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Disaster

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we always tried to turn every disaster into an opportunity.
when danger comes, some men cry, scream, cower or run, we are not those men.

Published in: Healthcare
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Disaster

  1. 1. MR.J.G SAMBAD IKDRC COLLEGE OF NURSING M.Sc. Nursing
  2. 2. INTRODUCTION • Disaster is a sudden, calamitous event bringing great damage, loss and destruction and devastation to life and property. • The damage caused by disasters is immeasurable and varies with the geographical location, climate and the type of the earth surface / degree of vulnerability. • This influences the mental, socio-economic, political and cultural state of the affected area.
  3. 3. Meaning of DISASTER • The word disaster derived from French “desastre” which means in Geek is “Bad Aster = Bed Star”. • The root of the word disaster comes from an astrological theme in which the ancients used to refer to the destruction or deconstruction of a star as a disaster. • The ancient people believed that the disaster is occurred due to the unfavourable position of the “planets” or “Act of God”.
  4. 4. DISASTER • D I S A S T E R • D – Destruction • I - Incidents • S - Sufferings • A – Administrative, Financial failures • S - Sentiments • T - Tragedies • E – Eruption of Communicable diseases • R – Research program and its implementation
  5. 5. DEFINITION • WHO define disaster as “ Any occurrence that causes damage, ecological disruption, loss of human life, deterioration of health and health services, on a scale sufficient to warrant an extraordinary response from outside the affected community or area”. OR • RED CROSS define disaster as “ An occurrence such as hurricane, tornado, storm, flood, high water, wind- driven water, tidal wave, earthquake, drought, blizzard, pestilence, famine, fire, explosion, building collapse, transportation wreck, or other situation that cause human suffering or creates human that the victims cannot alleviate without assistance”.
  6. 6. DISASTER NURSING • Disaster nursing refers to nursing services offered to the victims of disaster who experiences trauma caused by disaster. Disaster nursing is nursing practiced in a situation where professional supplies, equipment, physical facilities and utilities are limited or not available. • Disaster nursing can be defined as “ the adaptation of professional nursing knowledge, skills and attitude in recognizing and meeting the nursing, health and emotional needs of disaster victims”.
  7. 7. Goals – the overall goal of disaster nursing is to achieve the best possible level of health for the people and community involved in the disaster. 1. To meet the immediate basic survival needs of populations affected by disasters (water, food, shelter, and security). 2. To identify the potential for a secondary disaster. 3. To appraise both risks and resources in the environment. 4. To correct inequalities in access to health care or appropriate resources. 5. To empower survivors to participate in and advocate for their own health and well being. 6. To respect cultural, lingual, and religious diversity in individuals and families and to apply this principle in all health promotion activities. 7. To promote the highest achievable quality of life for survivors.
  8. 8. Role and Responsibility of a Disaster nurse D – Disseminate information on the prevention and control of environmental hazards I – Interpret health laws and regulations S – Serve yourself of self – survival. A – Accepts directions and take orders from an organized authority S - Serve the best of the MOST T – Teach the meaning of warning signals E – Exercise leadership R – Refer to appropriate agencies
  9. 9. Causes and Types of Disaster – 1.On the basis of origin/causes: A) Natural disasters - Hydro-metrological disaster - Geographical disaster - Biological disaster B) Men-made disasters - Technological disaster - Environmental Degradation
  10. 10. 2. On the basis of speed of onset • Sudden onset disasters • Slow onset disasters
  11. 11. List of important disaster • Earthquakes - • Floods • Tornadoes / Typhoons • Cyclone • Hurricane • Tsunamis • Fire • Nuclear leaks • Chemical leaks / Spill over • Terrorist activities • Structural damage
  12. 12. Nuclear leak
  13. 13. Tsunamis
  14. 14. Terrorist activity
  15. 15. Structural damage
  16. 16. Level of disaster Level I – if the organization, agency, or community is able to contain the event and respond effectively utilizing its own resources. Level II – if the disaster requires assistance from external sources, but these can be obtained from nearby agencies. Level III – if the disaster is of a magnitude that exceeds the capacity of the local community or origin and requires assistance from state level or even federal assets.
  17. 17. PHASES OF DISASTER • There are mainly three phase of disaster: •Pre-impact phase •Impact phase •Post-impact phase
  18. 18. 1. Pre-impact phase • it is the initial phase of disaster, prior to the actual occurance. A warning is given at the sign of the first possible danger to a community with the aid of weather networks and satellite many metrological disasters can be predicted. • This is the period when the emergency preparedness plan is put into effect emergency centers are opened by the local civil, detention authority. Communication is a very important factor during this phase, disaster personnel will call on amateur radio operators, radio and television stations. • The role of nurse in this warning phase is to assist in preparing shelters and emergency aid stations and establishing contact with other emergency service group.
  19. 19. 2. Impact phase • This phase occurs when the disaster actually happens. It is a time of enduring hardship or injury end of trying to survive. This phase may last for several minutes (eg. after an earthquake, plane crash or explosion) or for days or weeks (eg. in a flood, famine or epidemic). • This phase continues until the threat of further destruction has passed and emergency plan is in effect. This is the time when the emergency operation center is established and put in operation. It serves as the center for communication and other government agencies of health tears care, health care providers to staff shelters. • Every shelter has a nurse as a member of disaster action team. The nurse is responsible for psychological support to victims in the shelter.
  20. 20. 3. Post-impact phase • recovery begins during the emergency phase and ends with the return of normal community order and functioning. For persons in the impact area this phase may last a lifetime (eg. victims of the atomic bomb of Hiroshima).
  21. 21. Disaster management cycle (Phases of Disaster Management)
  22. 22. 1.Mitigation • mitigation includes measures to prevent disaster damaging effects of unavoidable disasters. Effective mitigation includes recognizing and preventing potential technological disaster and being adequately prepared should such events occurs. • To plan effectively for disaster prevention the need to have community assessment information including knowledge of community resources (eg, emergency services, hospital and clinics), community health personnel (eg, nurses, doctors, pharmacists, emergency medical teams, dentist and volunteers), community government officials and local industry.
  23. 23. 2. Disaster Preparedness • The goal of preparation is to decrease emergency response time and ensure that necessary equipment is available and on-site after a disaster. Issues to consider include – weather patterns, geographic location, expectations related to public events and gatherings, age, condition, and location of facility, and industries in close proximity to the hospital (eg. nuclear power plant or chemical factory). • Preparedness include – personal preparedness and professional prepardness.
  24. 24. 2. Preparedness the objectives of the disaster preparedness is to ensure that appropriate systems, procedures and resources are in place to provide prompt, effective assistance to disaster victims, thus facilitating relief measures and rehabilitation services. In this following activities are carried out – • Evaluate the risk of the country or particular region to disasters. • Adopt standards and regulations. • Organize communication, information and warning systems. • Ensure coordination and response mechanisms. • Adopt measures to ensure that financial and other resources are available for increased readiness and can be mobilized in disaster situations. • Develop public education programs • Coordinate information sessions with news media • Organize disaster simulation exercises that test response mechanisms.
  25. 25. 3.Response • the response phase is the actual implementation of the disaster plan. The best response plans use an incident command system, are relatively simple, are routinely practiced, and are modified when improvements are needed. Response activities need to be continually monitored and adjusted to the changing situation.
  26. 26. Cont… • Types of information included in initial assessment reports includes the • followings – • Geographical at risk or affected • Presence of continuing hazards • Injuries and deaths • Availability of shelter • Current level of sanitation • Status of health care infrastructure
  27. 27. Cont… • Acute and chronic illness can be exacerbated by the prolonged effects of disaster. The psychological stress of clean up and moving can bring about feeling of severe hopelessness, depression and grief. Recovery can be impeded by short term psychological effects eventually merging with the long term results of living in adverse circumstances. • CHN must also remain alert for environmental health hazards. Home visit may lead the nurse to uncover situations such as faulty housing structure, lack of water supply or lack of electricity.
  28. 28. 4. Recovery • once the incident is over, the organization and staff needs to recover. Recovery is usually easier if, during the response, some of the staff have been assigned to maintain essential services while others were assigned to the disaster response. • Recovery begins when the disaster is finished and serves the community, establishing long-term medical care for those in need after a disaster, rebuilding and working to reduce the chance of future similar disasters from occurring.
  29. 29. Cont.. • Flexibility remains important component of a successful recovery operation. Community clean- up efforts can incure a host of physical and psychological problems. For eg, the physical stress of moving heavy objects can cause back injury, severe fatigue and even death from heart attacks. • In addition, the continuing threat of communicable disease will continue as long as the water supply remains threatened and the living conditions remain crowed. CHN must remain vigilant in teaching proper hygiene and making sure immunization records are up to date.
  30. 30. DISASTER TRIAGE • The word triage is derived from the French word trier, which means, “to sort out or choose”. The Baron Dominique Jean Larrey, chief surgeon of Napoleon, is credited with organizing the first triage system. • Triage is the process of determining the priority of patient’s treatments based on the severity of their condition. • Triage is the process of sorting people based on their need for immediate medical treatment as compared to their chance of benefiting from such care.
  31. 31. Definition of triage system • Triage is a process which places the right patient in the right place at the right time to receive the right level of care. - (Rice & Abel) • Triage is the process of prioritizing which patients are to be treated first and is the cornerstone of good disaster management in terms of judicious use of resources. - (Aduf der Heide)
  32. 32. Aims • To sort patients based on needs for immediate care • To recognize futility • Medical needs will outstrip the immediately available resources. • Additional resources will become available given enough time.
  33. 33. Purpose • Inadequate resources to meet immediate needs • Infrastructure limitations • Inadequate hazard preparation • Limited transport capabilities • Multiple agencies responding • Hospital resources Overwhelmed
  34. 34. Advantages • 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 decision easier • Assure that resources are used in the most effective manner • May take some emotional burden away from those doing triage.
  35. 35. Principles • Every patient should receive and triaged by appropriate skilled health care professionals. Triage is a clinic managerial decision and must involve collaborative planning. • Triage process should not cause a delay in the delivery of effective clinical care.
  36. 36. Types • There are mainly two types it include following: i) Simple triage ii) Advanced triage
  37. 37. 1. Simple triage • simple triage is used in a scene of mass casualty, in order to sort patients into those who need critical attention and immediate transport to the hospital and those with less serious injuries. This step can be started before transportation becomes available. The categorization of patients based on the severity of their injuries can be aided with the use of printed triage tags or colored flagging. • S.T.A.R.T (Simple Triage and Rapid Treatment) is a simple triage system that can be performed by lightly trained lay and emergency personnel in emergencies. Triage separates the injured into 4 groups – • 0 – The decreased who are beyond help • 1 – The injured who can be helped by immediate transportation • 2 – The injured whose transport can be delayed • 3 – Those with minor injuries, who needs help less
  38. 38. 2. Advanced triage • in advanced triage, Doctors may decides that some seriously injured people should not receive advanced care because they are unlikely to survive. Advance care will be used on patients with less severe injuries. It is used to divert scarce resources away from patients with little chance of survival in order to increase the chances of survival of others who are more likely to survive. • Principles of advanced triage are – • Do not greatest good for the greatest number. • Preservation of life takes precedence over preservation of limbs • Immediate threats to life : HEMORRHAGE
  39. 39. CLASS –I (EMERGENT) RED IMMEDIATE Victims with serious injuries that are life threatening but has a high probability of survival if they received immediate care. They require immediate surgery or other life-saving intervention, and have first priority for surgical teams or transport to advanced facilities. They can not wait, but are likely to survive with immediate treatment. (critical, life threatening – compromised airway, shock, hemorrhage) CLASS – II (URGENT) YELLOW DELAYED Victims who are seriously injured and whose life is not immediately threatened, and can delay transport and treatment for 2 hours. Their condition is stable for the moment but requires watching by trained persons and frequent re-triage, will need hospital care (and would receive immediate priority care under “normal” circumstances) (major illness or injury – open fracture, chest wound) CLASS – III (NON-URGENT) GREEN MINIMAL “walking wounded,” the casualty requires medical attention when all higher priority patients have been evacuated, and may not require monitoring. Victims whose care and transport may be delayed 2 hours or more. (minor injuries, walking wounded – closed fracture, sprain, strain) CLASS IV (EXPECTANT) BLACK EXPECTANT They are so severely injured that they will die of their injuries, possibly in hours or days (large- body burns, severe trauma, lethal radiation dose), or in life threatening medical crisis that are unlikely to survive given the care available (cardiac arrest, septic shock, severe head and chest wounds). They should be taken to a holding area and given painkillers as required to reduce suffering. (dead oe expected to die – massive head injury, extensive full-thickness burns)
  40. 40. EQUIPMENT IN DISASTER MANAGEMENT 1. First aid kit – • Sterile adhesive bandages in assorted sizes • Assorted sizes of safety pins • Cleansing agent / soap • Gloves (2 pairs) • 2 inch sterile gauze pad (4-6) • 4 inch sterile gauze pad (4-6) • Triangular bandages (3) • 2 inch roller bandages (3 rolls) • Scissors • Syringes • Antiseptic • Thermometer • Tube of petroleum jelly or other lubricants • Non prescription drugs – aspirin or non aspirin pain reliever, anti diarrhea, antacid, laxatives
  41. 41. 2. Equipments • Oxygen cylinder with mask • Spanner for opening • Strectures, wheelchairs and trolleys • Splints • I.V fluids with I.V set, blood transfusion sets for blood collection • Dressing and suture materials • Instruments for dressing, gloves, face masks, color tags and ambulance must kkep ready • Medications – antibiotics such as ciprofloxacin, doxycyclines, bronchodilators, fluroquinolones
  42. 42. 3. Ambulance equipments – • Airway management • Ventilation device • Suctioning unit • Oxygen delivery • Basic wound care supplies, splinting supplies • Emergency medications • Patient transfer equipment • Personal safety equipment • Safety boots and gloves • Safety ear plugs • Safety eye wear • Safety helmets
  43. 43. 4. Other equipment – • Air lifting bag • Lighting tower • Fire extinguisher • Fire alarm system • Fire entry suit • Hydraulic cutter • Life jacket • Industrial heat protective garments • Metal detectors • Bomb detection equipments • Bomb disposal equipments
  44. 44. 5. Color Coding – • Black tag – indicate victims who are already dead • Red tag – indicate top priority who have life threatening injuries but who can stabilized and have high probability of survival. Priority is given to injured rescue workers, hysterical persons and children. • Yellow tag – indicate second priority and assigned to victims with injuries with systematic complications who are able to withstand a wait of 45 – 60 minutes, for medical attention, also for victims who have poor chance of survival. • Green tag – indicate victims with local injuries without immediate systematic complications who can wait several hours for treatment
  45. 45. ROLE OF NURSE IN DISASTER
  46. 46. ROLE OF NURSE IN DISASTER The goal of disaster nursing is ensuring that the highest achievable level of care is delivered through identifying, advocating and caring for all impacted populations throughout all phases of a disaster event, including active participation in all levels of disaster planning and preparedness. • Determine magnitude of the event • Define health needs of the affected groups • Establish priorities and objectives • Identify actual potential public health problems • Determine resources needed to respond to the needs identified • Collaborate with other professional disciplines, governmental and governmental agencies • Maintain a unified chain of command • Communication
  47. 47. A. Personal preparedness – nurse assisting in disaster relief efforts must be as healthy as possible, both physical as well as psychologically. She must be certified in first aid and cardiopulmonary resuscitation.
  48. 48. B. Professional preparedness • Participate in the development of community disaster plans • Participate in community risk assessment : elements of hazards analysis for all hazards approach, hazard mapping and vulnerability analysis. • Initiate disaster prevention measures : prevention of hazards, movement / relocation of at risk population, public awareness campaign and establishment of early warning system • Perform disaster drills and table – top exercises • Identify educational and training needs for all nurses • Develop disaster nursing database for notification, mobilization, and triage of emergency nurse staffing resources. • Develop evaluation plans for all components of disaster nursing response.
  49. 49. CONT.. • She should develop and provide educational material relevant to disaster specific to the area. • Organize disaster drills with the help of government and non government organization. • Keeps up to date records of vulnerable population within the community. • Understand what the available community resources are and how the community will work together when disaster strikes. • The disaster which are not preventable their impact can be mitigated by public education to the peoples staying in disaster prone areas. • Giving instruction regarding proper safety precautions, proper storage of emergency supplies and basic first aid course for injuries in the actual event. • Public communication systems and how people can obtain information in the event of an actual disaster situation. Eg. Radio, Television etc.
  50. 50. • Activate disaster response plan – notification and initial response, leadership assumes control of events, command post is established, establish communication, conduct damage and need assessment at the scene, establish field hospital and shelters, triage and transport of patients. • Mitigate all ongoing hazards • Activate agency disaster plans • Establish need for mutual aid relationships • Integrate state and federal resources • Ongoing triage and provision of nursing care • Evaluate public health needs of affected population
  51. 51. • Establish safe shelter and the delivery of adequate food and water supplies • Establish safe shelter and delivery of adequate food and water supplies • Provide for sanitation needs and waste removal • Establish disease surveillance and vector control • Establish vector control • Evaluate the need for / activate additional nursing staff (Disaster Nurse Response Plan) • She must observe continuously faulty housing structure, lack of water and electricity objects blown by flood may be dangerous must be removed • She should also may be involved in providing psychological care to the community to assist its members with the grieving and coping processes. • She play a key role as preventionist in assisting in maintenance of proper sanitation measures, proper control of vector populations and control of infectious disease through public education.
  52. 52. • Continue provision of nursing and medical care • Continue disease surveillance and vector control • Monitor the safety of the food and water supply • Withdrawl from disaster scene • Restore public health infrastructure
  53. 53. CONT.. • Re-triage and transport of the patients to appropriate facilities • Reunite family members • Monitor long term physical health outcomes of survivors • Provide counseling and debriefing for staff • Provide staff with adequate time off for rest • Evaluate disaster nursing action response • Revise original disaster preparedness plan

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