Ms. Sweta K. Gaude
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.
A- Administrative, financial failure
E- Eruption of communicable diseases.
R- Research programme and its implementation.
In French word “DISATRE” and Italian word
“DISASTRO” which means “Bad Star”.
GLOBAL SCENARIO OF DISASTER:
by factor 8
Economic loss in last
decade is more than US $
95% of the disaster
related deaths are in
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).
Cyclone Amphan in India & China
Floods in India, Japan and China.
Antarctica snow turns green.
“American Red Cross”(ARC): defines a disaster as
“anoccurrence, either natural or man-made that
causes human suffering that victim’s cannot alleviate
“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”.
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.
TYPES OF DISASTER
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.
Man-made can be define as “an act of individuals
that causes deviation & destruction, such as war,
terrorist bombings or riots.
Civil disturbances: Riots & demonstrations.
Warfare: Conventional warfare (Bombardment,
Non conventional warfare: Nuclear, Biological &
Chemical warfare, Guerrilla Warfare including
Refugees: Forced movement of large people usually
Accidents: Transportation calamities (Land, air, & sea),
collapse of building, dams & other structure, mine
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
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.
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
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.
Cyclone is an area of closed, circular fluid motion
rotating in the same direction as the earth.
Warning should be given through proper media.
Research should be sent to safe areas.
Proper treatment must be done for injuries.
Water is a source for life forms.
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.
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.
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.
A drought is an extended period of months or years
when a region notes deficiency in its water supply.
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.
Avoid landslide-prone area.
Rescue team should be sent to clear the roads.
Protect trapped people.
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
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
Disruption of normal health programmes
Increased vector breeding
Inadequacy of food & nutrition
The health hazards
resulting from the disaster
Epidemic of diseases
Increase in indigenous diseases
Morbidity which result
from a disaster are:
Mitigation: Minimizing the effects of disaster. E.G;
Building codes & zoninng; vulnerability analyses; public
Preparedness: Planning how to respond. E.g;
Preparedness plans; emergency exercises/training;
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.
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
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.
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
Environmental factor that affect the outcome of a
PHYSICAL FACTOR CHEMICAL FACTOR
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
B) Chemical Factors:
Influencing disaster outcome include leakage of stored
chemical into the air, soil, ground water or food
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.
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
Extreme sense of urgency
Panic & fear
Disorientation & numbing
Fantasies that disaster never occurred
Reluctance to abandon properly
Difficulty in making decisions
Regressive behaviours (bed wetting, thumb sneaking)
Crying related problems
School to concentrate
Refuse to go back school.
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
Measures of preparedness include among others, setting
up disaster relief machinery formulation of emergency,
relief pain training of specific groups undertaken rescue
Stocking supplies and earmarking funds for relief
Recent Trends Shift From
Disaster Response To
DIMENSION OF A
These dimension influence the nature & possibility of preparation
planning as well as response to the actual event.
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.
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.
Most agencies have a disaster notification network
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.
Emergency personnel should be very familiar with the
equipment and supplies they will use in the event of an
In addition to mark disaster drill that allows personnel
to practice procedures & set up equipment.
A periodic check of equipment & supplies should be the
Some of the supplies are perishable & need to be
restocked at regular intervals.
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
ii. To ensure compliance with disaster preparation
iii. Reviewing and updating the hospital disaster plan.
iv. Assisting departments and services in developing
v. Integrating hospital planning with community
vi. Ensuring that the hospital plan and preparation
systems are in accordance with federal, state and local
vii. Integrating the disaster policies and procedures with
hospital policies and procedure.
viii. Educating & orienting hospital personnel & medical
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.
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.
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.
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.
Types of Drills:
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
TO FACE DISASTER
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
Candles & matches.
An extra set of car keys & credit cards, cash or traveler’s
Sanitation supplies, including toilet paper soap feminine
hygiene items & plastic garbage bags.
Special items for infant elderly or disabled family
An extra pair of eyeglasses important documents should
be kept in a waterproof container.
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
Personal items that are recommended for nurses
preparing to help In a disaster include the following:-
Copy of professional license
Personal equipment such as stethoscope
Flash light & extra batteries
Warm clothing & a heavy jacket for weather appropriate
Record keeping materials
Pocket sized references books.
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 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.
In disaster reconstitute of the following critical substrates
is mandatory to restore institutional function.
2) The physician plant
3) Supplies & Equipment
The key to effective disaster management is pre disaster
planning & preparation.
DEFENCE PLLANNING INCLUDE:
A Continuous process
A knowledge base
A focus base
Reducing unknown situations
Evoking appropriate actions
Governmental, environmental, technical, & economic
resources are involved in pre-disaster preparation.
Community education & mock disaster exercises are
part of certain types of disaster especially to man made
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
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.
According to Gach & Eng. (1969) there are eight
1) Prevent the occurrence of disaster whenever possible.
2) Minimize the number of casualties if the disaster cannot
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.
Triage is a French word meaning sorting or
During the disaster, the goal is to maximize the
number of survivors by sorting the treatable from
American Red Cross (1982) gives colour coding.
(priority, second priority, third priority, dying or
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:
Severe abdominal injury
1) RED- Most Urgent-1st
These victims can wait for transportation after they
receive initial emergency treatment.
Immobilized closed fracture.
Soft tissue injury without haemorrhage.
Burns less than 40% of the body.
2) YELLOW-2nd priority
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
These measures include the following:
Keeping families together, especially children with
Assigning a companion to frightened or injured victims
or placing victims in group when they can help each
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
Encouraging individuals to share their feelings &
support each other.
Isolating victims who demonstrate hysterical or panic
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
At least one registered nurse must be present at all
times while the emergency aid station is opened.
NURSING CARE GOALS
FOR DISASTER NURSING
1) Arranging with the volunteer medical consultant for
initial & daily health checks based on the health needs of
2) Establishing nursing priority & planning for health care
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
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
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
10) Arranging with the mass care supervision for the
purchase & replacement of essential prescription for
persons in the shelter.
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
NEEDS OF VICTIMS
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
Initial treatment & medication for expected general
Establishment of an infirmary for those who are ill
but do not require hospitalization.
ETHICAL AND LEGAL
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.
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.
4) Man-made disasters e.g. Bhopal gas tragedy
Both central & state governments share the
The basic role of Central government is supportive in
providing information, financial, technical &
The organizational component at the national level
1) Cabinet committee headed by the prime minister .
NATIONAL AND STATE
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’.
Shebeer P. Basheer, S. Yaseen Khan. Advance
Nursing Practice. 2nd edition. Bangalore: EMMESS
Medical Publishers; 2017. P.686-700.