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  1. 1. Presented By: Ms. Sweta K. Gaude M.Sc.(N) SDM INS
  2. 2.   Disaster are sudden catastrophic events that distrupt pattern of life and in which there is possible loss of life and properly and addition to multiple injuries.  DISASTER MEANS:  D- Destructions  S- Suffering  A- Administrative, financial failure  S- Sentiments  T- Tragedies  E- Eruption of communicable diseases.  R- Research programme and its implementation. INTRODUCTION
  3. 3.   In French word “DISATRE” and Italian word “DISASTRO” which means “Bad Star”. GLOBAL SCENARIO OF DISASTER: Death of million people. Economic loss increased by factor 8 Economic loss in last decade is more than US $ 400 billion 95% of the disaster related deaths are in developing countries
  4. 4.   Covid-19  Australian Bushfire (400 people were killed)  Devastating floods in Indonesia  Hurricane in United States  Volcano Eruption in the Philippines  Earthquakes in Turkey, the Caribbean, China, Iran, Russia, Philippines and India.  Locast Swarms in East Africa and parts of India and Asia. (5 states namely Rajasthan, Gujarat, Punjab, Haryana, Uttar Pradesh & MP). RECENT DISASTER
  5. 5.   Cyclone Amphan in India & China  Europe windstorm  Floods in India, Japan and China.  Antarctica snow turns green.
  6. 6.   “American Red Cross”(ARC): defines a disaster as “anoccurrence, either natural or man-made that causes human suffering that victim’s cannot alleviate without assistance.”  “WHO”: Defines disaster “any occurrence that causes damage ecological loss of human life, deterioration of health services on a scale sufficient to warrant an extraordinary response from outside the affected community or area”. DEFINATION OF DISASTER
  7. 7.   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 goals of disaster nursing is to achieve the best possible level of health for the people and the community involved in the disaster. DEFINATION DISASTER NURSING
  9. 9.   DEFENITION:  Natural disaster can be define as “a serious disruption of the functioning of a society, causing wide spread human, material or environmental losses which exceed the ability of the affected society to cope using its own resources.  It is caused by natural phenomenon. NATURAL DISASTERS
  10. 10.   Meteorological Disaster: Storms (like Cyclones, Hailstorms, Hurricans, Tornados, Typhoons, & Snow storms), cold spells, heat waves, & droughts.  Typological Disaster: Avalanches, land slides & floods  Telluric & Teutonic Disaster: Earthquakes, Tsunamis & Volcanic eruptions.  Biological Disaster: Insect swarms, (e.g locust and epidemics of communicable diseases. Types of natural disaster
  11. 11.   Man-made can be define as “an act of individuals that causes deviation & destruction, such as war, terrorist bombings or riots. TYPES:  Civil disturbances: Riots & demonstrations.  Warfare: Conventional warfare (Bombardment, Blockage, Siege). MAN-MADE DISASTER
  12. 12.   Non conventional warfare: Nuclear, Biological & Chemical warfare, Guerrilla Warfare including terrorism.  Refugees: Forced movement of large people usually across frontiers.  Accidents: Transportation calamities (Land, air, & sea), collapse of building, dams & other structure, mine disasters.  Technological failures:e.g. A mishap at nuclear power station, a leak at a chemical plant causing pollution of atmosphere or a breakdown of a public sanitation system.
  13. 13.  Earthquakes:  An earthquake (also known as a quake, tremor or temblor) is the result of a sudden release of energy in the Earth’s crust that creates seismic waves. Management:  Most injuries are sustained during impart &, thus, there is the greatest need for emergency care occurring in few hours. When quality & severity of injuries is overwhelmed, wealth facilities at different levels must be adopted. Natural Disaster
  14. 14.   Precaution:  Before entering a building: Observe the construction of the building & be careful for possible hazards, which may occur from weak structure.  When entering a damaged building: Use a helmet, work in pairs, listen for the possible sounds & keep calling.  While moving inside a damaged building: Do not ignite fire, keep close to walls & do not pull anything projecting out from the collapsed structures.  People affected need psychological support as they have lost their near & dear ones & property also.
  15. 15.   Cyclone is an area of closed, circular fluid motion rotating in the same direction as the earth. MANAGEMENT:  Warning should be given through proper media.  Research should be sent to safe areas.  Proper treatment must be done for injuries. CYCLONE
  16. 16.   Water is a source for life forms. MANAFEMENT:  In floods, fracture, injuries, bruises, drowning & various infections can occur: - Tinned cans, barrels, tubes, etc. must be used for floating to prevent people from drowning. - Food, shelter & medical care facilities are provided to the people from drowning. FLOODS
  17. 17.   A volcano is an opening, or rupture, in a planet’s surface or crust, which allows hot magma, ash & gases to escape from below the surface.  The word ‘volcano’ is derived from the name of volcano island off Sicily, which, in turn, was named after volcano, the Roman god of fire. VOLCANIC ERUPTIONS:
  18. 18.  A wildfire is any uncontrolled fire that occurs in the countryside or a wilderness area.  Other name such as brush fire, bushfire, forest fire, grass fire, hill fire, peat fire, vegetation fire & wild land fire. DROUGHTS:  A drought is an extended period of months or years when a region notes deficiency in its water supply. FIRES:
  19. 19.   These include wide range of ground movements such as risk falls, deep failure of slopes & shallow debris flows which can occur in offshores, coastal & onshore environment. MANAGEMENT:  Avoid landslide-prone area.  Rescue team should be sent to clear the roads.  Protect trapped people. FAMINES: A famine is a widespread scarcity of food that may apply to any faunal species. This phenomenon is usually accompanied by regional malnutrition, starvation, epidemic & increased mortality. LANDSLIDES:
  20. 20.   Health problems in disaster could be due to either factors given below:  Directly due to impact of drowning during floods, injuries during earthquake.  Due to delay in evacuation.  Due to non availability or availabillity of centers for advanced medical care.  Due to disorganization or non availability of centers for advanced medical care.  Due to delay in transortation to medical centers. CAUSES OF DISASTER & THEIR IMPACT ON HEALTH
  21. 21.   Population density  Population displacement  Disruption of normal health programmes  Increased vector breeding  Climate exposure  Inadequacy of food & nutrition The health hazards resulting from the disaster
  22. 22.   Injuries  Emotional stress  Epidemic of diseases  Increase in indigenous diseases Morbidity which result from a disaster are:
  24. 24.   Mitigation: Minimizing the effects of disaster. E.G; Building codes & zoninng; vulnerability analyses; public education.  Preparedness: Planning how to respond. E.g; Preparedness plans; emergency exercises/training; warning systems.  Response: Efforts to minimize the hazards created by a disaster. E.g; Search & rescue; emergency relief.  Recovery: Returning the community to normal. e.g; Temporary housing, grants, medical care.
  25. 25.   To reduce or avoid the potential losses from hazards.  Assure prompt and appropriate assistance to victims of disaster.  Achieve rapid and effective recovery. Aims of disaster management
  26. 26.  Epidemiolo gy of Disaster Disaste r Agents Host Factor s Environme ntal Factors Psychologi cal Factors EPIDERMIOLOGY OF DISASTER
  27. 27.  1) DISASTER AGENTS:  The agent is the physical item that actually causes the injury or destruction.  A primary agent includes falling buildings, heat, wind, rising of water and smoke.  Secondary agent include bacteria and viruses that produce contamination or infection after the primary agent has caused injury or destruction.
  28. 28.   The host is human kind.  Host factors include age, immunization status, pre- existing health status, degree of mobility and economical stability of individuals.  Host factor include age, immunization status, degree of mobility and economical stability of individuals.  Most severely affected by disaster are elder, children & person with respiratory and cardiac problems. 2) HOST FACTORS
  29. 29.   Environmental factor that affect the outcome of a disaster include: 3) ENVIRONMENTAL FACTORS PHYSICAL FACTOR CHEMICAL FACTOR BIOLOGICAL FACTOR SOCIAL FACTOR
  30. 30.  A) Physical Factor:  It includes the time when the disaster occurs; weather conditions, the availability of food and water and the functioning of utilities such as electricity & telephone service. B) Chemical Factors:  Influencing disaster outcome include leakage of stored chemical into the air, soil, ground water or food supplies.
  31. 31.  C) Biological Factors:  Are those that increase as a result of contaminated water, improper waste disposal insect or rodent proliferation improper food storage or lack of refrigeration due to interrupted electrical services. D) Social Factors:  Are those that contribute to the individual’s social support systems. Loss of family members, change in roles and the questioning of religious beliefs are social factors, to be examined after a disaster.
  32. 32.   Psychological factors contribute to the effect of the disaster on individual.  Psychological factors are closely related to agent, host and environmental conditions.  Common signs and symptoms to disaster by adults and children are:  ADULTS:-  Extreme sense of urgency  Panic & fear  Disbelief  Disorientation & numbing 4) PSYCHOLOGICAL FACTORS
  33. 33.   Fantasies that disaster never occurred  Reluctance to abandon properly  Difficulty in making decisions  Night mare  Insomnia  Headache etc…  CHILDREN:-  Regressive behaviours (bed wetting, thumb sneaking)  Crying related problems  School to concentrate  Refuse to go back school.
  34. 34.   Disaster preparedness has been defined by the United Nations Disaster Office as: a. series of measures designed to organize & facilities timely & effective rescue, relief & rehabilitation operations in case of disaster.  Measures of preparedness include among others, setting up disaster relief machinery formulation of emergency, relief pain training of specific groups undertaken rescue and relief.  Stocking supplies and earmarking funds for relief operations. Recent Trends Shift From Disaster Response To Disaster Preparedness:
  35. 35.  DIMENSION Predictabi lity Frequen cy Controllabi lity Time Scope and Intensity DIMENSION OF A DISASTER These dimension influence the nature & possibility of preparation planning as well as response to the actual event.
  36. 36.  a) Predictability: Some events are easily predicted. Examples for predictable disasters are weather related disasters like tornadoes, floods, hurricanes etc. b) Frequency: The natural disasters appear more often in certain geographical locations. Eg. California residents are at greater risk for earthquakes. c) Controllability: Some situations alllow for pre-warning & control measures. That can reduce the impact of disaster, Eg. In case of flood redirecting the water etc.
  37. 37.  d) Time: There are several characteristics of time which relates to the impact of disaster, The speed of outlet of disaster time available for warning the population, actual length of time of the impact phases etc. e) Scope and Intensity: A disaster may be concentrated on very small area or large, affecting many people. Disaster can be very intensive and distractive causing many injuries, death, property damage.
  38. 38.  Primary prevention:  Most agencies have a disaster notification network control.  Personnel staff must follow a protocol of notification so that all available personnel are altered or called to duty when need arises.  A good notification network should include contingency plan for cases in which some personnel may not be reachable in that way the communication network is not disabled. DEVELOPING A RESPONSE PLAN
  39. 39.   Emergency personnel should be very familiar with the equipment and supplies they will use in the event of an actual disaster.  In addition to mark disaster drill that allows personnel to practice procedures & set up equipment.  A periodic check of equipment & supplies should be the response plan.  Some of the supplies are perishable & need to be restocked at regular intervals.
  40. 40.  Planning:  Hospital disaster committee provides focus for institutional disaster planning;  Purposes of committee: i. To ensure institutional preparation for disaster situations through planning education, drills and evaluation. ii. To ensure compliance with disaster preparation regulatory standards. iii. Reviewing and updating the hospital disaster plan.
  41. 41.  iv. Assisting departments and services in developing individual plans. v. Integrating hospital planning with community planning. vi. Ensuring that the hospital plan and preparation systems are in accordance with federal, state and local regulations. vii. Integrating the disaster policies and procedures with hospital policies and procedure. viii. Educating & orienting hospital personnel & medical staff. ix. Planning, executing & evaluating exercises & drills. x. Maintaining an awareness of recent development & research in disaster preparation. xi. Serving as an internal & external resource to others.
  42. 42.   The department of service plan defines the specific responsibilities of hospital staff & physicians.  All department and services should use that some format or template for writing their plans.  It is important that the medical staff palns are integrated with plans of related hospital department.  Nursing hospital & physician service are so interdependent that a single plan suffices for both. DEPARTMENT PLANS:
  43. 43.  PRIORITY LIST:  Each unit should have a priority list to priority the patients who are transferable & dischargeable.  This will enable for quick decision making & appropriate response to huge inflow of critically ill patients during disaster situation. DRILLS:  To provide prompt & efficient care during a disaster the personnel involved must be trained for such an event & have practiced the technique & procedures to be used during to disaster.  It provides an opportunity to educate hospital employees about emergencies preparedness.
  44. 44.  Types of Drills: TYPES OF DRILLS Orientation Seminar Table Top Exercise Functional Exercise Full Scale Exercise
  45. 45.  a) Orientation Seminar: It is an Orientation to the hospital disaster plan. To a new procedure within the plan even the concepts of disaster preparation. b) Table top Exercise: It is an activity that presents key disaster response personnel with a stimulated disaster without time constraint. c) Functional Exercise: Designed to evaluate one or more plan function or complex activities. d) Full Scale Exercise: It evaluate all major aspects of the disaster preparation programme. This type of exercise requires actual mobilization of personnel, supplies & equipment to determine co-ordination & response capability.
  46. 46.  NURSE’S PREPARATION TO FACE DISASTER Personal Preparednes s Professional Preparednes s
  47. 47.  1) Personal Preparedness:  The nurse assisting in disaster relief efforts must be as healthy as possible both physically & mentally.  The following are the emergency supplies that should be prepared & stored in an easy to carry container.  A 3-days supply of water.  One change of clothing & footwear per person & one blanket per person.  A first aid kit that includes your family prescription medications.  Candles & matches.
  48. 48.   An extra set of car keys & credit cards, cash or traveler’s cheques.  Sanitation supplies, including toilet paper soap feminine hygiene items & plastic garbage bags.  Special items for infant elderly or disabled family members.  An extra pair of eyeglasses important documents should be kept in a waterproof container.
  49. 49.  2) Professional Preparedness:  Professional preparation requires that nursrs become aware of & understand the disaster plans at their work place & community nurses who take disaster preparation will read & understand will participate in disaster drills arid community mock disasters.  Adequately prepared nurses can function in a leadership capacity & assist others towards smoother recovery phase;  Personal items that are recommended for nurses preparing to help In a disaster include the following:-
  50. 50.   Copy of professional license  Personal equipment such as stethoscope  Flash light & extra batteries  Cash  Warm clothing & a heavy jacket for weather appropriate clothing.  Record keeping materials  Pocket sized references books.
  51. 51.   Relief refers to the period immediately following the occurrence of all disaster when steps are taken to meet the need of survivors with respect to shelter, water & medical care.  Rehabilitation includes activities that are undertaken to support the victim return to normal life & reintegration into regular community functions. INTERVENTION IN A DISASTER SITUATION
  52. 52.   Disaster mitigation is a collective term used to encompass all activities undertaken in anticipation of the occurrence of a potentially disaster event including preparation & long term risk reduction measures (UNDP, 1994) mitigation activities include the following:  Awareness and education such as holding community meeting on disaster preparation.  Disaster relief such as building retaining walls to divert flood water away from a residence.  Advocacy such as supporting actions & efforts for effective building codes & prudent land use.
  53. 53.   In disaster reconstitute of the following critical substrates is mandatory to restore institutional function. 1) Personal 2) The physician plant 3) Supplies & Equipment 4) Communication 5) Supervision 6) Transportation  The key to effective disaster management is pre disaster planning & preparation. DISASTER MANAGEMENT
  54. 54.   DEFENCE PLLANNING INCLUDE:  A Continuous process  A knowledge base  A focus base  Anticipatory guidance  Reducing unknown situations  Evoking appropriate actions  Overcoming resistance  Governmental, environmental, technical, & economic resources are involved in pre-disaster preparation.
  55. 55.   Community education & mock disaster exercises are part of certain types of disaster especially to man made one.  Public education.  Public communication system; i.e. radio & television.  Primary goal of disaster management are to prevent or minimize death disability suffering & loss on the part of disaster victims.
  56. 56.   In the event of a disaster situation, the Emergency Operation Centre (EOC) becomes operational.  Each community determines the local & personnel involved in their EOC.  These personnel will be involved in treating people at the scene of the disaster as well as at other designed locations, including local hospitals. EMEGGENCY OPERATION CENTRES AND EMERGENCY MEDICAL SYSYTEM
  57. 57.   According to Gach & Eng. (1969) there are eight fundamental principles. 1) Prevent the occurrence of disaster whenever possible. 2) Minimize the number of casualties if the disaster cannot be prevented. 3) Prevent further casualties from occurring after the initial impact of the disaster. 4) Rescue the victims 5) Provide first aid to the injured 6) Evacuate the injured too medical facilities 7) Provide definitive medical care 8) Promote re-construction of live. PRINCIPLES OF DISASTER MANAGEMENT
  58. 58.   Triage is a French word meaning sorting or categorizing.  During the disaster, the goal is to maximize the number of survivors by sorting the treatable from the untreatable.  American Red Cross (1982) gives colour coding. (priority, second priority, third priority, dying or dead system. TRIAGE
  59. 59.   These clients have reasonable chance of survival only if they receive immediate treatment.  Emergency treatment is initiated immediately & continued during the transportation.  This include victims with:  Respiratory insufficiency  Cardiac arrest  Haemorrhage  Severe abdominal injury 1) RED- Most Urgent-1st priority
  60. 60.   These victims can wait for transportation after they receive initial emergency treatment.  Victims include:  Immobilized closed fracture.  Soft tissue injury without haemorrhage.  Burns less than 40% of the body. 2) YELLOW-2nd priority
  61. 61.   Victims in this category are ambulatory have minor tissue injuries & may be dazed.  They can be treated by non-professionals & held for observations if necessary. 4) BLACK-dying or dead  At the disaster site or primary triage point simple support measure can alleviate the psychological trauma experienced by survivors. 3) GREEN-3rd priority
  62. 62.   These measures include the following:  Keeping families together, especially children with parents  Assigning a companion to frightened or injured victims or placing victims in group when they can help each other.  Giving survivor’s tasks to keep them busy & reduce trauma to their self esteem.  Provide adequate shelter food & rest.  Establishing & maintaining a communication network to reduce rumours.  Encouraging individuals to share their feelings & support each other.  Isolating victims who demonstrate hysterical or panic behaviour.
  63. 63.   Hospital nurses will be needed to care for disaster victims as they are brought in for acute care prblems. NURSES ROLE AT EMERGENCY AID STATIONS:  Nurses are involved in providing care at emergency aid stations.  At least one registered nurse must be present at all times while the emergency aid station is opened. NURSING CARE GOALS FOR DISASTER NURSING
  64. 64.  1) Arranging with the volunteer medical consultant for initial & daily health checks based on the health needs of shelter residents. 2) Establishing nursing priority & planning for health care supervision. 3) Planning for appropriate transfer of patients to community health care facilities as necessary. 4) Evaluating health care needs. 5) Requesting & assigning volunteer staff to appropriate duties & providing on the job training & supervision. THE RESPONSIBILITY OF NURSE IN CHARGE
  65. 65.  6) Arranging for secure storage of supplies, equipment records & medications & periodically checking to see whether material goods be ordered. 7) Consultation with the food supervisor regarding the preparation & distribution of special diets including infant formulas. 8) Planning & recommending adequate staff & facilities when local health department initiate an immunization program for shelter residents. 9) Establishing lines of communication with the health service officer. 10) Arranging with the mass care supervision for the purchase & replacement of essential prescription for persons in the shelter.
  66. 66.   Disaster procedures physical, social & psychological consequences that are exhibited to various degrees in different persons, families communities & cultures depending on their past experiences, coping skills & the scope & nature of disaster.  To function effectively the nurses & health workers use some of the defence mechanisms.  The nursing interventions more helpful here is crisis reduction & counseling crisis intervention.  Defusing (clearing the disillusions) Debriefing (discuss the event, feeling & reduction coping strategies etc.) NURSE ROLE IN PSYCHOLOGICAL NEEDS OF VICTIMS
  67. 67.   Standing Medical Orders: A nurse trained in disaster nursing is in a position to give first aid treatment & take decisions to transport casualties to the hospital. STANDING ORDERS GUIDING NURSE’S ACTIONS ARE:  Initial treatment & medication for expected general illness.  Establishment of an infirmary for those who are ill but do not require hospitalization. ETHICAL AND LEGAL IMPLICATIONS
  68. 68.   Organization of immunization programmes against notifiable diseases for the area under their care.  Responsibility for providing adequate and safe food at least an 1800 calories diet & take special care of people having diabetes, hypertension, infant & others with therapeutic dietary needs.
  69. 69.   India is a vast country, with 2.4% of worlds land & mass & 15% of world’s population.  The common natural disasters seen in India are: 1) Floods: India is one of the most flood prone countries in the world. 2) Earthquakes 3) Cyclones 4) Man-made disasters e.g. Bhopal gas tragedy DISASTER MANAGEMENT IN INDIA
  70. 70.   NATIONAL LEVEL:  Both central & state governments share the responsibility.  The basic role of Central government is supportive in providing information, financial, technical & material support.  The organizational component at the national level is: 1) Cabinet committee headed by the prime minister . DISASTER MANAGEMENT AT NATIONAL AND STATE LEVEL
  71. 71.  2) National crises management committee under the chairmanship of cabinet secretary. 3) Crisis management group under the chairmanship of central relief commissioner. 4) Financial arrangements are basically through the ‘calamity relief fund’. STATE LEVEL:  Preparedness  Rehabilitation  Relief operation
  72. 72.   Shebeer P. Basheer, S. Yaseen Khan. Advance Nursing Practice. 2nd edition. Bangalore: EMMESS Medical Publishers; 2017. P.686-700. REFERENCE