occur in areas thousands of miles apart.
 Health care providers need to be aware of potential signs
of biological weapon dissemination.
 Signs and symptoms are similar to those of
common disease process.
 Isolation practices depend on the infecting agent.
 Always use standard precautions.
 Some agents require transmission-based precautions.
 Terminal disinfection and disposal of wastes depend on
the infecting agent.

37. Recognizing a Bioterrorism Event
 Certain signs or events may present a warning that a
bioterrorism attack has occurred.
 Rapidly progressing flu-like illness, particularly in the
young and among those previously healthy
 Unusual orextensive rashes, especially if preceded by flu-
like symptoms
 Muscle paralysis
 Severe bleeding disorders
 A large group of patients with food-borne illness
 Sudden death of many animals in the community

38. Personal Protective Equipment
 Purpose: to shield the health care provider from
chemical, physical, biological, and radiological hazards
that may exist when caring for contaminated patients
 Categories of protective equipment
 Level A: Self-contained breathing apparatus (SCBA)
and vapor-tight chemical resistant suit, gloves, and
boots
 Level B: High level of respiratory protection (SCBA) but
lesser skin and eye protection; chemical-resistant suit
 Level C: Air purified respirator, coverall with splash
hood, chemical-resistant gloves and boots
 Level D: Typical work uniform

39. Bioterrorism
Nursing management
 Strict adherence to infection control
procedures and policies

40. Biologic Agents
 Category A agents: Easily disseminated, and some may be
transmitted from person to person as well. These could
cause mass casualties and require a well-organized and
extensive health care system response for management
 Category B agents: Delivered through water and food
sources. These produce moderate amounts of illness and
low death rates. Public health department action is needed
for management. Examples are Q fever, brucellosis,
glanders, ricin toxin, epsilon toxin of Clostridium
perfringens, and Staphylococcus aureus enterotoxin B.
 Category C: Agents that have not been weaponized as yet,
but have the potential for high morbidity and mortality.
These agents are plentiful and easy to produce and
disseminate. Examples include Hantavirus, tick-borne
encephalitis, yellow fever, and multidrug-resistant
tuberculosis.

41. Pandemic (Airborne Respiratory)
Infection
 Teach people to be prepared to stay at home for at least
two weeks
 Reassure people that basic measures for prevention
of respiratory infection can be effective
 Healthy lifestyle to support the immune system
 Washing hands and covering the mouth during
coughing or sneezing, disposing of tissues, and staying
away from public places if at all possible

42. • Thank you