COMMUNITY HEALTH

NURSING
COURSE CODE: NSC 300
FAREMI ADENIKE (RN, PH.D)

DEPARTMENT OF NURSING SCIENCE

FACULTY OF BASIC MEDICAL SCIENCES

DISASTER NURSING
 OBJECTIVES

At the end of this lecture, students should be able to:

• Define disaster and disaster Nursing
• Describe the phases of disaster
• Describe the stages of disaster management
• Explain the roles of nurses in disaster Management
 INTRODUCTION

• Most people look forward to a life where they pursue their chosen
career in relative order, peace and tranquility without interference
• However, the unexpected by its nature can strike anywhere, any time
and to anybody or everybody, including those who are unprepared.
• Disaster occurrence is a global phenomenon.
• The intensity of disaster (in terms of human and economic losses)
necessitate disaster planning / emergency preparedness.
 INTRODUCTION CONT`D

• Natural disasters are not bound by political boundaries and have

no social or economic considerations.
• They affect both developing and developed countries.
• They are merciless and as such the vulnerable tend to suffer more
at the impact of natural disasters.
• The developing countries are much more / seriously affected in
terms of the loss of lives and hardship borne by population
 INTRODUCTION CONT’D

• Definition: Disaster is any occurrence that causes damage,

ecological disruption, loss of human life or deterioration of
health and health services on a scale sufficient to warrant an
extraordinary response from outside the affected community
area.
 INTRODUCTION CONT`D

DEFINITION:
Disaster Nursing can be defined as the adaption of professional
nursing skills to meet physical, and emotional needs resulting from a
disaster.

The overall goal of disaster nursing is to achieve the best possible

level of health for the people and the community involved in disaster.
 INTRODUCTION CONT`D

• Nurses have a primary role in preparing for and managing medical

care during episodic and catastrophic events.

• It is important that all health care workers and nurses in particular

react professionally, efficiently, rationally and effectively when
disaster strikes.
 TYPES OF DISASTER

Disaster may be classified into two broad categories:

• Natural disaster
• Man-made disaster
 NATURAL DIASTER

• The world health organization defines natural disaster as the “result

of an ecological disruption or threat that exceeds the adjustment
capacity of the affected community”.
• Natural disasters are those caused by natural or environmental
forces.
• They include droughts, earthquakes, tsunamis, forest fires,
landslides and mudslides, blizzards, hurricanes, tornadoes, floods
and volcanic eruptions.
 MAN-MADE DISASTER

• Causes of man-made disasters are identifiable human actions that could be

deliberate or otherwise.
• Man-made disasters include hazardous substance accidents (e.g.,
chemicals, toxic gases).
• Radiologic accidents, dam failure, resource shortage (e.g., food,
electricity and water).
• Transportation accidents, structural fire, structural collapse, explosions
and domestic violence or disturbances (e.g., terrorism, bombing and riots),
Bio-terrorism and acts of war.
 MAN-MADE DISASTER (CONTD)

Man-made disaster can further be classified into:

• Complex emergencies: It involves situations where populations suffer
significant causalities as a result of war, civil strife, or other political
conflict.
• Technologic disasters: A large number 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.
 TYPES OF DISASTER (CONTD)

• However, the distinction between natural and man-made disasters may be

blurred.
• Natural disaster may trigger a secondary disaster as a result of weakness in
the human environment.
• An example of this is a chemical plant explosion following an earthquake.
• This combination is referred to as Natural and technological disasters (NA-
TECHs)
 PHASES OF DISASTER

There are three phases to any disaster.

• Pre- impact phase
• Impact Phase
• Post impact phase
 PHASES OF DISASTER

Pre- impact phase

•The pre-impact phase is the initial phase of the disaster, prior to 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 meteorological disasters can be predicted. This is period when
the emergency preparedness plan is put into effect.
•The role of nurses during the warning phase is to assist in preparing shelters
and emergency aid stations and establishing contact with other emergency
service group.
 PHASES OF DISASTER (CONTD)
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. The impact phase may last
for several minutes (e.g., in a flood, famine or epidemic)
•The impact phase continues until the threat of further destruction has passed and
the emergency plan is in effect. In case of no warning, it is necessary to establish
emergency operation center (EOC) and put in operation.
•The nurse is responsible for assessing health needs and providing physical and
psychological support to victims in the shelters.
 PHASES OF DISASTER (CONTD)

Post impact phase

•Recovery begins during the emergency phase and end with the
return of normal community order and functioning.
•The victims of a disaster go through four stages of emotional
response
 PHASES OF DISASTER (CONTD)

1. Denial: This is the first stage, the victim may deny the magnitude
of the problem, They may appear unusually unconcerned

2. Strong emotional response: In the second stage, the person is

aware of problem but regard 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.
 PHASES OF DISASTER (CONTD)

3. Acceptance: During the third stage the victim begins to accept the
problems caused by the disaster and make a concentrated effort to
solve them.
4. Recover: the fourth stage represent a recovery from the crises
reaction. Victims feel that they are back to normal and routines
become important again.
Recover also depicts restoring a sense of well-being.
 PHASES OF DISASTER MANAGEMENT

There are four phases involved in disaster management;

• Mitigation
• Preparedness
• Response
• Recovery
 MITIGATION
(ALLEVIATION/RELIEVE)
• The primary goal of disaster management is to prevent or minimize death,
suffering or loss, thus can be achieved through Mitigation.
• Mitigation refers to individual's activities channeled towards the prevention of
disaster or the reduction of the damaging effects of unavoidable disasters.
• Nurses have important role to play in;
• Identifying disaster risks
• Developing Disaster Prevention Strategies
 MITIGATION
(ALLEVIATION/RELIEVE)
Public Education
•Individuals in the communities become aware of activities that
promotes disaster prevention through Public Education.
•It Is an important strategies towards disaster prevention and
readiness.
•There are disasters that are preventable while some are not
preventable but their effects can be lessened.
•Man-made disaster can be prevented to a certain extent.
 MITIGATION
(ALLEVIATION/RELIEVE)
• Observing proper safety precautions like proper implementation of building codes, proper
storage, use and transport of chemicals, proper land and water management are activities
to curtail man made disaster
• The effects of unavoidable disaster can be lessened by public education on first aid, Easy
assess to emergency supplies/centers, and the creation of evacuation routes.
WHY PUBLIC EDUCATION?
• Public education help to enlighten the community on how to prevent man-made
disasters,
• It also helps to reduce the impact of dangerous unavoidable situations
 MITIGATION
(ALLEVIATION/RELIEVE)

EMERGENCY OPERATION CENTER (EOC)

•EOC is a center for health care personnel from the local emergency medical
system which are involved in treating people at the scene of the disaster.
•In helping victims of a disaster, certain principles must be used in proper sequence
•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.
 MITIGATION
(ALLEVIATION/RELIEVE)

• Rescue the victims

• Provide the first aid to the injured.
• Evacuate the injured to medical care.
• provide definitive medical care.
• Promote reconstruction of lives.
 MITIGATION
(ALLEVIATION/RELIEVE)
TRIAGE

•Triage means "sorting" or "categorizing" in French.

• It means the sorting of patients to determine the priority of their
health care needs and proper site for treatment.
• There are systems use in classifying patients; use of color code
system (Red, Yellow, Green, and Black) or numbering in terms of their
priorities
 TRIAGE CATEGORIES
TRIAGE CATEGORY PRIORITY COLOUR TYPICAL CONDITIONS

Immediate: Injuries are life threatening but 1 Red Sunken chest wound, shock, haemothorax,
survival with minimal intervention. abdominal wound, open fracture of long bones
Individuals in this group can progress rapidly and 2nd/3rd degree burns of 15-40% total
to expand if treatment is delayed. body surface area.
Delayed: injuries are significant and require 2 Yellow Soft tissue injuries, vascular injuries, genito-
medical care but can wait hours without urinary tract disruption, fracture requiring
threat to life or limb. Individuals in this group open reduction and CNS injuries.
receive treatment only after immediate
causalities are treated.
Minimal: Injuries are minor and treatment 3 Green Minor burns, sprains, behavioural disorders or
can be delayed hours to days. Individuals in psychological disturbances
this group should be moved away from the
main triage area.

Expectant: Injuries are extensive and 4 Black Unresponsive patients with penetrating head
chances of survival are unlikely even with injuries, high spinal cord injuries, 2nd/3rd
definite care. Persons in this group should be degree burns in excess of 60% of body surface
separated from other causalities, but not area, profound shock with multiple injuries, no
abandoned. Comfort measure should be pulse, no BP, pupils fixed and dilated.
provided when possible.
 TRIAGE (CONTD)

• The goal of disaster management during crisis is to maximize the number of

survivors by sorting the treatable from the untreatable.
• The primary criteria used to determine which patient receive immediate
treatment is the likelihood of survival and the availability of resources.
• Rapid assessment must be done for the injured at the disaster scene by the
triage officer, tagged and transported or given life saving interventions.
• Traffic must be controlled within the facility especially at the triage area
which may be outside or just by the entrance of the emergency department.
 PREPAREDNESS

• This refers to the proactive planning efforts designed to structure the

disaster response prior to its occurrence.
• Disaster planning encompasses evaluating the potential vulnerability
(assessment of risk) and the propensity for a disaster to occur.
• A key to disaster preparedness is that the plan must be simple and
realistic.
 FORMS OF PREPAREDNESS

A. Personal preparedness
• The nurse that will be assisting in disaster relief must be as
healthy as possible both physically and mentally.
• Personal preparedness can help situation which may cause
conflict.
• This will facilitate nurses prompt attention to client needs
 FORMS OF PREPAREDNESS

B. Professional preparedness
• This requires that nurses become aware and
understand the disaster plans in their workplace and
community.
• The nurse must be able to adapt and incorporate his
existing nursing skills to a disaster setting.
 FORMS OF PREPAREDNESS

C. Community preparedness
• The level of community preparedness for a disaster is as good
as commitment of the people and organizations in the
community.
• Some community remain vigilant as to the possibility of
disaster hitting their community.
• Such communities remained prepared by having a solid disaster
plan on paper and by participating in yearly mock disaster drill.
 FORMS OF PREPAREDNESS

NB:
A solid disaster plan requires the multidisciplinary talents
coordination, and cooperation of many different organizations and
professionals: which include clergy, police, fire and rescue and the
media.
ROLES OF THE COMMUNITY HEALTH NURSE IN
DISASTER PREPAREDNESS

1. Facilitate preparation within the community and

place of employment.
2. Initiates and update the disaster plan, and provide
educational programs and material regarding
disasters specific to the area.
3. Provide an updated record of vulnerable populations
within the community.
4. Assess for and report environmental health hazards.
 RESPONSE

• Response is the actual

implementation of the disaster
management plan. Response is
determined by the level of disaster.
 RESPONSE
• Level 1 disaster requires activation of local emergency medical system in corporation
with community organizations. Example of level 1 response is by the red cross society,
salvation army.
• Level 2 disaster requires more of regional response . Many agencies will be involved in
the management. Other voluntary organizations and local government will be involved
in this management
• Level 3 disaster is one in which a federal emergency has been declared because of
widespread destruction. National official agencies and other concerned citizens
including health professionals come to help
 RECOVERY

• Recovery includes all the actions taken to return to a normal, or even safer
situation following a disaster.
• This focuses on stabilizing and returning the community or organization to
normal which may last for a period of time.
• It is the period of reconstruction and rehabilitation.
• The stage of recovery occurs as all involved agencies pull together to restore the
economic and civic life of the community.
 RECOVERY

• Prevention and control of stress among emergency workers is important.

• It can range from rebuilding damaged buildings and repairing infrastructure.
• Also, it aids relocating populations and instituting mental health interventions.
• Includes rescue personnel in mental health and put efforts to the recovery
process
• All of the groups involved work in partnership with the people affected by
disaster, who are ultimately responsible for their own recovery
 ROLE OF COMMUNITY HEALTH NURSE
IN DISASTER MANAGEMENT

ROLE IN COMMUNITY ASSESSMENT

• Assess the community (E.g.-Local climate conductive for disaster).
• Past history of disaster
• Available community disaster
• Personnel available in the community
• Local agencies E.g. Relief Groups
• Health care facilities available.
 ROLE OF COMMUNITY HEALTH NURSE
IN DISASTER MANAGEMENT

ROLE IN DIAGNOSIS
• Diagnose community disaster threats.
• Determine the actual and potential disaster threats.
• Community disaster planning.
 ROLE OF COMMUNITY HEALTH NURSE
IN DISASTER MANAGEMENT

ROLE IN PLANNING
Develop disaster plan:
• Aim: To provide prompt and effective medical care to the maximum possible in order
to minimize morbidity and mortality.
• Objectives:
Prepare the staff and institutional resources.
Create a community awareness.
 ROLE OF COMMUNITY HEALTH NURSE
IN DISASTER MANAGEMENT
Plan for disaster management
• Constitution of disaster management committee
• Disaster control room.
• To refer the casualties for treatment
• Rapid response team
• Information and communication.
• Disaster beds
• Logistic support system-equipment and supplies.
• Training and drills.
 ROLE OF COMMUNITY HEALTH NURSE
IN DISASTER MANAGEMENT
Elements of disaster plan:
• Chain of authority
• Lines of communication
• Modes of transport
• Mobilization
• Warning
• Equation
• Rescue and recovery
• Triage
• Treatment
• Support of victims and families
• Care of dead bodies
• Disaster worker rehabilitation.
 ROLE OF COMMUNITY HEALTH NURSE IN
DISASTER MANAGEMENT

Activation of Disaster Management plans:

•Develop a standard operating procedure

•Reception area-Disaster content room.
•Triage
•Documentation at control room
•Public relation
•Essential services-e.g. water, power and food
•Crowd management / security arrangements.
 ROLE OF COMMUNITY HEALTH NURSE IN
DISASTER MANAGEMENT

Activities needed in planning:

•Identify local community communication system
•Identify disaster personnel like private and professional volunteer etc.
•Identify regional back up agencies and personnel
•Identify specific responsibilities for various personnel involved in the disaster plan.
•Set up an emergency medical system and chain of activation.
•Identify location and accessibility of equipment and supplies.
•Check proper functioning of emergency equipment.
•Identify outdated supplies and replace.
 ROLE OF COMMUNITY HEALTH NURSE
IN DISASTER MANAGEMENT
Implement disaster plans:
•Focus on primary prevention activities to prevent occurrence
of man made disaster.
• Practice community disaster plans with all personnel's –e.g.
Triage, Supply of food ,water.
• practice using equipment, obtaining and distributing
supplies.
 ROLE OF COMMUNITY HEALTH NURSE IN
DISASTER MANAGEMENT

Shelter management plans:

• Nurse can act as shelter managers
• Listen to the victims
• Encourage victims to overcome the crisis
• Delegate tasks to team members and co-ordinate
activities
• Provide the basic resources. like food, potable water,
electricity etc.
• Provide compassion and dignity to the victim.
 EVALUATION

• Evaluate effectiveness of disaster plan via

• All aspects of disaster plans.
• Practice drills for speed.
• Disaster impact on community and surroundings regions.
• Response of personnel involved in disaster relief efforts.
 ROLE OF NURSE IN DIFFERENT PHASES OF
DISASTER
COMMUNITY PREPAREDNESS (PRE-IMPACT PHASE)
• Education
• Organize first aid program
• Making each home to stock
• Emergency telephone numbers
• Battery operated radio
• Flash light
• First aid kit
• Three day supply of water
• Medical information &family physician detail
• Persons to be notified in emergency
 ROLE OF NURSE IN DIFFERENT PHASES OF
DISASTER
Response phase / impact phase

• Identify the population

• Triaging the victim
• Care for injured persons
• Transporting patients
• Arranging for physical
• Facilities for the victim.
• Referral services
 ROLE OF NURSE IN DIFFERENT PHASES OF
DISASTER
Recovery phase/ post impact
• Counseling
• Continuing care
• Vocational training
• Behavior modification
• Rehabilitation
• Home visit
• Relieve package – (finance or
or material support)
 ROLE AND RESPONSIBILITIES OF THE
DISASTER MANAGEMENT BOARD

• Develop a National Disaster Action plan

• Helping the ministries and agencies
• Working with local authorities
• Providing documentation and information services
• Monitoring and discussing with the Govt.
 ROLE AND RESPONSIBILITIES OF THE
DISASTER MANAGEMENT BOARD
During an emergency:
•Ensure the effective communication and information
•Put up activity and operate National emergency
•Private secretarial service and expert advice to the National Disaster
management Council / inter ministerial disaster management co-ordination
committee.
•Provide information to and liaise with the economic relations
•Divisions and the ministry of information.
 ROLE AND RESPONSIBILITIES OF THE
DISASTER MANAGEMENT BOARD

During post disaster recovery:

• Co-operate with the planning commission and line agencies on
reconstruction requirements
• Ensure the risk reduction measures.
• Under take final evaluation.
 CONCLUSION

• Community health nurses have vital roles in disaster planning and implementation
efforts.
• They are involved as planners, educators, direct care givers and assessment
supervisors.
• They serve as a community survey assessment or triage officers after the disaster has
occurred.
• Hence participate actively in disaster management as a community health nurse and
protect the health of the community before, during and after disaster.
 LINKS
• https://rajnursing.blogspot.com/2017/09/disaster-nursing.html
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7135108/
• https://www.currentnursing.com/nursing_management/disaster_nursing.html
• https://www.researchgate.net/publication/
298040436_Introduction_to_disasters_and_disaster_nursin
• https://www.trustedhealth.com/blog/what-is-disaster-nursing
THANKS FOR YOUR
ATTENTION