Introduction

Disasters have been integral parts of the human experience since the beginning of time, causing premature death, impaired quality of life, and altered health status. The risk of a disaster is ubiquitous. On average, one disaster per week that requires international assistance occurs somewhere in the world. The recent dramatic increase in natural disasters, their Intensity, the number of people affected by them, and the human and economic losses associated with these events have placed an imperative on disaster planning for emergency preparedness. Global warming, shifts in climates, sea-level rise, and societal factors may coalesce to create future calamities. Finally, war, acts of aggression, and the incidence of terrorist attacks are reminders of the potentially deadly consequences of man’s inhumanity toward man.

Definitions

WHO defines Disaster is any occurrence that causes damage, ecological disruption. loss of human life, deterioration of health and health services, on a scale sufficient to warrant an extraordinary response from outside the affected community or area.
Disaster may also be termed as “a serious disruption of the functioning of society, causing widespread human, material or environmental losses which exceed the ability of the affected society to cope using its own resources.

Thus, a disaster may have the following main features

  • Unpredictability
  • Unfamiliarity
  • Speed
  • Urgency
  • Uncertainty
  • Threat

Types  of disaster

  • Natural disasters
  • Man-made disasters

Natural Disasters

A serious disruption triggered by a natural hazard (hydro-metrological or biological in origin) causing human, material, economic or environmental losses, which exceed the ability of those affected to the cape.

  1. Floods
  2. Earthquakes
  3. Cyclones
  4. Tsunamis
  5. Droughts
  6. Blizzards
  7. Tornadoes
  8. Land slide
  9. Heat waves

Man-made disasters (Human-Induced Disasters)

A serious disruption triggered by a human-induced hazard causing human, material, economic or environmental losses. which exceeds the ability of those affected to cope. These can be –

  1. The Bhopal gas release and
  2. The nuclear accident are two examples of a man-made disaster.
  3. Forest fires (initiated by man) may be another example.

Disaster – Nursing Definition

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.”

Goals of disaster nursing

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.
  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.

Principles of disaster nursing

The basic principles of nursing during special (events) circumstances and disaster conditions include

  • Rapid assessment of the situation and of nursing care needs
  • Triage and initiation of life-saving measures first.
  • The selected use of essential nursing interventions and the elimination of nonessential nursing activities.
  • Adaptation of necessary nursing skills to disaster and other emergency situations. The nurse must use imagination and resourcefulness in dealing with a lack of supplies, equipment, and personnel.
  • Evaluation of the environment and the mitigation or removal of any health hazards.
  • Prevention of further injury or illness.
  • Leadership in coordinating patient triage, care, and transport during times of crisis.
  • The Teaching, supervision, and utilization of auxiliary medical personnel and volunteers.
  • Provision of understanding, compassion, and emotional support to all victims and their families.

Health effect of disaster

  • Disasters may cause premature deaths, illnesses. and injuries in the affected community. generally exceeding the capacity of the local health care system.
  • Disasters may destroy the local health care infrastructure, which will therefore be unable to respond to the emergency. Disruption of routine health care services and prevention initiatives may lead to long-term consequences in health outcomes in terms of increased morbidity and mortality.
  • Disasters may create environmental imbalances, increasing the risk of communicable diseases and environmental hazards.
  • Disasters may affect the psychological, emotional, and social well-being of he population in the affected community. Depending on the specific nature of the disaster, responses may range from fear, anxiety, and depression to widespread panic and terror.
  • Disasters may cause shortages of food and cause severe nutritional deficiencies. Disasters may cause large population movements (refugees) creating a burden on other health care systems and communities. Displaced populations and their host communities are at increased risk for communicable diseases and the health consequences of crowded living conditions.

Disaster Management Cycle

The disaster event

This refers to the real-time event of a hazard occurring and affecting the ‘elements at risk’. The duration of the event will depend on the type of threat, for example, ground shaking may only occur for a few seconds during an earthquake while flooding may take place over a longer period of time.

There are five basic phases to a disaster management cycle (Kim & Proctor, 2002), and each phase has specific activities associated with it.

Evaluation/development

Often this phase of disaster planning and response receives the least attention. After a disaster, employees and the community are anxious to return to usual operations. It is essential that a formal evaluation be done to determine what went well (what really Worked) and what problems were identified. A specific individual should be charged with the evaluation and follow-through activities.

Mitigation

These are steps that are taken to lessen the impact of a disaster should one occur and can be considered as prevention and risk reduction measures. Examples of mitigation activities include installing and maintaining backup generator power to mitigate the effects of a power failure or cross-training staff to perform other tasks to maintain services during a staffing crisis that is due to a weather emergency.

Preparedness/risk assessment

Evaluate the facility’s vulnerabilities or propensity for disasters. Issues to consider include: weather patterns; geographic location; expectations related to public events and gatherings: age, condition, and location of the facility; and industries in close proximity to the hospital (e.g. nuclear power plant or chemical factory).

Triage

The word triage is derived from the French word trier, which means, “to sort out or choose.”

  • The Baron Dominique Jean Larrey, who was the Chief Surgeon for Napoleon, is credited with organizing the first triage system.
  • “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).

Types of Triage

There are two types of triage:

  1. Simple triage
  2. Advanced triage

Simple triage

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 hos and those with less serious injuries.

Advanced triage

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.

Response

The response phase is the actual implementation of the disaster plan. The best response plans use an incident command system, are relatively simple, are routinely practiced, and are modified when improvements are needed. Response activities need to be continually monitored and adjusted to the changing situation.

Activities a hospital, healthcare system, or public health agency take immediately during and after a disaster or emergency occurs.

Recovery

Once the incident is over, the organization and staff need to recover. Invariably, services have been disrupted and it takes time to return to routines. Recovery Is usually easier if, during the response, some of the staff have been assigned to maintain essential services while others were assigned to the disaster response.
Activities are undertaken 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

MAJOR ROLES OF NURSE IN DISASTERS

  1. Determine magnitude of the event
  2. Define health needs of the affected groups
  3. Establish priorities and objectives
  4. Identify actual and potential public health problems
  5. Determine resources needed to respond to the needs identified
  6. Collaborate with other professional disciplines, governmental and non-governmental agencies
  7. Maintain a unified chain of command
  8. Communication

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