DISASTER NURSING

DISASTER NURSING

INTRODUCTION:-

                             Emergency care is care that must be rendered without delay. In a hospital emergency department outside the hospital at the disaster site, several patients with diverse health problems, some life-threatening, some not may present to the emergency department simultaneously. One of the first principles of emergency care is triage.

                                   Since the beginning of time, disasters have been a part of life. Disaster can violently disrupt our day to day lives and change history forever as the population of the world continues to grow, so does potential for mass casualty incident associated with disaster

DEFINITION:-

                      A disaster can be defined as “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”

TYPES OF DISASTER:-

Natural disaster

Earthquake

Earthquake is an unexpected and rapid shaking of the earth due to the breakage and shifting of underneath layers of Earth. Earthquake strikes all of a sudden at any time of day or night and quite violently. It gives no prior warning. If it happens in a populated area, the earthquake can cause great loss to human life and property.

Tornado

Tornado is one of the most violent storms on earth. It seems like a rotating and funnels shape cloud. It expands from the thunderstorm to the ground in the form of whirlwinds reaching around 300 miles per hour. The damage path could move on to one mile wide and around 50 miles long. These storms can strike quickly without any warning.

Flood

Flood is also one of the most common hazards in the United States and other parts of the world. The effects of a flood can be local to a neighbourhood or community. It can cast a larger impact, the whole river basin and multiple states could get affected. Every state is at its risk due to this hazard.

Water Damage

Water damage has a huge effect on your home, its neighbourhood and your city. It is very much necessary that you should prepare for water damage. You must know what should be done during and after water damage.

Hail

Hail comes into existence when updrafts in the thunder clouds take the raindrops up towards the extremely cold regions in the atmosphere. They freeze and combine forming lumps of ice. As these lumps can be very heavy and are not supported by the updraft, they fall off with the speeds of about 100 km per hour or more. A Hail is created in the form of an enormous cloud, commonly known as thunderheads.

Wildfire

Wild forest areas catching fire is a very big problem for the people who live around these areas. The dry conditions caused several times in the year in different parts of the United States can increase the possibility of wildfires. If you are well prepared in advance and know how to protect the buildings in your area, you can reduce much of the damage caused by wildfire. It is everyone’s duty to protect their home and neighbourhood from wildfire.

Hurricane

Hurricane also like the tornado is a wind storm, but it is a tropical cyclone. This is caused by a low-pressure system that usually builds in the tropical. Hurricanes come with thunderstorms and a counterclockwise spread of winds near the surface of the earth.

Winter Freeze

Winter freeze storms are serious threats for people and their property. They include snow, frozen rain, strong winds and extreme cold. Many precautions have to be taken in order to protect yourself, your family, home or property.

Lightning

Lightning is a much-underestimated killer. Lightning is an abrupt electric expulsion which comes from cloud to cloud or from cloud to earth followed by emission of light. Lightning is a common phenomenon after heavy rain and can also occur around 10 miles off from rainfall. Most lightning victims are people who are captivated outdoors in summer during the afternoon and evening.

Volcano

The volcano is a mountain that has an opening downwards to the reservoir of molten rock towards the surface of the earth. Volcanoes are caused by the accrual of igneous products. As the pressure caused by gases in the moulted rock becomes intense, the eruption takes place. The volcanic eruption can be of two kinds, quiet or volatile. The aftermaths of a volcano include flowing lava, flat landscapes, poisonous gases and fleeing ashes and rocks. Read on to know more on types of disaster

Manmade disaster

Major manmade disaster:

Setting of fires

Epidemic

Deforestation

Pollution due to prawn cultivation

Chemical pollution.

War

Minor manmade disaster:

Road/train accidents,

Food poisoning

Industrial disaster/ crisis

Environmental pollution

Objective of disaster nursing:-

To effectively reduce the impact of human life and health

To participate in the coordinated efforts of all groups to reduce of human life, property damage, social and economic disruption

PRINCIPLES OF DISASTER NURSING:-

                                    Sanford listed eight principles for disaster management.

1.      Prevention of occurrence

2.      Minimizing casualty members

3.      Preventing further causalities

4.      Rescuing the injury

5.      Providing first aid

6.      Evacuating the injury

7.      Providing definite care

8.      Facilitating reconstruction

Aspect of disaster nursing:-

There fundamental aspects of disaster management are;

^{Disaster response}

^{Disaster mitigation}

^{Disaster preparedness}

^{Disaster impact and response:-}

                 ^{Medical treatment for large no. of casualty is like to be needed only after a certain type of disaster. Most injuries are sustained during impact and thus the greatest need for emergency care occurs in the first few hours. The management of mass casualties is further classified into-}

^{1.        Search, rescue and first aid:-}

                                            ^{After a major disaster need for a search, rescue and first aid is likely to be so great that organized relief services will be able to meet only a small the fraction of demands most immediate helps come from the uninjured survivors.}

  ^{2   Field care:-}

                       ^{Most injured person converge spontaneously to health services, using whatever transport is available, regardless of facilities, operating states, priorities should be given to victims identification and adequate mortuary space should be provided}

    ^{3. Triage:-}

             ^{When the quality and severity of injuries overwhelm the operative capabilities of health services. Different approaches to medical treatment must be adopted. Although different triage the system has been adopted, the most common classification uses internationally accepted four-colour code systems}

^{·          Red- it indicates high priority treatment}

^{·          Yellow- signal medium priorities}

^{·          Green- it indicates ambulatory patient}

^{·          Black-  for dead moribund patients}

    ^{4. Tagging: - All patients should be identified with tags stating their name, age, place, triage category, diagnosis and initial treatment}

^{Identification of the dead:- Taking care of the dead is an essential part of disaster management care of dead include}

^{Removal of dead from the disaster scene}

^{Mortuary shifting}

^{Identification}

^{Reception of buried relatives}

^{Relief phase: -      it begins when assistance from outside start to reach disaster sites the type and quality of humanitarian relief supplies are determined by two factors}

^{The type of disaster, since disaster events have a different effect on population}

^{The type and quality of supplies available locally}

^{There are four principles component in managing humanitarian supplies they are-}

^{Ø    Acquisition of supply}

^{Ø    Transportation}

^{Ø    Storage}

^{Ø    Distribution}

The supply include food, blanket clothing, shelter, sanitary engineering and construction material

^{Rehabilitation:}

 The first step of disaster should lead to restoration of predisaster condition start from very first movement of disaster provisional by external agencies of satisfactory medical care for a temporary period has negative effects on withdrawal of such care.

In first weak after the disaster, the pattern of health needs will change rapidly moving from casualty treatment to move routine primary health care treatment. Priorities shift from health care towards environmental health measures are-

Water supply:- A survey of all public water supplies should be made .this include distribution system and water sources . it is essential to determine the physical integrity of system components, the remaining capacities, and bacteriological and chemical quality of water supplied. The main public safety aspect of water quality

Food supply;- Poor hygiene is major cause of foodborne disease in disaster situation. Where feeding programme is used kitchen sanitation is of utmost importance. Personal hygiene should be monitored in individuals involved in food preparation

Basic sanitation^{: -} many communicable diseases are spread through faecal contamination of drinking water and food. Hence, every effort should be made to ensure the sanitary disposal of excreta. Emergency latrines should be made available to the displaced, where toilet facilities have been destroyed.  

Vector control: - a control programme for vector-borne diseases should be intensified in the emergency and rehabilitation period, especially in areas where such diseases are known to be endemic. of special concern are dengue fever and malaria,leptospirosis, rat-bite fever, typhus and plague

Disaster mitigation:-

                              Emergency prevention and mitigation involves designed either to prevent hazards from causing emergencies or to lessen ^{the likely effects of emergencies.}

These measures include:

·         food mitigation work

·         Appropriate land-use planning

·         Improved building codes

·         Reduction or protection of vulnerable population structure

Disaster preparedness:-

 Emergency preparedness is a programme of long term Development activities whose goal is to strengthen the overall activities capabilities of a country to manage efficiency of all type of emergencies. the objectives of disaster preparedness is to ensure that appropriate systems, procedures and resources all in place to provide prompt effective assistance to disaster victims. The corner stone of emergency preparedness is community preparedness.

 The reason for community preparedness are-

the member of community has must to less chance of being vulnerable to disaster and must get from effective disaster programme

Those who first respond to emergency come within community

^{Resources are more easily found in a community, and every community possess capabilities}

^{Sustained development is best achieved by emergencies affected communities to design, manage and implement internal and external assistance preparedness programme.}

^{Agencies which help in disaster management:-}

^{Ø    Red cross:- provide relief for human suffering}

^{Ø    Community and local govt.:- help in maintaining law and order, resume transportation.}

^{Ø    Civil defence service: - provide for shelter post-disaster services, sanitation facility, and assistance to affected community.}

^{Ø    Hospital services, medical and paramedical personals}

Role of Nurse:-

            The role of nurse in disaster management varies according to the different stages.

Disaster Preparedness:-

            *          Facilitate preparation within the community and place of the employment.

            *          Initiate and update disaster plan - provide disaster education programme specific to the area.

            *          Organize disaster drill.

            *          Provide an updated record of vulnerable population within the community.

            *          Educate the vulnerable population about the impact the disaster might have on them.

            *          Review individualized strategies like the availability of specific resources in the event of emergency.

            *          As a community advocate the nurse should always seek to keep a safe environment.

            *          She has an obligation to assess and report environmental hazards it anticipation and creating awareness among community about it.

Disaster Response :-

            The role of the nurse during disaster depends upon nurses past experience role in the institution, community preparedness, specialized training and special interest.

            *          As a member of assessment team has the responsibility of feeding back accurate information to relief managers to facilitate rapid rescue and recovery.

            *          She is needed to make home visits to gather required information.

            *          Collection of information about the geographical extent of disaster impact,

            -           Population at risk

            -           Presence of continuing hazards.

            -           Injuries and death

            -           Availability of shelter

            -           Current level of sanitation

            -           Status of health care infrastructure.

            *          She should begins the triage and separate the casualties according the priorities and giving direct care

            *          Ongoing assessment or surveillance report is important for to know the status of affected population and effectiveness of ongoing relief effort.

            *          Ongoing surveillance use the various methods to gather information like interview, observation, physical examination illness screening, survey and record.

Role of Nurse in Disaster Recovery:-

            *          Teaching of proper hygiene and making sure immunization records upto date.

            *          Referrals to mental health professional should continue as long as the need exists.

            *          Must remain alert for environmental hazards during the recovery phase

            *          By visiting she knows faulty housing structure water supply and lack of electricity.

            *          Must be attentive to the danger of live or dead animals and rodents that might be considered harmful to persons health.

            *          Case finding and referral remains critical during the recovery phase and in some cases will continue for long time.

Psychosocial Intervention:-

            *          Keep the people in their natural group if they must be relocated.

            *          Provide social activity for new community; group meetings in which     participant brainstorm about various themes for rebuilding help survivors to recognize the loss.

            *          Encourage them to work together to achieve specific goal.

            *          Family level intervention - encourage families to talk together about their experiences losses and feelings.

            *          encourage to resume their normal activities to the extent possible.

            *          Help them to handle conflict appropriately as to minimize negative encounters caused by strain fatigue and Irritability that often follow trauma.

Conclusion :-

            World wide nurses plays an important role in disaster management. Nurses should involve activity in decision making with all aspect of disaster planning. They amend policies and procedure as needed to ensure safety and standard of care. Nurses also act liaisons into the community for the purpose of planning with officials that may be involved in an actual disaster.

ROLE OF NURSE IN DISASTER    MANAGEMENT LEGAL ASPECTS

DEFINITION:-

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 area (WHO).

NURSING ROLE IN DISASTER:-

In a disaster, nurses play key leadership and service provision role in planning and implementing disaster relief efforts, 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 determine the nursing role. Nurses collaborates with agencies and officials to recognize and reduce disaster risks and maximize the health and safety of individuals involved in disaster crisis.

                                        Recovery encompassed dealing with many disaster effects such as loss of life, income and home. Nurses to realize that the emotional effects of disasters may persist for many years. So the nurses work in all phases of disaster management.

PHASES OF DISASTER MANAGEMENT:-

ü  MITIGATION-

                             It involves actions are taken to reduce the risks of hazards and to reduce potential human suffering and property loss. Nurses have a key role in disaster mitigation by working with local, state and federal agencies in identifying disaster risks and developing disaster prevention strategies through extensive public education in disaster prevention and readiness. To plan effectively for disaster prevention the nurse needs to have information’s including knowledge of resources (eg. Hospital, emergency services), health personnel (eg. Pharmacists, doctor, emergency medical teams), government officials and local industry. Nurses may be involved in such efforts, which may include instructions regarding proper safety precautions, proper storage of emergency supplies and first aid courses to prepare the  public to care for injuries in the event of an actual emergency.

                                Early warning systems alert the public to the probability of immediate danger and help to reduce the impact of predictable disaster. The primary goals of disaster management is to prevent or minimize death, disability, sufferings and loss on the part of disaster victims.

ü  PREPAREDNESS-

                                   Preparedness requires that nurses become aware of and understand the disaster plans at their workplace. Nurses who take disaster preparation seriously will take the time to read and understand workplace and disaster plans and will participate in disaster drills and mock disasters. The more adequately prepared nurse are able to function in a leadership capacity and assist others towards a smoother recovery phase. Personal items that are recommended for any nurse preparing to help in a disaster including the following:-

__      A copy of their professional license.

__      Personal equipment.

__      A flashlight and extra batteries.

__ Cash.

__      Warm clothing or weather- appropriate clothing.

__      Record keeping materials.

__      Pocket-sized reference books.

Mass Causality Drills or Mock Disasters:

They are valuable components of any preparedness plan. The objectives are to do the following:-

_ Promote confidence.

_ Develop skills.

_ Coordinate activities.

_ Coordinate participants.

                                  Preparedness includes plans made to save lives and to help response and rescue operations in the event of a natural or technologic disaster. Nurses have a key role in maximizing the health and safety of all individuals affected by a disaster.

                                   Disaster preparedness involves developing plans for rescue, evacuation, caring for disaster victims, training disaster response personnel, gathering resources, equipments and materials necessary for coping with disaster.

ü  RESPONSE-

                        Response includes actions taken to save lives and prevent further damage in a disaster or emergency situations and put pre-disaster planning services into action. Nurses play a key role in disaster response.

Nurses have skills in triage and crisis interventions and involved in acute care, first aid, rescue and evacuation procedures, managing life-threatening events, recognizing and preventing communicable illnesses, assessment and providing immediate health care needs during disaster impact.

                          This includes providing immediate health care (first aid), providing food and shelter, maintaining effective channels of communication and minimizing chaos and panic.

                           In disaster response a primary concern for nurses is safety ie. Safety for themselves, the rescue team and victims. Nurses are involved in promoting not only safety and physical health but also mental health. The nurse works to reduce fears and concerns. Helping people to cope with the disaster situations involves caring, listening, encouraging people to express their feelings and providing emotional support to the victims and their families.

ü  RECOVERY-

                         Recovery involves sustained care offered over a longer period to help people re-establish their lives. It includes actions taken to return to a normal, or even safer situations following a disaster. The recovery period may last for an extended period of time. It is a period of reconstruction and rehabilitation. The goal of recovery is to prevent debilitating effects and restore personal, economic and environmental health and stability to the community.

                           The  role of case finding and referral remains critical during the recovery phase and in some cases will continue for a long time.