LEARNING MATERIAL I: SIGNIFICANCE OF complexity of the entire spectrum of disaster

DISASTER NURSING health from pre-event planning through

recovery, it is not surprising that there are
According to the International multiple perspectives on what nurses need to
Classification of Nursing Practice (ICNP) know, and how they will apply that knowledge.
Catalogue, the disaster nursing is significant to
nursing for several reasons: 1) reflects nursing Nursing process guides nursing care
leadership and research in disaster nursing; 2) Regardless of the precise manner in
shows how the nursing process guides nursing which an individual nurse becomes involved in
care; and, 3) demonstrates the commitment of practice related to disasters and major
nursing to high quality health care. emergencies, it is useful for them to use
consistent language to communicate with one
Nursing leadership and research in disaster another about the assessments and diagnoses
nursing they make, the interventions they carry out, and
Nursing has been a part of the response the outcomes of their patients. Capturing data
to a wide range of natural disasters (e.g., floods, through the use of a standardized terminology
cyclones, earthquakes, extremes of heat and can be useful to nurse researchers as they seek
cold) and disasters related to human activity to evaluate nursing practice and patient and
(e.g., industrial explosions, airplane crashes, war, family outcomes, through the use of a
terrorism) for many years. The multiple types of standardized clinical data set and thus make the
patients the disaster nurse may care for and the processes and outcomes of disaster nursing care
environment in which the patient is treated more visible.
dictates that the disaster nurse is prepared for a
variety of challenges. The role of the disaster Commitment of nursing to high quality health
nurse is multifaceted and includes practice, care
education, management, consultation, advocacy Nurses with disaster experiences and
and research. Disaster nurses come from a roles (illustrated in figure below) is a way of
variety of specialty nursing areas and all bring a continuing communication across the global
wealth of expertise of different types and levels nursing profession, establishing consistent
to the people experiencing a disaster. evidence-based practice standards in disaster
Interest in clarifying the roles carried out nursing.
by disaster nurses, and the competencies they
need to fulfil these roles, has intensified since LEARNING MATERIAL II: CONCEPT OF DISASTER
the late 1990’s and continues today. Some Disaster Defined: Is a serious disruption of
attention has been paid to disaster and functioning of a community or society involving
emergency skills needed by all nurses (World widespread human, material, economic, or
Health Organization & International Council environmental losses and impacts, which exceed
of Nurses, 2009) while others have considered the ability of the affected community or society
only individual specialty nurses such as those in to cope using its own resources. Disaster is often
the areas of public health practice, emergency described as a result of combination of: the
departments, intensive care units, flight nurses exposure to hazard; the condition of
and nurses involved in military service. Given the vulnerability that are present; and the
extensive range and specialization of nurses insufficient capacity of measure to reduce or
from around the globe who are involved in the cope with potential negative consequences.
Disaster impacts may include loss of life, injury, Hazard is any phenomenon that has the
disease and other negative on human physical, potential to cause disruption or damage to the
mental and social well-being, together with people and their environment. It is a natural
damage to property, destruction of asset, loss of event while disaster is its consequence. A hazard
service, social and economic disruption and is perceived natural event which threatens both
environmental degradation. life and property. A disaster is a realization of this
Disaster is any occurrence that causes damage, hazard (Whittow, J.n.s.)
ecological disruption, loss of human life, Hazard may be inevitable but disaster
deterioration of health and health services on a can be prevented.
scale, sufficient to warrant an extraordinary
response from outside the affected community Classification of hazards
or area (WHO). Natural hazards are those which are cause by
Disaster is an occurrence either natural or man- forces in our environment that disrupts human
made that causes human suffering and creates activity, or that may cause damage or injury to
human needs that victims cannot alleviate life and property. Earthquake, floods, and
without assistance (American Red Cross). thunderstorm are examples of natural hazards.
Disaster is a widespread serious destruction of Quasi-natural Hazards are the second
the functioning of the community or a society. It classification of hazards. These hazards which
involves widespread human, material, resulted from natural process and intervention
economic, or environmental impacts which of human activities.
exceed the ability of the affected community or An example of quasi-natural hazard is smog.
society to cope using its own resources (United Smog is a type of pollution in the air like haze.
Nations). The difference is that smog is a mixture of dust,
smoke, and other dry particles. It is considered
When Does a Natural Event Become a Hazard? a quasi-natural hazard as it may be the result of
Natural events like earthquake, forest fire caused by human in which smoke is
typhoon, volcanic eruptions and others does not mixed with the air. Haze is also classified as
automatically become hazard, much less cause quasi-natural hazard. Haze is traditionally an
disaster. atmospheric phenomenon where dust, smoke
A. The Exposure to Hazard and other dry particles obscure the clarity of the
sky (No condensation). Sources for haze particles
What is a hazard? include farming (ploughing in dry weather),
Hazards are the potential for damage to traffic, industry, and wildfires. The latest incident
man and his environment that may result from on haze is that which occurred in September of
the occurrence of natural events such as 2015. The disaster was term as the 2015
eruptions, earthquake, floods, and storm surges. Southeast Asian haze. It originated in Indonesia
An event per se does not constitute a hazard. It in cutting and burning plants and trees during
is only when man and his environment are the dry season. The smoke mixed with some dry
threatened and these events can be considered particles in the air reached several countries
hazards. Without a threat to a population, the including the Philippines.
eruption of an isolated volcano remains an event Technological (or man-made) hazards are those
but when volcanic activity occurs close to or right arising from industrial conditions like accidents
at the center of a populated area, a mere event and equipment malfunction which may cause
become a hazard. loss of lives of people, animals, and properties.
In the history of technological hazards, the most eruption in large sea wave is formed that
recent is that which occurred in the warehouse may drown people, animals and
wall in Guiguinto, Bulacan in January 2015. This properties including huge buildings.
hazard result in disastrous event as it resulted to 4. Volcanic eruptions. The flow of lahar and
the death of 11 people with several injured and the accent of magma are the two most
properties smashed. distressing effects of volcanic eruptions.
Biological- Biological hazards include viruses,
Climate and Weather-related Hazards Climate bacteria, insects, animals, etc., that can cause
and weather-related hazards are types of natural adverse health impacts.
hazards which have direct effect to people’s lives
and properties. The Philippines for instance, has Anthropogenic Hazards. Anthropogenic,
a tropical rainforest type climate. This type of or man-made hazards include pollution,
climate is characterizing by high temperature deforestation, mining and climate change.
and high atmospheric humidity. However, when Generally, anthropogenic hazard is the result of
season pertaining to high temperature is human act or omission. Burning of waste is an
prolonged and became excessive, it is already example of human act leading to smog while the
called El Nino. This phenomenon can cause refusal of using toxic chemicals may lead to
damage to crops and animals and to the people damage of ozone layer. These two combines may
as well. aggravate global warming.

Geophysical Hazards Geophysical events are Biological hazards, also known as biohazards,
normal occurrences of forces of the earth. refer to biological substances that pose a threat
However, when this event cause destruction to to the health of living organisms, primarily that
life and properties, they are already classified as of humans. This can include medical waste or
geophysical hazards. Geophysical hazards have samples of a microorganism, viruses, or toxins
different categorization. These categories are (from a biological source) that can affect human
made by the Philippine Institute of Volcanology health.
and Seismology (PHILVOCS) and the Earthquake During the last few decades, biological
and Natural Resources Atlas of the Philippine of emergencies have assumed an increasing
1998. These are the following: importance: major outbreaks related to new and
1. Earthquake is the result of sudden slip re-emerging infectious diseases such as SARS,
on a fault in the earth. As a result, the influenza (H1N1 and H5N1), cholera, and the
ground shaking will be felt. Earthquake latest is Covid-19.
may be due to some natural occurrence
or man-made events. Natural causes of Natural Hazards Versus Disaster
earthquake include volcanic or magnetic
activity and movement of fault lines. Floods, earthquake, volcanic eruption,
Man-made causes of earthquake include hurricanes are types of natural hazards. But
mining and man-made explosions. when do they become disaster? The main
2. Earthquake-induce landslide. This is the difference lies on hazards effect on people.
downslope movement of soil and rock as When typhoon strikes a thickly populated area in
a result of earthquake. the Philippines, causing massive destruction of
3. Tsunamis. This phenomenon may be properties and lives, it become a disaster.
associated with earthquake or volcanic
EXPOSURE AND VULNERABILITY certain community. For instance, a community
Elements of risk are the people, which composes of diverse young, old, and sick
economic activities, and private and public are more vulnerable than other communities.
services potentially threatened by a harmful Physical vulnerability of infrastructure may
event. pertain to the type of houses, building
compositions or bridges and buildings, and
B. WHAT IS VULNERABILITY? others.
Exposure and Vulnerability  Social Vulnerability
Elements of risk are the people, Social vulnerability is the incapacity of the
economic activities, and private and public community to survive the hostile effects of
services potentially threatened by a harmful threats of disasters. Social vulnerability may be
event. due to the principles and beliefs of the people in
a certain locality. It includes aspects related to:
Vulnerability is the characteristic of a. awareness of the people to disaster
community as being susceptible or [prone to b. the existence of emergency-
hazard or diseases. Vulnerability is due to several preparedness plan
characteristics or conditions. Some of the c. access to basic social services
characteristics affecting vulnerability includes d. custom and traditions
social, economic, and environmental factors. e. leadership of government officials
Vulnerability of some elements is not f. optimism in life
permanent. The risk factor may change Example: Even the weather bureau forecasted
depending on how the element cope with the possible occurrence of storm surge, people
changes in the environment for its own safety. refuse to leave the locality because of the
mistrust to the local government, lack of
Vulnerability is having the conditions awareness about storm surge, and the fear of
determined by physical, social, economic, and losing their resources of livelihood.
environmental factors or processes which  Economic Vulnerability
increase the susceptibility of a community to the This kind of vulnerability may be associated
impacts of hazards (United Nation International with financial status of a person to stay in safer
Strategy for Disaster Reduction, 2004) place and build a safer home. It can be drawn in
that poor people are more vulnerable to the
Classification of Vulnerabilities impact of disaster because of their incapacity to
There are different classification of sustain a better place to stay, live and build a
vulnerabilities. These are the following: family. The poor may choose to stay along
 Physical Vulnerability. coastal areas, squatters, and bridges which make
This pertains to the physical aspect of the them more susceptible to disaster.
community, the people and the infrastructures. Countries which are economically progressive
Physical aspect of the community may pertain to are also more vulnerable to disasters. Economic
the location of the community. Those who are instability may result to low standard of
located on low-lying areas are more vulnerable infrastructures, emergency equipment, supplies,
to flood while those located on mountainous and reliefs.
areas are more vulnerable to landslides.  Environmental Vulnerability
Physical aspect of the people may pertain to Even in our environmental and natural
demographic profile of the people living on a resources are also vulnerable to disasters. For
 instance, our forests are vulnerable to wildfires Vulnerability to Hazards and Disaster
brought by some human negligence of by
lightning. Mountains may also erode due to There are various factors that influence the
heavy rains, and the depth of our ocean may be severity of a disaster from natural hazards. Even
affected by seiche. within the same region, different people have
different levels of vulnerability to natural
Vulnerability of Exposed Elements hazards.
I.Vulnerability of Physical Elements
Physical vulnerability includes those which Vulnerability to a natural hazard depends on the
are actually built in the environment vulnerable following factors:
to disasters. Physical elements include  Wealth. People living in poverty are
infrastructure like buildings, houses, roads, and unable to afford adequate housing or
bridges. One way to reduce vulnerability of infrastructure. They more likely are
physical elements is to place them in a more unable to obtain adequate resources
strategic place. For instance, roads may not be before and after natural hazards strikes.
built along the mountainous areas to avoid Thus, they are more vulnerable to the
erosion or possibility bring damaged by resulting disaster.
landslides.  Education. Education greatly increase
II. Vulnerability of Social Elements awareness of the people on avoiding or
Social vulnerability pertains to the overall reducing the impact of natural hazard
aspect of the society which is a combination of and disaster. A better-educated
political, cultural, and personal characteristics. population will have more professionals
The behavior of the people in a certain and non-professionals trained to
community has direct influence to social catastrophic natural hazards
vulnerability  Governance. Governance can set policy
III. Vulnerability of Environmental and establish infrastructure to reduce
Elements vulnerability to hazards. Some
Environmental vulnerability pertains to the government have more resources
physical aspect of the environment which may at available for resources for disaster risk
risk to the occurrence of disaster. Our forest, reduction program.
mountains, and seas are also considered as  Technology. Advance technology allows
vulnerable elements of disaster. The earth in its authorities to forecast weather
entirety is in distress due to global warming and significantly reducing vulnerability.
climate change.
IV. Vulnerability of Economic Elements C. WHAT IS RISK?
Economic elements may pertain to small, Risk is used interchangeably with hazard.
medium, and large enterprises that provide job However, in the field of disaster management,
and manufactured products. These elements are risk is different from hazard. Risk is the product
likewise vulnerable to disaster. In times of of hazard and vulnerability. It is simplified by the
natural calamities, their products may be formula:
damaged, production may be lessened and so
supply will be affected. There are also instances Hazard x Vulnerability = Risk
wherein disaster can lead to loss of job or loss of The question means that risk is the
the business. product of the probability hazard and the degree
of vulnerability. The increase of either of the two stakeholder group, the development of
factors will increase “risk” as the product. DRR capacity is the concern of an entire
Therefore, a probability of hazard increase, so society.
does the risk increase. Further, as the degree of  The development of technical
vulnerability increases, so does risk also capabilities associated with professional
increases. discipline or functions—such as
environment management or land-use
How to deal with risk? management—needs to be combined
1. Risk Identification with other types of capacity
2. Risk Classification development that include the
3. Risk Acceptance promotion of leadership and other
4. Risk Avoidance managerial capabilities and
5. Risk Reduction performance-enhancing measures.
6. Risk Transfer  An enabling environment—i.e., strong
political ownership and commitment at
VULNERABITY + HAZARD/CAPACITY=DISASTER the highest levels or authority, extensive
participation, transparency, and clear
WHAT IS CAPACITY public accountability—is essential for
According to United Nations translating capacity into performance.
International Strategy for Disaster Reduction or
UNISDR (2009), capacity refers to “all strengths, Capacity /coping capacity is the ability of the
attributes, and resources available within a people, organizations, and system, using
community, organization, or society that be used available skills and resources, to deal with and
to achieved an agreed goal.” These qualities give manage conditions such as hazards, emergencies
space to citizens and communities to cope with, or disasters. These are strength, attributes, and
overcome the adverse effects of, and reduce the resources available within the community,
risks of disasters through preparation, society, or organization that can be used to
mitigation, and recovery. achieve the agreed goals.
The United Nations Development
Program or UNDP (2009) defines capacity Disaster Impact
development as the “the process through which Impact Phase: The impact phase occurs when
individual, organizations, and societies obtain, the disaster actually happens. It is a time of
strengthen, and maintain the capabilities to set enduring hardship or injury end of trying to
and achieve their own development objectives survive.
over time.” Moreover, UNDP (2009) identified a The impact phase may last for several
number of assumptions in developing minutes (e.g. after an earthquake, plane crash or
sustainable DRR capabilities, which consist of the expulsion) of for days or weeks (e.g. flood famine
following: or epidemic)
 Essential to the success of any DRR The impact continues until the threat of
initiative is also ensuring locally further destruction has passed and emergency
generated, owned, and sustainable plan is in effect. This is the time when emergency
capacity. operation is established and put in operation. It
 Rather than being concern of any single serves as a center for communication and other
agency, professional discipline, or government agencies of health care providers to
 staff shelters. Every shelter has a nurse as a disrupted. These changes can have a harmful
member of disaster action team. The nurse effect on psychological health.
responsible for psychological support to victims
in the shelter. Sign and Symptoms of Psychological Effects of
Disasters
Post Impact Phase: Recovery begins during the 1. Fear- This may be characterized by fear
emergency phase and ends with the return of of the dark, of being alone or of some
normal community order and functioning. For things.
person in the impact area this phase may last a 2. Shock- Any victim of disaster under the
lifetime (e.g. victims of atomic bomb in stage of shock may show irregularity in
Hiroshima). The victims of disaster go through breathing, nausea, and confusion.
four stages of emotional response. 3. Grief- A victim of disaster may show
1. Denial: During this stage the victim may deny extreme sadness by crying and sighing
or may not fully registered the magnitude of the due to the effect of the event.
problem. The victims may appear usually 4. Irritability- A victim of disaster may
unconcerned. display sudden burst of anger. The
2. Strong Emotional Response: in this stage the person may also get easily frustrated by
person is aware of the problem but regard it as small events like noisy surroundings and
overwhelming and undesirable. Common lack of basic need like food and water.
reaction during this stage is trembling, tightening
of muscles, speaking with difficulty, weeping Disaster, by their very nature, are stressful,
heightened, sensitivity, recklessness, sadness, life-altering experiences, and living through such
anger and passivity. The victim may want to experience can cause serious psychological
retell or relieve the disaster experience over and effects and social disruption. Depending on the
over. nature and scope of the disaster the degree of
3. Acceptance: During the third stage, the victim disruption can range from mild anxiety to family
begins to accept the problems caused by the dysfunction (e.g. marital discord or parent-child
disaster and make a concentrated effort to solve relational problems) to separation anxiety,
them. It is important for the victims to take posttraumatic stress disorder (PTSD),
specific action to help themselves and their engagement in high-risk behaviors, addictive
families. behaviors, severe depression, and even
4. Recovery: Victims feel that they are back to suicidality.
normal. A sense of well-being is restored. Victims  30-40% of those who directly experience
develop a realistic memory of the experience. the trauma have PTSD. Children are the
most vulnerable. Goldman and Galea
E. EFFECTS OF DISASTER ON ONE’S LIFE 2014.
I.Psychological effects of Disaster  After terrorist attack on the World Trade
When a person lives through disaster, Center, 25% of New Yorkers reported
physical mental, and emotional health can be increased in alcohol use, 10% increase in
disturbed. These are normal reactions to cigarette use, 3% increase marijuana
disasters. use. Vlahov et al 2022.
Disasters definitely disrupt our daily  1 in 6 people (10%-15%) who experience
activities. Access to electricity or clean water disaster will suffer mild to moderate
may be denied. People’s routine may be mental disorder. 1 in 30 (3-4%) will be
 emotionally impacted to the degree that  14 months after the Great EasT Japan
it interferes with their ability to function. Earthquake of 2011. 10%-20% of the
Van Ommeren, Hanna, Weissbecker, responders have PTSD. Factors causing
and Ventovogel, 2015 PTSD in Great East Japan Earthquake:
 Hurricane Katrina was a unique in that it Lack or rest, depression, lack of
was not only a natural disaster was also communication. Sakuma et.al, 2015
a man-made disaster in the sense that
much of the suffering occurred as a Management of the Psychosocial Impact of
result of delayed or ineffective rescue. Disaster
Of the displaced survivors: 50% met the The management psychosocial effects
criteria of major depressive dis-order, begin with a sound plan to mitigate the adverse
20% had suicidal ideation, and 14% had impact of the disaster on the emotional,
increased substance use. Larraine, cognitive, and behavioral capacity of the
Anastario, and Lawry, 2007 individual. Involvement of mental health
 Hurricane Katrina: A year after the professionals, such as psychiatric nurse
disaster. A study over 7,000 children practitioners and clinical nurse specialist, should
affected by Katrina found out that 50% begin with the development of community or
have PTSD symptoms and depression. A agency disaster plan.
year after the study, 41% of the affected
children still have symptoms of PTSD and
depression. Osofsky, Kronenberg, 1. The Mental Health Response Team
Brennan, and Hansel, 2009 1. Designation of a Mental Health
Coordinator is a crucial first step in the
An environmental disaster can lead to a sense of formulation of a team.
mistrust towards the government and business, 2. Function of Mental Health Coordinator
leading to a sense of helplessness and 1. Manage and coordinate the mental
hopelessness. health response from command center;
 Puerto Rico Hurricane Maria in 2017, a 2. Decide what resources are needed;
level 5 hurricane with sustained gale 3. Activate appropriate mental health
force wind of 155mph and severe agencies;
flooding after the Hurricane surge. The 4. Assign staff to locations;
government neglect of the island’s 5. Monitor field reports regarding the
infrastructure and ongoing poverty lead ongoing needs of victims, workers, and
to angry outlash. Davila and Rushing, counselors;
2017. 6. Adapt a plan as event unfold.
7. Order demobilization
On the Responders: 3. Some of immediate responders
 Those involved in the rescue and deployed by the Mental Health Coordinator
recovery profession to be one of the  Mobile crisis teams
groups of highest risk of developing  Case managers
negative mental health consequences in  Professionals; and
response to the event. Neria and Shultz,  Volunteers who have been preapproved
2012.
The deployed team includes: Psychiatrists, also identifies those individuals and
Psychologists, Licensed Clinical Social Workers, families needing additional follow-up
Marriage and Family Therapist, Professional and referral.
Clinical Counselor, Nurses with specialty
certification, School Psychologists, and School People in need of immediate emotional and
Counselors depending on the types or nature of practical support dur to a recent disaster benefit
disaster. from psychological first aid, which should be
made available by field personnel such as
Skills healthcare workers, educators, or qualified
 Psychiatric nurse and psychiatrist can volunteers.
1. Identify organic mental disorders caused
by conditions such as head injuries, toxic Other steps to reduce potential psychological
exposures, preexisting illnesses, harm
dehydration, or hyper/hypothermia
 Nurses The prevention of re-traumatization- limit the
1. Have tradition practice in homes, in number of persons with whom victims must
school, and other natural settings, they interact in order to receive services. “Telling the
tend to be readily accepted by members story” can be a source of trauma to some
of the community. individual; therefore, forcing someone to tell his
 Paraprofessionals and volunteers or her story in contraindicated.
1. They may be indigenous workers known
to the community affected by disaster; Prevention of new victim- limit the number of
2. May share ethnic or religious people exposed to the sight, the sounds, and the
background. smells of disaster site, whenever possible. Those
who do not to be at the disaster site should be
Mental Health Coordinator Responsibility discouraged from witnessing any of the horror of
Following Demobilization Order the aftermath.
1. Conduct a review of the mental health
response both separately and in Prevention of “pathologizing” distress- Avoid
conjunction with the entire disaster labeling normal reaction as pathological to
response team prevent symptoms from being interrupted as
2. Review the adequacy of the predisaster interpreted as medical condition or disorder that
plan in light of the actual response requires treatment. Provide anticipatory
3. Conduct psychological debriefing to the guidance about the emotional, cognitive,
workers at demobilization. behavioral, and physiological survivors are likely
to experience in the coming weeks or months,
Disaster Mental Health Intervention normalize these reactions, and help survivors to
1. Psychological First Aid is an evidence- regain perspective and self-confidence.
informed approach to assist and support
survivors in the immediate aftermath of Identification of individuals showing signs of
a disaster. The goal is to help survivors to acute distress- Those who need immediate
reduce distress, assist with current medical intervention includes individuals with
needs, promote adoptive function to obvious and active physiological stress reaction
recover normally. Psychological first aid (exceeding frantic, panicky, or extremely anger)
or individual who are profoundly shut down  Development of serious depressive
(numb)dissociated, disconnected). symptoms within 1-week that last for 1
2. Crisis Intervention should be considered month of longer
as the first line of emergency management for  Numbness, depersonalization, a sense of
those potentially affected by large-scale reliving the trauma, and motor
community disaster. This is a technique used to restlessness after the event
assist persons whose coping abilities have been  Preexisting psychiatric problems
overwhelmed by stressful event. This include  Previous trauma
active listening and problem solving. Active  Loss of home or community
listening allows the disaster workers to  Extended exposure to danger
established a sense of respect and trust and to  Toxic exposure
better understand the survivor’s situation and  Absence of social support, or social
needs. This intervention are meant to “lend” support who were also traumatized and
survivors the strengths needed to decrease their thus are incapable of adequate
fear responses (thereby calming themselves) and emotional availability (Lubit, 2016,
access immediate care and support, allowing “Etiolgy”)
them to move to the stage of recovery. 5. Mental Health Referrals to the
3. Social Support networks can provide professionals ought to be made when one or
important effective and material aid that more of the following symptoms are present.
mitigates the adverse effects of disaster trauma. (DeWolfe, 2000)
(van Ommerin, Hanna, Weissbecker and  Disorientation-dazed; memory loss;
Ventevogel, 2015). Thus, mobilizing the natural inability to give date and time, state
social support system of family, friends, the where he or she is, recall events of the
faith-based community, and the coworkers can past 24 hours, or understand what is
be one of the most helpful intervention in the happening.
aftermath of a disaster.  Depression- pervasive feeling of
4. Psychosocial Triage is the identification hopelessness and despair, unshakable
of individuals that are most at risk for psychiatric feeling of worthlessness and
complications and to make referrals for further inadequacy, withdrawal from others,
mental health evaluation and treatment when inability to engage in productive activity.
indicated. Psychiatric difficulties seem to follow  Anxiety – constantly on the edge,
a dose-related trajectory—those closest to the restless, agitated, unable to sleep,
vent are at greater risk. frequent frightening nightmares,
flashbacks, intrusive thoughts, obsessive
Factors increasing the risk of ASD (Acute Stress fear of another disaster, excessive
Disorder) and PTSD (Post Traumatic Stress rumination about the disaster.
Disorder) in someone suffering a sufficient  Psychosis- hearing voices, seeing visions,
precipitating event include the following: delusional thinking, excessive
 Loss of love one in the event preoccupation of ideas or thoughts,
 Significant injury from the event pronounce pressure of speech (talking
 Witnessing of horrendous images rapidly with little content continuity).
 Dissociation at the time of the traumatic  Inability to care for self- not eating,
event bathing, or changing clothes, inability to
manage activity of daily life.
  Suicidal thoughts or plan- expressing leading to pulmonary edema and cardia
indirect and direct thoughts of harming arrythmias (Beach, 2010; Gausche -Hill, 2009).
self.
 Other behavior of concern- problematic Cardiovascular- A child’s estimated
use of alcohol or drugs, domestic blood volume is 80 mL/kg, which is larger than an
violence, child abuse, or elder abuse. adult on a milliliter per kilogram basis and this
can result in small amount of blood loss from
F. CHILDREN’S NEED DURING DISASTER AND trauma decreasing circulation blood volume
OTHER PUBLIC HEALTH EMERGENCIES leading to shock (Gausche-Hill, 2009). Children
Children have physiological differences have greater cardiac reserves and catecholamine
that, compared with the adult, have implication responses compared with adults, allow them to
for signs, symptoms, and severity of illness or compensate for fluid losses from hemorrhage,
injury following a disaster or public health diarrhea, or lack of oral intake. However, when
emergencies. this system of compensation fails, shock and
cardiopulmonary failure can result quickly in
Pulmonary- Children’s faster respiratory children exposed in severe trauma, biological or
rates, higher metabolic rate, as well as greater chemical agents, or in those sustaining kinetic
minute ventilation increase risk of inhaling a energy or burn trauma.
higher dosage or amount of toxic airborne
substance including radioactive gasses (Chung Integumentary-The skin of infant and
and Shannon 2005; Gausche-Hill 2009; Save the children are more permeable compared whith
Children, 2015). skin of adults (Gausche-Hill, 2009).
Sarin, other nerve agents, chlorine, as They also have less subcutaneous fat
well as other gasses, have high vapor densities, than adults. Infants and children have higher
making them heavier than that air and more body-area-to-weight ratio, predisposing them to
concentrated closer to the ground, leaving greater heat loss through conduction,
infants and small children much more convection, radiation, and evaporation
susceptible than their adult counterpart (Bearer, (Gausche-Hill, 2009). Skin permeability and
1995; Gausche-Hill, 2009). larger area-to-weight ratio may result in a
Oxygen consumption of infant is 6 to greater exposure to absorption of dermal
8mL/kg/min compare with 3-4 mL/kg/min in toxicants (COEH and COID, 2000).
adults (Chamedies and Hazinski, 1998); children
exposed to noxious chemicals or vapor would Musculosketal- The long bone of
require early oxygenation administration. children continues to grow throughout
When a child is in respiratory distress, childhood and into adolescence. Physical injury
suprasternal, supraclavicular, intercostal, or to the growth plate, or physis, can result to
substernal retractions result from the child’s growth arrest and deformity. Such injury could
increased work of breathing. Respiratory distress occur in children sustaining blast injuries or other
could result from exposure to biological or traumatic injuries during natural disasters.
chemical agents, as well as dust and particles
from blasts or collapsed buildings. Kinetic energy Cognitive: - Cognitive development of
from blast, earthquake or other forces easily the child can be seriously affected by chemical
transmitted to underlying cardiac tissues, and hazardous materials producing both short-
resulting in pulmonary and cardiac contusions and long-term impact. During 2014 to 2016, the
population of Flint, Michigan experienced one of health sequela such as PTSD, depression, anxiety
the worst community contamination of water and in, in the case of children, developmental
supply in the United State. The health effects of regression.
lead exposure in children are known to include
impaired cognition, behavioral disorder, hearing G. DISASTER NURSING IN SCHOOLS AND OTHER
problems and delayed growth. COMMUNITY CONGREGATE CHILD CARE
SETTINGS
PEDIATRIC CARE DURING DISASTER
Pediatric Disaster Triage: - For children’s triage Elementary and Secondary Schools-
during a disaster, the most commonly use in the Preparedness:
Jump START System. The JumpSTART Pediatric  Readiness and Emergency
Multiple Casualty Incident Triage is a method Management for Schools (REM)-
that focuses exclusively on the triage of children Developing of an individualized
during mass casualty event and is modeled after comprehensive emergency
the Simple Triage And Rapid Treatment program management and disaster planning.
(Romig, 2002). The JumpSTART triage help Example: vulnerability assessment, Disaster-
rescuer categorize pediatric patient into safe room during a disaster, protection of
treatment group quickly and accurately (Romig, personally identifiable information,
2002). The JumpSTART Triage System assesses
the victims’ airways, vital signs, and level of Example: school crisis guide (before, during, and
consciousness categorizing them in the following after the disaster) which include: crisis
groups: minor, delayed, immediate, or deceased. prevention activities, identification of crisis
The assessment is designed to be completed in response team with specific roles identified,
less than 60 seconds. research-based violence prevention program
The JumpSTART triage approach is using and safety policy in place; clear internal and
a color-coded length-based tape that is designed external communication avenues; school safety
to provide the responder with rapid assessment updated regularly; crisis response
understanding of what physiological signs and policies and procedure; written plan for
symptoms should be considered. Once the child recovery.
is triage using this method, he or she is assigned Nurses Role:
to triage priority from green to black. Green is 1. Nursing students may be invited to
delayed priority, yellow is urgent priority, red is collaborate with school nurses to assess
immediate priority, and black is dead. the disaster preparedness level of local
schools. If schools are not prepared, the
PsySTART TRIAGE- Developed by Dr. nursing students could offer to assist the
Merritt Shreiber, is a mental health triage system school develop or expand their plans as
that has been tested and commonly used in real- community health nursing project.
world events. The tool is best used at regular 2. Nurses and nursing students can
intervals (Schreiber, 2010). PsySTART is a very volunteer to participate in school’s
simple screening that relies on the individual’s vulnerability assessments, with one of
self-report using a checklist scoring system. The their responsibilities being to examine
checklist can be used at intervals to assist in functional access requirement and how
helping direct mental health resources to assist the schools are meeting the needs of
individuals in reducing mental and behavioral students living with various disabilities.
 3. Nurses and nursing students can 2. Family may be rebuilt. Even broken
volunteer their services to any disaster homes come together in times of
organization. Nurses who obtain the disaster. Relative with long-time
appropriate national, state, or local arguments may even forget the issue of
volunteer training stand ready and help the past and immediately come to the
manage the surge capacity of the rescue of the relative in need.
response teams (Veenema et.al., 2016, 3. Circle of friend will expand. A simple
p.194). thought of lending a blanket or slippers
in times of disaster is a gesture to start
SOME EFFECTS OF DISASTER another friendship which will then
1. Emotional Effects of Disaster expand the social group.
Emotional effect of disasters may be shown
through the acts of victims/survivors or through COVID -19 Social Impact
the words they utter. Some of the emotional 4. Service sector is not able to provide their
effects are the following: proper service
1. Feeling of guilt with the thought that had 5. Cancellation or postponement of large
he/she done something, he/she may not sport and tournaments
have lost a member of the family. 6. Avoiding the national and international
2. Feeling of dissatisfaction from the travelling and cancellation of services
support coming from the family, 7. Disruption of the celebration of cultural,
neighbors, friends, or even from the religious and festive events
government. 8. Undue stress among population
3. Feeling of bitterness for those who 9. Social distancing with our peers and
survived the disaster or to those who family members
were not actually affected by it. 10. Closure od hotel, restaurants and
3. Physical Effects of Disaster religious places
The following are the 11. Closure of places for entertainment such
manifestation of physical effects of disasters: as movie and play theatres, sports clubs,
1. Physical sickness like headaches, fever, gymnasium, swimming pools, and so on.
cough and others 12. Postponement of examinations
2. Change of appetite 5. Economic Effects of Disaster
3. Poor sleeping condition Disaster will generally affect the economy of the
4. Constipation country, specifically that of the family. These
4. Social Effects of Disaster effects may be characterized by:
Social effects of disaster may be displayed by 1. Loss of Job
children or even adolescents. Some of the social 2. Loss of business
effects of the disaster are the following: 3. Damaged bridges, buildings, and roads
1. Loss of interest in the activity previously 4. Forfeiture of investments from other
enjoyed by the victim/survivor. Children countries
may display loss of interest with his/her 5. Decline of tourism industry
favorite toys or games while adults may
display loss of interest on his/her job or COVID 19-Economic Impact
hobbies. 6. Slowing the manufacturing of essential
goods
7. Disrupt the supply of chain products
8. Losses in national and international
business
9. Poor cash flow in the market
10. Significant slowing down of the revenue
growth

6. Healthcare Effects of Disaster

COVID 19- Impact on Healthcare
1. Challenges in the diagnosis, quarantine and
treatment of suspected or confirmed Cases
2. High burden of the functioning of the existing
medical system
3. Patients with other disease and health
problems are getting neglected
4. Overload on doctors and other healthcare
professionals, who are at a very risk
5. Overloading of medical shops
6. Requirement of high protection
7. Disruption of medical supply chain

Other Economic Effects of Disaster:

1. Agricultural damage
2. Loss of life
3. Destruction of property
4. Disruption of production
5. Disruption of lifestyle
6. Loss of livelihood
7. Disruption of essential services
8. Disruption of governmental system
9. National economic loss
10. Sociological and psychological after-
effects