BHARATI VIDYAPEETH (DEEMED TO BE UNIVERSITY)

COLLEGE OF NURSING, PUNE-43

F.Y.M.SC. NURSING
ADVANCE NURSING PRACTICE

NAME OF TOPIC: DISASTER MANAGEMENT

SUBJECT: ADVANCE NURSING PRACTICE

UNIT: UNIT 1

NAME OF PRESENTAOR: MS. LOMA R WAGHMARE

F.Y.MSC NURSING (MEDICAL SURGICAL NURSING
SPECIALITY) STUDENT,
BVDUCON, PUNE

NAME OF EVALUATOR: DR. BHAGESHREE JOGDEV

BVDU, PUNE

GROUP: F.Y.M.S.C NURSING

DATE: 16.12.20

TIME:

VENUE/ ONLINE ZOOM MEETING

MODE OF PRESENTATION:

AV AIDS: CHART/FLASH CARDS/PPT/ ONLINE

GENERAL OBJECTIVE:

AT THE END OF THE SEMINAR, THE STUDENTS WILL BE ABLE TO GAIN KNOWLEDGE
ON DISASTER MANAGEMENT AND WILL ABLE APPLY IN CLINICAL PRACTICE

SPECIFIC OBJEVTIES:

At the end of the seminar, the group will be able to,

1. Define Disaster
2. Enlist types of disaster
3. Describe the epidemiology of disaster
4. Describe the phases of disaster management
5. Enumerate the principles of disaster management
6. Discuss about the disaster management committee
7. Discuss about disaster nursing
8. Enlist the qualities of a nurse working in disaster management team
9. Discuss what is triaging
10. Explain the role of disaster management nurse with respect to the phases of
disaster management
 OUTLINE FOR SEMINAR

1. Definition of Disaster
2. Types of disaster
- Natural
- Man made
- Mix
3. The epidemiology of disaster
- Agent
- Environment
- Host
4. The phases of disaster management
- Preventive mitigation
- Preparedness
- Disaster
- Environmental response
- Rehabilitation and Reconstruction
5. The principles of disaster management
6. Disaster management committee
7. Introduction to Disaster Nursing
8. Qualities of a nurse working in disaster management team
9. Triaging
- Need of triage
- Color code
- Advantages
- Who will triage
- Tagging in triaging
10. Role of disaster management nurse with respect to the phases of disaster
management
11. Summary
12. Conclusion
13. Bibliography
INTRODUCTION:
DEFINITION:
1. Disaster is any occurrence that causes damage, ecological disruption, loss of human life or
deterioration of health and health services on a scale sufficient to warrant an extraordinary response
from outside the affected community or area. (WHO 1995)

2. 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)

3. A disaster can be defined as an occurrence either nature or man made that causes human
suffering and creates human needs that victims cannot alleviate without assistance.
- American Red Cross (ARC)

TYPES:
1. Natural
2. Man made
3. Mixed

MAN-MADE VS NATURAL DISASTER Unpredictable Unexpected Disruptive Target Dangerous

Casualties focused Difficult to management Sentiment and feeling Never ending

EPIDIMIOLOGY OF DISASTER:
1. AGENT
- Primary agents include falling buildings, heat, wind, rising water and smoke.
- Secondary agents include bacteria and viruses that produce contamination or infection after the
primary agent has caused injury or destruction.
2. HOST
- Human kind.
- Age, sex, immunization status, pre-existing health, degree of mobility, emotional stability,

3. ENVIRONMENT
- PHYSICAL FACTORS
- CHEMICAL FACTOR
- BIOLOGICAL FACTORS
- SOCIAL FACTORS
- PSYCHOLOGICAL FACTORS

PHASES OF THE DISASTER:

Fig 1: Phases of Disaster

 A. DISASTER MITIGATION:
Definition: Disaster mitigation refers to actions or measures that can either prevent the occurrence of a
disaster or reduce the severity of its effects. (American Red Cross).
Mitigation activities include awareness and education and disaster prevention measures.
Activities that reduce or eliminate hazard prevention and risk reduction
Examples like immunization programs and public education

B. DISASTER PREPAREDNESS:
Disaster preparedness refers to measures taken to prepare for and reduce the effects of disasters. That
is, to predict and, where possible, prevent disasters, mitigate their impact on vulnerable populations,
and respond to and effectively cope with their consequences. (International Red Cross)
Activities are undertaken to handle a disaster when it strikes.
Activities include
 Disaster Preparedness Plan
 Emergency communication plan
 Prevent spread of disease outbreak
 Public Education and awareness

C. DISASTER IMPACT AND RESPONSE:

- Activities a hospital, healthcare system, or public health agency take immediately before, during,
and after a disaster or emergency occurs.
- Search, rescue and first aid ,field care , triage activation , referral services clearing debris, and
feeding and sheltering victims .
D. DISASTER RECOVERY , RECONSTRUCTION AND REHABILITATION:
This phase involves getting a community back to its pre-disaster status
Activities include
- Debris Removal
- Care and Shelter
- Damage Assessments
- Funding Assistance
- Emotional care

IMPACT OF DISASTERS:
- Death
- Severe injuries requiring extensive treatment
- Increase risk of communicable diseases and epidemics outbreak
- Excess NCD mortality
- Mental health (disaster syndrome)
- The destruction of the health care infrastructure,
- Damage water supply and basic sanitation
- Food shortage and Malnutrition
- Population movement and migration

WHAT IS DISASTER MANAGEMENT?

Definition: It can he defined as the effective organization direction and utilization of available counter-disaster
resources

Aims of disaster plans : To provide prompt and effective medical care to the maximum possible in order to
minimize morbidity and mortality.

Objectives: To optimally prepare the staff and institutional resources for effective performance in disaster
situation.  To make the community aware of the sequential steps that could be taken at individual and
organizational levels.
PRINCIPLES OF DISASTER MANAGEMENT (GRAB AND ENG 1995)
a. Prevent the occurrence of the disaster whenever possible.
b. Minimize the number of casualties if the disaster cannot be prevented.
c. Prevent further casualties from occurring after the initial impact of the disaster.
d. Rescue the victims.
e. Provide first aid
f. Evacuate the injured to medical facilities.
g. Provide definitive medical care.
h. Promote reconstruction of lives.

DISASTER MANAGEMENT COMMITTEE:

There has to be a well prepared and planned disaster management committee. Every committee member
should have defined roles and responsibilities in a set protocol.
The disaster management committee should consist of following members.
- Chairman
- Medical superintendent/ Director
- Additional Medical Superintendent
- Nursing Superintendent/ Chief Nursing Officer
- Chief medical officer (Emergency Department)
- Head of departments- surgery, medicine, orthopedics, radiology, anesthesiology, neurosurgery
- Blood bank in charge
- Security officers
- Transport officer
- Sanitary personnel

Fig2 : Multi-Disciplinary Team

TRIAGE :
In French, verb “trier” means to sort. Triaging is the process of determining the priority of patients'
treatments by the severity of their condition or likelihood of recovery with and without treatment. It
prioritises patient treatment efficiently when resources are insufficient for all to be treated immediately;
influencing the order and priority of emergency treatment, emergency transport, or transport destination
for the patient.

Triage separates the injured into four groups:

• The expectant who are beyond help

• The injured who can be helped by immediate transportation
• The injured whose transport can be delayed
• Those with minor injuries, who need help less urgently
COLOR CODES DURING TRIAGING:

❖ BLACK code: Deceased are left where they fell. These include those who aren't breathing and
repositioning their airway efforts were unsuccessful.
❖ RED code: evacuation by ambulance as they need advanced medical care at once or within 1
hour. These people are in critical condition and would die without immediate assistance.
❖ YELLOW code: can have their medical evacuation delayed until all immediate people have been
transported. These people are in stable condition but require medical assistance.
❖ GREEN code: are not evacuated until all immediate and delayed persons have been evacuated.
These will not need advanced medical care for at least several hours. Continue to re-triage in
case their condition worsens. These people are able to walk, and may only
need bandages and antiseptic.

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

WHO DECIDES IN TRIAGE?

- 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.

TAGGING IN TRIAGE:
✓ Name
✓ Age /Sex
✓ Place of Origin
✓ Triage Category
✓ Diagnosis
✓ Initial Treatment

Fig 3: Triage level

DISASTER NURSING
Disaster nursing can be defined as the adaptation of professional nursing skills in recognizing and meeting the
physical, health and emotional needs of the affected community resulting from a disasters.
NURSING GOAL is to achieve the best possible level of health for the people and the community affected by
disasters.

QUALITIES OF A NURSE WORKING IN DISASTERS

Following are the qualities of nurse working in disaster team
- Confidence
- Cooperation
- Commitment
- Coordination
- Control
- Value of human life
- Gentleness and devotion
- Strength
- Trust
- Interdependence and Team spirit
- Accept Self criticism
- Toughness & Sensitivity
- Leadership
- Responsibility and accountability

ROLE OF NURSING IN 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)

1. Role of nurse in mitigation:

Measures designed either to prevent hazards from causing emergency or to lesson the likely effects of
emergencies. The nurse must do community assessment, knowledge of community resources (e.g.,
emergency services, hospitals, and clinics), community health personnel, community government
officials, and local industry. A structured and logical approach is made to the identification and
management of risks, will assist communities to minimize the likelihood or impact of disasters.

- Risk assessment and analysis: Identify previous disaster , local climate conducive to disaster
formation understand the magnitude of disaster, the coping strategies of the locals, current
community disaster plan, health personnel available, health facilities available , local agencies and
organizations.
- Diagnose Community Disaster : Nurse should determine actual and potential disaster threats,
preventive measures is been taken care of , is there collabative activites are undertaken, are the
people aware about the disaster, and community preparedness

2. Role of a nurse in disaster preparedness

Objectives:- To insure the appropriate system procedures & resources are in place to provide prompt
effective assistance to disaster victims, thus facilitating relief measure & rehabilitation services.

Elements of disaster plan: Chain of authority → Lines of communication →Modes of transport

→Mobilization →Warning → Equation →Rescue and recovery →Triage →Treatment →Support of
victims and families → Care of dead bodies →Disaster worker rehabilitation.
a. PERSONAL PREPAREDNESS:
• Capacity Building
• Readiness to work in the multidisciplinary team
• Knowledge about community
• Types of disaster and its management
• Certified first aider and CPR
• Knowledge about Policies and protocols
• Communication skill

b. PROFESSIONAL PREPAREDNESS:
o Prepared disaster preparedness written plan
o Control room  Rapid Response Team
o License and health resources personal equipment, such as a stethoscope, a flashlight and
extra batteries, Cash, Warm clothing and a heavy jacket (or weather-appropriate clothing),
Record-keeping materials, Pocket-sized reference books

c. COMMUNITY PREPAREDNESS :
“A prepared community is one which has developed effective emergency and disaster management
arrangements at the local level, resulting in :
• Alert, informed and active community
• Supports its voluntary organizations.
• Active and involved local government.
• Agreed and coordinated arrangement
• Education on First aid program, Making each home to store, Emergency telephone numbers,
Battery operated radio, Flash light, First aid kit, Three day supply of water, Medical
information &family physician detail, Persons to be notified in emergency

3. Role of a nurse in disaster impact and response  “Actions taken in anticipation of, during and
immediately after impact to ensure that its effects are minimized and that people are given immediate
relief and support”.
➢ DISASTER IMPACT
A set of principles which provide a framework for managing any event includes following points
- Command
- Control
- Coordination
- Communication
- Clinical Management
- Continuity
- Capability
➢ NURSES’ TASK IN DISASTERS IMPACT:
• Determine magnitude of the event
• Define health needs of the affected groups
• Establish priorities
• Identify actual and potential public health problems
• Determine resources needed to respond
• Collaborate with other professional disciplines, governmental and non-governmental agencies
• Maintain a unified chain of command
• Communication

4. Role of a nurse in disaster response:

Immediate post disaster intervention include
 - Establish safety
- Medical Treatment & Nursing Care as Per Need
- Utilization of Available Resources
- Psychological Support
- Life Saving Measures , First Aid
- Evacuation & Supply - Shelter, Food, Water, Medicine, Communication
- Maintaining Public Moral
- Voluntary Reception, Relatives Waiting Areas
- Management of Infection Control
- Re-riving post disaster stress.
- Encourage ventilation.
- Establishing outreach program to provide community support.
- Referral services

MENTAL WELLNESS:
Mental stress is the major concern during any disaster. In any major disaster, people want to know the
well being of their loved once.

In case of loss, people need to mourn. Giving them space for mooning, finding family friends or local
healers to encourage and support them is very important. Most of them are back to normal within 2
weeks. About1% to 3%, may need additional help.

Common Psychiatric disorders observed after any disaster includes- Acute stress reaction, post
traumatic stress disorders (ptsd), adjustment disorders, depressive disorders , acute psychosis,
dissociative disorders, anxiety disorders, suicides, personality changes, crises intervention

5. Role of a nurse in recovery , rehabilitation and reconstruction phase

This phase involve the help of multidisciplinary team. The nurse role in this phase include
- Community cleanup efforts
- Teaching Proper Hygiene
- Alert For Environmental Health Hazards
- Home Visits
- Follow up care

WHAT THE NURSES SHOULD KNOW

1. NODAL AGENCY AND ORGANIZATION DISASTER:
- Ministry of home affair
- Ministry of agriculture
- Ministry of civil aviation
- Ministry of railways
- Ministry of environment and forests
- Ministry of health
- Department of atomic energy
2. CORE COMPETENCIES IN DISASTER 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)
 3. TOPICS THAT MUST BE 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)

SUMMARY:
To summaries, disaster is any sudden occurrence that causes damage, ecological disruption, loss of human life
or deterioration of health and health services. They care of natural, man-made and mix type. Disaster
management involves with a set of principle. Disaster mitigation, preparedness, response and recovery are the
main phases of disaster management and nurse have very important role in each of these phases. Triaging is
the key element in disaster to priorities care and use of available resources. There has to be training programs
to know the job and responsibility of each member in the disaster management team.

CONCLUSION: Disaster is an unpredictable situation. Having set protocols and formulation of Disaster
committee is of great importance. Disaster management is a team work and every team member should be
aware of their role and responsibility so as to have a smooth functioning during the actual disaster
Nursing workforce is the integral part of disaster management team. They should work with confidence
command, co –ordination and control with the effective use of communication skill in the affected
community.

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
www.ready.gov
www.onestorm.org
www.fema.gov
www.who.org
www.un.orgwww.healthalerts.com