Disaster & its Managements:

Presented By: Talha Abdullah, M.Ali, Sahar Farooq & Fazal Subhan
 Objectives
 Introduction to disaster
 Enlist types of disaster
 Various phases of disaster
 Disaster effects
 Nursing role in disaster management
 Discuss rehabilitation
Definition
A disaster can be defined as any occurrence that can cause any
damage ,ecological disruption ,loss of human life and deteriotion of health and
health services on a sufficient scale
( W.H.O )

Disaster is any occurrence ether natural or man-made, that can cause human
suffering and create human needs that victim cannot alleviate without
assistance.
( American red cross)
What is Disaster?
 A catastrophe, sudden, calamitous event bringing great damage, loss,
destruction and devastation to life and property by natural or
man-made causes.
 According to United Nations International Strategy for Disaster Reduction;
 'A serious disruption in the functioning of a community or society
resulting in widespread human, material, economic, or environmental losses
and impacts that exceed the affected community's or society's ability to cope
using its own resources.'
 Disasters can be broadly classified as
Natural or Manmade
 Natural Disaster:

 Earthquakes
 Heat & Cold waves
 Floods
 Natural Fires
 Cyclones & Storms
 River & Sea Erosion
 Tsunami
 Land Slides etc.
 Drought
 Fog
 Lightning
Man-made Disaster:

This is caused due to activities undertaken by Man or Group of People ranging from one or more of
the following:
Terrorist Activities
Fire
Wars & Riots
Vehicular Accidents
Pollution – Air, Water, Noise, etc
Sabotage Activities
Bio-terrorism
Dam failure
Hazardous substance accident
Explosions
Phases of disaster

1) Pre-impact phase :
It is the initial phase of disaster, prior to the actual occurrence . A warning is given at
the sign of first possible danger.

2) Impact phase :

This phase occurs when actual disaster happens . It is time of enduring

hardships injuries and try for survival. In this phases individual helps
families until the help is not arrived from outside:
 lasts for several minutes e:g
earthquakes ,explosions and plane crashes.
Last for several days and weeks e:g
floods , epidemics, terrorist attack .
Post impact phase :
Recovery is began during this emergency phase and end with
the return of normal community functioning and order.
Victims goes through four stages
Denial
Strong emotional response
Acceptance
Recovery
Disaster effects

 Death
 Disability
 Increase in communicable diseases
 Psychological problems
 Water and food shortage
 Social and economies losses
 Shortage of drug and medical supplies
Major roles of a nurses in disaster

 Determine the magnitude of a event

 Identify need of effected group
 Establishing priorities and objective
 Identify the actual and potential health problem
 Determine the recourse needed to respond
 Collaborative work with other professionals, governmental and non
governmental organization .
 Maintain a unified chain of command
 Skilled Communication
What is Disaster Management

Like any other Management activity or process, Disaster

Management is also a management activity or process undertaken
by various segments of the society - public, governmental, NGOs,
etc. with an aim to minimize or avoid occurrence of disaster and to
provide relief to the affected people and rehabilitate them.
Role Players in Disasters
 Community

 NGOs

 National Red Cross

 Media

 Fire Services

 Police and Para-Military Forc

 Civil Defence

 Armed Forces

 Public Sector & Private Sector

Disaster management
There are four phases of disaster management :
1) Mitigation,
2) Preparation,
3) Response,
4) Recovery Rehabilitation/Reconstruction
1. Mitigation :
It includes an activity that reduce the chance of a disaster , to prevent disaster or
reduce the damaging effect .
The role of a nurse is very important because working with the local and
state to identify the disaster risk and developing a disaster planning
strategies .
Disaster management
Mitigation measures include building codes, zoning and land use
management; building use regulations and safety codes; preventive health
care, and public education.
Spatial Planning:
The methods used by the public sector to influence the distribution of people
and activities in spaces of various scales.
Spatial planning include land use planning, urban planning or regional
planning, transport planning
and environmental planning
2. Preparation

 Strengthen the technical and managerial capacity of governments,

organizations and communities
 Response mechanisms and procedures, rehearsals, developing long-term and
short-term strategies, public education and building early warning systems.
Preparedness measures include preparedness plans; emergency
exercises/training; warning systems; emergency communications systems;
evacuations plans and training; resource inventories; emergency
personnel/contact lists; mutual aid agreements; and public
information/education
3. Response :

 To provide immediate assistance to maintain life, improve health and support

the morale of the affected population
 Such assistance may range from providing specific but limited aid, such as
assisting refugees with transport, temporary shelter and food, to establishing
semi-permanent settlement in camps and other locations.
 It also may involve initial repairs to damaged infrastructure.
 The focus in the response phase is on meeting the basic needs of the people
until more permanent and sustainable solutions can be found.
The response is determine by the level of a disaster , and disaster is
not determine by the no of causality but the amount of recourses
need .
Level 1:
if the organization agency or community is able to manage the event
and response effectively , utilizing its own recourses
Example : one family fire explosion.
Level 2 :
if the disaster require any assistance from outside source they can be
obtain from nearby agency .
Level 3:
if the disaster magnitude is exceeded from the capacity of the local
community or region and require assistance from state level or even
federal asset
4.Recovery (Rehabilitant/Reconstruction)
 Returning the community to normal (Resilience)
 Essential services such as providing drinking water, transport, electricity, etc.
are restored
 The people are taught how to follow healthy and safety measures.
 The victims are provided with temporary accommodation, financial assistance
and employment opportunities
 Those who have lost their family members are consoled
 If there is a danger of epidemics, vaccination programme are to be
undertaken
Psychological Responses to Disaster

Signs and symptoms of emotional shock

Stages
•Impact stage. Survivors are stunned, apathetic, and disorganized. For
several hours after the initial event, they may have difficulty following
directions and will need strong support and firm guidance.
• Heroic stage. Individuals want to be helpful, and may minimize or ignore
their own injuries and demonstrate rescue behavior that is risky to self.
• Honeymoon stage. Survivors are grateful that they are still alive. There
is a strong sense of brotherhood and community spirit.
• Disillusionment stage. Reality of loss occurs. Ongoing physical and
emotional fatigue can result in substance abuse and
discouragement. Survivors feel abandoned and ignored by the
larger community because of the gap between resources and need.
• Reconstruction stage. This stage may continue for years as people
rebuild lives and even begin to see the crisis, in retrospect, as a
growth and opportunity period.
 Triage
The sorting of patients to determine priority health care needs and
the proper site of treatment.
In non disaster situations, health care workers assign highest
priority and allocate most resources to the most critically ill
patients.
In disaster situations with large numbers of casualties, decisions
are based on the likelihood of survival and the consumption of
resources.
 Disaster Triage System

Class I: Emergent (red)

Class II: Urgent (yellow)
Class III: Nonurgent (green)
Class IV: Minor (white)
Class V: Dead or expected to die (black)
 Triage During Disasters

 Victims with life-threatening conditions and a good chance of

survival are cared for first
 When there are more victims of a disaster than medical personnel
to treat them, those who are likely to survive are treated first;
these patients are given green tags
 The mortally wounded and those who are not expected to survive
are attended later, and these patients are issued a black tag.
 Chemical Disaster

Indications that a chemical attack has occurred might include

 Fog-like or low-lying cloud suddenly appearing in the
atmosphere.
 Many dead birds, domestic animals, or insects within a
particular area.
 Many dead, dying, or sick people in an area or downwind from a
suspicious cloud or fog
 An atypical, unexplained odor for the location
 Chemical Weapons

 Chemical substances that quickly cause injury or death and cause

panic and social disruption
Agents
 Vesicants

 Nerve agents
 Limitation of exposure is essential with evacuation and
decontamination as soon possible and as close to the scene of the
incident as possible
 Vesicants
(Agent that causes blistering)

 Lewisite, sulfur mustard, nitrogen mustard, phosgene

 Cause blistering and burning
 Respiratory effects can be serious and cause death
 Decontamination with soap and water; do not scrub or use
hypochlorite solutions
 Eye exposure requires copious irrigation
 Treatment for lewisite exposure: Dimercaprol IV or topically
 Nerve Agents
(Chemicals that affect the nervous system)
 Sarin, soman,organophosphates
 Inhibit cholinesterase, causing cholinergic symptoms progressing to
loss of consciousness, seizures, copious secretions, apnea, and
death
 Treatment: supportive care, atropine, benzodiazepine and
pralidoxime chloride .
 Decontaminate with copious amounts of soap and water or saline
for at least 20 minutes
 Radiation Exposure

 Radiation exposure may occur because of nuclear weapon, nuclear

reactor incidents, or exposure to radioactive samples
 Exposure to radiation is affected by time distance and shielding
 Types of radiation exposure
 External radiation: all or part of the body is exposed to radiation;
decontamination is not necessary; not a medical emergency
 Contamination: exposure to radioactive gases, liquids, or solids;
requires immediate medical management to prevent
incorporation
 Incorporation: uptake of the radioactive material into the body
 Radiation Exposure
 Treatment of particulate radiation exposure
 Chelating agents (removing heavy metals from the bloodstream, in treating lead or mercury
poisoning
 Isotope-specific blocking agents
 Excretion agents

 Diluting agents
 Radiation Decontamination

 Triage outside the hospital.

 Cover floor and use strict isolation precautions to prevent
the tracking of contaminants.
 Waste is double bagged and labeled “radiation waste.”
 Staff protection
 Water-resistant gowns, two pairs of gloves, caps, goggles,
masks, and boot
 Dosimetry devices : to measure radiation dose
 Radiation Decontamination
 Patients are surveyed for radiation and directed to the
decontamination area.
 Decontaminate each patient outside the ED with a shower.
 Water, tarps, towels, soap, gowns, all patient belongings, and so on must
be collected and contained.
 Patients are resurveyed and reshowered as necessary.
 Showering should be performed to not contaminate clean areas with
runoff from the showering.
 Samples: nasal and throat swabs, blood.
 Internal contamination requires additional treatment—(gastric lavage
with chelating agents)
 Biologic Disaster

 Anthrax (gram-positive, rod-shaped bacteria known as Bacillus anthracis)

 Botulism (serious illness caused by a toxin that attacks the body's nerves and causes
difficulty breathing, muscle paralysis, and even death, toxin is made by Clostridium
botulinum )
 Plague (It is caused by the bacterium, Yersinia pestis)
 Smallpox
 Tularemia( known as rabbit fever or deer fly fever, it typically attacks the skin, eyes,
lymph nodes and lungs. caused by the bacterium Francisella tularensis.
 Viral hemorrhagic fevers (Ebola)
 Isolation Precautions for Biological
Terrorism Agents

 Biological agents may be delivered or spread in a number of

ways.
 Because off modern travel, spread of infection may occur in areas
thousands of miles apart.
 Health care providers need to be aware of potential signs of biological weapon
dissemination.
 Signs and symptoms are similar to those of common disease process.
 Isolation practices depend on the infecting agent.

 Always use standard precautions.

 Some agents require transmission-based precautions.

 Terminal disinfection and disposal of wastes depend on the infecting agent.
 Recognizing a Bioterrorism Event

 Certain signs or events may present a warning that a bioterrorism attack

has occurred.
 Rapidly progressing flu-like illness, particularly in the young and among
those previously healthy
 Unusual or extensive rashes, especially if preceded by flu-like symptoms
 Muscle paralysis
 Severe bleeding disorders
 A large group of patients with food-borne illness
 Sudden death of many animals in the community
 Personal Protective Equipment
 Purpose: to shield the health care provider from chemical, physical, biological,
and radiological hazards that may exist when caring for contaminated patients
 Categories of protective equipment
 Level A: Self-contained breathing apparatus (SCBA) and vapor-tight
chemical resistant suit, gloves, and boots
 Level B: High level of respiratory protection (SCBA) but lesser skin and eye
protection; chemical-resistant suit
 Level C: Air purified respirator, coverall with splash hood, chemical-
resistant gloves and boots
 Level D: Typical work uniform
 Bioterrorism

Nursing management
 Strict adherence to infection control procedures and policies
 Biologic Agents

 Category A agents: Easily disseminated, and some may be transmitted from

person to person as well. These could cause mass casualties and require a well-
organized and extensive health care system response for management
 Category B agents: Delivered through water and food sources. These produce
moderate amounts of illness and low death rates. Public health department
action is needed for management. Examples are Q fever, brucellosis, glanders,
ricin toxin, epsilon toxin of Clostridium perfringens, and Staphylococcus aureus
enterotoxin B.
 Category C: Agents that have not been weaponized as yet, but have the
potential for high morbidity and mortality. These agents are plentiful and easy
to produce and disseminate. Examples include Hantavirus, tick-borne
encephalitis, yellow fever, and multidrug-resistant tuberculosis.
 Pandemic (Airborne Respiratory) Infection

 Teach people to be prepared to stay at home for at least two

weeks
 Reassure people that basic measures for prevention of
respiratory infection can be effective
 Healthy lifestyle to support the immune system

 Washing hands and covering the mouth during coughing or

sneezing, disposing of tissues, and staying away from public
places if at all possible
THANK YOU!