IKDRC COLLEGE OF NURSING
• 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
• This influences the mental, socio-economic, political
and cultural state of the affected area.
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”.
• 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
• 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”.
• 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”.
• 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
• 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
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
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
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
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
S - Serve the best of the MOST
T – Teach the meaning of warning signals
E – Exercise leadership
R – Refer to appropriate agencies
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
2. On the basis of speed of onset
• Sudden onset disasters
• Slow onset disasters
List of important disaster
• Earthquakes -
• Tornadoes / Typhoons
• Nuclear leaks
• Chemical leaks / Spill over
• Terrorist activities
• Structural damage
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.
PHASES OF DISASTER
• There are mainly three phase of disaster:
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
• 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
• 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.
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
• Every shelter has a nurse as a member of disaster
action team. The nurse is responsible for psychological
support to victims in the shelter.
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
Disaster management cycle
(Phases of Disaster Management)
• 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.
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.
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
• 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
• Develop public education programs
• Coordinate information sessions with news media
• Organize disaster simulation exercises that test 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.
• 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
• 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
• 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
• 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
• 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.
• 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
• 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.
• 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
• 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.
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)
• To sort patients based on needs for immediate
• To recognize futility
• Medical needs will outstrip the immediately
• Additional resources will become available
given enough time.
• Helps to bring order and organization to a
• 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
• May take some emotional burden away from
those doing triage.
• 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.
• There are mainly two types it include
i) Simple triage
ii) Advanced triage
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
• 2 – The injured whose transport can be delayed
• 3 – Those with minor injuries, who needs help less
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
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,
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)
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)
• Tube of petroleum jelly or other lubricants
• Non prescription drugs – aspirin or non aspirin pain reliever,
anti diarrhea, antacid, laxatives
• Oxygen cylinder with mask
• Spanner for opening
• Strectures, wheelchairs and trolleys
• I.V fluids with I.V set, blood transfusion sets for
• 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
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
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
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
• Collaborate with other professional disciplines, governmental
and governmental agencies
• Maintain a unified chain of command
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
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
• Initiate disaster prevention measures : prevention of hazards,
movement / relocation of at risk population, public
awareness campaign and establishment of early warning
• 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
• Develop evaluation plans for all components of disaster
• She should develop and provide educational material relevant
to disaster specific to the area.
• Organize disaster drills with the help of government and non
• Keeps up to date records of vulnerable population within the
• 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.
• 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
• Establish safe shelter and the delivery of adequate food and
• Establish safe shelter and delivery of adequate food and water
• 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
• 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
• 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
• Re-triage and transport of the patients to appropriate
• Reunite family members
• Monitor long term physical health outcomes of
• Provide counseling and debriefing for staff
• Provide staff with adequate time off for rest
• Evaluate disaster nursing action response
• Revise original disaster preparedness plan