1. DISASTER NURSING GOLDEN LECTURE
Kawkab Shishani, RN, PhD
Community Health Nursing
Kawkab.shishani@gmail.com
Jordan
Richard Garfield, RN, DrPH
Director WHO/PAHO Collaborating Center School of
Nursing, Columbia University in the City of New York
Nicolas Padilla, MD
Universidad de Guanajuato
Mexico
Ronald LaPorte, PhD
Director Telecommunications and Disease Monitoring;
WHO Collaborating Center
University of Pittsburgh June 8, 2009
2. NURSES AND EDUCATION
Education is the most powerful weapon
which you can use to change the
world.
Nelson Mandela
3. MISSION STATEMENT
Disasters are a primary cause of morbidity and
mortality. Nurses can play an important role in
disaster mitigation, but they receive very little
training. This lecture is designed to help to
introduce to nursing the concepts of disasters and
disaster mitigation. We propose that you teach this
lecture to your nursing students to build awareness
world wide.
4. OBJECTIVES
1. Define a disaster
2. Discuss patterns of mortality and injury
3. Understand impact of disasters on health
4. Describe the factors that contribute to disasters
severity
5. Discuss role of nursing in disasters
6. Apply principles of triage in disaster
7. Analyze the WHO components of effective
disaster nursing
5. WHAT IS DISASTER
Is a result of vast ecological breakdown in the
relation between humans and their environment, as
serious or sudden event on such scale that the
stricken community needs extraordinary efforts to
cope with outside help or international aid.
7. HURRICANES
The primary health hazard from hurricanes or
cyclones lies in the risk of drowning from the storm
surge associated with the landfall of the storm.
Most deaths associated with hurricanes are
drowning deaths.
Secondarily, a hazard exists for injuries from flying
debris due to the high winds.
Nurses can be instrumental in providing direct
emergency care to drowning and head injuries.
8. TORNADOES
The primary hazard from a health perspective in a
tornado is the risk for injuries from flying debris. The
high winds and circular nature of a tornado leads to
the elevation and transport of anything that is not
fastened down. Most victims of tornadoes are affected
by head and chest trauma due to being struck by
debris or from a structural collapse. Some individuals
are injured while on the ground. Others are lifted into
the air by the tornado and dropped at another location.
9. FLOODS
Floods may originate very quickly following a quick rain
storm, or they may develop over a short period following
an extended period of rain or quick snow melt
The primary hazard from flooding is drowning
Longer term health concerns from flooding is the
development of disease from contaminated water and
lack of hygiene.
10. EARTHQUAKES
A significant global concern
The primary health concern:
• Injuries arising from structural collapse
• Most injuries occur amongst individuals trapped at the
time of the earthquake
Well known prevention strategy is to prevent buildings
from collapsing
There is a recognized need to develop better rescue
strategies for retrieving individuals from collapsed
buildings
11.
12. VOLCANOES
Rare, but can be catastrophic when they occur
Over the 25 year period (1972-1996), there was an
average of 6 eruptions per year, causing an
average of 1017 deaths and 285 injuries
Health outcomes are associated with volcanic
eruptions:
• Respiratory illnesses from the inhalation of ash
• For individuals close to the volcano, some
danger exists from lava flows, or more likely mud
flows
19. COMPONENTS OF DISASTER DEBRIS
Building Debris
Household Debris
Vegetative Debris
Problem Waste Streams
20. MYTHS ASSOCIATED WITH DISASTERS
Any kind of assistance needed in disasters
A response not based on impartial evaluation contributes to
chaos
Epidemics and plagues are inevitable after every
disaster
Epidemics rarely ever occur after a disaster
Dead bodies will not lead to catastrophic outbreaks of exotic
disease
Proper resumption of public health services will ensure the
public’s safety (sanitation, waste disposal, water quality, and
food safety)
Disasters bring out the worst in human behavior
The majority responses spontaneous and generous
The community is too shocked and helpless
Cross-cultural dedication to common good is most common
response to natural disasters
21. PATTERNS OF MORTALITY AND INJURY
Disaster events that involve water are the most
significant in terms of mortality
Floods, storm surges, and tsunamis all have a
higher proportion of deaths relative to injuries
Earthquakes and events associated with high winds
tend to exhibit more injuries than deaths
The risk of injury and death is much higher in
developing countries – at least 10 times higher
because of little preparedness, poorer
infrastructure.
22. DISPLACEMENT OF DISASTER VICTIMS
Mass Shelters
Shelter management:
• Organized team (chain)
• Sleeping area and necessities
• Water and food handling
• Sanitation (toilets, showers,..)
• Special care to children and elderly
• Health services (physical, mental)
23. DISASTER AND HEALTH
In a major disaster water treatment plants,
storage & pumping facilities, & distribution
lines could be damaged, interrupted or
contaminated.
Communicable diseases outbreak due to:
Changes affecting vector populations (increase vector),
Flooded sewer systems,
The destruction of the health care infrastructure, and
The interruption of normal health services geared
towards communicable diseases
24. DISASTER AND HEALTH
Injuries from the event
Environmental exposure after the event (no shelter)
Malnutrition after the event (feeding the population
affected)
Excess NCD mortality following a disaster
Mental health (disaster
syndrome)
25. MENTAL WELLNESS
Little attention is paid to the children
Listen attentively to children without denying their
feelings
Give easy-to-understand answers to their questions
In the shelter, create an environment in which
children can feel safe and secure (e.g. play area)
26. MENTAL WELLNESS
In any major disaster, people want to know where their
loved ones are, nurses can assist in making links.
In case of loss, people need to mourn:
• Give them space,
• Find family friends or local healers to encourage
and support them
• Most are back to normal within 2 weeks
• About1% to 3%, may need additional help
28. THE PHASES OF DISASTER
Mitigation:
Lessen the impact of a disaster before it strikes
Preparedness:
Activities undertaken to handle a disaster when it strikes
Response:
Search and rescue, clearing debris, and feeding and
sheltering victims (and responders if necessary).
Recovery:
Getting a community back to its pre-disaster status
29. MITIGATION
Activities that reduce or eliminate a hazard
Prevention
Risk reduction
Examples
Immunization programs
Public education
30. PREPAREDNESS
Activities that are taken to build capacity and
identify resources that may be used
Know evacuation shelters
Emergency communication plan
Preventive measures to prevent spread of disease
Public Education
31. RESPONSE
Activities a hospital, healthcare system, or public
health agency take immediately before, during, and
after a disaster or emergency occurs
32. RECOVERY
Activities undertaken by a community and its
components after an emergency or disaster to
restore minimum services and move towards long-
term restoration.
Debris Removal
Care and Shelter
Damage Assessments
Funding Assistance
33. WHAT IS TRIAGE?
French verb “trier” means to sort
Assigns priorities when resources
limited
Do the best for the greatest
number of patients
35. ADVANTAGES OF TRIAGE
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 decisions easier
Assure that resources are used in the most
effective manner
May take some of the emotional burden away from
those doing triage
36. WHO DECIDES IN TRIAGE
Nurses don’t act for legal fears of being blamed for
deaths, and lack of clarity on where they fit in the
command structure
Nurses function to the level of their training and
experience.
If nurses they are the most trained personnel the
site, they are in charge.
38. HEALTH WORKER DENSITY BY
REGION
2.3
2.6
4.2
6.9
8.7
9.9
10.3
0.8
0 2 4 6 8 10 12
Europe
N ort h A merica
W est ern Pacif ic
M iddle East
Global
S&C ent ral A merica
A sia
Sub- Saharan A f rica
Workers per 1,000 population
41. ROLE OF NURSING IN DISASTERS
Disaster preparedness, including risk assessment and
multi-disciplinary management strategies at all
system levels, is critical to the delivery of effective
responses to the short, medium, and long-term health
needs of a disaster-stricken population.
International Council of Nurses (2006)
42. NURSES’ ROLES IN DISASTERS
Determine magnitude of the event
Define health needs of the affected groups
Establish priorities and objectives
Identify actual and potential public health problems
Determine resources needed to respond to the
needs identified
Collaborate with other professional disciplines,
governmental and non-governmental agencies
Maintain a unified chain of command
Communication
43. COMMUNICATION IS A SUCCESS KEY
Nursing organizations must have a comprehensive
and accurate registry for all members
Have a structured plan:
• Collaborate and coordinate with local authorities
• Have a hotline 24x7
• Inform nurses where to report and how (keep records)
• Make sure have a coordinator to prevent chaos
• Ensure ways to maintain communication between
nurses and their families
44. THE NEED FOR DISASTER NURSING TRAINING
11 million nurses world wide:
• Form the backbone of the health care system
• Are the frontline health care workers who are in
direct contact with the public
• Contribute to health of individuals, families,
communities, and the globe
Schools of nursing offer little or no information on
disaster nursing (WHO, 2008)
Shortage of trained instructors/faculty (WHO, 2008)
45. CORE COMPETENCIES IN DISASTER NURSING
TRAINING
Ethical and legal issues, and decision making;
Care principles;
Nursing care;
Needs assessment and planning;
Safety and security;
Communication and interpersonal relationships;
Public health; and
Health care systems and policies in emergency
situations
(WHO, 2008)
46. TOPICS THAT MUST BE COVERED BY DISASTER
NURSING TRAINING
Basic life support
System and planning for settings where nurses
work
Communications (what to report and to whom)
Working in the damaged facilities and with
damaged equipment
Safety of clients and practitioners
Working within a team (understand each member’s
role and responsibility)
Infection control
Mental and psychosocial support
(WHO, 2006)
47. SUPERCOURSE INITIATIVE
Supercourse is a “Library of Lectures” to
empower educators
Twenty Nobel Prize winners, 60 IOM members
and other top people contributed lectures. Gil
Omenn, AAAS former president, Vint Cerf, the
father of the Internet, Elias Zerhouni, head of NIH,
etc. , Ala Alwan, Assistant Director General of the
WHO
With the growing number of nurses in the network,
there was a need to establish a DisasterNursing
Supercourse to emphasize the contribution of
nursing to global health
48. BUILDING DISASTER NURSING SUPERCOURSE
Reasons:
Nurses form the largest health care professional
group
Nurses are the main health professionals in
touch with the community
Shortage in number of structured nursing
programs in disaster preparedness
Nurses deal with the physical stresses of a
disaster, and more importantly the fear,
stress and uncertainties of disasters
49. BUILDING DISASTER NURSING SUPERCOURSE
Reasons:
Nurses receive little training in disaster
preparedness, prevention and Mitigation
(general not specialized training)
Expected increase in disasters and in numbers
of causalities in particular in developing countries
Developing countries has the highest burden and
has limited resources
50. BUILDING DISASTER NURSING SUPERCOURSE
How:
1. Provide training for future generations of
nurses who might be engaged in a disaster
2. Collaborate with WHO
3. Build disaster nursing lectures to train nurses
worldwide
4. Promote partnerships among instructors at
schools of nursing in the world in the area of
disaster nursing
5. Offer up to date evidence based scientific
knowledge to enhance faculty training
51. “Most of all, if gains in health and nutrition during
emergencies are to be sustained, graduates need to
understand the importance of capacity building of
national staff and institutions.”
Salama et al, Lessons Learned from Complex Emergencies
52. DISASTER NURSING SUPERCOURSE
o To join the Nursing Supercourse, please visit
www.pitt.edu/~super1
or e-mail
super2@pitt.edu.
o Membership in the Global Health Network
Supercourse will allow you to receive free Supercourse
CDs, just in time lecture, and annual prevention lectures
o Note: “send this lecture to a friend” button works from
PowerPoint slide show mode
53. More information
This lecture is available at:
http://www.pitt.edu/~super1/lecture/lec35051/index.htm
Please fee free to e-mail at:
kawkab.shishani@gmail.com
