OSASTER MANAGEMENT

DEFINITION
Disaster is "any occurrence that causes damage,
cconomic disruption, loss of human life and deterioration
of health and health service on a scale sufficient to
warrant an extraordinary response from outside the
affected community or area". (WHO)
"Disaster can be defined as an overwhelming ccological
disruption, which exceeds the capacity of a community
to adjust and consequently requires assistance from
outside.
-Pan AmericanHealth Organization (PAHO)
Disaster is an event, natural or manmade, sudden or
progressive, which impacts with such severity that the
affected community has to respond by taking
exceptional measures. -W. Nick Carter
CLASSIFICATION OF DISASTERS
Disasters are comnonly classified according to their
causes into two distinct categories:
. Natural disaster
" Man-made disaster
Natural disasters
Metrological disaster: Storms (Cyclones,
typhoons, hurricanes, tornados, hailstorms,
snowstorms), cold spells, heatwaves and droughts.
. Typological Disaster: landslides, avalanches,
mudflows and floods.
Telluric and Teutonic (Disaster
underground): originates
Earthquake,
tsunamis (seismic sea waves).volcanic eruptions and
Biological Disaster: communicable disease,
epidemics and insect swarms (locusts).
Mas Made Disasters
'Warfare: conventional warfare
blockade and siege) and (bombardment,
non-conventional
(nuclear, chemical and biological). warfare 141
 Nursing Managemenn
AComprehensive Text book on

HOSPITAL DISASTER PLANING: Depending

Civil disasters: riots and demonstration. mobilizes
size, it
upon the hospital's location anddisaster. It should
transportation (planes,, trucks, its resources to manage
any
" Accidents: collapse event of:
automobiles, trains and ships); structural provide for immediate action in the
structures);
(building, dams, bridges, mines and othet i. An internal disaster in hospital
itself e.g. fire,
explosions and fires. explosion, etc.
Technological failures: A mishap at a nuclear ii. Some minor external
disaster.
power station, leak at a chemical
plant causing
ofa public iüi. Major external disaster.
pollution of atmosphere or the breakdown iv. Threat of disaster.
sanitation.
communities/country.
PRINCIPLES OF DISASTER
MANAGEMENT v. Disaster in neighboring
" Prevent the disaster
EVACUATION: There is usually a system which
superintendent, is
Minimize the casualties on order of the medical
Prevent further casualties activated : e.g.
of the
" Rescue the victims i Percentage of evacuation (discharge)
First aid
patient from the hospital.
ii. Addition of extra beds.
Evacuate
Medical care ii. Preparation of emergency ward.
Reconstruction iv. Such facilities should be near to X-ray,
READINESS FOR DISASTER operation theatre, central supply, medical
store, etc.
Readiness for disaster involves two aspects:
ORDERLY FLOW OF CASUALITY: IL is
1. Resource for readiness.
important to minimize confusion in receiving
2. Disaster pre planning.
causalities. Ateam of wellqualified physician
1. Resources for readines: and nurses at the reception itself sorts out
RED CROSS: Its primary concerm in a disaster causalities and make quick decisions of the
situation is to provide elief for human suffering treatment.
the form of food, shelter, clothing, medical i. Additional nursing staff volunteers may be
care, and occupational fehabilitation of victims.
called and posted.
COMMUNITY AND LOCAL GOVERNMENT:
ii. Services of all departments of the hospital
shares the responsibility in clearing rubble,
maintaining law and order, determining the safety should be well integratedin the disaster plan
of a structure of habitàtion, repairing bridges, viz. dietary department, laundry, public works
resuming transportation, maintaining sanitation, depart1nent (PWD), engineering unit, etc.
providing safe food and drinking water, ete. iü. The planning should also take into
CIVIL DEFENCE SERVICES: The civildefense consideration other aspects like traffic
and its medical facility programners provide for control, types of medical records to be
shelters, establishing communication linkage, maintained,
medical tags,standardization
post disaster services, assistance to affected of
emergency
community in the area of health, sanitation, public information centers,
controlled dissemination of information
maintaining law and order, fire fighting, clearing without or: with minimum
of emergency suppliesdistortion,
debris, prevention and control of epidemic
various diseases etc.
of preparation
all ambulance kept kept ready,
2. Disaster pre-planning: It is important to make
additional vehicles. ready, arrangement of
the best possible use of thÇ resources. Some of
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care as follows:
the
pre-planning aspects for disaster related to medical COMMUNICATION
communication system
SYSTEM:
should be
Addi tional
also important to planned. It is
keep the hospital
about the inflow of the informed
casualties from the scene.
 Unit 4: Organisation

THE DISASTER MANAGEMENT CYCLE Objectives of triage

1. DISASTER EVENT: This refers to the "REAL An effective triage system should be able to achieve
TIME" event of the hazard occurring and affecting the following:
elements of risk.
Ensure immediate medical intervention in life
2. RESPONSE AND RELIEE: This refers to the first
threatening sitjations.
stage response to any calamity, which include setting " Expedite the care of patents through a systematic
up control rooms, putting the contingency plan in initial assessment.
action, issue warnings, evacuating people to safe Ensure that patients are prioritized for treatment in
arcas, rendering medical aid to the needy, etc. accordance with the severity of their medical
3. RECOVERY: It has threc overlapping phases of Condition.
emergency relief rehabilitation and reconatructing. Reduce morbidity through early medical
4. DEVELOPMENT: Evolving economy and long intervention.
term prevention/disaster reduction measures like Improve public relations by communicating
construction of houses capable of withstanding the appropriate information to friends and relatives who
onslaught of heavy rains, wind speeds and shocks accompany patients.
of earthquakes. Improve paients flow within emergency
S. REDUCTION AND MITIGATION: Protective or departments and/or disaster management situation.
preventive actions that lessons the sale of Provide supervised learning for appropriate
impact. Minimizing the effects of disaster. E.g. personnel.
building codes and zoning, vulnerability analyses,
public education. Principles of triage
The main principles of triage are as follows:
Every patient should be received and triaged by
appropriate skilled health-care professionals.
DISASTER Triage is a clinic-managerial decision and must
IMPACT:
involve collaborative planning.
The triage process should not cause a delay in the
PREPAREDNESS
RESPONSE delivery of effective clinical care.
Triage system
Triage consists of rápidly classifying the injured on the
of
bases of severity of their injuries and the likelihood
MITIGATION
RECOVERY
their survival with prompt medical intervention
1. GOLDEN HÌUR
hour in which
A seriously injured patient has one
Trauma Life
they need to receive Advanced
DEVELOPMENT hour
PREVENTION Support. This is referred to as the golden
PRIORITY
Fig. 4.8 2. IMMEDIATE OR HIGH
who's immediate
Higherpriority is granted to victims
dramatically affected
6.PREPAREDNESS: Includes the formulation and or long term prognosis can be
development of viable emergency plans, of the by simple intensive care.
inventories and forlearlydeath
waning system, the maintenance of " Immediate patients are at risk
the training of personnel. categories.
They usually fall into one of two loss or they
TRIA GE They are in shock from severe blood 143
word "Trier" have severe head injury
The word triage is denved from French These patients should be transported
as soon as
which means sorting or choosing.
possible
 Nursing Managemenn
Comprehensive Text book on
A
hospital staff
Documentation oftheplan and making
PRIORITY: 5. steps of the plan
DELAYED OR MEDIUM aware about the various PLAN
3.
patients may have injuries that span a ESIENING OF HOSPITAL DISASTER
Delayed
management committee:
wide range I. Disaster management committee is the
intermal injuries, but are
They may have severe The hospital disaster
the policy
still compensating for formulation ofconstitutes
decision making body management.
disaster It
Delayed þatients have: and plan for
Respirations under30/minutes the following members.
seconds hospital
Capillaryrefill under 2 a. Director of the services
commands accidents and emergency
Can do-follow simple AMBULATORY b. HOD of
MINIMAL OR departments
4. MINOR OR C..Allheads of the
PATIENTS d. Nursing superintendent
lacerations, contusions, sprains, e. Hospital administrator
Patients with minor "'minor/minimai"
burns are identified as of the staff
superficial PRIORITY f. Representatives disaster management
OR LEAST of the
5. EXPECTANT deal.of 2. Functions The functions of the committee are:
require a great
Morbid patients who committee-
attention with questionable
benefit have the disaster plan for the hospital
a. Toprepare a hospital support of the
lowest priority.
impending b. To prepare departmental plan in
Patients withwhom there are signs of hospital plan
poor likelihood of
death or massive injuries with C. Assignduties to
the staff
Survival are labeled asexpectant emergency care
d. Establishment of criteria for
and evaluate the training
Color code e. To conduct, supervise
treatment or transfer
Red indicate high priority programmes
drills
Yellow signals medium priority f. Tosupervise the mock
arises
Green indicate ambulatory patients g. Updating of plans as need
progranmes,
Black indicates dead or moribund patients h. Organize community awarenesS
HOSPITAL DISASTER PLAN through mass media
education, and
and it has: / Assist in information,
The hospital is an integral part of the society communication (IEC) programmes in respect of
great role to play in the disaster management. Every:
hospital big or small, public or private has to prepare a the disaster preparedness, prevention and
disaster
disaster plan, and must leam to activate the ?management.
plan at the hour of need. Disasters in the hospital. 3. Role and functions: The effective implementation
perspective can be grouped into two categories: ofthe program will depend upon clarity of the plan,
1. Intemal Hospital disasters like fire, building collapse, role and functions of the different members and
terrorism, etc the staff. They are:
2. External disasters like earthquakes, floods, etc a' Disaster co-coordinator: The co-c0ordinators
OBJECTIVES OF HOSPITAL DISASTER: role will be:
PLAN " Organizing
1. Preparedness of staff, optimizing of resources and Communicating
mobilization of the logistics and supplies within short Assigning duties
notice Deployment of staff
2. To make community aware about the hospital " Taking key decisions
disaster plan and benefits of plan b. Administrator: The responsibilities of the
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3. Training and motivation of the staff administrator is to execute the authority through
4. Tocarry out mock drills the departmental heads
 Unit - 4:Organisation
c. Departmental heads: Development of an cvacuation,andorganizing meet up points so that
depart1mental plans peoplc can find each other after a disaster.
d. Nursing superintendent : deployment of Disaster drills handle topics like what to do when
nursing staff communications are cut off, how to deal with lack
e. Medical staff: specific role of rendering medical of access to equipment, tools, and even basic services
care both pre-hospital and hospital care like water and power, and how to handle evacuations.
[. Nursing staff: nursing care and support criticâl Italso provides a chance to practice for events such
care as'imass casualties which can occur during a disaster.
4. Important departments Regular disaster drills are often required for public
The important department of the hospital has to play ,buildings like government offices and schools where
a key role in the disaster management. people are expected to practice things like
a. Accident and emergency department evacuating the building and assisting each other so
that they will know what to do when a real alarm
b. Operating department
C. Critical care units sounds.
d. Radiologydepartments Community-based disaster drills such as whole-city
drills provide achance to practice the full spectrum
e. Laboratory of disaster response. These drills can include actors
f. Blood bank
and civilian volünteers who play roles of victims,
5. Support areas lootèrs, and other people who may be encountered
Prompt supply of drugs, linen and surgical items, during a disaster, and extensive planning may go
fluids are required in the hospital and due care has into such drills. A disaster drill on this scale may be
to be taken to incorporate the role and function of done once a year or once every few years.
following units. Benefits
a. Laundry Used toidentify 'weak points in a disaster response
b. CSSD plan
c. Dietary department To get people familiar with the steps they need to
d. Housekeeping seryices tak'so that their response in adisaster will be
e. Medical records automatic.
f. Public relations ROLE OF NURSES IN DISASTER
g. Communications MANAGEMEN
h. Transportation I. In disaster preparedness
i. Mortuary 1. To facilitate preparation with community : For
j Medic-social worker facilitating preparation within the community, the
k. Engineering department nurse can help initiate updating disaster plan, provide
J. Security and safety services educational programmes& material regarding.
m. Media relations disasters specific to areas.
DISASTER DRILL
2. To provide updated record of vuinerable populations
within community: The nurse should be involved in
Definition educating these populations about what impact the
Adisaster drill is an exercise in which people simulate disaster can have bn them.
the circumstances of a disaster so that they have an :3. Nurse leads a preparedness effort: Nurse can help
opportunity to practice their responses. recruit others within the organization that will help
Features when a response, is required. It is wise to involve
. On a basic level, drills can include person in these efforts who demonstrate flexibility,
responses by decisiveness, stamina, endurance and emotional
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individuals to protect themselves, such as learning
howto shelter in place, understanding what to do in stability.
 Management
Comprehensive Text book on Nursing
A
III.In disaster recovery
: Nurse might Preparation: Flexibility is an
4. Nurse play multi roles in community 1. Successful Recovery
roles. As a community successful recovery
be involved in many seek to keep a important component of
advocate, the nurse should always and report efforts can incure
must assess preparation. Community cleanup problems. E.g.
safe environment. She psychological
environmental hazards. ahost of physicaland heavy objects can cause
Physical stress of moving
understanding of community and even death from
5. Nurse should have have an understanding of back injury, severe fatigue
resources : Nurse should available after a
heart attacks.
will be of
what conmunity resources The continuing threat
work together. 2. Health teaching:
disaster strikes and how comimunity will the iurse
long as the
communicable disease will continue as relieving
will guide
Acommunity wide disaster planoccur before, during water supply remains threat
and the
in understanding what should her role in the plan. conditions remain crowded. Nurses
must remain
and after the response and his or vigilant in teaching proper hygiene and
making sure
involved in community
6. Disaster Nurse must be involvement immunization records are up to date.
organization: Nurse who sects greater chronic illness
in-depth understanding of disaster 3. Psychological support : Acute and disaster.
or a more of exacerbated by prolonged effects of
be involved in any number can be
management can and moving can
community organizations such s the American
Red The psychoiogical stress of cleanup hopelessnes,
Cross, Ambulance Corps etc. biring about feelings of severe
depression and grip.
IIL In disaster response to
community assessiment, case 4. Referrals to hospital as needed: Stress can lead
1. Nursemust involve in suicide and domestic abuse. Although most people
finding and referring, prevention, health education recover from disasters, mental distress may persist
and surveillance health
in vulnerable populations. Referrals to mental
2. Once rescue workers begin (to arrive at the scene, professionals should continue as long as the need
immediate plans for triage should begin. Triage is exists.
allocating
the process of separating causalities and
treatment based on the victim's potential for survival. 5. Remain alert for environmental health:Nurse must
also remain alert for environment health hazards
" Higherprioity is always given to victim's potential during recovery phase of a disaster. Home visit may
who have life threatening injuries but who h¡ve lead the nurse to uncover situations such as lack of
a high probability of survival once stabilized. water supply or lack of electricity.
Second Priority is given to victüns who have
injuries with systemic complications that are not PARAMETERS FOR NURSING PRACTICE
yet life threatening but who can wait up ta 45 All nurses providing health care at mass gatherings
60 minutes of treatrment. müst be competent in the basic principles of first aid
Last priority in given to those victims who have including CPR and use of automated external
local injuries without immediate complications defibrillator. In addition nurses should possess the
and who can wait several hours, for.medical. following minimum care competencies.
attention
Nursing assessment
3. Nurse work as a member of assessment team Perform respiratory airway assessment
Nurse working as members of an assessment team Perform a cardiovascular assessment including vital
have the responsibility of give accurate feed back signs, monitoring for signs of shade.
to relief managers to facilitate rapid rescue and
recovery. Perform an integumentary assessment, including
burn assessment
4. To be involved in ongoing surveillance: Nurse
involved in ongoing surveillance uses the following. Perform a pain assessment.
methods to gather information - interview, Perforn a trauma assesSment from head to toe
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observation, physical examination, health and iülness Perform amental status includingGlasgow coma scale
Screening surveys, records etc. Know the indications of intubation