Disaster Management (ANP, MSC PREVIOUS)

DISASTER MANAGEMENT
ANP, MSC PREVIOUS
DIVYESH PAL SINGH,
MSC NURSING
GOVERNMENT COLLEGE OF NURSING, UDAIPUR
PBBSC
GEETANJALI COLLEGE OF NURSING, UDAIPUR
GNM
PADAMSHREE NURSING INSTITUTE, FALNA
DIVYESH

GOAL
• The goal of disaster management is the
safety and sustainability of human lives.
• Safety is related to avoiding death and
injuries to human lives during a disaster.
• Sustainability is related to livelihood,
socioeconomic, cultural, environmental and
psychological aspects
DIVYESH

PRINCIPLES
1. Disaster management is the responsibility of
all spheres of government
2. Disaster management should use resources
that exist for a day-to-day
3. Organizations should function as an
extension of their core business
4. Individuals are responsible for their own
safety
5. Disaster management planning should focus
on large-scale events
6. Disaster management planning should
recognize the difference between incidents
and disasters
7. Disaster management operational
arrangements are additional to and do not
replace incident management operational
arrangements
8. Disaster management planning must take
account of the type of physical environment
and the structure of the population
9. Disaster management arrangements must
recognize the involvement and potential role
of non- government agencies
Disaster management is the
responsibility of all spheres
of government: No single
service or department in itself
has the capability to achieve
comprehensive disaster
management. Each affected
service or department must
have a disaster management
plan which is coordinated
through the Disaster
Management Advisory Forum
DIVYESH

PRINCIPLES
safety
and disasters
arrangements
Disaster management should
use resources that exist for a
day-to-day purpose: There are
limited resources available
specifically for disasters, and
it would be neither cost
effective nor practical to have
large holdings of dedicated
disaster resources. However,
municipalities must ensure
that there is a minimum
budget allocation to enable
appropriate response to
incidents as they arise, and to
prepare for and reduce the
risk of disasters occurring.
DIVYESH

PRINCIPLES
safety
and disasters
arrangements
Organizations should
function as an extension of
their core business: Disaster
management is about the use
of resources in the most
effective manner. To achieve
this during disasters,
organizations should be
employed in a manner that
reflects their day-to-day role.
But it should be done in a
coordinated manner across all
relevant organizations, so
that it is multidisciplinary and
multi-agency.
DIVYESH

PRINCIPLES
safety
and disasters
arrangements
Individuals are responsible
for their own safety:
Individuals need to be
aware of the hazards that
could affect their
community and the counter
measures, which include
the Municipal Disaster
Management Plan, that are
in place to deal with them.
DIVYESH

PRINCIPLES
safety
and disasters
arrangements
Disaster management
planning should focus on
large-scale events: It is easier
to scale down a response
than it is to scale up if
arrangements have been
based on incident scale
events. If you are well
prepared for a major disaster
you will be able to respond
very well to smaller incidents
and emergencies,
nevertheless, good multi
agency responses to incidents
do help in the event of a
major disaster.
DIVYESH

PRINCIPLES
safety
and disasters
arrangements
Disaster management
planning should recognize
the difference between
incidents and disasters:
Incidents - e.g. fires that occur
in informal settlements,
floods that occur regularly,
still require multi-agency and
multi-jurisdictional
coordination. The scale of the
disaster will indicate when it
is beyond the capacity of the
municipality to respond, and
when it needs the
involvement of other
agencies.
DIVYESH

PRINCIPLES
safety
and disasters
arrangements
Disaster management
operational arrangements
are additional to and do
not replace incident
management operational
arrangements: Single
service incident
management operational
arrangements will need to
continue, whenever
practical, during disaster
operations.
DIVYESH

PRINCIPLES
safety
and disasters
arrangements
Disaster management
planning must take account
of the type of physical
environment and the
structure of the population:
The physical shape and size of
the Municipality and the
spread of population must be
considered when developing
counter disaster plans to
ensure that appropriate
prevention, preparation,
response and recovery
mechanisms can be put in
place in a timely manner.
DIVYESH

PRINCIPLES
safety
and disasters
arrangements
Disaster management
arrangements must
recognize the involvement
and potential role of non-
government agencies:
Significant skills and
resources needed during
disaster operations are
controlled by non-
government agencies.
These agencies must be
consulted and included in
the planning process.
DIVYESH

PHASES OF DISASTER MGT.
These are fundamental aspects of
disaster management
 Disaster Preparedness
 Disaster impact
 Disaster Response
Relief Phase
Rehabilitation Phase
 Disaster MitigationDIVYESH

1. Disaster Preparedness
2. Disaster impact
3. Disaster Response
4. Disaster Mitigation
It is an ongoing multisectorial activity, consists of
strengthening the capacity of a country to manage
efficiently all types of emergencies, so that the
resources should be able to provide assistance to
the victims and bring back the life to normal. The
preparedness should start from the community
people because many times the external agency
may not arrive for days to the affected area,
especially if transportation and communication are
affected.
• Preparedness should be in the form of money,
manpower and materials
• Evaluation from past experiences about risk
• Location of disaster prone areas
• Organization of communication, information
and warning system
• Ensuring co-ordination and response
mechanisms
DIVYESH

1. The International
Agencies
2. Non Governmental
Organizations
2. Disaster impact
• Development of public education programme
• Co-ordination with media
• National & international relations
• Keeping stock of foods, drug and other
essential commodities.
The International Agencies
• Office for the co-ordination of Humanitarian
Affair (OCHA)
• World Health Organization (WHO)
• UNICEF
• World Food Programme (WFP)
• Food & Agricultural Organisation (FAD)
Non Governmental Organizations
• Co-Operative American Relief Every where
(CARE)
• International committee of Red cross
• International committee of Red crossDIVYESH

2. Disaster impact
1. Search, rescue and first
aid
2. Field care
Medical treatment for large number of causalities is
likely to be needed only after certain type of
disaster. Most injuries are sustained during the
impact, and thus, the greatest need for emergency
care occurs in the first few hours.
The management of mass causalities can be further
divided into search and rescue, first aid, triage and
stabilization of victims, hospital treatment and
redistribution of patients to other hospital if
necessary.
Search, rescue and first aid: After a major disaster,
the need for search, rescue and first aid is likely to
be so great that organized relief services will be
able to meet only a small fraction of the demand.
Most immediate help comes from the uninjured
survivors.
Field care: Most injured person’s coverage
spontaneously to health facilities, using whatever
transport is available, regardless of the facilities,
operating status.
DIVYESH

2. Disaster impact
1. Search, rescue and
first aid
2. Field care
3. Triage
1. Shorting
Providing proper care to the casualties requires that
the health service resources be redirected to this
new priority. Bed availability and surgical services
should be maximized. Provisions should be made
for food and shelter. A centre should be established
to respond from inquiries from patient’s relatives
and friends. Priority should be given to victim’s
identification and adequate mortuary space should
be provided.
Triage
Triage consists of rapidly classifying the injured on
the bases of severity of their injuries and the
likelihood of their survival with prompt medical
intervention.
Sorting casualties for the purpose of assigning
priorities: Triage should be carried out at the site of
disaster in order to determine transportation
priority and admission to the hospital or treatment
center where the patients needs an priority of
medical care will be reassessed.
DIVYESH

2. Disaster impact
first aid
2. Field care
3. Triage
1. Immediate
Golden hour: A seriously injured patient has one
hour in which they need to receive Advanced
Trauma Life Support. This is referred to as the
golden hour Triage helps to support this golden
hour concept by identifying the most seriously
injured patients so that they may be
treated/transported first.
Immediate or high priority: Higher priority is
granted to victims who’s immediate or long term
prognosis can be dramatically affected by simple
intensive care.
• Immediate patients are at risk for early death
• They usually fall into one of two categories.
They are in shock from severe blood loss or they
have severe head injury
• These patients should be transported as soon as
possible
• If the patient passes the RPM assessment, they
are placed in the delayed categoryDIVYESH

2. Disaster impact
first aid
2. Field care
3. Triage
1. Immediate
2. Delayed
Delayed or medium priority: Because patients are
categorized, “Delayed” does not mean that they
may not have serious injuries; It just means that
they are not at high risk for death
• Delayed patients may have injuries that span a
wide range
• They may not be able to join the walking
wounded because of a broken ankle
• They may have severe internal injuries, but are
still compensating
• It is important that the delayed patients are
frequently reassessed and further prioritized for
transport. This will usually be done in a central
treatment area
– Delayed patients have:
» under 30/minutes
» Capillary refill under 2 seconds
» Can do-follow simple commandsDIVYESH

2. Disaster impact
first aid
2. Field care
3. Triage
1. Immediate
2. Delayed
3. Minor
4. Expectant
Minor or minimal or ambulatory patients:
• Patients with minor lacerations, contusions,
sprains, superficial burns are identified as
“minor/minimal”
• These patients will not suffer significant
morbidity if no medical intervention is
performed
Expectant or least priority
• Morbid patients who require a great deal of
attention with questionable benefit have the
lowest priority.
• Patients with whom there are signs of
impending death or massive injuries with poor
likelihood of survival are labeled as expectant
• These are patients with penetrating head
wounds, high spinal cord injuries, second or
third degree burns with greater than 60 percent
of total body surface area, profound shock with
agonal respirationsDIVYESH

2. Disaster impact
Colour code: The most common classification uses
the internationally accepted four colour code
system.
• Red indicate high priority treatment or transfer
• Yellow signals medium priority
• Green indicate ambulatory patients
• Black indicates dead or moribund patients
Triage should be carried out at the site of disaster,
in order to determine transportation priority, and
the admission to the hospital or treatment centers,
where the patient’s needs and priority of medical
care will be reassessed. Ideally, local health workers
should be taught the principles of triage as part of
disaster training.
Person with minor or moderate injuries should be
treated at their own homes to avoid social
dislocation and the seriously injured should be
transported to hospital with specialized treatment
facilities DIVYESH

2. Disaster impact
Tagging: All patients should be identified with tags
stating their name, age, place of origin, triage
category, diagnosis, and initial treatment.
Identification of dead: Taking care of the dead is an
essential part of the disaster management. A large
number of deaths can also impede the efficiency of
the rescue activities at the site of the disaster.
Care of the dead includes:
• Removable of the dead from the disaster scene;
• Shifting to the mortuary;
• Identification;
• Reception of relatives. Proper respect for the
dead is great importance.
DIVYESH

2. Disaster impact
1. RELIFE PHASE
This is carried out under the following phases:
1. RELIEF PHASE
2. REHABILITATIVE PHASE
RELIEF PHASE
• This phase begins when assistance from outside
starts to reach the disaster area. The type and
quantity of humanitarian relief supplies are
usually determined by two main factors:
• The type of disaster, since distinct events have
different effects on the population, and
• The type and quantity of supplies available
locally.
Immediately following a disaster, the most critical
health supplies are those needed for treating
casualties, and preventing the spread of
communicable diseases. Following the initial
emergency phase, needed supplies will include…DIVYESH

2. Disaster impact
1. RELIFE PHASE
blankets, clothing, shelter, sanitary engineering
equipments and construction material. A rapid
damage assessment must be carried out in order to
identify needs and resources.
Disaster managers must be prepared to receive
large quantities of donations. There are four
principle components in managing humanitarian
supplies:
– Acquisition of supplies;
– Transportation;
– Storage; and
– Distribution.
The relief phase mainly includes Epidemiologic
surveillance and disease control, Vaccination and
nutrition.
Epidemiologic surveillance and disease control:
Disasters can increase the transmission of
communicable diseases through following
mechanisms:
DIVYESH

2. Disaster impact
1. RELIFE PHASE
• Overcrowding and poor sanitation in temporary
resettlements.
• Disruption and the contamination of water
supply,
• damage to sewerage system and power systems
are common in natural disasters.
• Disruption of routine control programmes as
funds and personnel are usually diverted to
relief work.
• Ecological changes may favour breeding of
vectors and increase the vector population
density.
DIVYESH

2. Disaster impact
1. RELIFE PHASE
• Displacement of domestic and wild animals,
which carry with them zoonoses that can be
transmitted to humans as well as other animals.
Leprosies cases have been reported following
large floods. Anthrax has been reported
occasionally.
• Provision of emergency food, water and shelter
in disaster situation from different or new
source may itself be a source of infectious
disease.
• Outbreak of gastroenteritis, which is the most
commonly reported disease in the post- disaster
period, is closely related to first three factors
mentioned above. Increased incidents of acute
respiratory infections also common in displaced
population. Vector- borne diseases will not
appear immediately but may take several weeks
to reach epidemic levels.
DIVYESH

2. Disaster impact
1. RELIFE PHASE
1. Vaccination
Vaccination
Health authorities are often under
considerable public and political pressure to begin
mass vaccination programmes, usually against
typhoid, cholera and tetanus.
Vaccination programme requires large number of
workers who could be better employed elsewhere.
DIVYESH

2. Disaster impact
1. RELIFE PHASE
1. Vaccination
2. Nutrition
Nutrition: A natural disaster may affect the
nutritional status of the population by affecting one
or more components of food chain depending on
the type, duration and extent of the disaster.
The immediate step of ensuring that the food relief
programme will be effective includes:
• Assessing the food supplies after the disaster;
• Gauging the nutritional needs of the affected
population;
• Calculating daily ration foods and need for large
population groups;
• Monitoring the nutritional status of the
affected population.
DIVYESH

2. Disaster impact
1. RELIFE PHASE
1. Vaccination
2. Nutrition
2. REHABILITAION
PHASE
REHABILITAION PHASE
This should be started from the time of onset of
disaster to see that the normal conditions of life
are restored as early aS possible.
DIVYESH

2. Disaster impact
1. RELIFE PHASE
1. Vaccination
2. Nutrition
2. REHABILITAION
PHASE
1. Water Supply
2. Food Safety
3. Basic
Sanitation &
personal
hygiene
4. Vector Control
1. Water Supply
2.Food Safety
3.Basic Sanitation
& personal
hygiene
4.Vector Control
DIVYESH

2. Disaster impact
4. Rehabilitation
This involves lessening the likely effects of
emergencies.
These include depending upon the disaster,
protection of vulnerable population and structure.
For examples, improving structural qualities of
schools, houses and such other buildings so that
medical causalities can be minimized.
Similarly ensuring the safety of health facilities and
public health services including water supply and
sewerage system to reduce the cost of
rehabilitation and reconstruction.
This mitigation compliments the disaster
preparedness and disaster response activities.
DIVYESH

ROLE OF NURSE IN DISASTER MANAGEMENT
1. In Disaster
Preparedness
2. In Disaster Response
3. In Disaster Recovery
• To Facilitate preparation with community:
Facilitating preparation within the community
and place of employment within employing
organization the nurse can help initiate updating
disaster plan, provide educational programmes
& Material regarding disasters specific to areas.
• To provide updated record of vulnerable
populations within community: The nurse
should be involved in educating these
populations about what impact the disaster
have / cause on them. Review availability of
specific resources, in the event of an emergency.
• Nurse leads a preparedness effort: Nurse can
help recruit others within the organization that
will help when a response is required. It is wise
to involve person in these efforts who
demonstrate flexibility, decisiveness, stamina,
endurance and emotional stability.
• Nurse play multiroles in community: Nurse
might be involved in many roles.
DIVYESH

1. In Disaster
Preparedness
As a community advocate, the nurse
should always seek to keep a safe
environment. She must assess and report
environmental hazards. Eg: Nurse should
be aware of & report unsafe equipment.
• Nurse should have understanding of community
resources: Nurse should have an understanding
UP what community resources will be available
after a disaster strikes and how community will
work together. A community wide disaster plan
will guide the nurse in understanding what
should occur before, during and of to the
response and his or her role with in the plan.
• Disaster Nurse must be involved in community
organization: Nurse who sects greater
involvement or a more in-depth understanding
of disaster management can become involved
any number of community organizations and the
peat of official response team such as the
American Red cross, American Red cross,
DIVYESH

1. In Disaster
Preparedness
• Nurse must involve in community assessment,
case finding and referring, prevention, health
education and surveillance
• Once rescue workers begin to arrive at the
scene, immediate plans for triage should begin.
Triage is the process of separating causalities
and allocating treatment based on the victims
potential for survival. Higher priority is always
given to victim’s potential who have life
threatening injuries but who have a high
probability of survival once stabilized.
• Second Priority is given to victims who have
injuries with systemic complications that are not
yet life threatening but who can wait up to 45-60
minutes of treatment. Last priority in given to
those victims who have local injuries without
immediate complications and who can wait
several hours for medical attention
DIVYESH

1. In Disaster
Preparedness
• Nurse work a member of assessment team
– Nurse working as members of an assessment
team have the responsibility of give accurate
peed back to relief managers to facilities
rapid rescue and recovery. Eg: Manytimes
nurses are required to make homevisite to
galties needed information. Type of
information included in initial assessment
report include geographical extend of
disasters impact population at risk or
affected, presence of contincing hozuds
injuries and dislike, availability of shelter,
current leved of sanitation & status of health
care infrastructures.
• To be involved in ongoing surveillance
– Nurse involved in ongoing surveillance uses
the following methods to gather information
– interview, observation, physical
examination, health and illness screening
surveys, records etc.
DIVYESH

1. In Disaster
Preparedness
• Successful Recovery Preparation: Flexibility is an
important component of successful recovery
preaparation. Community clean up efforts can
incure a host of physical and psychological
problems. Eg: Physical stress of moving heavy
objects can cause back injury, severe fatigue and
even death from heat attacks.
• Be vigilant in Health teaching: The continuing
threat of communicable disease will continue as
long as the water supply remains threat and the
relieving conditions remain crowded. Nurses
must remain vigilant in teaching proper hygiene
and making sure vigilant in teaching proper
hygiene and making sure immunization records
are up to date.
• Psychological support: Acute and chronic illness
can be exacerbated by prolonged effects of
disaster. The psychological stress of cleanup and
moving can bring about feelings of severe
hopelessness, depression and grip.
DIVYESH

1. In Disaster
Preparedness
• Referrals to hospital as needed: Stress can lead
to suicide and domestic abuse. Although most
people recovery from disasters, mental distress
may persist in those vulnerable populations
referrals to mental health professionals should
continue as long as the need exists.
• Remain alert for environmental health: Nurse
must also remain alert for environment health
hazards during recovery phase of a disaster.
Home visit may lead the nurse to uncover
situations such as faculty having structure, lack
of water supply or lack of electricity.
• Nurse must be attentive to the danger: Nurse
must be attentive to dangers of live or dead
animals and rodents which are harmful to
person’s health. Eg: finding snakes in and
around homes once water from flood start to
reduce.
DIVYESH

Disaster Management (ANP, MSC PREVIOUS)

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