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This document provides an overview of a lecture on disaster nursing. It begins with introducing the speakers and objectives of the lecture. The bulk of the document then defines disasters and different types. It discusses the health impacts of various natural disasters like hurricanes, tornadoes, floods, earthquakes, and volcanoes. The document also covers disaster phases, the role of nursing in disasters, and argues that disaster nursing training needs to be incorporated into nursing education programs globally. It promotes using an online "Supercourse" to disseminate disaster nursing education materials worldwide.
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- 1. DISASTER NURSING GOLDENLECTURE Kawkab Shishani, RN, PhD Community Health Nursing Kawkab.shishani@gmail.com Jordan Richard Garfield, RN, DrPH Director WHO/PAHO Collaborating Center School of Nursing, Columbia University in the City of New York Nicolas Padilla, MD Universidad de Guanajuato Mexico Ronald LaPorte, PhD Director Telecommunications and Disease Monitoring; WHO Collaborating Center University of Pittsburgh June 8, 2009
- 2. NURSES AND EDUCATION Education is the most powerful weapon which you can use to change the world. Nelson Mandela
- 3. MISSION STATEMENT Disasters are a primary cause of morbidity and mortality. Nurses can play an important role in disaster mitigation, but they receive very little training. This lecture is designed to help to introduce to nursing the concepts of disasters and disaster mitigation. We propose that you teach this lecture to your nursing students to build awareness world wide.
- 4. OBJECTIVES 1. Definea disaster 2. Discuss patterns of mortality and injury 3. Understand impact of disasters on health 4. Describe the factors that contribute to disasters severity 5. Discuss role of nursing in disasters 6. Apply principles of triage in disaster 7. Analyze the WHO components of effective disaster nursing
- 5. WHAT IS DISASTER Is a result of vast ecological breakdown in the relation between humans and their environment, as serious or sudden event on such scale that the stricken community needs extraordinary efforts to cope with outside help or international aid.
- 6. TYPES Natural Pandemics Transportation Technological Terrorism
- 7. HURRICANES Theprimary health hazard from hurricanes or cyclones lies in the risk of drowning from the storm surge associated with the landfall of the storm. Most deaths associated with hurricanes are drowning deaths. Secondarily, a hazard exists for injuries from flying debris due to the high winds. Nurses can be instrumental in providing direct emergency care to drowning and head injuries.
- 8. TORNADOES Theprimary hazard from a health perspective in a tornado is the risk for injuries from flying debris. The high winds and circular nature of a tornado leads to the elevation and transport of anything that is not fastened down. Most victims of tornadoes are affected by head and chest trauma due to being struck by debris or from a structural collapse. Some individuals are injured while on the ground. Others are lifted into the air by the tornado and dropped at another location.
- 9. FLOODS Floodsmay originate very quickly following a quick rain storm, or they may develop over a short period following an extended period of rain or quick snow melt The primary hazard from flooding is drowning Longer term health concerns from flooding is the development of disease from contaminated water and lack of hygiene.
- 10. EARTHQUAKES Asignificant global concern The primary health concern: • Injuries arising from structural collapse • Most injuries occur amongst individuals trapped at the time of the earthquake Well known prevention strategy is to prevent buildings from collapsing There is a recognized need to develop better rescue strategies for retrieving individuals from collapsed buildings
- 12. VOLCANOES Rare,but can be catastrophic when they occur Over the 25 year period (1972-1996), there was an average of 6 eruptions per year, causing an average of 1017 deaths and 285 injuries Health outcomes are associated with volcanic eruptions: • Respiratory illnesses from the inhalation of ash • For individuals close to the volcano, some danger exists from lava flows, or more likely mud flows
- 15. VULNERABILITIES, NEEDS, AND ABILITIES VARY
- 16. 0 1000000 2000000 3000000 4000000 5000000 6000000 7000000 8000000 9000000 10000000 1900 1905 1910 1915 1920 1925 1930 1935 1940 1945 1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000 Conflict Natural Disasters
- 18. MAN-MADE THREAT UnpredictableChallenges Disruptive Unexpected Targeting weaknesses Very rare, impossible to conceive before event Threats to Civilians, Information Infrastructure
- 19. COMPONENTS OF DISASTERDEBRIS Building Debris Household Debris Vegetative Debris Problem Waste Streams
- 20. MYTHS ASSOCIATED WITH DISASTERS Any kind of assistance needed in disasters A response not based on impartial evaluation contributes to chaos Epidemics and plagues are inevitable after every disaster Epidemics rarely ever occur after a disaster Dead bodies will not lead to catastrophic outbreaks of exotic disease Proper resumption of public health services will ensure the public’s safety (sanitation, waste disposal, water quality, and food safety) Disasters bring out the worst in human behavior The majority responses spontaneous and generous The community is too shocked and helpless Cross-cultural dedication to common good is most common response to natural disasters
- 21. PATTERNS OF MORTALITYAND INJURY Disaster events that involve water are the most significant in terms of mortality Floods, storm surges, and tsunamis all have a higher proportion of deaths relative to injuries Earthquakes and events associated with high winds tend to exhibit more injuries than deaths The risk of injury and death is much higher in developing countries – at least 10 times higher because of little preparedness, poorer infrastructure.
- 22. DISPLACEMENT OF DISASTER VICTIMS Mass Shelters Shelter management: • Organized team (chain) • Sleeping area and necessities • Water and food handling • Sanitation (toilets, showers,..) • Special care to children and elderly • Health services (physical, mental)
- 23. DISASTER AND HEALTH In a major disaster water treatment plants, storage & pumping facilities, & distribution lines could be damaged, interrupted or contaminated. Communicable diseases outbreak due to: Changes affecting vector populations (increase vector), Flooded sewer systems, The destruction of the health care infrastructure, and The interruption of normal health services geared towards communicable diseases
- 24. DISASTER AND HEALTH Injuries from the event Environmental exposure after the event (no shelter) Malnutrition after the event (feeding the population affected) Excess NCD mortality following a disaster Mental health (disaster syndrome)
- 25. MENTAL WELLNESS Little attention is paid to the children Listen attentively to children without denying their feelings Give easy-to-understand answers to their questions In the shelter, create an environment in which children can feel safe and secure (e.g. play area)
- 26. MENTAL WELLNESS In any major disaster, people want to know where their loved ones are, nurses can assist in making links. In case of loss, people need to mourn: • Give them space, • Find family friends or local healers to encourage and support them • Most are back to normal within 2 weeks • About1% to 3%, may need additional help
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- 28. THE PHASES OFDISASTER Mitigation: Lessen the impact of a disaster before it strikes Preparedness: Activities undertaken to handle a disaster when it strikes Response: Search and rescue, clearing debris, and feeding and sheltering victims (and responders if necessary). Recovery: Getting a community back to its pre-disaster status
- 29. MITIGATION Activitiesthat reduce or eliminate a hazard Prevention Risk reduction Examples Immunization programs Public education
- 30. PREPAREDNESS Activitiesthat are taken to build capacity and identify resources that may be used Know evacuation shelters Emergency communication plan Preventive measures to prevent spread of disease Public Education
- 31. RESPONSE Activitiesa hospital, healthcare system, or public health agency take immediately before, during, and after a disaster or emergency occurs
- 32. RECOVERY Activitiesundertaken by a community and its components after an emergency or disaster to restore minimum services and move towards long-term restoration. Debris Removal Care and Shelter Damage Assessments Funding Assistance
- 33. WHAT IS TRIAGE? French verb “trier” means to sort Assigns priorities when resources limited Do the best for the greatest number of patients
- 34. WHY IS DISASTERTRIAGE NEEDED Inadequate resource to meet immediate needs Infrastructure limitations Inadequate hazard preparation Limited transport capabilities Multiple agencies responding Hospital Resources Overwhelmed
- 35. ADVANTAGES OF TRIAGE Helps to bring order and organization to a chaotic scene. It identifies and provides care to those who are in greatest need Helps make the difficult decisions easier Assure that resources are used in the most effective manner May take some of the emotional burden away from those doing triage
- 36. WHO DECIDES INTRIAGE 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.
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- 38. HEALTH WORKER DENSITYBY REGION 2.3 2.6 4.2 6.9 8.7 9.9 10.3 0.8 0 2 4 6 8 10 12 S ub - S aharan Af r ic a As ia S &C e nt ral Ame r ic a G lo b al M id d le E as t We s t e rn P ac if ic No r t h Ame r ic a E uro p e Workers per 1,000 population
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- 41. ROLE OF NURSINGIN DISASTERS Disaster preparedness, including risk assessment and multi-disciplinary management strategies at all system levels, is critical to the delivery of effective responses to the short, medium, and long-term health needs of a disaster-stricken population. International Council of Nurses (2006)
- 42. NURSES’ ROLES INDISASTERS Determine magnitude of the event Define health needs of the affected groups Establish priorities and objectives Identify actual and potential public health problems Determine resources needed to respond to the needs identified Collaborate with other professional disciplines, governmental and non-governmental agencies Maintain a unified chain of command Communication
- 43. COMMUNICATION IS ASUCCESS KEY Nursing organizations must have a comprehensive and accurate registry for all members Have a structured plan: • Collaborate and coordinate with local authorities • Have a hotline 24x7 • Inform nurses where to report and how (keep records) • Make sure have a coordinator to prevent chaos • Ensure ways to maintain communication between nurses and their families
- 44. THE NEED FORDISASTER NURSING TRAINING 11 million nurses world wide: • Form the backbone of the health care system • Are the frontline health care workers who are in direct contact with the public • Contribute to health of individuals, families, communities, and the globe Schools of nursing offer little or no information on disaster nursing (WHO, 2008) Shortage of trained instructors/faculty (WHO, 2008)
- 45. CORE COMPETENCIES INDISASTER NURSING TRAINING Ethical and legal issues, and decision making; Care principles; Nursing care; Needs assessment and planning; Safety and security; Communication and interpersonal relationships; Public health; and Health care systems and policies in emergency situations (WHO, 2008)
- 46. TOPICS THAT MUSTBE COVERED BY DISASTER NURSING TRAINING Basic life support System and planning for settings where nurses work Communications (what to report and to whom) Working in the damaged facilities and with damaged equipment Safety of clients and practitioners Working within a team (understand each member’s role and responsibility) Infection control Mental and psychosocial support (WHO, 2006)
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- 48. BUILDING DISASTER NURSING SUPERCOURSE
- 49. BUILDING DISASTER NURSING SUPERCOURSE
- 50. BUILDING DISASTER NURSING SUPERCOURSE
- 51. “Most ofall, if gains in health and nutrition during emergencies are to be sustained, graduates need to understand the importance of capacity building of national staff and institutions.” Salama et al, Lessons Learned from Complex Emergencies
- 52. DISASTER NURSING SUPERCOURSE o To join the Nursing Supercourse, please visit www.pitt.edu/~super1 or e-mail super2@pitt.edu. o Membership in the Global Health Network Supercourse will allow you to receive free Supercourse CDs, just in time lecture, and annual prevention lectures o Note: “send this lecture to a friend” button works from PowerPoint slide show mode
- 53. More information This lecture is available at: http://www.pitt.edu/~super1/lecture/lec35051/index.htm Please fee free to e-mail at: kawkab.shishani@gmail.com
Editor's Notes
- #4 Over the past few decades, disasters have been on the rise. Millions of people have been affected, lost homes and family members, or displaced. No one is immune against disasters. However, what makes a difference is the degree of preparedness. Nurses are the largest health care professional group, yet, they are not well prepared for disasters. Disasters pose threats to physical as well psychosocial wellbeing. Nurses view health as a state of physical and psychosocial wellbeing. In this context nurses who receive disaster training can contribute significantly in disaster mitigation both at ground zero and throughout the country. This lecture intends to provide basic information on disasters and describe nurses’ roles in disaster management on the three levels of prevention. There are millions of nurses, and many thousands of nursing schools that teach nothing on disasters –especially in places exposed to continuous natural disasters. The teachers at these countries are in need for teaching material on disaster management. A Nursing Supercourse will empower faculty members and instructors at nursing schools world wide by providing them with state of art ready to teach lectures on disaster management.
- #6 Noji: www.pitt.edu/~super7/20011-21001/20351.ppt
- #7 Nurses are the main health professionals in touch with the community. They have exceptional knowledge of the most vulnerable populations, and this information can be immediately used in a disaster. Nursing recognizes the physical and the psychosocial impact of disasters on well being of individuals, families and community. Nurses deal not only with the physical stresses of a disaster, but potentially more importantly the fear, dangers, stress and uncertainties of disasters. Nurses in disasters provide support and help the public in regain confidence in rebuilding their lives and living through hard times. Understanding and finding a meaning to suffering helps in healing and in reducing impact on physical health.
- #8 Songer: www.pitt.edu/~epi2170/lecture15/sld001.htm
- #9 Nurses can save lives and reduce public's fear and assist in mitigation measures such as equipped shelters. Nurses play key roles in disaster preparedness. Nurses can help in initiating or updating emergency plans at their work settings as well as being knowledgeable about the disasters that their areas are vulnerable to. Nurses can inform the public about the shelters available in the area and the importance of having an emergency family plan especially when there are family members who have special health needs.
- #10 Nurses play a key role as preventionists in assisting in maintenance of proper sanitation measures, proper control of vector populations, and control of infectious disease through public education.
- #11 Head and chest injuries and fractures are common in earthquake victims. Nurses poses clinical skills that can save lives when they assist in searching and retrieving trapped individuals. Also the injury rate is high for first responders, and nurses can play a major role in protecting the rescue teams. In fact all rescue teams should have at least one nurse.
- #12 The column to the left demonstrates that people who live in lower middle income countries are at higher risk of being exposed to earthquakes. The column to the right confirms that the same countries have higher death rates compared to other countries. Nurses in these countries need to take leadership role and be actively involved in planning and implementing national preventive strategies. Deans of schools of nursing should ensure that curricula provide sufficient training and that nursing graduates are competent and posses necessary critical skills.
- #14 La Porte: www.bibalex.org/Supercourse/SupercoursePPT/21011-22001/21601.ppt This slide indicates that there has been almost a doubling in the rates of natural disasters. This could be due to: improved reporting, and/or the major increase in populations living in dangerous areas. This alerting trend mandates increase in level of preparedness among health care workers. Nurses are in frontline and are trained to provide emergency direct care to individuals under normal conditions. Disasters result in massive causalities and responsiveness can be often challenging. Under such critical circumstances nurses can be more effective when receive adequate training in preparedness and responding to disasters.
- #15 The increase in number of disasters has been accompanied by increase in numbers of people affected. Consequences of disasters include: displacement, losing employment and income, physical and mental health disabilities. Therefore, responding to the needs requires working as a team. Multidisciplinary teams serve a wide range of affected populations. Nurses are often under estimated when dealing with disasters. This lecture demonstrates that nurse involvement in disaster management can be beneficial at local, national and international level. Vulnerable populations such as people with chronic health conditions are in great danger in disasters due to the risk of occurrence of an acute critical event. Individuals with chronic conditions, e.g. cardiovascular disease, diabetes, renal failure, etc. need to be monitored and have their health conditions managed with care.
- #16 The circles demonstrate overlapping the concentration of water emergencies. More money means more abilities which means that responses to disasters are improving. Higher risk of water events means more need. How well a country is organized determines the level of vulnerability, hence the importance of preparedness and training for nurses.
- #17 Deaths per year have actually declined over the long period, these data are from Centre for Research on the Epidemiology of Disasters. There are fewer conflicts, and the conflicts have a smaller number of deaths, but this is only an accounting of battle deaths.
- #18 Asia is at higher risk for disasters and Africa for complex emergencies. Connolly A, Gayer M, Ryan M, Salama P, Spiegel P, Heyman D. Communicable diseases in complex emergencies: impact and challenges. The Lancet, 364, 9449: 1974 – 1983, 2004
- #19 We need to focus on each of the components of man-made threats. The Supercourse model has done this as evidenced with Natural, Asymmetric attacks. Supercourse has significant number of lectures specific disaster focus. Shortly after the building of the Supercourse we realized that it had exceptional potential in the area of disasters. We had the idea if a disaster were to occur we could rapidly develop a network of people from out network interested in helping and to develop a Just-in-Time (JIT) lecture. This was established by: Rapid Contact of Expert Supercourse Network Lecture Created by Experts with Vetting Rapid JIT Development of Customized lectures Rapid Dissemination Continuously updated learning as crisis enfolds With the same vision, building Nursing Supercourse can serve faculty at schools of nursing well by empowering them with an innovative educational teaching model. Chotani RA, LaPorte RE, Linkov F, Dodani S, Ahmed D, Ibrahim KM. Just-in-time lectures: SARS. Lancet. 2003 Jun 7;361(9373):1996 La Porte: www.supercourse.cn/SupercoursePPT/29741.ppt
- #20 Severe injuries can be caused by disaster debris. Clean up of debris is the authorities responsibility but nurses can assume the role of educators by increasing public’s awareness to hazards of debris and precautionary measures to protect their own and their families safety. Nurses also a major role in long term mitigation such as with land minds or rebuilding.
- #21 Noji: www.pitt.edu/~super7/20011-21001/20351.ppt
- #22 Knowing the patterns of mortality and injuries associated with particular disasters can be most beneficial when providing training. This can result in effective preparedness and ensure better outcomes. It is important to bring this to the attention of nurses in developing counties especially that their countries at higher risk for disasters and causalities.
- #23 Immediate response is mostly concerned with saving lives and eliminating immediate threats. However, what is substantial too is working with survivors with minimal or no physical injuries. These groups are usually displaced in shelters to meet their survival needs. Survivors vary according to age groups or health conditions. These shelters are expected to work in a systematic way to ensure high performance. Lay professional volunteers can assume the role of organizing and management of the shelter. Nurses can be spared for other important tasks such as taking care of the affected people, assessing their health conditions and any special needs and use the available resources to attend to these health needs. Nurses can be responsible for establishing mental services, counseling and providing social support especially that under such circumstances people need to make meaning of what happened and how to adjust in order to be able to continue their lives. Pediatric nurses have the most burden because children unlike other populations need to have an outlet for their energy, have their own ways of understanding and coping to unusual conditions. Community/public health nurses can serve vulnerable populations during a disaster and assist communities in recovery. This requires expansion of their knowledge by providing state of art training in disaster preparedness.
- #24 Infection control is an important strategy in eliminating infectious diseases (e.g. cholera, etc.). Nurses receive training in infection control during their undergraduate or as part of continuing education. Public education about preventive strategies in times where water is contaminated can be a determinant factor in eliminating any epidemic.
- #25 Disasters consequences range between short and long-term. Effective assessment can establish the base for appropriate actions. This can serve well in lessening the burden of disaster and enhancement of coping. Nursing education acknowledges mental wellness by itself an outcome , however, it is also looked as the key for physical well being.
- #26 College of nursing, university of Hyogo: http://www.coe-cnas.jp/english/index.html
- #27 Everyone has a role identity in family and community; when they lose everything and are then taken care of with emergency assistance, they may be turned intopassive receivers and lose that role identity. We can help themrecover their sense of purpose and worth along with helping themexpress and process the loses.
- #28 Nurses assume multiple roles with different populations. Nurses are highly skilled health care workers trained to work with vulnerable groups. Therefore, they are essential team players in any emergency preparedness team.
- #29 Nursing can contribute to prevention, mitigation, preparedness, response, and recovery. Nurses work systematically by gathering data, planning according to priorities to target all who might benefit, working skillfully to promote health of the community, and evaluating the outcomes.
- #30 Keith: www.queens.edu/pdf/upload/nursing/
- #34 In triage causalities are categorized according to severity of injury. The color red requires immediate and quick attention because it means life threatening injury. On this level nurses focus on airway, breathing, and circulation and based on that decide the level of intervention needed. Triage aims to: To sort patients based on needs for immediate care To recognize futility Assumption: Medical needs will outstrip the immediately available resources Additional resources will become available given enough time
- #36 How Does Triage Manage Resources? By preventing the use of excessive resources on patients who are likely to die no matter what we do for them By preventing the use of excessive resources on patients who have minor injuries and require little to no treatment By focusing resources on those patients with severe injuries and high survivability rates
- #38 Worldwide nurses receive minimal training on disaster preparedness. The World Health Organization (WHO) report 2006 acknowledges that nurses lack knowledge and skills in disaster and recommends that nurses to be involved in planning, policy-making for disaster preparedness and response. Furthermore, WHO demonstrates that training nurses will have a great impact on risk reduction and response to a disaster. WHO (2006). The Contribution of nursing and midwifery in emergencies: report of a WHO consultation, WHO, Geneva. http://www.who.int/hac/events/2006/nursing_consultation_report_sept07.pdf
- #39 Nursing and midwifery densities across the Region are found in the slide. Note particularly low densities of each in PNG, Cambodia, etc, and also, what isn‘t apparent in the density table, rural/urban inequities, with nurses/midwives, other health professionals concentrated in urban areas.
- #40 Geography is modified by the relative size of the nursing population in these bubble charts. According to the size of the bubbles, there are more nurses in the developed countries.
- #41 Again, the bubbles size in this slide demonstrates that there are more resources and more nurses in the richer countries, but the majority of deaths due to disasters occurs in the poorer countries. So nurses are even more important in developing countries.
- #43 Nursing curricula, starting from the first year equip nurses with clinical skills to assess, plan, implement, and evaluate the health needs of individuals and groups. They also are trained to work in the context of team work. This workforce must be prepared for disaster management and integrated into each country’s national emergency team.
- #44 Nursing organizations have the responsibility of coordinating with the officials in having clear understanding in nurses' roles during disaster and taking all measures to speed nurses’ involvement in crisis times. Nurses can integrate into an existing team or lead one if there is not yet one on site. And document what they do for continuity with each patient, or record where the injured are sent.
- #45 World Health Organization (2008). Integrating Emergency Preparedness and Response into Undergraduate Nursing Curricula. Geneva, Switzerland
- #46 To build national and international capacity of nurses, the WHO proposed a set of competencies that are essential in disaster preparedness training program.
- #47 World Health Organization (2006). The contribution of nursing and midwifery in emergencies. Geneva, Switzerland
- #48 Question: What is the best way to improve global health and science training? Answer: Improve lectures. Question: How do we improve global health and science lectures: Answer: Faculty worldwide share their best PowerPoint lectures: Question: Will faculty share lectures? Answer: Yes, The Supercourse has 64.000 faculty from 172 countries who created an open source Library with 3500 lectures. We have collaborators from over 1200 medical and public health schools using our lectures. In the last 12 months we taught over 1 million students world wide.
- #51 Nursing Supercourse will serve as educational model for instructors at schools of nursing to ensure effective training of nurses worldwide in disaster management based on the competencies proposed by the World Health Organization. These competencies give a clear picture on the skills that are essential when preparing nurses for disaster management. Capacity building is the core of disaster management. Training of nurses can have significant impact on the degree of harm inflicted by disasters. Training will also expand the scope of practice and augment the role of other healthcare workers. Nursing Supercourse will also establish a solid foundation for building a global network of nurses before the disaster occurs, which would lead to much better coordination.
- #53 We, at the Nursing Supercourse project look forward to collaborating with you. So join us and let the one thousand mile journey start with this first step toward bringing together nurses in the world to promote healthier life on this planet.