EMERGENCY AND

DISASTER NURSING

NCM 106A
JHOANNA V. TABI, RN, MAN
Subject:
3RD YEAR SUMMER
• NCM 106A-1 (2 UNITS) 36 HOURS
Care of Clients with Cell Aberrations, Acute biologic Crisis,
including Emergency and Disaster Nursing

4TH YEAR 1ST SEMESTER

• NCM 106A-B (4 UNITS) 72 HOURS
MISION 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.
Emergency or disaster?
Emergency refers to any extraordinary event or
situation that requires an intense, rapid response
and that can be addressed with existing
community resources.
Disaster refers to an event or situation that is of
greater magnitude than an emergency; disrupts
essential services such as housing, transportation,
communications, sanitation, water, and health
care; and that requires the response of people
outside the community affected. The term disaster
particularly signifies an event that carries
unforeseen, serious, and immediate threats to
public health.
WHO defines Disaster as…
“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.”
Red Cross (1975) defines Disaster as…
“An occurrence such as hurricane, tornado,
storm, flood, high water, wind-driven water,
tidal wave, earthquake, drought, blizzard,
pestilence, famine, fire, explosion, building
collapse, transportation wreck, or other situation
that causes human suffering or creates human
that the victims cannot alleviate without
assistance.”
UNDP (2004) defines…

“Disaster is a serious disruption

triggered by a hazard, causing human,
material, economic or (and)
environmental losses, which exceed the
ability of those affected to cope.”
Disaster can be defined as…
“Any catastrophic situation in which the
normal patterns of life (or ecosystems) have
been disrupted and extraordinary,
emergency interventions are required to
save and preserve human lives and/or the
environment.”
A disaster may have the following main
features:
• Unpredictability
• Unfamiliarity
• Speed
• Urgency
• Uncertainty
• Threat
TYPES OF DISASTER
Disasters are classified in various ways, on
the basis of its origin/cause.
1. Natural disasters
2. Man-made disasters
And On the basis of speed of onset-
1. Sudden onset disasters
2. Slow onset disasters
NATURAL DISASTERS

A serious disruption triggered by a natural

hazard (hydro-metrological, geological or
biological in origin) causing human, material,
economic or environmental losses, which
exceed the ability of those affected to cope.
Natural hazards can be classified according
to their (1) hydro meteorological, (2)
geological or (3) biological origins.
Hydrometer logical disaster

Natural processes or phenomena of

atmospheric hydrological or
oceanographic nature.
Great Bhola Cyclone, Bangladesh
Geographical disaster
Natural earth processes or phenomena
that include processes of endogenous
origin or tectonic or exogenous origin
such as mass movements, Permafrost,
snow avalanches.
Tsunamis
Biological Disaster
Processes of organic organs or those
conveyed by biological vectors,
including exposure to pathogenic,
microorganism, toxins and bioactive
substances.
HUMAN-INDUCED DISASTERS

A serious disruption triggered by a human-

induced hazard causing human, material,
economic or environmental losses, which
exceed the ability of those affected to cope.
These can be classified into –
(1) Technological Disaster and
(2) Environmental Degradation.
Technological disaster
Danger associated with technological or
industrial accidents, infrastructure failures or
certain human activities which may cause
the loss of life or injury, property damage,
social or economic disruption or
environmental degradation, sometimes
referred to as anthropological hazards.
Environmental Degradation
Processes induced by human behaviors and
activities that damage the natural resources
base on adversely alter nature processes or
ecosystems. Potentials effects are varied
and may contribute to the increase in
vulnerability, frequency and the intensity of
natural hazards.
LEVELS OF DISASTER
Disasters are classified by the following levels:
1) Level I: If the organization, agency, or
community is able to contain the event and
respond effectively utilizing its own resources.
2) Level II: If the disaster requires assistance
from external sources, but these can be obtained
from nearby agencies.
3) Level III: If the disaster is of a magnitude that
exceeds the capacity of the local community or
region and requires assistance from state-level or
even federal assets.
KEY ELEMENTS OF DISASTERS

Disasters result from the combination

of hazards, conditions of vulnerability
and insufficient capacity or measures to
reduce the potential negative
consequences of risk.
HAZARDS
Hazards are defined as “Phenomena that pose a
threat to people, structures, or economic assets
and which may cause a disaster. They could be
either manmade or naturally occurring in our
environment.”
Hazard is a potentially damaging physical event,
phenomenon or human activity that may cause the
loss of life or injury, property damage, social and
economic disruption or environmental degradation.
(UN ISDR 2002)
VULNERABILITY

Vulnerability is the condition determined by

physical, social, economic and
environmental factors or processes, which
increase the susceptibility of a community to
the impact of hazards. (UN ISDR 2002)
CAPACITY
Capacity is the combination of all the
strengths and resources available within a
community, society or organization that can
reduce the level of risk, or the effects of a
disaster. Capacity may include physical,
institutional, social or economic means as
well as skilled personal or collective
attributes such as ‘leadership’ and
‘management.’ Capacity may also be
described as capability. (UN ISDR 2002)
RISK
Risk is the probability of harmful
consequences, or expected losses (deaths,
injuries, property, livelihoods, economic
activity disrupted or environment damaged)
resulting from interactions between natural
or human-induced hazards and vulnerable
conditions. (UNDP 2004)
Risk is conventionally expressed by the
equation:
Risk = Hazard x Vulnerability

Some professionals use the notation:

Risk = (Hazards x Vulnerability) –
Capacity
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 THE 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
1. Rapid assessment of the situation and of
nursing care needs.
2. Triage and initiation of life-saving measures
first.
3. The selected use of essential nursing
interventions and the elimination of nonessential
nursing activities.
4. 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.
5. Evaluation of the environment and the
mitigation or removal of any health hazards.
6. Prevention of further injury or illness.
7. Leadership in coordinating patient triage, care,
and transport during times of crisis.
8. The teaching, supervision, and utilization of
auxiliary medical personnel and volunteers.
9. Provision of understanding, compassion, and
emotional support to all victims and their families.
HEALTH EFFECTS OF DISASTERS
Disasters affect the health status of a
community in the following ways:

• 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 the
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.
PHASES OF A DISASTER

There are three phases of disaster.

1. Pre-Impact Phase
2. Impact Phase
3. Post – Impact Phase
PRE-IMPACT PHASE
It is the initial phase of disaster, prior to the actual
occurrence. A warning is given at the sign of the
first possible danger to a community with the aid of
weather networks and satellite many
meteorological disasters can be predicted.

The role of the nurse during this warning phase is

to assist in preparing shelters and emergency aid
stations and establishing contact with other
emergency service group.
IMPACT PHASE
• The impact phase occurs when the disaster
actually happens. It is a time of enduring hardship
or injury end of trying to survive.

• The impact phase continues until the threat of

further destruction has passed and emergency
plan is in effect.

• Every shelter has a nurse as a member of

disaster action team. The nurse is responsible for
psychological support to victims in the shelter.
POST – IMPACT PHASE

Recovery begins during the emergency

phase and ends with the return of normal
community order and functioning. For
persons in the impact area this phase may
last a lifetime.
The victims of disaster in go through four
stages of emotional response:

1. Denial
2. Strong emotional response
3. Acceptance
4. Recovery
Rehabilitation

The final phase in a disaster should lead to

restoration of the pre-disaster conditions.

The pattern of healthy needs with change

rapidly, moving from casualty treatment to
more primary health care.