Dr. v.v.p. f’s college of nursing,Ahmednagar.

SEMINAR ON
DISASTER
NURSING

SUBMITTED TO: SUBMITTED BY:

DR.YOGITA AUTADE MR. DINESH MAGAR
PROF.CUM 1ST YEAR MSc. NURSING
VICE PRINCIPAL Dr.V.V.P.F.CON
Dr.V.V.P.F.CON AHMEDNAGAR
AHMEDNAGAR
 SUBMITTED ON

GENERAL OBJECTIVES:
At the end of topic student will receive in depth knowledge regarding disaster nursing.

SPECIFIC OBJECTIVES:

At the end of the topic student will be able to…..

1. Meaning of disaster and hazard.

2. Explain the types of disaster.

3. Discuss the phases of disaster.

4. Explain the dimensions of disaster.

5. Describe the triage system of disaster management.

6. Explain stages of disaster and the role of nurse in disaster management.

7. Describe role of Nurse in Disaster Response.

8. Explain role of nurse in Disaster Recovery.

INTRODUCTION

Presently at the global level, there has been considerable concern over natural disasters.
Even as substantial scientific and material progress is made, the loss of lives and property
due to disasters has not decreased. In fact, the human toll and economic losses have
mounted. There has been an increase in the number of natural disasters over the past
years and with it, increasing losses on account of urbanization and population growth, as
a result of which the impact of natural disasters is now felt to a larger extent. According
to the United Nations, in 2001 alone, natural disasters of medium to high range caused at
least 25,000 deaths around the world, more than double the previous year and economic
losses of around US $36 billion. These figures would be much higher, if the
consequences of the many smaller and unrecorded disasters that cause significant losses
at the local community level were to be taken into account.
Natural disasters are not bound by political boundaries and have no social or economic
considerations. They are borderless as they affect both developing and developed
countries. They are also merciless and as such the vulnerable tend to suffer more at the
impact of natural disasters. For example, the developing countries
Since 1991, two-third of the victims of natural disasters was from developing countries,
while just 2 percent were from highly developed nations. Those living in developing
countries and especially those with limited resources tend to be more adversely affected.
With the alarming rise in the natural disasters and vulnerability per se, the world
community is strengthening its efforts to cope with it.

MEANING
Disaster means that any occurrence that causes damage, ecological disruption, loss of
human life or deterioration of health and health services on a scale sufficient to warrant
and extraordinary response from outside the affected community or area (WHO, 1995).
TYPES
Disaster is an occurrence, either natural or man-made that causes human suffering and
creates human needs that victims cannot alleviate without assistance.
Disasters can be natural & man-made.
 Natural disasters include droughts, earthquakes, tsunamis, forest fires, landslides and
mudslides, blizzards, hurricanes, tornadoes, floods and volcanic disruptions.
 Man-made disasters includes hazardous substance accidents (e.g., chemicals, toxic
gases), radiologic accidents, dam failures, resource shortage (e.g., food, electricity and
water), structural fire and explosions and domestic disturbances (e.g., terrorism,
bombing ), Bioterrorism.
DISASTER AGENT
 Agent
 It is the physical item that actually causes the injury or destruction. Primary agents
include falling buildings, heat, wind, rising water and smoke. Secondary agents
include bacteria and viruses that produce contamination or infection after the primary
agent has caused injury or destruction.
 Primary and secondary agents will vary according to the type of disaster.

 Host:
 The host is human kind. Host factors are those characteristics of humans that
influence the severity of the disaster's effect. Host factors include age, immunization
status, pre-existing health status, degree of mobility and emotional stability.
 Environment:
 Environmental factors that affect the outcome of a disaster include physical, chemical,
biological and social factors.
 Physical factors include the time when the disaster occurs, weather conditions, the
availability of food and water and the functioning of utilities such as electricity and
telephone service.
 Chemical factors influencing disaster outcome include leakage of stored chemicals
into the air, soil, ground water or food supplies.
 Biological factors are those that occur or increase as a result of contaminated water,
improper waste disposal, insect or rodent proliferation, improper food storage, or lack
of refrigeration owing to interrupted electrical services.
 Social factors are those that contribute to the individual's social support systems.
Loss of family members, changes in roles, and the questioning of religious beliefs are
social factors to be examined after a disaster.
 Psychological factors contribute to the effect of the disaster on individuals.
Psychological factors are closely related to agent, host and environmental conditions.
The nature and severity of the disaster affect the psychological distress experienced
by victims. The existence and length of a warning period and physical proximity to
the actual site of the disaster influence the amount of psychological distress
experienced by victims. The closer an individual is to the actual site of the disaster
and the longer the individual is exposed to the immediate site of the disaster, the
greater the psychological distress that individual will experience.
 Individuals may suffer impaired intellectual functioning, have difficulty
concentrating, or making decisions and experience impaired memory. Psychosomatic
complaints and mental illness are also responses to disaster situations and are
evidenced by loss of appetite, fatigue, intestinal upset, sleep disorders and muscular
weakness.

PHASES OF A DISASTER
 Pre-Impact Phase:
The pre-impact phase is the initial phase of the disaster, prior to the actual occurrence.
A warning is given at the sign of the first possible danger to a community. Many
times there is no warning, but with the aid of weather networks and satellites, many
metrological disasters can be predicted. The earliest possible warning is crucial in
preventing loss of life and minimizing damage. This is the period when the
 emergency preparedness plan is put into effect.
Emergency centers are opened by the local Civil Defense Authority. Communication
is a very important factor during this phase; disaster personnel will call on amateur
radio operators, radio and television stations and any available method to alert the
community and keep it informed. The community must be educated to recognize
the threat as serious. When communities experience false alarms several times,
members may not take future warnings very seriously. 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 groups.
 Impact Phase:
The impact phase occurs when the disaster actually happens. It is a time of enduring
hardship or injury and of trying to survive. This is a time when individuals help
neighbors and families at the scene, a time of "holding on" until outside help arrives.
The impact phase may last for several minutes or for days or weeks (e.g., in a flood,
famine or
epidemic).
This phase must provide for preliminary assessment of the nature, extend and
geographical area of the disaster. The number of persons requiring shelter, the type
and number of needed disaster health services anticipated and the general health status
and needs of the community must be evaluated. The impact phase continues until the
threat of further destructions has passed and the emergency plan is in effect. If there
has been no warning, this is the time when the Emergency Operation Center (EOC) is
established and put in operation. The EOC is the operating center for the local chapter
of the American Red Cross. It serves as the center for communication with other
government agencies, the center for recruitment of health care providers to staff
shelters
 Post impact Phase:
Recovery beings during the emergency phase and end with the return of normal
community order and functioning. For persons in the impact area this phase may last a
lifetime (e.g., victims of the atomic bombing of Hiroshima).
The victims of a disaster go through four stages of emotional response:
1. Denial: During the first stage, the victim may deny the magnitude of the problem or,
more likely, will understand the problem but may seem unaffected emotionally. The
problems created by the disaster are being denied or have not fully "registered." The
victim may appear unusually unconcerned.
2. Strong emotional response: In the second stage, the person is aware of the problem
but regards it as overwhelming and unbearable. Common reactions during this stage are
trembling, tightening of the muscles, sweating, speaking with difficulty, weeping,
heightened sensitivity, restlessness, sadness, anger, and passivity. The victim may want to
retell or relive the disaster experience over and over.
3. Acceptance: During the third stage, the victim begins to accept the problems caused
by the disaster and makes a concentrated effort to solve them. He or she feels more
hopeful and confident. It is especially important for victims to take specific actions to
help themselves and their families.
4. Recover: The fourth stage represents a recovery from the crisis reaction. Victims feels
that they are back to normal. Routines become important again. A sense of well-being is
restored. The ability to make decisions and carry out plans returns. Victims develop a
realistic memory of the experience.

DIMENSIONS OF A DISASTER

Disasters have a number of dimensions in which they may differ: predictability,

frequency, controllability, time and scope or intensity. These dimensions influence the
nature and possibility of preparation planning, as well as response to the actual event.
Predictability:
Some events are more easily predicated then others. Advances in meteorology, for
example, have made it more feasible to accurately predict the probability of certain types
of natural, weather-related disasters (e.g., tornadoes, floods, and hurricanes), while
others, such as earthquakes, are not as easily predicted. Man-made disasters, such as
explosions or weeks, are also less predictable. Whenever an event is predictable,
authorities and emergency personnel have more time to prepare for situation than when
an event is not foreseeable (i.e., spontaneous).
Frequency:
Although natural disasters are relatively rare, they appear more often in certain
geographical locations. Residents of the coastal area live in what is commonly referred to
as cyclone are at greater risk for experiencing later greater risk for earthquakes, and
people who live near large river systems are at greater risk for flooding than people who
live elsewhere
Controllability:
Some situations allow for pre warning and control measures that can reduce the impact of
the disaster; others do not. Emergency planners were able to control some of the effects
of the flooding by sandbagging levees and river or sea banks to reduce the effects of
water damage, and by deliberately blasting dikes and dams to divert flood waters to less
populated areas. The immediate impact on people was reduced by the ability of
emergency personnel to organize evacuations and reduce the risk of injury and death.
Time:
There are several characteristics of time as it relates to the impact of a disaster; the speed
of onset of the disaster, the time available for warning the population, and the actual
length of time of the impact phase.
Scope and Intensity:
A disaster may be concentrated in a very small area or involve a very large geographical
region, usually affecting many more people. A disaster can be very intense and highly
destructive, causing many injuries, deaths, and property damage, or less intense, with
relatively little damage done to property or individuals.

THE NURSING ROLE IN DISASTERS

 Disaster nurses play key leadership and service provision roles in planning and
implementing disaster relief efforts, preventing technologic disasters, and addressing
problems that occur during a disaster, such as the physical and emotional stress of
 disaster victims.
 During a disaster many environmental health problems emerge. The scope and
magnitude of these problems determines the nursing role. Nurses collaborate with
community agencies and officials to recognize and reduce disaster risks and maximize
the health and safety of individuals involved in disaster crises.
 Following a disaster, nurses make numerous referrals to community agencies for a
variety of needs including psychologic care, emotional support services, and treatment
for victims and their families. Recovery encompassed dealing with many disaster
effects such as loss of life, income, and home. The communicable disease
implications of disasters are also immense:
Assess the Community
 Is there a current community disaster plan in place?
 What previous disaster experiences has the community been involved with locally,
statewide, nationally?
 How is the local climate conducive to disaster formation (e.g., hurricanes, tornadoes,
blizzards)?
 How is the local terrain conducive to disaster formation (e.g., earthquakes, flooding,
forest fires, avalanches, mudslides)?
 What are the local industries?
 Are there any community hazards (e.g., toxic waste and chemical spills, industrial or
agricultural pollutants, mass transportation problems)?
 What personnel are available for disaster interventions (e.g., nurses, doctors, dentists,
pharmacists, clergy, volunteers, emergency medical teams)?
 What are the locally available disaster resources (e.g., food, clothing, shelter,
pharmaceutical)?
 What are the local agencies and organizations (e.g., hospitals, schools, churches,
emergency medical, Red Cross)?
 What is immediately available for infant care (e.g., formula, diapers) and care of the
elderly and disabled?
 What are the most salient chronic illnesses in the community that will need immediate
attention (e.g., diabetes, arthritis, cardiovascular)?
 Diagnose Community Disaster Threats
 Determine actual and potential disaster threats (e.g., toxic waste spills, explosions,
mass transit accidents, hurricanes, tornadoes, blizzards, floods, earthquakes).
Disaster Planning
 Develop a disaster plan to prevent or deal with identified disaster threats.
 Identify a local community communication system.
 Identify disaster personnel, including private and professional volunteers, local
emergency personnel, agencies, and resources.
 Identify regional backup agencies, personnel.
 Identify specific responsibilities for various personnel involved in disaster coping and
establish a disaster chain of command.
 Set up an emergency medical system and chain for activation. Identify location and
accessibility of equipment and supplies. Check proper functioning emergency
equipment. Identify outdated supplies and replenish for appropriate readiness.

Implement Disaster Plan

 Focus on primary prevention activities to prevent occurrence of man-made disasters.
 Practice community disaster plans with all personnel carrying out their previously
identified responsibilities (e.g., emergency triage, providing supplies such as food,
water, medicine, crises and grief counselling).
 Practice using equipment, obtaining and distributing supplies.
 Evaluate Effectiveness of Disaster Plan
 Critically evaluate all aspects of disaster plans and practice drills for speed,
effectiveness, gaps, and revisions.
 Evaluate the disaster impact on community and surrounding regions.
 Evaluate response of personnel involved in disaster relief efforts.
PRINCIPLES OF DISASTER MANAGEMENT
There are eight fundamental principles that should be followed by all who have a
responsibility for helping the victims of a disaster. It is critical that rescue workers use
these principles in proper sequence, or they will be ineffective and possibly detrimental a
disaster victims. The eight basic principles are as follows (Grab and Eng 1969):
Prevent the occurrence of the disaster whenever possible.
Minimize the number of casualties if the disaster cannot be prevented.
Prevent further casualties from occurring after the initial impact of the disaster.
Rescue the victims.
Provide first aid to the injured.
Evacuate the injured to medical facilities.
Provide definitive medical care.
Promote reconstruction of lives.
TRIAGE
There are several times during the emergency response in which triage may be necessary
to best determine the needs of injured victims. Triage is a French word meaning "sorting"
or "categorizing." The term first came into use during World War 1 when casualties were
sorted during battle. During a disaster, the goal is to maximize the number of survivors
by sorting the treatable from the untreatable victims. In a disaster, the potential for
survival and the availability of resources are the primary criteria used to determine which
patients receive immediate treatment. In a disaster situation, saving the greatest number
of lives is the most important goal. Triage may take place during the rescue operation at
the scene of the disaster, and again at each stage of transport for the disaster victims.
Prioritizing of victims for treatment can be done in many ways; some communities use
color coding. Probably the best and most easily understood four-category system is the
first-priority, second-priority, third-priority, and dying-or-dead system:
Red - most urgent, first priority
Yellow - urgent, second priority
Green - third priority
Black - dying/dead
STAGES OF DISASTER AND THE ROLE OF NURSES
1. Preparedness
Personal Preparedness
Great stress is placed on the nurse with client responsibilities who also becomes a disaster
victim. Conflicts arise between family and work-related responsibilities. In addition, the
community health nurse who will be assisting in disaster relief efforts must be as healthy
as possible, both physically and mentally. A disaster worker who is not well is of little
service to his or her family, clients, and other disaster victims. Personal preparedness can
help case some of the conflicts that will arise and allows nurses to attend to client needs
sooner that one may anticipate.
Professional Preparedness
 Professional preparedness requires that nurses become aware of and understand the
disaster plans at their workplace and community. Nurses who take disaster
preparation seriously will take the time to read and understand workplace and
community disaster plans and will participate in disaster drills and community mock
disasters. The more adequately prepared nurses are, the more they will be able to
function in a leadership capacity and assist others toward a smoother recovery phase.
Personal items that are recommended for any nurse preparing to help in a disaster
include the following
 A copy of their professional license
 Personal equipment, such as a stethoscope
 A flashlight and extra batteries
 Cash
 Warm clothing and a heavy jacket (or weather-appropriate clothing)
 Record-keeping materials
 Pocket-sized reference books
Community Preparedness
The level of community preparedness for a disaster is only as good as the people and
organisations in the community make it. Some communities remain vigilant as to the
possibility of a disaster hitting their community and stay prepared by having a solid
disaster plan on paper and by participating in yearly mock disaster drills

ROLE OF THE NURSE IN DISASTER RESPONSE

 The role of the community health nurse during disaster depends greatly on the nurse's
past experience, role in the institutions and community's preparedness, specialized
training, and special interest. The most important attribute for anyone working in a
disaster, however, is flexibility. One certain factor about disaster is that change is a
constant.
 Although valued for their expertise in community assessment, case finding and
referring, prevention, health education, surveillance, and working with aggregates, at
times the community health nurse is the first to arrive on the scene and must respond
accordingly.
 Community health nurses working as members of an assessment team have the
responsibility of feeding back accurate information to relief managers to facilitate
rapid rescue and recovery. Many times nurses are required to make home visits to
gather needed information, a task that comes quite naturally to the community health
nurse. Types of information included in initial assessment reports include the
following:
 Geographical extent of disaster's impact
 Population at risk or affected
 Presence of continuing hazards
 Injuries and deaths
 Availability of shelter
 Current level of sanitation
 Status of health care infrastructure
ROLE OF THE NURSE IN DISASTER RECOVERY
 The role of the nurse in the recovery phase is as varied as in the preparedness and
response phases of a disaster. Flexibility remains an important component of a
 successful recovery operation. Community cleanup efforts can incur a host of physical
and psychological problems. For example, the physical stress of moving heavy
objects can cause back injury, severe fatigue, and even death from heart attacks. In
addition, the continuing threat of communicable disease will continue as long as the
water supply remains threatened and the living conditions remain crowded.
Community health nurses must remain vigilant in teaching proper hygiene and
making sure immunization records are up to date.
 Acute and chronic illnesses can be exacerbated by the prolonged effects of disaster.
The psychological stress of cleanup and moving can bring about feelings of severe
hopelessness, depression, and grief. Recovery can be impeded by short-term
psychological effects eventually merging with the long-term results of living in
adverse circumstances. In some cases, stress can lead to suicide and domestic abuse.
In addition, although most people eventually recover from disasters, mental distress
may persist in these valuable populations who continue to live in chronic adversity.
Referrals to mental health professional should continue as long as the need exists.
 The community health nurse must also remain alert for environmental health hazards
during the recovery phase of a disaster. Home visits may lead the nursing to uncover
situations such as a faulty housing structure. Lack of water supply, or lack of electric
 ABSTRACT

National and global disasters require immense resources, including nurses. Personal,
professional, and spiritual preparation is strongly recommended for healthcare
workers who desire to serve in disaster settings. Most nurses are underprepared for
this role; options for preparation are described along with the ministry of nursing and
spiritual care that expresses God's heart of mercy and care for hurting and desperate
people.
 SUMMERY

In todays seminar we discussed about

1. Meaning of disaster and hazard.

2. the types of disaster.

3. phases of disaster.

4. dimensions of disaster.

5. the triage system of disaster management.

6. stages of disaster and the role of nurse in disaster management.

7. role of Nurse in Disaster Response.

8. role of nurse in Disaster Recovery.

 CONCLUSION

Disaster management depends upon all personnel performing right task at right time.
Disaster can be natural or manmade individuals respond in many different ways to the
disaster experience, and emergency care providers are not immune to personal responses
to the experience. Community health nurses provide encouragement, care and support to
community members during a disaster and are equally qualified to meet the challenges of
disaster nursing.
 BIBLIOGRAPHY:-

1. Basvantappa B.T. textbook of Community Health Nursing, 7 th edition, Jaypee

Brothers, New Delhi pp 953-961.

2. Gulani K Community Health Nursing, 1 st edition, kumar publishing services New

Delhi

3. Kamalan, Essentials of Community Health Nursing, 1 st edition, Jaypee brothers

New Delhi.

4. Park K Preventive And Social Medicine, 19 th edition, Banarasidas Publishers

Jabalpur Pp 600.

5. Tener Goodwin, Venera, Disaster Nursing, Spring Publication Company New

York,