Faculty at Department of Medical Surgical Nursing, ESIC CON
Dec. 8, 2017

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  2. Introduction: India’s geo-climatic conditions as well as its high degree of socio-economic vulnerability, makes it one of the most disaster prone country in the world. A disaster is an extreme disruption of the functioning of a society that causes widespread human, material, or environmental losses that exceed the ability of the affected society to cope with its own resources. Disasters are sometimes classified according to whether they are “natural” disasters, or “human-made” disasters. For example, disasters caused by floods, droughts, tidal waves and earth tremors are generally considered “natural disasters.” Disasters caused by chemical or industrial accidents, environmental pollution, transport accidents and political unrest are classified as “human-made” or “human induced” disasters since they are the direct result of human action.
  3.  ‘DISASTER’ alphabetically means: D - Destructions I - Incidents S - Sufferings A - Administrative, Financial Failures. S - Sentiments T - Tragedies E - Eruption of Communicable diseases. R - Research programme and its implementation
  4. Definitions:  A disaster can be defined as any occurrence that cause damage, ecological disruption, loss of human life, deterioration of health and health services, Vs a scale sufficient to warrant as extraordinary response from outside the affected community or area. (W.H.O.) An occurrence of a severity and magnitude that normally results in death, injuries and property damage that cannot be managed through the routine procedure and resources of government. - FEMA (Federal Emergency Management Agency)
  5. Contd..  Disaster is an event or series of events, which gives rise to casualties and damage or loss of properties, infrastructures, environment, essential services or means of livelihood on such a scale which is beyond the normal capacity of the affected community to cope with. Disaster is also sometimes described as a “catastrophic situation in which the normal pattern of life or eco-system has been disrupted and extra-ordinary emergency interventions are required to save and preserve lives and or the environment”.
  6. Contd…. 2.The Disaster Management Act, 2005 defines disaster as “a catastrophe, mishap, calamity or grave occurrence in any area, arising from natural or man made causes, or by accident or negligence which results in substantial loss of life or human suffering or damage to, and destruction of, property, or damage to, or degradation of, environment, and is of such a nature or magnitude as to be beyond the coping capacity of the community of the affected area”. .The United Nations defines disaster as “the occurrence of sudden or major misfortune which disrupts the basic fabric and normal functioning of the society or community”
  7. TYPES OF DISASTER:  Disasters can take many different forms, and the duration can range from an hourly disruption to days or weeks of ongoing destruction.– both I.NATURAL II.MAN-MADE
  8. Natural Types of Disasters •Agricultural diseases & pests •Damaging Winds •Drought and water shortage •Earthquakes •Emergency diseases (pandemic influenza) •Extreme heat •Floods and flash floods •Hail •Hurricanes and tropical storms •Landslides & debris flow •Thunderstorms and lighting •Tornadoes •Tsunamis •Wildfire •Winter and ice storms •Sinkholes
  9. Earthquake
  10. Damaging Winds
  12. HAIL
  14. FLOOD
  15. Emergency diseases (pandemic influenza)
  19. CONTD..
  21. CONTD..
  23. Tornadoes
  26. CONTD…
  28. CONTD..
  29. Man-Made and Technological Types of Disasters •Hazardous materials •Power service disruption & blackout •Nuclear power plant and nuclear blast •Radiological emergencies •Chemical threat and biological weapons •Cyber attacks •Explosion •Civil unrest
  31. CONTD..
  35. IMPACT OF DISASTER  Impact of natural disaster in the last 30 years. Ø Death of 3 million people Ø Economic loss increased due to disaster like flood Ø In Indian scenario, 34jmijlion people affected per year and 5116 death per year. Ø In US, economic loss is 400 million dollar and 3 million people died.
  36. The Symptoms related to Trauma Produced by disaster usually occurs in Five Phases.  a. Impact Phase: It includes event itself and is characterized by shock, extreme b. Heroic Phase: Characterized by co-operative spirit exist between friends, neighbor and emergency teams. Constructive activity at this time can help to overcome feelings of anxiety and depression. c. The honeymoon phase: It begins to appear one week to several months after the disaster, the need to help others is sustained, and the money, resources and support received from varying agencies allow life to begin again in the community. d. Disillusionment phase: It last from two months to one year._ A time of disappointment, resentment, frustration and anger. Victims often begin to compare their neighbors with their own and may start to resent or show hostility towards others. e. Reconstruction and reorganization phase: In this individual recognize that they must adjust with their own problems. They begin to rebuild their homes, business and lives in cons
  38.  Disaster impact and response Medical treatment for large number of casualties is likely to be needed only after certain types of disaster. Most injuries are sustained during the impact, and thus, the greatest need for emergency care occurs in the first few hours. The management of mass casualties can be further divided into search and rescue, first aid, triage and stabilization of victims, hospital treatment and redistribution of patients to other hospitals if necessary.
  39.  Search, rescue and first aid After a major disaster, the need for search, rescue and first aid is likely to be so great that organized relief services will be able to meet only a small fraction of the demand. Most immediate help comes from the uninjured survivors. Field care Most injured persons converge spontaneously to health facilities, using whatever tansport is available, regardless of the facilities, operating status. Providing proper care to casualties requires, that the health service resources be redirected to this new priority. Bed availability and surgical services should be maximized. Provisions should be made for food and shelter. A centre should be established to respond to inquiries from patient's relatives and friends. Priority should be given to victim's identification and adequate mortuary space should be provided. Triage (5) When the quantity and severity of injuries overwhelm the operative capacity of health facilities, a different approach to medical treatment must be adopted. The principle of "first come, first treated", is not followed in mass emergencies
  40.  Tagging All patients should be identified with tags stating their name, age, place of origin, triage category, diagnosis, and initial treatment. Identification of dead Taking care of the dead is an essential part of the disaster management. A large number of dead can also impede the efficiency of the rescue activities at the site of the disaster. Care of the dead includes : (1) removal of the dead from the disaster scene; (2) shifting to the mortuary; (3) identification; (4) reception of bereaved relatives. Proper respect for the dead is of great importance. The health hazards associated with cadavers are minimal if death results from trauma and corps are quite unlikely to cause outbreaks of disease such as typhoid fever, cholera or plague. If human bodies contaminate streams, wells, or other water sources as in floods etc., they may transmit gastroenteritis or food poisoning to survivors. The dead bodies represent a delicate social problem. Relief phase This phase begins when assistance from outside starts to reach the disaster area. The type and quantity of humanitarian relief supplies are usually determined by two main factors : (1) the type of disaster, since distinct events have different effects on the population, and (2) the type and quantity of supplies available locally. Immediately following a disaster, the most critical health supplies are those needed for treating casualties, and preventing the spread of communicable diseases. Following the initial emergency phase,
  41.  Disasters can increase the transmission of communicable diseases through following mechanisms : 1. Overcrowding and poor sanitation in temporary resettlements. This accounts in part, for the reported increase in acute respiratory infections etc. following the disasters. 2. Population displacement may lead to introduction of communicable diseases to which either the migrant or indigenous populations are susceptible. 3. Disruption and the contamination of water supply, damage to sewerage system and power systems are common in natural disasters. 4. Disruption of routine control programmes as funds and personnel are usually diverted to relief work. 5. Ecological changes may favour breeding of vectors and increase the vector population density.
  42.  Vaccination (5) Health authorities are often under considerabie public and political pressure to begin mass vaccination programmes, usually against typhoid, cholera and tetanus. The pressure may be increased by the press media and offer of vaccines from abroad.  Nutrition A natural disaster may affect the nutritional status of the population by affecting one or more components of food chain depending on the type, duration and extent of the disaster, as well as the food and nutritional conditions existing in the area before the catastrophe.
  43.  There are three fundamental aspects of disaster management: a. disaster response ; b. disaster preparedness ; and c. disaster mitigation.
  44.  Rehabilitation The final phase in a disaster should lead to restoration of the pre-disaster conditions. Rehabilitation starts from the very first moment of a disaster. Too often, measures decided in a hurry, tend to obstruct establishment of normal conditions of life. A provision by external agencies of sophisticated medical care for a temporary period has negative effects. On the withdrawal of such care, the population is left with a new level of expectation which simply cannot be fulfilled. In first weeks after disaster, the pattern of health needs, will change rapidly, moving from casualty treatment to more routine primary health care. Services should be reorganized and restructured. Priorities also will shift from health care towards environmental health measures. Some of them are as follows:
  45.  Water supply A survey of all public water supplies should be made. This includes distribution system and water source. It is essential to determine physical integrity of system components, the remaining capacities, and bacteriological and chemical quality of water supplied. The main public safety aspect of water quality is microbial contamination. The first priority of ensuring water quality in emergency situations is chlorination. It is the best way of disinfecting' water. It is advisable to increase residual chlorine level to about 0.2-0.5 mg / litre. Low water pressure increases the risk of infiltration of pollutants into water mains. The existing and new water sources require the following protection measures : (1) restrict access to people and animals, If possible, erect a fence and appoint a guard; (2) ensure adequate excreta disposal at a safe distance from water source; (3) prohibit bathing, washing and animal husbandry, upstream of intake points in rivers and streams; (4) upgrade wells to ensure that they are protected from contamination
  46.  Food safety Poor hygiene is the major cause of food-borne diseases in disaster situations. Where feeding programmes are used (as in shelters or camps) kitchen sanitation is of utmost importance. Personal hygiene should be monitored in individuals involved in food preparation. Basic sanitation and personal hygiene Many communicable diseases are spread through faecal contamination of drinking water and food. Hence, every effort should be made to ensure the sanitary disposal of excreta. Emergency latrines should be made available to the displaced, where toilet facilities have been destroyed. Washing, cleaning and bathing facilities should be provided to the displaced persons. Vector control Control programme for vector-borne diseases should be intensified in the emergency and rehabilitation period, especially in areas where such diseases are known to be endemic. Of special concern are dengue fever and malaria (mosquitoes), leptospirosis and rat bite fever (rats), typhus (lice, fleas), and plague (fleas). Flood water provides ample breeding opportunities for mosquitoes.
  47. NURSE’S ROLE IN DISASTER MANAGEMENT  Definitions of Disaster Nursing Disaster Nursing can be defined as the adaptation of professional nursing skills in recognizing and meeting the nursing physical and emotional needs resulting from a disaster. 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.  “Disaster Nursing is nursing practiced in a situation where professional supplies, equipment, physical facilities and utilities are limited or not available”.
  48. Nurse along with the health team needs to utilize primary health care intervention in acute emergencies as follows:- · Nursing Management · Immunization and preventive health · Management of diarrheas and dehydration. · Management of acute respiratory infections. · Setting up a health information system. · Safe drinking water supply. · Sanitation. · Training and support for health workers. · Other basic services. In addition to above the following psychosocial intervention are provided by the nurses: · Crises intervention / counseling · Group work · Telephone contact services. · Disaster response managements · Health education · Community services like facilitation of self help groups etc.
  49. Community measures in DisasterA nurse should be the part of the team for disaster planning. a. Community Participation: It is the process by which individuals, families and communities assume the responsibility of promoting their own health and welfare. The community heath nurse maintains the link between professional group pf experts in disaster management and community. b. Mock trails/training: The training of various inter-disciplinary forces like school children, voluntary organizations can be imparted by community health nurse and her team, c. Mass awareness: The community should have the knowledge of all the Channel communication system, stand by equipment supplies and other resources; otherwise disaster preparedness will be failure. d. Education: Mass awareness through media, booklets, panel discussion, films and televisions information is very essential.
  50. Basic community Education should incorporate the following essentials: a. Setting up the first aid post b. Causality evaluation c. Basic hygiene and sanitation d. Safety measures e. Maintenance of food and water supply f. Maintenance of law and order. g. Provision of shelters h. Rescue streaming i. Significance of traffic control and communication j. Use of fire services k. Hazards of radiation and preventive measures l. Prevention of future disasters. m. Grant in aid n. Rehabilitation
  51. CONCLUSION Disasters are of different types which can happen any time ,any where, in the world causing tremendous after effects such as loss of human life ,economical imbalances, food scarcity epidemics , forced relocation of population etc. Disasters usually affect the developing countries comparing with the developed countries. While deserting the matter we could come to the conclusion that the adverse effects of natural disasters can be minimized by proper preventive measures alert technologies at high risk areas, proper mobilization of resources, decreased corruption in the field and also the mock training programmes in the community.
  52. BIBLIOGRAPHY  1.Park K;PREVENTIVE AND SOCIAL MEDICINE;2005;18th edn;Jabalpur;Banarsidas Bhanot publishers;pp 600-605 2.Alexander,David;PRINCIPLES OF EMERGENCY PLANNING AND MANAGEMENT;2002;harpenden;Terra publishing;pp 1- 1036. 3.Haddow,George D;Jane A Bullock;INTRODUCTION TO EMERGENCY MANAGEMENT;Amsterdam;Butterworth- Heinemann;pp 6-194. 4.WHO;COPING WITH NATURAL DISASTERS,THE ROLE OF LOCAL HEALTH PERSONNEL AND THE COMMUNITY;1989;WHO publishing;pp 10-225. 5.Maxy,R,Last;PUBLIC HEALTH AND PREVENTIVE MEDICINE;1992;13th edn;Massattussette;Mosby Inc;pp214-268. 6.WHO;COMMUNITY EMERGENCY PREPAREDNESS A MANUAL FOR MANAGERS AND POLICY MAKERS;1999;2nd edn;Geneva;WHO;pp 3-331. JOURNALS 1.Walker,Peter;International search and rescue teams,A league discussion paper;geneva;League of the Red Cross and Red Crecent societies;28:37:1998. 2.Singh J;72 hours kits,an article from home security guru;Indian Journal of public health;20:43:2002. Web sites