This document discusses disasters, including definitions, types, phases and the role of nursing. It begins by defining a disaster according to the WHO and FEMA. It describes different types of natural disasters such as earthquakes, floods and volcanic eruptions. The three phases of a disaster are outlined as pre-impact, impact and post-impact. Nursing goals in each phase are summarized, including rapid assessment, triage and meeting physical and emotional needs. The overall goal of disaster nursing is achieving the best possible health outcomes for those affected.

1. Presented by:
J.Chozharajan
M.Sc Nursing
Community Health Nursing

3. Disaster occurrence is a global phenomenon. It can occur at
anywhere at any time. Disaster occurrence in any countries affects
its health and economic conditions. Most types of natural disaster
are apt to reoccur in the same areas or countries. Disaster cause
great harm to the existing infrastructure & threaten the future of
sustainable development. Furthermore with the changing
ecosystem, deforestation, misuse of land we have every reason to
believe that frequency of disasters such as floods, droughts will
increase in the coming decades.

4. There are many types of disasters such as
earthquakes, cyclones, floods, tidal waves, land slides,
volcanic eruptions, fires, snow storms, smog etc. Every
catastrophic event has its own special features. Some can
be predicted several hours or days before hand, as in the
case of cyclones or floods, others such as earthquakes
occur without warning.

5. According to W.H.O “A disaster can be defined
as any occurrence that causes damage, ecological
disruption, loss of human life, deterioration of health
& health services, on a scale sufficient to warrant an
extraordinary response from outside the affected
community or area.”

6. According to FEMA (Federal Emergency
Management Agency) “An occurrence of a severity
& magnitude that normally results in death, injuries
& property damage that cannot be managed through
the routine procedure & resources of government.

7. Disaster nursing can be defined as the adaptation
of professional nursing skills in recognizing &
meeting the nursing physical & emotional needs
resulting from a disaster. The overall goal of disaster
nursing is to achieve the best possible level of health
for the people & community involved in the disaster.

8. “Disaster nursing is the nursing practiced in a situation where
professional supplies, equipments, physical facilities & utilities are
limited or not available.”
Disaster alphabetically means:
D = destructions
I = incidents
S = sufferings
A = administrative, financial failure
S = sentiments
T = tragedies
E = eruption of communicable diseases
R = research program & its implications

9. In 2007 ,
Russia : explosion killed 38 person at coal mines,
after 2 month a similar explosion is near by town
killed 110 persons.
Pakistan: more than 200 people died due to
severe storms in Karachi.
Greece: fire accidents held's in ancient Olympic
sites around Athens, around 59 peoples are died.
Sudan: over 20 people died, 65 were injured and
100 of livestock were lost by flooding in central
Sudan.

10. California: wildfires burned more than 516000
acres in southern California. Seven died and
nearly 90 people were injured. over 5 lakh
people were forced to evacuate their
homes,2000 homes are destroyed.
Bangladesh: cyclone killed nearly 3500 people
in southern Bangladesh millions of people
were left homeless.

11. In India
Bhopal (1984): there was a chemical leak 2500
peoples were killed and 1500000were injured.
Gujarat(2001): earthquakes affects 21 districts
out of 25 districts near to totally destroyed.
They were more than 20000 death and
167000people were homeless.
Tamilnadu (2004): tsunami
Nepal(2015): Nepal earthquake (also known as
the Gorkha earthquake)killed more than 9,000
people and injured more than 23,000.

12.  India’s geo-climatic conditions as well as
its high incidence of poverty and socio-
economic vulnerability make the country
among the most vulnerable to natural disasters
in the world.
 Disasters strike the country with regular
frequency, causing massive human and
economic losses.

13.  Along with the large-scale disasters such as the
earthquakes in Gujarat &Jammu & Kashmir, Tsunami
in South India, cloudburst and flash-floods in
Uttarakhand, a very large number of smaller disasters
have serious impaction the population.
 Among the disasters which strike the country on a
regular basis are floods, earthquakes, cyclones,
landslides, avalanches, droughts, forest fire, etc.

15. Disasters are classified in various ways,
on the basis of its origin/cause.
1. Natural disasters
2. Man-made disasters
And On the basis of speed of onset,
1. Sudden onset disasters
2. Slow onset disasters

16. A serious disruption triggered by a natural
hazard . Natural hazards can be classified
according to their,
(1) hydro meteorological,
(2) geological
(3) biological origins.

17. Hydrometer logical disaster – Natural processes or
phenomena of atmospheric hydrological or oceanographic
nature.
Examples :
 Cyclones,
 typhoons,
 hurricanes,
 tornados,
 Storms,
 hailstorms,
 snowstorms,
 cold spells,
 heat waves and
 droughts.

18. Geographical disaster – Natural earth processes
or phenomena that include processes of endogenous
origin or tectonic or exogenous origin such as mass
movements, Permafrost, snow avalanches.
Examples :
 Earthquake,
 tsunami,
 volcanic activity,
 Mass movements landslides,
 Surface collapse,
 geographical fault activities etc.

19. Biological Disaster – Processes of organic organs or
those conveyed by biological vectors, including
exposure to pathogenic, microorganism, toxins and
bioactive substances.
Examples –
 Outbreaks of epidemics Diseases,
 plant or animal contagion and
 extensive infestation etc.

20.  Rotating, funnel-shaped clouds from powerful
thunderstorms
 Winds up to 300 MPH capable of producing
major damage
 More occur in the United States than anywhere
else in the world; they occur in every state in
America.

22.  Massive severe storms occurring in the tropics
 Winds greater than 75 MPH
 Clouds & winds spin around the eye
 Produce heavy rains, high winds, large waves,
and spin-off tornadoes.

24.  More than 500 active volcanoes in the
world; over half in the Ring of Fire
 Pressure builds below the earth’s surface
producing eruptions of lava, rock, and
volcanic gases.

25.  Result from heavy rains
 May involve rivers overflowing, storm
surge/ocean waves, & dams or levees breaking
 Most common natural hazard
 Flashfloods -floods that happen very fast

26.  Form as a result of earthquakes, volcanoes, or
landsides under the ocean
 Waves grow taller as they reach the coast
 Four out of Five occur in the Ring of Fire
 Over 200,000 people killed in the 12/26/04
Indian Ocean tsunami.

28.  Occur in forests, grasslands, and wooded areas
 Most common causes: lightning and human
accidents
 Burn more than 4 million acres in the U.S.
each year.

29. A serious disruption triggered by a human-
induced hazard causing human, material,
economic or environmental losses, which exceed
the ability of those affected to cope.
These can be classified into –
(1) Technological Disaster and
(2) Environmental Degradation.

30. Technological disaster – Danger associated with technological or
industrial accidents, infrastructure failures or certain human activities
which may cause the loss of life or injury, property damage, social or
economic disruption or environmental degradation, sometimes
referred to as anthropological hazards.
Examples include:
 industrial pollution,
 nuclear release and radioactivity,
 toxic waste,
 dam failure,
 technological accidents (explosions fires spills).
.

31. Environmental Degradation – Processes induced by human
behaviors and activities that damage the natural resources base
on adversely alter nature processes or ecosystems
Examples include:
 land degradation,
 deforestation,
 wild land fire,
 loss of biodiversity,
 land, water and air pollution
 climate change,
 sea level rise and
 ozone depletion

32.  Disaster are often characterized by their
cause.
 Although the major disaster sometimes
occurs without any injury or loss of life .
 Disaster are commonly characterized by
their of casualties involved.
1.Multiple casualty incident
2.Mass casualty incident.

33. If the casualties number more than two people but
fewer than 100 people, the disaster is characterized as a
Multiple casualty incident. The health care system of small
or mid-sized communities.
2.Mass casualty incident:
It involving 100 or more casualties often completely
overwhelms the resources of even large cities.
E.g.:
Terrorist attack in New York city caught 1000 of
civilians unaware. they were trapped in buildings were
trapped in buildings with limited escape route and very
little time to retreat to safety.

34. Agent
EnvironmentHost

35. The agent is the natural or technological element
that causes the disaster
For example: volcano's, radiation, industrial chemical,
bombs etc.
Host factor:
The host is the human beings who experiences the
disaster. It includes age, general health, mobility,
psychological factors and even socio-economic
factors.
For example: elderly residents of a mobile home
community may be unable to evacuate independently
in response to a tornado warming.

36. 1.Physical factor: weather condition, availability of food
and water, utilities such as electricity and telephone
services.
2.Chemical factor: leakage of stored chemical into air,
soil, ground water or food supplies.
3.Biological factor: contaminated water, improper waste
disposal, improper food storage, insects and rodents
proliferations.
4.Social factor: loss of family members, changes in
roles.

37. 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.”

38. The overall goal of disaster nursing is to
achieve the best possible level of health for the
people and the community involved in the disaster.
Other goals of disaster nursing are the following:
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.

39. 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.

40. 1. RAPID ASSESSMENT of the situation and of
nursing care needs.
2. TRIAGE AND INITIATION of life-saving measures
first.
3. THE SELECTED use of essential nursing
interventions and the elimination of nonessential
nursing activities.
4. ADAPTATION of necessary nursing skills to
disaster and other emergency situations. The nurse in
dealing with a lack of supplies, equipment, and
personnel.
5. EVALUATION of the environment and the
mitigation or removal of any health hazards.

41. 6. PREVENTION of further injury or illness.
7. LEADERSHIP in coordinating patient triage,
care, and transport during times of crisis.
8. THE TEACHING, supervision, and utilization
of auxiliary medical personnel and volunteers.
9. PROVISION OF UNDERSTANDING,
compassion, and emotional support to all victims
and their families.

42. There are three phases of disaster,
1. Pre-Impact Phase
2. Impact Phase
3. Post – Impact Phase

43. It is the initial phase of disaster, prior to the
actual occurrence. A warning is given at the
sign of the first possible danger to a community
with the aid of weather networks and satellite
many meteorological disasters can be
predicted.
Communication is a very important factor
during this phase; disaster personnel will call
on amateur radio operators, radio and television
stations.

44. 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 group.

45. The impact phase occurs when the disaster
actually happens. It is a time of enduring
hardship or injury end of trying to survive.
The impact phase may last for several
minutes (e.g. after an earthquake, plane crash
or explosion.) or for days or weeks (eg in a
flood, famine)

46. The impact 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 healthcare providers to staff shelters.

47. Every shelter has a nurse as a member
of disaster action team. The nurse is
responsible for psychological support to
victims in the shelter.

48. 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 (e.g. – victims of the atomic bomb of
Hiroshima). The victims of disaster in go through four
stages of emotional response.
1. Denial – during the stage the victims may deny the
magnitude of the problem or have not fully registered.
The victims may appear usually unconcerned.

49. 2. Strong Emotional Response – in the second stage, the
person is aware of the problem but regards it as
overwhelming and unbearable. Common reaction during
this stage is trembling, tightening of muscles, speaking with
the difficulty, weeping heightened, sensitivity, restlessness
sadness, anger and passivity. The victim may want to retell
or relieve 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 effect to solve them. It is important for victims
to take specific action to help themselves and their families.

50. 4. Recovery – The fourth stage represent a
recovery from the crisis reaction. Victims feel
that they are back to normal. A sense of well-
being is restored. Victims develop the realistic
memory of the experience.

51. 1. Prevention phase
2. Preparedness phase
3. Response phase
4. Recovery phase

52.  No disaster is expected or anticipated.
 To identify the community risk factors.
 To develop and implement to prevent disaster from
occurring.
 Task focus representatives from the community,
local government, health care provides, social services
provides, police and fire departments, major
industries, local media and citizen group.

53.  It involves improving community and
individual reaction and responses
 It saves lives and minimizes injuries and
property damage.
 It includes plan for (CERT)
communication,evacuation,rescue and
treatment.

54.  Respond in period immediately after a disaster
 Assist emergency response personnel when requested
 CERT members’ first responsibility is personal and
family safety
 Respond after a disaster:
◦ Locate and turn off utilities, if safe
◦ Extinguish small fires
◦ Treat injuries
◦ Conduct light search and rescue
◦ Help to relieve survivor stress

56.  Advanced first aid
 Animal issues in disasters
 Automated External Defibrillator (AED) use
 Community relations
 CPR skills
 Debris removal
 Donations management
 Shelter management
 Special needs concerns
 Traffic/crowd control
 Utilities control
 Online courses

57.  It begins immediately after the onset of the
disaster events.
 It deals immediately with the goals of
saving lives and preventing further injury or
damage.
 At the disaster site police, fire-fighters,
nurse and other relief workers develop a
coordinated response to :

58. 1. Rescue
2. Triage
3. Immediate treatment and support
4. Care of dead bodies and
notifications of families.

59.  It is typically belongs to fire fighters with special
training in search and rescue persons.
 Usually the immediate disaster site is not the
best place for the disaster nurse.
 Nurses are more effective in triage and treatment
of victims.
 The need of medical professionals was at the
local hospitals, not at the disaster site.

60. Meaning :
The word triage is derived from the French word
trier, which means, “to sort out or choose.”
The Baron Dominique Jean Larry, who was the
Chief Surgeon for Napoleon, is credited with
organizing the first triage system.

61. “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, 1992).
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.
(Auf der Heide, 2000).

62. 1. Inadequate resource to meet immediate needs
2. Infrastructure limitations
3. Inadequate hazard preparation
4. Limited transport capabilities
5. Multiple agencies responding
6. Hospital Resources Overwhelmed

63. 1. To sort patients based on needs for immediate care
2. To recognize futility
3. Medical needs will outstrip the immediately
available resources
4. Additional resources will become available given
enough time.

64. The main principles of triage are as follows:
1. Every patient should receive and triaged by
appropriate skilled health-care professionals.
2. Triage is a clinic-managerial decision and
must involve collaborative planning.
3. The triage process should not cause a delay
in the delivery of effective clinical care.

65. 1. Helps to bring order and organization to a chaotic scene.
2. It identifies and provides care to those who are in greatest
need
3. Helps make the difficult decisions easier
4. Assure that resources are used in the most effective
manner
5. May take some of the emotional burden away from those
doing triage.

66. There are two types of triage:
1. Simple triage
2. Advanced triage

67.  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.

68.  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 four groups:
0 – The deceased 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 need help less
urgently.

69.  In advanced triage, doctors may decide that some
seriously injured people should not receive advanced
care because they are unlikely to survive.
 Advanced care will be used on patients with less
severe injuries. Because treatment is intentionally
withheld from patients with certain injuries, advanced
triage has an ethical implication.
 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.

70. · “Do the greatest good for the greatest
number”
· Preservation of life takes precedence over
preservation of limbs.
· Immediate threats to life: HEMORRHAGE.

71. Red(emergent)
immediate
Yellow(urgent)
Within 30min to 2
hours
Green(non-urgent)
wait for more than
2 hours
White(minor)
dismiss
Black(dead)

72.  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.

73.  Disaster nurses provide immediate
treatment at the mobile field hospitals in
shelter, local hospitals and clinics.
 Disposable items might be in short supply
requiring resterilization procedure that may be
unfamiliar to a nurse not accustomed to a field
of work, even to experience nurse because of
the field of an environment.

74.  The nurses also manage the provision or
distribution of food and beverages including
infant formulas, and rehydration of fluids, safe
sanitation facilities.
 The nurse often must also arrange for
psychological and spiritual care of victims in
disaster.

75.  Identification and transport of the dead to a
morgue or holding facility are crucial,
especially of contagion is feared.
 Toe tags make documentation visible and
accessible .
 Records of death must be made and
maintained .
 The family members should be notified of their
loved ones death quickly and compassionately as
possible.

76. Disaster doesn't suddenly end when the
rubble is cleared and the victims wounds are
healed.
It often includes:
1. Long term treatment
2. Physical rehabilitation
3. Financial restitution
4. Psychological and spiritual support
5. Long term support
6. Need for self care.

77. 1. primary prevention : participate in developing
disaster management plan for the community.
2.Secondary prevention: assess the disaster
victims and triage for a care.
3.Teritary prevention: participate in home visits
to uncover danger that may cause additional
injury to victims or instigate other problems.
For example: house fires from faulty wiring.

78. 1.Nurse as first responder
2.Nurses as epidemiologists
3.Nurse as communicator
4.Nurse in action

79.  The nurse is the first to arrive on the scene.
 Once the rescue workers begin to arrive at the
scene plan for triage should begin immediately.
 Although valued for their expertise in community
assessment, care findings, and referring, and working
with the aggregates.

80.  Detecting the outbreak
 Determine the cause
 Identify factor that place people at risk
 Implementing measures to control outbreak
 Informing the medical and public communities
about treatment.

81.  Nurse working as a member of an assessment
team need to return accurate information to
relief managers to facilitate rapid rescue and
recovery.
 Lack of or inaccurate information regarding the
scope of the disaster .
 The objective in emergency communication are
to identify and respond to the barriers or re-
establish trust.

82.  Determine the magnitude of the event.
 Define health needs of affected group.
 Establishes priorities and objectives.
 Collaborate with other professional,
governmental and non-governmental
agencies.
 Maintain unified chain of command.

83.  Ethical and legal issues, and decision making
 Care principles
 Nursing care
 Needs assessment and planning
 Safety and security
 Communication and interpersonal
relationships(what to report & whom)
 Public health
 Health care systems and policies in emergency
situations

84.  Basic life support (BLS)
 Infection control
 Mental and psychological support
 Working with damaged facilities and
damaged equipment.
 Working with the team.
(WHO, 2008)

85. 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

86. 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.

89.  Identification bandage
 Copy of nurse license
 Packet size reference book
 Blood pressure cuff(adult & paediatric)
 Stethoscope
 Mouth-to-mouth CPR barrier
 Certification updates for CPR & first aid

90.  First aid kit
 Sun protection
 Steady shoes
 Emergency phone numbers
 Wear appropriate clothing
 Watch, cell phone
 Flash light
 Medications
 Map of the area

92. International organizations:
 International Association of Emergency Managers
 International Recovery Platform
 Red Cross/Red Crescent
 Baptist Global Response
 United Nations
 European Union

93. National organizations:
Australia -Emergency Management in Australia
Germany- The Federal Government controls the German
India,
The National Disaster Management Authority
The National Institute of Disaster Management
The National Disaster Management Authority
The Indian Armed Forces
Aniruddha's Academy of Disaster Management (ACDM)
is a non-profit organization in Mumbai, India with 'disaster
management' as its principal objective.

94. New Zealand
 National Crisis Management Centre (NCMC),
 Ministry of Civil Defence & Emergency
Management (MCDEM)
Russia
 The Ministry of Emergency Situations (EMERCOM)
is engaged in fire fighting, civil defense, and search
and rescue after both natural and human-made
disasters.
The Netherlands
 The Ministry of Security and Justice

95.  NGOs are organizations registered under various
Indian laws such as the Societies Registration Act,
1860, Section 25(1) of Companies Act, 1956 meant
for non-profit companies, or State-specific Public
Charitable Trust Acts.
 NGOs work on a variety of areas like
humanitarian assistance, sectorial development
interventions and sustainable development.
 NGOs play important roles in different stages of
the Disaster Management Cycle.