DISASTER

PREPAREDNESS:
ESSENTIALS OF
DISASTER PLANNING
DISASTER
• “a serious disruption of the functioning of a community or
a society at any scale due to hazardous events interacting
with conditions of exposure, vulnerability and capacity,
leading to one or more of the following: human, material,
economic and environmental losses and impacts” (United
Nations International Strategy for Disaster Reduction
[UNISDR], 2017).
DISASTER NURSING
• The adaptation of professional nursing skills in
recognizing & meeting the nursing physical & emotional
needs resulting from a disaster.
• “Nursing practiced in a situation where professional
supplies, equipment, physical facilities & utilities are
limited or not available”.
• GOAL: To achieve the best possible level of health for the
people & the community involved in the disaster.
Nurses’ Roles in Disaster
• 1. Determine magnitude of the event
• 2. Define health needs of the affected groups
• 3. Establish priorities & objectives
• 4. Identify actual & potential public health problems
• 5. Determine resources needed to respond to the needs
identified
• 6. Collaborate with other professional disciplines,
governmental & non-governmental agencies
• 7. Determine magnitude of the event
• 8. Define health needs of the affected groups
HEALTH DISASTER
• :is a catastrophic event that results in casualties that
overwhelm the healthcare resources in that community
and may result in a sudden unanticipated surge of
patients, a change in standards of care, and a need to
allocate scarce resources.
TWO BROAD CATEGORIES OF DISASTER

• 1. Natural

• 2. Man-made or anthropogenic
NATURAL DISASTER
• Those caused by natural or environmental forces.

• WHO defines “natural disaster” as the “result of an

ecological disruption or threat that exceeds the
adjustment capacity of the affected community” (Lechat,
1979). Natural disasters include earthquakes, floods,
tornadoes, hurricanes, volcanic eruptions, ice storms,
tsunamis, and other geological or meteorological
phenomena. Natural disasters are the consequence of the
intersection of a natural hazard and human activity.
MAN-MADE OR ANTHROPOGENIC (Human Generated)

• Anthropogenic disasters are those in which the principal

direct causes are identifiable human actions, deliberate or
otherwise (Jha, 2010). Anthropogenic disasters include
biological and biochemical terrorism, chemical spills,
radiological (nuclear) events, fire, explosions,
transportation accidents, armed conflicts, and acts of war.
THREE CATEGORIES OF HUMAN-GENERATED
DISASTERS:
• 1. Complex Emergencies
• Involve situations where populations suffer significant
casualties as a result of war, civil
• strife, or other political conflict.
• 2. Technological disasters
• large numbers of people, property, community
infrastructure, and economic welfare are directly
• and adversely affected by major industrial accidents,
unplanned release of nuclear energy, and fires or
explosions from hazardous substances such as fuel,
chemicals, or nuclear materials.
• 3. Disasters that are not caused by natural hazards but
occur in human settlements
• It triggers each other and the distinctions between the two
disaster types may be blurred. A natural and human-
generated disaster may trigger a secondary disaster, the
result of weaknesses in the human environment. An
example of this is a chemical plant explosion following an
earthquake.
Disasters are frequently categorized based on their:
• 1. Onset

• 2. Impact

• 3. Duration
• - Earthquakes and tornadoes are rapid-onset events—
short durations but with a sudden impact on communities.
• - Hurricanes and volcanic eruptions have a sudden impact
on a community; however, advanced warnings are issued
enabling planners to implement evacuation and early
response plans.
• - A bioterrorism attack may be sudden and unanticipated
and have a rapid and prolonged impact on a community.
• - In contrast, droughts and famines have a more gradual
onset or chronic genesis, the so- called creeping disasters
• and generally have a prolonged onset.
Factors that influence Impact of a Disaster on a
Community:
• 1. Nature of the event
• 2. Time of day and year
• 3. Health and age characteristics of the population
affected
• 4. Availability of resources
Classification of disasters in the field of disaster
science
• 1. Hazards (cause) is a potential threat to humans and
their welfare (Smith & Petley, 2009)
• 2. Disasters
• 3. Risk-- is the actual exposure of something of human
value and is often measured as the product of probability
• and loss (Smith & Petley, 2009).
Classification of Disasters in hospital and other
health care facilities
• External disasters are those that do not affect the hospital
infrastructure but tax hospital resources due to numbers
of patients or types of injuries (Burstein, 2014). For
example, a tornado that produced numerous injuries and
deaths in a community would be considered an external
disaster.
• Internal disasters cause disruption of normal hospital
function due to injuries or deaths of hospital personnel or
damage to the facility itself, as with a hospital fire, power
failure, or chemical spill (Hendrickson & Horowitz, 2016).
HEALTH EFFECTS OF DISASTERS
• Disasters may cause premature deaths, illnesses, and injuries in the
affected community, generally exceeding the capacity of the local
healthcare system.
• Disasters may destroy the local healthcare infrastructure, which therefore
will be unable to respond to the emergency. Disruption of routine health
and mental healthcare 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 air, soil, and water 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 be fear, anxiety, depression,
widespread panic, terror, and exacerbation of preexisting mental health
problems. Children, in particular, may be deeply affected by the impact of
a disaster (Save the Children, 2017).
• Disasters may cause shortages of food and cause severe
nutritional deficiencies.
• Disasters may cause large population movements
(refugees) creating a burden on other healthcare systems
and communities. Displaced populations and their host
communities are at increased risk of communicable
diseases and the health consequences of crowded living
conditions (Lam, McCarthy, & Brennan, 2015).
• Disaster frameworks for response are increasingly shaped
by globalization, changing world dynamics,
socialinequality, and sociodemographic trends (Tierney,
2012; WHO, 2016).
2 Major Concerns about Role (Dr. Veenema)

• 1. Personal safety: “Nurses want to know that they’re safe

& that their loved ones & patients are safe.”

• 2. Clinical competence: “They want to know they can deal

with emergencies properly—even less common ones like
massive radiation exposure or SARS outbreaks.”
Nurses’ Roles in Disaster
• 1. Determine magnitude of the event
• 2. Define health needs of the affected groups
• 3. Establish priorities & objectives
• 4. Identify actual & potential public health problems
• 5. Determine resources needed to respond to the needs
identified
• 6. Collaborate with other professional disciplines,
governmental & non-governmental agencies
• 7. Determine magnitude of the event
• 8. Define health needs of the affected groups
THE DISASTER CONTINUUM – life cycle of a
disaster management program.
• Three Major Phases

• 1. Preimpact (before)
• 2. Impact (during)
• 3. Postimpact (after)
Basic phases or “life cycle” of a disaster management
program: (PMPRR)
• 1. Preparedness refers to the proactive planning efforts
designed to structure the disaster response prior to its
occurrence. Disaster planning encompasses evaluating
potential vulnerabilities (assessment of risk) and the
propensity for a disaster to occur.

• - Warning (also known as “forecasting”) refers to

monitoring events to look for indicators that predict the
location, timing, and magnitude of future disasters.
• 2. Mitigation includes measures taken to reduce the
harmful effects of a disaster by attempting to limit its
impact onhuman health, community function, and
economic infrastructure. These are all steps that are taken
to lessen the impact of a disaster should one occur and
can be considered as prevention measures.
• Prevention refers to a broad range of activities, such as
attempts to prevent a disaster from occurring, and any
actions taken to prevent further disease, disability, or loss
of life. Mitigation usually requires a significant amount of
forethought, planning, and implementation of measures
before the incident occurs.
• 3. Response phase is the actual implementation of the
disaster plan. Disaster response, or emergency
management, is the organization of activities used to
address the event. Traditionally, the emergency
management field has organized its activities in sectors,
such as fire, police, hazardous materials management
(hazmat), and emergency medical services. The response
phase focuses primarily on emergency relief: saving lives,
providing first aid, minimizing and restoring damaged
systems such as communications and transportation, and
providing care and basic life requirements to victims (food,
water, and shelter).
• 4. Recovery actions focus on stabilizing and returning the
community (or an organization) to normal (its preimpact or
improved status). This can range from rebuilding
damaged buildings and repairing infrastructure to
relocating populations and instituting physical, behavioral,
and mental health interventions. Rehabilitation and
reconstruction involve numerous activities.

• Goal: “Build, Back, Better”

• 5. Evaluation is the phase of disaster planning and
response that often receives the least attention. After a
disaster, it is essential that evaluations be conducted to
determine what worked, what did not work and what
specific problems, issues and challenges were identified.
DISASTER PLANNING
• Addressing the problems posed by various potential events.
• Participation by nurses in all phases of disaster planning is
critical to ensure that nurses are aware of and prepared to
deal with whatever these numerous other factors may turn
out to be.
• Individuals and organizations responsible for disaster plans
should consider all possible eventualities from the sanitation
needs to the crowd, psychosocial needs of vulnerable
populations, to evacuation procedure.
• Completion of the disaster planning process should result in
the production of a comprehensive disaster or “emergency
operations plan”.
DISASTER PLAN
• a formal plan of action of coordinating the responsive of
health care agency staff in the event of a disaster.

• AIM: to provide prompt & 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.
Types of Disaster Planning
• 1. Agent specific approach – focus their preparedness
activities on the most likely threats to occur based on their
• geographic location (Hurricanes in Florida)

• 2. All -hazards approach- conceptual model for disaster

preparedness that incorporates disaster management
component that are consistent across all major events to
maximize resources, expenditures and planning efforts.
Nurses’ Roles in Disaster Planning
• 1. Personal and professional preparedness
• 2. Make a personal and family preparedness.
• 3. Be aware of the disaster plan at the workplace and
community.
• 4. Maintain certification in disaster training and CPR
• 5. Participate in Mock disaster drills.
Problems, Issues and Challenges in Disaster
Planning
• 1. Anticipate communication problems.
• 2. Address operational issues related to effective triages,
transportation and evacuation.
• 3. Accommodate the management, security of and distribution
of resources at the disaster sides.
• 4. Implement advanced warning systems and increase the
effectiveness of warning messages
• 5. Enhance coordination of search and response efforts.
• 6. Effective triage of patients (prioritization for care and
transport of patients).
• 7. Establish plans for the distribution of patients to hospitals in
an equitable.
• 8. Patient identification and tracking.
• 9. Damage or destruction of the health care infrastructure.
• 10. Management of volunteers, donations and other large
numbers of resources.
• 11. Organized improvisational response to the disruption
of major systems.
• 12. Encountering overall resistance (apathy) to planning
efforts.
HAZARD IDENTIFICATION, VULNERABILITY ANALYSIS,
AND RISK ASSESSMENT
• Methods for Data Collection for Disaster Planning:
• 1. Hazard identification is used to determine which events are most
likely to affect a community and to make decisions about whom or what
to protect.
• 2. Vulnerability analysis is used to determine who is most likely to be
affected, the property most likely to be damaged or destroyed, and the
capacity of the community to deal with the effects of the disaster. Data
are collected regarding the susceptibility of individuals, property, and the
environment to potential hazards in order to develop prevention
strategies. A separate vulnerability analysis should be conducted for
each identified hazard.
• 3. Risk assessment uses the results of the hazard identification and
vulnerability analysis to determine the probability of a specified outcome
from a given hazard that affects a community with known vulnerabilities
and coping mechanisms (risk equals hazard times vulnerability).
Disaster Planning and Public Health Preparedness
• Six Domains:
• 1. Community resilience
• 2. Incident management
• 3. Information management
• 4. Countermeasure and mitigation
• 5. Surge management
• 6. Biosurveillance
EVALUATING CAPACITY TO RESPOND
• Resource identification is an essential feature of disaster
planning. A community’s capacity to withstand a disaster is
directly related to the type and scope of resources available,
the presence of adequate communication systems, the
structural integrity of its buildings and utilities (e.g., water,
electricity), and the size and sophistication of its healthcare
system (Burstein, 2014; Cuny, 1998). Resources include both
human and physical elements, such as organizations with
specialized personnel and equipment. Disaster preparedness
includes assembling lists of healthcare facilities; medical,
nursing, and emergency responder groups; public works and
other civic departments; and volunteer agencies, along with
phone numbers and key contact personnel for each.
CORE PREPAREDNESS ACTIVITIES
• 1. Prepare a theoretical foundation for disaster planning.
• 2. Disaster planning is only as effective as the assumptions
upon which it is based.
• 3. Core preparedness activities must go beyond the routine
• 4. Have a community needs assessment.
• 5. Identify leadership and command post.
• 6. Design a local response for the first 72 hours.
• 7. Identify and accommodate vulnerable populations.
• 8. Know about state and federal assistance.
• 9. Identify training and educational needs, resources, and
personal protective equipment (PPE).
• 10. Plan for the early conduction of damage assessment.
EVALUATION OF A DISASTER PLAN
• An essential step in disaster planning and preparedness is the
evaluation of the disaster response plan for its effectiveness and
completeness by key personnel involved in the response. The
comprehension of people expected to execute the plan and their
ability to perform duties must be assessed. The availability and
functioning of any equipment called for by the disaster plan needs to
be evaluated and reviewed on a systematic basis. Several methods
may be used to exercise the disaster plan, the most comprehensive of
which would be its full implementation in an actual disaster. Disaster
drills may also provide an excellent means of testing plans for their
completeness and effectiveness. Drills can be staged as large, full-
scale exercises, using triaged victims and requiring vast resources of
supplies and personnel, or they may be limited to a small segment of
the disaster response, such as drills that assess the effectiveness of
communications protocols or notification procedures
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