Chapter 28Natural and Man-Made DisastersCopyright © 2015, .docx

Chapter 28
Natural and Man-Made Disasters
Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders,
an imprint of Elsevier Inc.
Disaster Definitions
A disaster is any event that causes a level of destruction, death,
or injury that affects the abilities of the community to respond
to the incident using available resources.
Mass casualty involves 100+ individuals
Multiple casualty involves 2 to 99 individuals
Casualties can be classified as a direct victim, indirect victim,
displaced person, or refugee
2
Types of Disasters
Natural disasters
Man-made disasters
Combination disasters
NA-TECH (natural/technological) disaster: a natural disaster
that creates or results in a widespread technological problem
3

Types of Disasters (Cont.)
(from Textbook, Box 28-1)
Natural Disasters
Avalanches
Blizzards
Communicable disease epidemics
Droughts, wildfires
Earthquakes, tsunamis
Hailstorms
Heat waves
Hurricanes
Tornados, cyclones
Volcanic eruptions
Man-Made Disasters
Terrorism
Civil unrest (riots)
Explosions, bombings
Fires
Structural collapse (bridges)
Airplane crashes
Toxic or hazardous spills
Mass transit accidents
Pollution
Wars
4

Acts of Terrorism
Terrorism is
“the unlawful use of force and or violence against persons or
property to intimidate or coerce a government, the civilian
population, or any segment thereof, in furtherance of political
or social objectives.” (FBI, 2013)
“is premeditated, politically motivated violence perpetrated
against noncombatant targets by sub-national groups or
clandestine agents.” (CIA, 2013)
5
Weapons of Mass Destruction
Any weapon that is designed or intended to cause death or
serious bodily injury through release, dissemination, or impact
of toxic or poisonous chemicals, or their precursors
Any weapon involving a disease organism (biological agents)
Any weapon that is designed to release radiation or
radioactivity at a level dangerous to human life (chemical
agents)
6
Characteristics of Disasters
Frequency

Predictability
Preventability/mitigation
Imminence
Scope and number of casualties
Intensity
7
Prevention in Disasters
Primary prevention
Aimed at preventing the occurrence of a disaster or limiting the
consequences when the event itself cannot be prevented
(mitigation)
Nondisaster stage: period before a disaster occurs
Predisaster stage: actions taken when a disaster is pending
8
Prevention in Disasters (Cont.)
Nondisaster activities include:
Assessing communities to determine potential disaster hazards
Developing disaster plans at local, state, and federal levels
Conducting drills to test the plan
Training volunteers and health care providers
Providing educational programs of all kinds
Developing risk maps and resource maps

9
Predisaster activities include:
Notification of the appropriate officials
Warning the population
Advising what response to take
voluntary or mandatory evacuation
10
Secondary prevention
Implemented once the disaster occurs
Aimed at preventing further injury or destruction
“Safety before search and rescue.”
11

Tertiary prevention
Focuses on recovery and restoring the community to previous
levels of functioning and its residents to their maximum
functioning
Aimed at preventing a recurrence or minimizing the effects of
future disasters through debriefing meetings to identify
problems with the plan and making revisions
12
Nurses Need to …
… be involved in all stages of prevention and related activities
… educate others about disasters and how to prepare for and
respond to them
… keep up to date on latest recommendations and advances in
life-saving measures
13
Questions Nurses Should Ask
What kind of disasters threaten the communities where I live?
What injuries should I expect from different disaster scenarios?
What are the evacuation routes?
Where are shelters located?
What warning systems are used so I can respond effectively,
personally, and professionally during different types of
disasters?

14
Disaster Management
A collaborative interdisciplinary team effort is needed between
a network of agencies and individuals.
Develop a disaster plan.
Communities can respond more quickly, more effectively, and
with less confusion.
Ensures that resources are available.
Delineates roles and responsibilities of all personnel and
agencies, both official and unofficial.
15
Governmental Responsibilities
Local government (first responders)
Responsible for the safety and welfare of its citizens.
State government (Office of Emergency Management)
Involved when a disaster overwhelms the local community’s
resources.
Federal government (Department of Homeland Security and
CDC)
A single department focusing on protecting the American people
and their homeland

16
U.S. Department of Homeland Security (DHS)
DHS has three primary missions:
Lead the unified national effort to secure America
Prevent and deter terrorist attacks
Protect against and respond to threats and hazards to the nation
DHS goal (2011):
Sets the “vision for nationwide preparedness”
Identifies the core capabilities and targets necessary to achieve
preparedness across five mission areas: Prevention, Protection,
Mitigation, Response, and Recovery.
17
NIMS
NIMS (National Incident Management System) provides a
systematic, proactive approach for all levels of governmental
and nongovernmental agencies to work seamlessly to prevent,
protect against, respond to, recover from, and prevent the
effects of disasters.
– Federal Emergency Management Agency (FEMA) (2012)
18

FEMA
Mission is to support citizens and first responders to ensure
that, as a nation, everyone works together to build, sustain, and
improve the capacity to prepare for, protect against, respond to,
recover from, and mitigate all hazards.
Established National Terrorism Advisory System
Threat alert: elevated or imminent threat
FEMA published in-depth guide for citizen preparedness: Are
You Ready?
19
Partnerships in Disasters
Department of Homeland Security (DHS)
Federal Emergency Management Agency (FEMA)
Department of Health and Human Services/ Centers for Disease
Control and Prevention
Public Health System (PHS)
American Red Cross (ARC)
Other local, state, and federal agencies
20
Disaster Management Stages
Prevention stage
Preparedness and planning stage
Response stage
Recovery stage

21
Prevention Stage
Identify potential disaster risks.
Create risk maps
Educate citizens regarding what actions to take to prepare for
disasters.
Individual, family, and community level
Develop a plan for meeting the potential disasters identified.
Create resource maps
22
Community Risk Map
(from Textbook, Figure 28-1)
23
Community Resource Map
(from Textbook, Figure 28-2)

24
Preparedness/Planning Stage:
Individual and Family Preparedness
Training in first aid
Assembling a disaster emergency kit
Establishing a predetermined meeting place away from home
Making a family communication plan
25
Preparedness/Planning Stage:
Community Disaster Planning
Plans must include:
Authority
Communication
Logistical coordination of:
Supplies and equipment
Human resources
Evacuation and rescue
Plans must be dynamic and change as needed.
Plans must be tested in different disaster scenario drills.
26

Disaster Planning Principles
(from Textbook, Box 28-8)
Measures usually taken are not sufficient for major disasters.
Plans should be adjusted to people’s needs.
Planning does not stop with development of a written plan.
Lack of information causes inappropriate responses by
community members.
People should be able to respond with or without direction.
Plans should coordinate efforts of the entire community, so
large segments of the citizenry should be involved in the
planning.
Plans should be linked to surrounding areas.
Plans should be general enough to cover all potential disaster
events.
As much as possible, plans should be based on everyday work
methods and procedures.
27
Disaster Planning Principles (Cont.)
(from Textbook, Box 28-8, Cont.)
Plans should specify a person’s responsibility for implementing
segments by position or title rather than by name.
Plans should develop a record-keeping system before a disaster
occurs, regarding:
Supplies and equipment
Records of all present at any given time (to account for
everyone and to identify the missing)
Identification of victims and deceased, conditions and treatment
documented, and to which facility victims are sent

Backup plans need to be in place for the following:
Disruption of telephone and cell phone lines
Disruption of computer data (should be downloaded weekly and
stored off site)
28
Response Stage
Response stage begins immediately after the disaster incident
occurs.
May include:
Shelter in place
Evacuation
Search and rescue
Staging area
Disaster triage
29
Areas of Operation in Disaster Response
30
Figure 28-3

Disaster Triage
START triage system
“Simple Triage And Rapid Treatment”
Used in multicasualty or mass casualty incident
Triage of injured person should occur in less than 1 minute
based on:
Respirations
Perfusion
Mental status
Uses people with minor injuries to assist
Person is tagged with a colored triage tag
Victims moved to the treatment area
31
START Color-Coded Triage Tag
Green = walking wounded
Yellow = systemic but not yet life-threatening complications
Red = life-threatening conditions that can be stabilized and have
a high probability of survival
Black = deceased or injuries so extensive that nothing can be
done to save them
Hazmat tag = contaminated
32
Figure 28-4
Source: http://www.mettag.com.
Reprinted with permission.

Psychological Triage
Four keys to gauging mental health impact:
Extreme and widespread property damage
Serious and ongoing financial problems
High prevalence of trauma in the form of injuries, threat to life,
and loss of life
When human intent caused the disaster
In addition, panic during the disaster, horror, separation from
family, and relocation or displacement may play a part
33
Public Health Activities
While search and rescue is going on …
Surveil for threats (e.g., contaminated water, vectors, and air
quality).
Disseminate data on what has been found.
Relate health information to officials, the media, and the public
as appropriate.
Gather epidemiological information.
Allocate resources and work to prevent further adverse health
problems.
34
Responses to Disasters
Community
Heroic phase
Honeymoon phase

Disillusionment phase
Reconstruction phase
Individual
Cognitive
Emotional
Physical
Behavioral
PTSD
35
Recovery Stage
Begins when the danger from the disaster has passed.
All local, state, and federal agencies are present in the area.
Help victims rebuild their lives
Restore public services
Cleanup of damage and repair begins
Evaluation and revision of the disaster plans
Understand the financial impact
36
Chapter 22
Homeless Populations

1
Recent Efforts to Count Homeless
Homeless Information Management System (HMIS)
Directed by Congress to gather homeless data
Continuum of Care (CoC) concept
One-night point-in-time (PIT) count
Annual estimate based on reports of service use
A “snapshot” picture of the homeless population
National Alliance to End Homelessness (NAEH) and Housing
and Urban Development (HUD)
U.S. Conference of Mayors
2
2
Defining Homelessness
ETHOS perspective: Home has three domains:
Physical—adequate dwelling for which a person/family has
exclusive possession
Social—being able to maintain privacy and enjoy relations
Legal—having exclusive possession, security of occupation, and
legal title to occupation
ETHOS = European Typology of Homelessness and Housing
Exclusion
– European Federation of National Associations

Working with the Homeless (2011)
3
Defining Homelessness (Cont.)
ETHOS Types of Living Situations
Rooflessness
Houselessness
Insecure housing
Inadequate housing
4
Defining Homelessness (Cont.)
Canadian Homelessness Research Network (2012) defined four
major categories based on ETHOS:
Unsheltered
Emergency sheltered
Provisionally accommodated
At risk of homelessness
5
HUD Legal Definitions in the United States
Category 1. Literally Homeless. Individuals and families who
lack a fixed, regular, and adequate nighttime residence and
includes a subset for an individual who resided in an emergency
shelter or a place not meant for human habitation and who is

exiting an institution where he or she temporarily resided
6
HUD Legal Definitions in the United States (Cont.)
Category 2. Imminent Risk of Homeless. Individuals and
families who will imminently lose their primary nighttime
residence
Category 3. Homeless Under Other Federal Statutes.
Unaccompanied youth and families with children and youth who
are defined as homeless under other federal statutes who do not
otherwise qualify as homeless under this definition
7
HUD Legal Definitions in the United States (Cont.)
Category 4. Fleeing/Attempting to Flee Domestic Violence
(DV). Individuals and families who are fleeing, or are
attempting to flee, domestic violence, dating violence, sexual
assault, stalking, or other dangerous or life-threatening
conditions that relate to violence against the individual or a
family member.
– U.S. Department of Housing and Urban Development,
Office of Community Planning and Development (December 5,
2011)
8
Definition of Homeless Student
McKinney-Vento Homeless Education Assistance Improvements

Act of 2001 ensures that each child and each homeless youth
has equal access to the same free, appropriate public education,
including a public preschool education, as provided to other
children and youths.
Includes children and youth who are:
Sharing the housing of other persons (frequently referred to as
“doubling up”)
Abandoned in hospitals
Awaiting foster care placement
– U.S. Department of Education (2001)
9
DHHS Definition of Homelessness
Runaway Youth is “. . . a person under 18 years of age who
absents himself or herself from home or place of legal residence
without the permission of his or her family”
Homeless Youth is “. . .a person under 18 years of age who is in
need of services and without a place of shelter where he or she
receives supervision and care”
– U.S. Department of Health and Human Services,
Administration for Children & Families, Family and Youth
Service Bureau (2012)
10
Prevalence of Homelessness
Point-In-Time (PIT) count of sheltered homeless people on a
single night in late January of every year and submit this data to
HUD—use data to prepare an Annual Homeless Assessment
Report (AHAR)
Department of Education includes youth and families for

services through Education for Homeless Children and Youth
(ECHY) program
Conference of Mayors’ Hunger & Homelessness Survey gathers
data for their cities each year
11
12
Table 22-1PIT Estimates of Homeless People January
2012 PopulationSheltered & Unsheltered Single Night
January 2012ChangeYearsHouseholdsIndividuals394,379-
6.8%2007-2012Families with children239,403-3.7%2007-
2012Total 633,782-5.7%2007-
2012SubpopulationsVeterans62,619-17.2%2009-
20123Chronically homeless99,894-19.3%2007-2012Estimates of
Homelessness, Retrieved September 2013 from
http://abtassociates.com/CMSPages/GetFile.aspx?guid
=77fdb6fa-6e6b-4524-8b5a-8e68c68caca9.
We would be wise . . . to avoid the numbers game. Any search
for the “right number” carries the assumption that we may at
last arrive at an acceptable number. There is no acceptable
number. Whether the number is 1 million or 4 million . . . there
are too many homeless people in America.
– Kozol (1988)
13
13

Demographic Characteristics
Based on Jan 2010-2011 reports on homeless:
More men than women
Women head up more single families
Younger than general population
Minorities were overrepresented
Disability rate twice that of all families
Veterans were primarily male
– U.S. Department of Housing and Urban Development,
Office of Community Planning and Development (2008)
14
14
Factors That Contribute to Homelessness
Shortage of affordable housing
Income insufficient to meet basic needs
Inadequate and scarce support services
Note: Factors contribute to homelessness rather than cause
homelessness.
15
HHS Homeless Services
Federally Qualified Health Centers (FQHC) and FQHC Look-A-

Likes
Provide services to generally underserved populations (low
income)
Health Care for the Homeless
Provide primary health care and substance abuse services to
homeless populations
16
Health Status of Homeless Adults
Homeless population experience morbidity rates that are higher
than those occurring in comparable groups in the general
population.
Acute physical health problems (including respiratory and
trauma)
Chronic disorders and poor dentition
Mental illness and minor emotional problems
Alcohol and drug use
17
Health Status: Homeless Women
Higher rates of pregnancy (often unintended) with higher
preterm births and low-birth-weight infants
More stressful life events, foster care as children, IPV as adults,
hospitalization for psychiatric issues
History of violence from childhood to adulthood
High risk for physical and sexual victimization
Women veterans:

Being unemployed, disabled, or unmarried strongly predict
homelessness
Many report history of military sexual trauma
18
Health Status: Homeless Families
Histories of chronic physical and mental health conditions,
substance abuse, victimization, and low education and job
training of adults are also risk factors for compromised
caregiver-child relations
Impact on children:
Affect children’s educational achievements
Risk of nonacceptance or teasing
19
Health Status: Homeless Youth
Unintended pregnancy
STDs, physical/sexual abuse, skin disorders, anemia,
drug/alcohol abuse, unintentional injuries
Depression; suicidal ideation; disorders of behavior,
personality, or thought
Family disruption; school failures; prostitution or “survival
sex”; involvement with the legal system

Social health severely compromised
20
Homeless adolescents experience health problems from high-
risk behaviors at higher rates than the general adolescent
population.
Chronically Homeless
Unaccompanied adults who are homeless for extended or
numerous periods and have one or more disabling conditions
Disabling conditions are often severe mental and substance use
disorders
Biological, psychological, and social health is rarely addressed
21
Framework for C/PHN
Based on principles of Social Justice, the framework
emphasizes Upstream Thinking in addressing the SDH (Social
Determinants of Health) factors contributing to homelessness.
The interventions (from the Intervention Wheel) identified
reflected macro-upstream factors and more micro-downstream
condition of individuals and families experiencing
homelessness.
- Nies & McEwen (2015)

22
Models of Justice
Market justice system
Dominant model
Belief that people are entitled to valued ends (i.e., status,
income, and happiness) according to their own individual
efforts
Stresses individual responsibility, minimal collective action,
and freedom from collective obligations other than respect for
another person’s fundamental rights
Results in a downstream approach to problems
23
Models of Justice (Cont.)
Social justice system
Belief that all people are equally entitled to key ends (e.g.,
access to health care and minimum standards of income)
Says all members of society must accept collective burdens to
provide a fair distribution of these ends
A foundational aspect of public health
Supports upstream thinking
24

Social Determinants of Health
Circumstances in which people are born, grow up, live, work
and age, and the systems put in place to deal with illness. These
circumstances are in turn shaped by a wider set of forces:
economics, social policies, and politics.
– World Health Organization Commission
on the Social Determinants of Health (2013)
25
Social Determinants of Health (Cont.)
Healthy People 2020
New goal: to “Create social and physical environments that
promote good health for all”
New topic area: Social Determinates of Health (SDH)
26
Social Determinants of Health (Cont.)
Five broad dimensions of SDH are defined within Healthy
People 2020 as:
Economic Stability
Education
Social and Community Context
Health and Health Care
Neighborhood and Built Environment

27
Table 22-2
http://www.healthypeople.gov/2020/about/DOHAbout.aspx
28Social Determinants of Health and Factors Contributing to
HomelessnessHealth People 2020 Social Determinant of Health
Dimensions and Key IssuesFactors Contributing to
HomelessnessEconomic StabilityPovertyIncome Insufficiency
Employment StatusIncome InsufficiencyAccess to
EmploymentIncome InsufficiencyHousing Stability (e.g.,
homelessness foreclosure) Shortage of Affordable
HousingHealth and Health CareAccess to Health services—
including clinical and preventive careInadequate and Scarcity of
Supportive ServicesAccess to Primary Care—including
community-based health promotion and wellness
programsInadequate and Scarcity of Supportive Services
Public Health Intervention Wheel
C/PH Nurses, working downstream with individuals, families,
or groups use surveillance, disease, and other health event
investigation, outreach, screening, case finding, referral and
follow-up, case management, delegated functions, health
teaching, counseling, and consultation.
C/PH Nurses working more upstream, at the system level,
employ collaboration, coalition building, community
organizing, advocacy, social marketing and policy development,
and enforcement.
29

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