Disaster nursing

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DISASTER MANAGEMENT
INTRODUCTION
Presently at the global level, there has been considerable concern over natural disasters. Even as
substantial scientific and material progress is made, the loss of lives and property due to disasters has not
decreased. In fact, the human toll and economic losses have mounted. There has been an increase in the
number of natural disasters over the past years and with it, increasing losses on account of urbanization
and population growth, as a result of which the impact of natural disasters is now felt to a larger extent.
According to the United Nations, in 2001 alone, natural disasters of medium to high range caused at
least 25,000 deaths around the world, more than double the previous year and economic losses of around
US $36 billion. These figures would be much higher, if the consequences of the many smaller and
unrecorded disasters that cause significant losses at the local community level were to be taken into
account.
Natural disasters are not bound by political boundaries and have no social or economic considerations.
They are borderless as they affect both developing and developed countries. They are also merciless and
as such the vulnerable tend to suffer more at the impact of natural disasters. For example, the developing
countries are much more seriously affected in terms of the loss of lives, hardship borne by population
and the percentage of their GNP lost. Since 1991, two-third of the victims of natural disasters was from
developing countries, while just 2 percent were from highly developed nations. Those living in
developing countries and especially those with limited resources tend to be more adversely affected.
With the alarming rise in the natural disasters and vulnerability per se, the world community is
strengthening its efforts to cope with it.
MEANING
Disaster means that any occurrence that causes damage, ecological disruption, loss of human life or
deterioration of health and health services on a scale sufficient to warrant and extraordinary response
from outside the affected community or area (WHO, 1995).
PRINCIPLES OF DISASTER MANAGEMENT

There are eight fundamental principles that should be followed by all who have a responsibility for
helping the victims of a disaster. It is critical that rescue workers use these principles in proper sequence,
or they will be ineffective and possibly detrimental a disaster victims.
The eight basic principles are as follows (Grab and Eng 1969):
1. Prevent the occurrence of the 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 to medical facilities.
7. Provide definitive medical care.
8. Promote reconstruction of lives.
TYPES
Disaster is an occurrence, either natural or man-made that causes human suffering and creates human
needs that victims cannot alleviate without assistance.
Disasters can be natural or man-made.
Natural disasters include droughts, earthquakes, tsunamis, forest fires, landslides and mudslides,
blizzards, hurricanes, tornadoes, floods and volcanic disruptions.
Man-made disasters includes hazardous substance accidents (e.g., chemicals, toxic gases), radiologic
accidents, dam failures, resource shortage (e.g., food, electricity and water), structural fire and
explosions and domestic disturbances (e.g., terrorism, bombing and riots), Bioterrorism. Explosions
Fires, Toxic materials, Pollution, Civil unrest (e.g., riots, demonstrations), Terrorists’ attacks
Throughout history natural and man-made disasters have disrupted food and water supplies and.
salutation causing communicable diseases, injury, illness and death.
Disaster Agent:
To apply the epidemiological framework in a disaster situation, the agent is the physical item that
actually causes the injury or destruction. Primary agents include falling buildings, heat, wind, rising
water and smoke. Secondary agents include bacteria and viruses that produce contamination or infection
after the primary agent has caused injury or destruction.
Primary and secondary agents will vary according to the type of disaster.

Host:
In the epidemiological framework as applied to disaster, the host is human kind. Host factors are those
characteristics of humans that influence the severity of the disaster's effect. Host factors include age,
immunization status, pre-existing health status, degree of mobility and emotional stability. Individuals
most
Environment:
Environmental factors that affect the outcome of a disaster include physical, chemical, biological and
social factors.
Physical factors include the time when the disaster occurs, weather conditions, the availability of food
and water and the functioning of utilities such as electricity and telephone service.
Chemical factors influencing disaster outcome include leakage of stored chemicals into the air, soil,
ground water or food supplies.
Biological factors are those that occur or increase as a result of contaminated water, improper waste
disposal, insect or rodent proliferation, improper food storage, or lack of refrigeration owing to
interrupted electrical services.
Social factors are those that contribute to the individual's social support systems. Loss of family
members, changes in roles, and the questioning of religious beliefs are social factors to be examined
after a disaster.
Psychological factors are closely related to agent, host and environmental conditions. The nature and
severity of the disaster affect the psychological distress experienced by victims. The existence and
length of a warning period and physical proximity to the actual site of the disaster influence the amount
of psychological distress experienced by victims. The closer an individual is to the actual site of the
disaster and the longer the individual is exposed to the immediate site of the disaster, the greater the
psychological distress that individual will experience. The victim's perception of the disaster is the
strongest influence on the type of psychological response to a disaster that individual will experience.
PHASES OF A DISASTER
Pre-Impact Phase:
The pre-impact phase is the initial phase of the disaster, prior to the actual occurrence. A warning is
given at the sign of the first possible danger to a community. Many times there is no warning, but with
the aid of weather networks and satellites, many metrological disasters can be predicted. The earliest

possible warning is crucial in preventing loss of life and minimizing damage. This is the period when the
emergency preparedness plan is put into effect. Emergency centers are opened by the local Civil
Defense Authority. Communication is a very important factor during this phase; disaster personnel will
call on amateur radio operators, radio and television stations and any available method to alert the
community and keep it informed. The community must be educated to recognize the threat as serious.
When communities experience false alarms several times, members may not take future warnings very
seriously. The role of the nurse during this warning phase is to assist in preparing shelters and
emergency aid stations and establishing contact with other emergency service groups.
Impact Phase:
The impact phase occurs when the disaster actually happens. It is a time of enduring
hardship or injury and of trying to survive. This is a time when individuals help neighbours and families
at the scene, a time of "holding on" until outside help
arrives. The impact phase may last for several minutes or for days or weeks (e.g., in a flood, famine or
epidemic).
This phase must provide for preliminary assessment of the nature, extend and geographical area of the
disaster. The number of persons requiring shelter, the type and number of needed disaster health services
anticipated and the general health status and needs of the community must be evaluated. The impact
phase continues until the threat of further destructions has passed and the emergency plan is in effect. If
there has been no warning, this is the time when the Emergency Operation Center (EOC) is established
and put in operation. The EOC is the operating center for the local chapter of the American Red Cross. It
serves as the center for communication with other government agencies, the center for recruitment of
health care providers to staff shelters, and the liaison center for working with other volunteer agencies.
Shelters are opened, and every shelter has a nurse as a member of the disaster action team (DAT). The
nurse is responsible for assessing health needs and providing physical and psychological support to
victims in the shelters. During the impact phase injured persons are triaged, morgue facilities are
established and coordinated, and search and reunion activities are organized.
Post impact Phase:

Recovery beings during the emergency phase and end with the return of normal community order and
functioning. For persons in then impact area this phase may last a lifetime (e.g., victims of the atomic
bombing of Hiroshima).
The victims of a disaster go through four stages of emotional response:
1. Denial: During the first stage, the victim may deny the magnitude of the problem or, more likely,
will understand the problem but may seem unaffected emotionally.
2. Strong emotional response: In the second stage, the person is aware of the problem but regards it as
overwhelming and unbearable. Common reactions during this stage are trembling, tightening of the
muscles, sweating, speaking with difficulty, weeping, heightened sensitivity, restlessness, sadness,
anger, and passivity. The victim may want to retell or relive the disaster experience over and over.
3. Acceptance: During the third stage, the victim begins to accept the problems caused by the disaster
and makes a concentrated effort to solve them. He or she feels more hopeful and confident. It is
especially important for victims to take specific actions to help themselves and their families.
4. Recover: The fourth stage represents a recovery from the crisis reaction. Victims feel that they are
back to normal. Routines become important again. A sense of well-being is restored. The ability to make
decisions and carry out plans returns. Victims develop a realistic memory of the experience.
Heroic Phase: This phase appears at the time of the disaster and is characterized by people working
together to save each other and their property. Excitement is intense, and people are concerned with
survival.
Honeymoon Phase: This is a relatively short (2 weeks to 2 months) post disaster period in which the
victims feel buoyed and supported by the promises of governmental and communal help and see an
opportunity to reconstitute quickly. Optimism continues high, losses are counted, and plans to re-
establish are made.
Disillusionment Phase: Lasting anywhere from several months to a year or more, this phase contains
unexpected delays and failures, which emphasize the frustration from bureaucratic confusion. Victims
turn to rebuilding their own lives and solving their own individual problems.
Reconstruction Phase: This phase may last for several years. It is characterized by a coordinated
individual community effort to rebuild and reestablish normal functioning. Environmental health

legislation supports public health problems in their efforts to resolve environmental health problems.
Environmental health remains a major, worldwide public health concern. Man-made and natural
disasters in recent years have caused tremendous economic instability and extensive personal suffering
in communities. The threat of terrorism is an emerging disaster concern.
DIMENSIONS OF A DISASTER
Disasters have a number of dimensions in which they may differ: predictability, frequency,
controllability, time and scope or intensity. These dimensions influence the nature and possibility of
preparation planning, as well as response to the actual event.
Predictability
Some events are more easily predicated then others. Advances in meteorology, for example, have made
it more feasible to accurately predict the probability of certain types of natural, weather-related disasters
(e.g., tornadoes, floods, and hurricanes), while others, such as earthquakes are not as easily predicted.
Man-made disasters, such as explosions are also less predictable. Whenever an event is predictable,
authorities and emergency personnel have more time to prepare for situation than when an event is not
foreseeable (i.e., spontaneous).
Frequency
Although natural disasters are relatively rare, they appear more often in certain geographical locations.
Residents of the coastal area live in what is commonly referred to as cyclone are at greater risk for
experiencing greater risk for earthquakes, and people who live near large river systems are at greater risk
for flooding than people who live elsewhere. The greater frequency of natural disasters may or may not
prepare citizens for their occurrence. Some citizens become immune to repeated warnings and are less
likely to seek shelter to protect themselves and their property when warned. Other citizens take each
warning seriously and regularly take appropriate safety
Controllability
Some situations allow for pre warning and control measures that can reduce the impact of the disaster;
others do not. Emergency planners were able to control some of the effects of the flooding by
sandbagging levees and river or sea banks to reduce the effects of water damage, and by deliberately
blasting dikes and dams to divert flood waters to less populated areas. The immediate impact on people
was reduced by the ability of emergency personnel to organize evacuations and reduce the risk of injury
and death.

Time
There are several characteristics of time as it relates to the impact of a disaster; the speed of onset of the
disaster, the time available for warning the population, and the actual length of time of the impact phase.
It is more difficult to prepare for very sudden events. A flash flood for instance, may catch many
unaware, while the gradual flooding allowed more time for preparation. When there is a lengthy period
of warning, more protective measures can be introduced. For example, several days’ warning allows
authorities in low coastal areas to evacuate vulnerable communities before a hurricane hits. Tornadoes
do not offer such lengthy warning periods. The impact phase of the disaster may last for minutes, hours,
or even days. The most damage is generally caused by the worst possible combination of time factors: a
rapid onset, no opportunity for warning the populace, and lengthy duration of the impact phase.
Scope and Intensity
A disaster may be concentrated in a very small area or involve a very large geographical region, usually
affecting many more people. A disaster can be very intense and highly destructive, causing many
injuries, deaths, and property damage, or less intense, with relatively little damage done to property or
individuals. Sometimes a relatively small disaster may be extremely disruptive to a large segment of the
community. For example, an explosion at a water purifying plant may cause minimal injury to property
and personnel at the plant, but may reduce or eliminate the water supply for an entire community for
days or even weeks.
THE NURSING ROLE IN DISASTERS
Disaster nurses play key leadership and service provision roles in planning and implementing disaster
relief efforts, preventing technologic disasters, and addressing problems that occur during a disaster,
such as the physical and emotional stress of disaster victims.
During a disaster many environmental health problems emerge. The scope and magnitude of these
problems determines the nursing role. Nurses collaborate with community agencies and officials to
recognize and reduce disaster risks and maximize the health and safety of individuals involved in
disaster crises.
Following a disaster, nurses make numerous referrals to community agencies for a variety of needs
including
- Psychological care,
- Emotional support services,

- Treatment for victims and their families.
Assess the Community
1. Is there a current community disaster plan in place?
2. What previous disaster experiences has the community been involved with locally, statewide,
nationally?
3. How is the local climate conducive to disaster formation (e.g., hurricanes, tornadoes, blizzards)?
4. How is the local terrain conducive to disaster formation (e.g., earthquakes, flooding, forest fires,
avalanches, mudslides)?
5. What are the local industries?
6. Are there any community hazards (e.g., toxic waste and chemical spills, industrial or agricultural
pollutants, mass transportation problems)?
7. What personnel are available for disaster interventions (e.g., nurses, doctors, dentists, pharmacists,
clergy, volunteers, emergency medical teams)?
8. What are the locally available disaster resources (e.g., food, clothing, shelter, pharmaceutical)?
9. What are the local agencies and organizations (e.g., hospitals, schools, churches, emergency medical,
Red Cross)?
10. What is immediately available for infant care (e.g., formula, diapers) and care of the elderly and
disabled?
11. What are the most salient chronic illnesses in the community that will need immediate attention
(e.g., diabetes, arthritis, cardiovascular)?
12. Diagnose Community Disaster Threats
13. Determine actual and potential disaster threats (e.g., toxic waste spills, explosions, mass transit
accidents, hurricanes, tornadoes, blizzards, floods, earthquakes).
Community Disaster Planning
1. Develop a disaster plan to prevent or deal with identified disaster threats.
2. Identify a local community communication system.
3. Identify disaster personnel, including private and professional volunteers, local emergency personnel,
agencies, and resources.
4. Identify regional backup agencies, personnel.

5. Identify specific responsibilities for various personnel involved in disaster coping and establish a
disaster chain of command.
Implement Disaster Plan
1. Focus on primary prevention activities to prevent occurrence of man-made disasters.
2. Practice community disaster plans with all personnel carrying out their previously identified
responsibilities (e.g., emergency triage, providing supplies such as food, water, medicine, crises and
grief counseling).
3. Practice using equipment, obtaining and distributing supplies.
4. Evaluate Effectiveness of Disaster Plan
5. Critically evaluate all aspects of disaster plans and practice drills for speed, effectiveness, gaps, and
revisions.
6. Evaluate the disaster impact on community and surrounding regions.
7. Evaluate response of personnel involved in disaster relief efforts.
PHASES OF DISASTER MANAGEMENT
It has been identified that there are four phases of disaster management which include:-
Mitigation,
Preparedness,
Response, and
Recovery,
Mitigation
Mitigation includes my activities that prevent a disaster, reduce the chance of a disaster happening, or
reduce the damaging effects of unavoidable disasters. Nurses have a key role in disaster mitigation by
working with local, state and federal agencies in identifying disaster risks and developing disaster
prevention strategies through extensive public education in disaster prevention and readiness.
Effective mitigation includes recognizing and preventing potential technologic disasters and being
adequately prepared

To plan effectively for disaster prevention the nurse needs to have community assessment information,
including knowledge of community resources (e.g., emergency services, hospitals, and clinics),
community health personnel (e.g., nurses, doctors, pharmacists, emergency medical teams, dentists, and
volunteers), community government officials, and local industry.
Early warning systems alert the public to the probability of immediate danger and help to reduce the
impact of predictable disaster such as hurricanes or tornadoes. They may also provide information on an
evacuation plan or other immediate actions that improve the chance of survival and reduce the
probability of injures.
The primary goals of disaster management are to prevent or minimize death, disability, suffering and
loss on the part of disaster victims. How these goals are achieved will vary with the type of disaster and
the type of rescue worker. Police officers and firefighters will have an entirely different focus than
health care workers.
Triage
There are several times during the emergency response in which triage may be necessary to best
determine the needs of injured victims. Triage is a French word meaning "sorting" or "categorizing." The
term first came into use during World War 1 when casualties were sorted during battle. During a
disaster, the goal is to maximize the number of survivors by sorting the treatable from the untreatable
victims.
In a disaster, the potential for survival and the availability of resources are the primary criteria used to
determine which patients receive immediate treatment. In a disaster situation, saving the greatest number
of lives is the most important goal. Triage may take place during the rescue operation at the scene of the
disaster, and again at each stage of transport for the disaster victims.
Prioritising of victims for treatment can be done in many ways; some communities use color coding.
Probably the best and most easily understood four-category system is the first-priority, second-priority,
third-priority, and dying-or-dead system:
Red - most urgent, first priority
Yellow - urgent, second priority
Green - third priority
Black - dying/dead
First-priority patients have life-threatening injuries and are experiencing hypoxia. Examples of injuries
in this category include shock, chest wounds, internal haemorrhage, head injuries producing increased

loss of consciousness, partial-or full-thickness burns over 20% to 60% of the body surface, and chest
pain. Patients with catastrophic head or chest injuries do not fall into this category because they have a
poor chance of survival.
Second-priority patients have injuries with systemic effects and complications but are not yet in shock
or hypoxic. The patients appear stable enough to withstand a 30 to 60-minute wait without immediate
risk. Examples of injuries in this category include multiple fractures, open fractures, spinal injuries,
large lacerations; partial- or full-thickness burns over 10% to 20% of the body surface, and medical
emergencies such as diabetic coma, insulin shock; and epileptic seizure. Patients with second-priority
status may need to be observed closely for signs of shock, at which time they would be re-categorized to
first priority.
Third-priority patients have minimal injuries unaccompanied by systemic complications. Usually these
patients can wait several hours for treatment without danger. Examples of injuries in this category
include closed fractures, minor burns, minor lacerations, sprains, contusions, and abrasions.
Dying or dead patients are hopelessly injured patients or dead victims. These patients have catastrophic
injuries (e.g., crushing injuries to the head or chest) and would not survive under the best of
circumstances. These patients create the greatest difficulty, because failure to treat patients conflicts
with nursing philosophy.
STAGES OF DISASTER AND THE ROLE OF NURSES
1. PREPAREDNESS
i) Personal Preparedness
Great stress is placed on the nurse with client responsibilities who also becomes a disaster victim.
Conflicts arise between family and work-related responsibilities. For example, a mother whose child
care needs go unmet will not be able to participate fully, if at all, in disaster relief efforts. In addition, the
community health nurse who will be assisting in disaster relief efforts must be as healthy as possible,
both physically and mentally. A disaster worker who is not well is of little service to his or her family,
clients, and other disaster victims. Personal preparedness can help case some of the conflicts that will
arise and allows nurses to attend to client needs sooner that one may anticipate.
ii) Professional Preparedness
Professional preparedness requires that nurses become aware of and understand the disaster plans at
their workplace and community. Nurses who take disaster preparation seriously will take the time to

read and understand workplace and community disaster plans and will participate in disaster drills and
community mock disasters. The more adequately prepared nurses are, the more they will be able to
function in a leadership capacity and assist others toward a smoother recovery phase. Personal items that
are recommended for any nurse preparing to help in a disaster include the following
A copy of their professional license
Personal equipment, such as a stethoscope, a flashlight and extra batteries, Cash, Warm clothing and a
heavy jacket (or weather-appropriate clothing), Record-keeping materials, Pocket-sized reference books
iii) Community Preparedness
The level of community preparedness for a disaster is only as good as the people and organizations in
the community make it. Some communities remain vigilant as to the possibility of a disaster hitting their
community and stay prepared by having a solid disaster plan on paper and by participating in yearly
mock disaster drills. Other communities are not as vigilant and depend on luck and the fact that they
have never been hit before to see them through.
ROLE OF NURSE IN DISASTER PREPAREDNESS
The role of the community health nurse in disaster preparedness is to facilitate preparation within the
community and place of employment. Within the employing organization, the nurse can help initiate or
update the disaster plan, provide educational programs and material regarding disasters specific to the
area, and organize disaster drills. The community health nurse is also in a unique position to provide an
updated record of vulnerable populations within the community. Individualized strategies should be
reviewed, including the availability of specific resources, in the event of an emergency.
The leader should also possess an intimate knowledge of the institution and familiarity with the
individuals who work there. Persons with disaster management training, and especially those who have
served on "real" disasters, make valuable members of any preparedness team as well.
Within the community the nurse might be involved in many roles.
As a community advocate, the community health nurse should always seek to keep a safe environment.
Recalling that disasters are not only natural but also man-made, the nurse in the community has an
obligation to assess for and report environmental health hazards.
The community health nurse should also have an understanding of what community resources will be
available after a disaster strikes and most important, how the community will work together. A

community-wide disaster plan will guide the nurse in understanding what "should" occur before, during,
and after the response and his or her role within the plan.
The community health nurse who seeks greater involvement or a more in-depth understanding of
disaster management can become involved in any number of community organizations that are part of
the official response team, such as the Red Cross, Salvation Army, or Emergency Medical System/
Ambulance Corps. The Red Cross offers classed on disaster health services and disaster mental health
services in an effort to "help participants identify disaster.
ROLE OF NURSE IN DISASTER RESPONSE
The role of the community health nurse during disaster depends greatly on the nurse's past experience,
role in the institutions and community's preparedness, specialized training, and special interest. The
most important attribute for anyone working in a disaster, however, is flexibility. One certain factor
about disaster is that change is a constant.
Although valued for their expertise in community assessment, case finding and referring, prevention,
health education, surveillance, and working with aggregates, at times the community health nurse is the
first to arrive on the scene and must respond accordingly. In this situation, it is important to remember
that all life-threatening problems take precedence. Once rescue workers begin to arrive at the scene,
immediate plans for triage should begin.
Triage is the process of separating casualties and allocating treatment based on the victim's potential for
survival.
Lack of or inaccurate information regarding the scope of the disaster and its initial effects contributes to
the misuse of resources.
Local and regional emergency and public health resources can be readjusted as assessment reports
continue to come in. Prioritising needs that benefit the largest aggregate of imperiled individuals with
the most correctable problems is consistent with the most basic tenets of triage.
Shelter Management:
Shelters are generally responsibility of the local Red Cross chapter, although in level III disasters the
military may be used to set up "tent cities" for the masses that are in need of temporary shelter.
Community health nurses because of their experience with delivering aggregate health promotion,
disease prevention, and emotional support, make ideal shelter managers and team members.

Although nurses may need to attend to physical health needs, especially among elderly and chronically
ill persons, many of the predominant problems in shelters revolve around stress. Stress may be instigated
by the shock of the disaster itself, loss of personal possessions, fear of the unknown, living in proximity
to total strangers, and even boredom.
Other shelter functions with which a community health nurse will be involved include assessing and
referring, ensuring medical needs, providing first aid, serving meals, keeping patient records, ensuring
emergency communications and transportation, and providing a safe environment.
The Red Cross provides training for shelter management and expects those trained to follow appropriate
protocols.
International Relief Efforts:
Counties other than the affected counter, especially those involved with political upheavals, suffer not
only from natural disasters, but from man-made disasters as well. Civil strife leads to war, famines, and
communicable disease outbreaks. Sometimes disaster or relief workers are sent to these international
calamities at the request of the affected country's government. At other times, workers are not welcomed
but instead may go with the support of the United Nations. When workers are not welcomes, their lives
may be in danger, even though they go as peacekeeping agents of the Federation of Red Cross and Red
Crescent Societies and the International Committee of Red Cross or as health representatives from the
WHO. International disaster or relief workers generally have very intense training and preparation
before embarking on a mission.
Psychological Stress of Disaster Workers:
Psychological stress among victims, as well as workers, during disasters is well-documented. The degree
of worker stress depends "on the nature of the disaster, role in the disaster, individual stamina, and other
environmental factors.
Environmental factors include noise, inadequate work space, physical danger, and stimulus overload,
especially being exposed to death and trauma. Other sources of stress may evolve from workers not
feeling they are doing enough to help, the burden of making life and death decisions, and the overall
change in living patterns.
When the nurse is from the same community in which disaster has struck, role conflict from
organizational chaos, including the organization being cut off from usual support systems, also causes
stress. Nothing has the potential for causing more stress and role conflict, however, than when the
disaster nurse worker is also a victim of the disaster. Anger and resentment may occur

Frustration and conflict may occur because the worker's needs may be totally inconsistent from the
family's and co-workers needs. Frustration and conflict also occur as a result of having left the disaster
site, when a real or perceived belief remains that much more could have been done. Issues or problems
that once seemed pressing may now seem trivial. Anger may set in as others present problems that seem
trivial compared with those that were faced by the victims left behind. Disaster workers may fantasize
about returning to the disaster site, where they perceive their actions to have been more appreciated than
at home or the office. Finally, mood swings are common and are part of a normal process to resolve
conflicting feelings. Feelings or actions that persist or that the worker perceives are interfering with
daily life should be dealt with by a trained mental health professional.
ROLE OF NURSE IN DISASTER RECOVERY
The role of the community health nurse in the recovery phase is as varied as in the preparedness and
response phases of a disaster. Flexibility remains an important component of a successful recovery
operation. Community cleanup efforts can incur a host of physical and psychological problems. For
example, 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 crowded. Community
health nurses must remain vigilant in teaching proper hygiene and making sure immunization records
are up to date.
Acute and chronic illnesses can be exacerbated by the prolonged effects of disaster. The psychological
stress of cleanup and moving can bring about feelings 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. In some cases, stress can lead to suicide and domestic abuse.
In addition, although most people eventually recover from disasters, mental distress may persist in these
valuable populations who continue to live in chronic adversity. Referrals to mental health professional
should continue as long as the need exists.
The nurse must also remain alert for environmental health hazards during the recovery phase of a
disaster. Home visits may lead the nurse to uncover situations such as a faulty housing structure.

Disaster nursing

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