disaster nursing

1. SEMINAR ON
DISASTER NURSING
Guided BY
DR.NILIMA V.SONAWANE MADAM
PRINCIPLE & HOD, C. H. N. AND
SMT. SONAL GAWADE MADAM
LECT. INE MUMBAI
PRESENTING
MR.ANANT SAHEBRAO WAYZADE,
M.SC.NURSING FIRST YEAR,

2. AIM-
 At the end of seminar learner will be able to
understand concept of disaster nursing and
management of disaster and role and responsibility
CHN

3. OBJECTIVE-
Students will be able to-
 Define disaster nursing.
 Explain the types of disaster.
 Discuss levels of disaster.
 Explain key elements of disasters.
 Explain disaster nursing, goal and principle.
 Know health effects of disasters.
 Discuss phases of a disaster.
 Explain disaster management cycle.
 Explain disaster triage.
 Discuss role of nursing in disasters.
 Discuss role of disaster timeline and nursing action.
 Know legal issue and The Disaster Management Act,

4. Disaster
The word disaster is derived from Middle French désastre
and that from Old Italian disastro, which in turn comes
from the Ancient Greek pejorative
Prefix δυσ-, (dus-) "bad" and
ἀστήρ (aster), "star".
BADSTAR

5. DISASTER ALPHABETICALLY MEANS..
D - DESTRUCTION
I - INCIDENTS
S- SUFFERINGS
A-ADMINISTRATIVE,FINANCIAL FAILURES
S- SENTIMENTS
T - TRAGIDIES
E - ERRUPTIONOF COMMUNICABLE DISEASES
R-RESEACHPROGRAMMEANDITS
IMPLEMENTATION

6. Definition of Disaster
“An occurrence, either natural or manmade
that causes human suffering and creates
human needs that victims cannot alleviate
without assistance.
- The AmericanRed Cross.

7. Definition of Disaster
 WHO defines Disaster as "any occurrence that causes
damage, ecological disruption, loss of human life,
deterioration of health and health services, on a scale
sufficient to warrant an extraordinary response from
outside the affected community or area."

8. TYPES OF DISASTER
Natural disaster
Hurricanes Tornados Blizzards Floods
Earth quacks Volcanic eruption

9. Man Made disaster
Conventional Warfare Explosions Pollution
Transportation accidents Terrorist attacks

10. 1.Natural disaster:
Hurricanes
Tornados
Floods
Earth quacks
Blizzards
Cyclones
Tsunami
Drought
Mudslides
Volcaniceruption
Communicable diseases
epidemics

11. Man made disaster
Conventional Warfare
Explosions
Toxic materials
Civil unrest (riots)
Transportation accidents
Fires
Pollution
Terrorist attacks

12. LEVEL OF DISASTER
 Goolsby and Kulkarni (2006) further classify disasters
according to the magnitude of the disaster in relation to
the ability of the agency or community to respond.
Disasters are classified by the following levels:
 1) Level I: If the organization, agency, or community is
able to contain the event and respond effectively
utilizing its own resources.
 2) Level II: If the disaster requires assistance from
external sources, but these can be obtained from nearby
agencies.
 3) Level III: If the disaster is of a magnitude that
exceeds the capacity of the local community or region
and requires assistance from state-level or even federal
assets.

13. KEY ELEMENT OF DISASTER
 Disasters result from the combination of hazards,
conditions of vulnerability and insufficient capacity or
measures to reduce the potential negative consequences
of risk.
Hazards
 Hazards are defined as “Phenomena that pose a threat to
people, structures, or economic assets and which may
cause a disaster. They could be either manmade or
naturally occurring in our environment.”
 Hazard is a potentially damaging physical event,
phenomenon or human activity that may cause the loss of
life or injury, property damage, social and economic
disruption or environmental degradation. (UN ISDR
2002)

14.  Vulnerability
 Vulnerability is the condition determined by physical,
social, economic and environmental factors or processes,
which increase the susceptibility of a community to the
impact of hazards. (UN ISDR 2002)
 Capacity
 Capacity is the combination of all the strengths and
resources available within a community, society or
organization that can reduce the level of risk, or the effects
of a disaster. Capacity may include physical, institutional,
social or economic means as well as skilled personal or
collective attributes such as 'leadership' and
'management.' Capacity may also be described as
capability. (UN ISDR 2002)

15.  Risk
 Risk is the probability of harmful consequences, or
expected losses (deaths, injuries, property,
livelihoods, economic activity disrupted or
environment damaged) resulting from interactions
between natural or human-induced hazards and
vulnerable conditions. (UNDP 2004)

16. Disaster nursing
Disaster nursing can be defined as ''a
adaptation of professional nursing skills in
recognizing and meeting the nursing physical and
emotional needs resulting from the disaster.''

17. GOALS OF THE DISASTER NURSING
1. To meet the immediate basic survival needs of populations
affected by disasters (water, food, shelter, and security).
2. To identify the potential for a secondary disaster.
3. To appraise both risks and resources in the environment.
4. To correct inequalities in access to health care or
appropriate resources.
5. To empower survivors to participate in and advocate for
their own health and well-being.
6. To respect cultural, lingual, and religious diversity in
individuals and families and to apply this principle in all
health promotion activities.
7. To promote the highest achievable quality of life for
survivors.

18. Principles of Disaster Nursing
• Rapid assessment of the situation and of nursing care needs.
• Triage and initiation of life-saving measures first.
• The selected use of essential nursing interventions and the
elimination of nonessential nursing activities.
• Evaluation of the environment and the mitigation or
removal of any health hazards.
• Prevention of further injury or illness.

19. • Leadership in coordinating patient triage, care,
and transport during times of crisis. The teaching,
supervision, and utilization of auxiliary medical
personnel and volunteers.
• Provision of understanding, compassion and
emotional support to all victims and their
families.

20. HEALTH EFFECTS OF DISASTER
 Disasters may cause premature deaths, illnesses, and
injuries in the affected community, generally exceeding
the capacity of the local health care system.
 Disasters may destroy the local health care infrastructure,
which will therefore be unable to respond to the
emergency. Disruption of routine health care services and
prevention initiatives may lead to long-term consequences
in health outcomes in terms of increased morbidity and
mortality.

21.  Disasters may create environmental imbalances,
increasing the risk of communicable diseases and
environmental hazards.
 Disasters may affect the psychological, emotional, and
social well-being of the population in the affected
community.
 Disasters may cause shortages of food and cause severe
nutritional deficiencies.
 Disasters may cause large population movements
(refugees) creating a burden on other health care systems
and communities..

22. Phases of a Disaster
• Pre-impact phase
• Impact phase
• Post-impact phase

23. PRE-IMPACT PHASE
• It is the initial phase of disaster, prior to the actual
occurrence. A warning is given at the sign of the first
possible danger to a community with the aid of weather
networks and satellite many meteorological disasters can
be predicted.
• 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 group.

24. Disaster Preparedness Phase
Activities prior to a disaster
It is an on going multi sectoral activity
Example :
Preparedness plans
Emergency exercise
Training
Warning symptoms

25. IMPACT PHASE
• The impact phase occurs when the disaster actually happens. It is
a time of enduring hardship or injury end of trying to survive.
• This is the time when the emergency operation center is
established and put in operation. It serves as the center for
communication and other government agencies of health care
healthcare providers to staff shelters. Every shelter has a nurse as
a member of disaster action team. The nurse is responsible for
psychological support to victims in the shelter.

26. POST – IMPACT PHASE
• Recovery begins during the emergency phase ends with
the return of normal community order and functioning.
The victims ofdisaster in go through four stages of
emotional response.
• 1. Denial – during the stage the victims may deny
the magnitude of the problem or have not fully
registered.
• 2. Strong Emotional Response – in the second
stage, the person is aware of the problem but regards it
as overwhelming and unbearable.

27. 3.Acceptance – During the third stage, the
victim begins to accept the problems caused
by the disaster and makes a concentrated
effect to solve them.
4.Recovery – The fourth stage represent a
recovery from the crisis reaction. Victims
feel that they are back to normal.

28. DISASTER MANAGEMENT
CYCLE

30. RESPONSE
The response phase is the actual
implementation of the disaster plan. response
activities need to be continually monitored
and adjusted to the changing situation.
•A hospital, healthcare system, or public
health agency take immediately during, and
after a disaster or emergency occurs.

31. Disaster Response Phase
Activities During a disaster
Example:
Search ,rescuer and first aid
Field Care
Triage
Tagging
Identification of Dead

32. RECOVERY
Once the incident is over, the organization and staff needs to
recover. Invariably, services have been disrupted and it takes
time to return to routines.
•Activities undertaken by a community and its components
after an emergency or disaster to restore minimum services
and move towards long-term restoration.
• Debris Removal
• Care and Shelter
• Damage Assessments

33. Disaster Recovery phase
Activities following a disaster
Example:
Provision of supply
Transportation
Storage
Vaccination
Nutrition
Temporary housing
Long medical care
Counselling

34. Evaluation/ Development
Often this phase of disaster planning and response
receives
the least attention. After a disaster, employees and the
community are anxious to return to usual operations. It is
essential that a formal evaluation be done to determine
what went well (what really worked) and what problems
were identified. A specific individual should be charged
with the evaluation and follow-through activities.

35. Mitigation
These are steps that are taken to lessen the
impact of a disaster should one occur and can be
considered as prevention and risk reduction
measures. Examples of mitigation activities
include installing and maintaining backup
generator power to mitigate the effects of a power
failure or cross training staff to perform other
tasks to maintain services during a staffing crisis
that is due to a weather emergency.

36. Prevention Mitigation phase
Activities that reduces the effects of disaster
Examples:
Improved building codes
Reduction and protection of vulnerable population
Public education
Flood mitigation works

37. Preparedness/Risk assessment
Evaluate the facility’s vulnerabilities or propensity for
disasters. Issues to consider include: weather patterns;
geographic location; expectations related to public events
and gatherings; age, condition, and location of the facility;
and industries in close proximity to the hospital (e.g.,
nuclear power plant or chemical factory)

38. Principles of Disaster Management
• 1) prevent the occurrence ofdisaster whenever
possible.
• 2) provide first aidto the injured
• 3) provide definitive medical care
• 4) disaster management isthe responsibility ofall
sphere of government

39. 5) disaster managementshould use resources that exist
for day-to-day purpose
6) individual are responsible for their own safety
7) disaster managementplanningshould focuson large
scale events.
8) disaster managementplanningshould not recognize
the different between incident and disaster.

40. DISASTER TRIAGE
•It is an Rapidly classifying the injured on the basis
of their injuries.
•Triage is the only approach that can provide
maximum benefit to the greatest number of
injured in a major disaster situation.
•Triage colour coding system:
1. Red colour
2. Yellow colour
3. Green colour
4. Black colour
- Indicates High Priority treatment
and transport
-Medium priority
-Ambulatory patients
-Dead patients

41. ADVANCED TRIAGE CATEGORIES
CLASS I (EMERGENT) RED IMMEDIATE
– Victims with serious injuries that are life threatening but has a high probability of survival if they received immediate care.
– They require immediate surgery or other life-saving intervention, and have first priority for surgical teams or transport to advanced
facilities; they “cannot wait” but are likely to survive with immediate treatment.
“Critical; life threatening—compromised airway, shock, hemorrhage”
CLASS II (URGENT) YELLOW DELAYED
– Victims who are seriously injured and whose life is not immediately threatened; and can delay transport and treatment for 2 hours.
– Their condition is stable for the moment but requires watching by trained persons and frequent re-triage, will need hospital care
(and would receive immediate priority care under “normal” circumstances).
“Major illness or injury;—open fracture, chest wound”
CLASS III (NON-URGENT) GREEN MINIMAL
– “Walking wounded,” the casualty requires medical attention when all higher priority patients have been evacuated, and may
not require monitoring.
– Patients/victims whose care and transport may be delayed 2 hours or more.
“minor injuries; walking wounded—closed fracture, sprain, strain”
CLASS IV (EXPECTANT) BLACK EXPECTANT
They are so severely injured that they will die of their injuries, possibly in hours or days (large-body burns, severe trauma, lethal
radiation dose), or in life-threatening medical crisis that they are unlikely to survive given the care available (cardiac arrest,
septic shock, severe head or chest wounds);
They should be taken to a holding area and given painkillers as required to reduce suffering.
“Dead or expected to die—massive head injury, extensive full-thickness burns”

42. The Nursing Role in Disaster
Management
ROLEOFNURSE
Assess the Community Diagnose Community Disaster Threats
Community Disaster Planning
Implementation Disaster Plan
Evaluate Effectiveness of Disaster Plan

43. THE NURSING ROLE OF DISASTER MANAGEMENT
 Nurses work in all phases of disaster management. Some of
community disaster strategy for nurses include:
1.Assess the Community:
 -Is there a current community disaster plan in place?
 -Previous disaster experiences?
-How is the local terrain conductive to disaster
formation( hurricanes, tornados, blizzards)
-What are local industry?
-What personnel are available for disaster interventions?
(Nurses, doctors)
-What are local agencies and organization?
(hospital, schools, Red cross)

44. 2.Diagnose Community Disaster Threats:
•Determine actual and potential disaster
threats.(eg. toxic waste,explosions,road
accidents,hurricanes,
tornandos,floods,earthquicks)

45. 3 Community Disaster Planning:
• Develop a disaster plan to prevent or deal with
identified disaster threats.
• Identify a local community communicable
system.
• Set up of an emergency medical systems and
chain for activation.

46. 4.Impliment Disaster plan:
 Focuson primary prevention activities to prevent
occurrence of man made disaster.
 Practice using equipments, obtaining and distributing
supplies.

47. 5.Evaluate effectiveness of Disaster plan:
 Critically evaluate all aspects of disaster
plan and practical drills for speed,
effectiveness, gaps and revision.
 Evaluate the disaster impact on
community and surrounding regions.
 Evaluate response of personnel involved in
disaster relief efforts.

48. INTERNATIONAL AGENCIES
1.World health organisation(WHO.)
2.UNICEF
3.World Food programme (WFP.)
4.United Nation office for the co-ordination of
Humanitarian affairs.
5.Food and agriculture organisation (FAO.)
6.Organisation of America State (OAS.) 7.Cambridge
Disaster Emergency Response Agency. 8.Co-operative
for American Relief
Everywhere(CARE)
9.International committee of Red Cross.
10.International council of Voluntary agency.

49. Nursing Department, College of Applied
Medical Sciences, Taif University, Ta’if,
Saudi Arabia; 2King Faisal Medical
Complex, Ministry of Health, Taif, Saudi
Arabia

50.  Abstract:
To reduce the impact of disasters, healthcare providers,
especially nurses, need to be prepared to respond immediately.
However, nurses face several challenges in all phases of
disaster management. The findings of a literature review based
on scoping approaches, which utilized the Joanna Briggs
Institute methodology, indicated that the major barriers facing
nurses include the following: (1) disaster nursing is a new
specialty; (2) inadequate level of preparedness; (3) poor formal
education; (4) lack of research; (5) ethical and legal issues; and
(6) issues related to nurses’ roles in disasters. Educators,
researchers, and stakeholders need to make efforts to tackle
these issues and improve disaster nursing.

51. US Military Nurses: Serving Within
the Chaos of Disaster
Abstract
 The purpose of this article is to share US military nurses'
experiences of responding to disasters. Using phenomenology,
23 participants serving as US military nurses from different
service branches and the US Public Health Service volunteered
for a single face-to-face interview. Five polar themes plus one
final theme emerged from the narratives. Nurses expressed a
sense of loss, reshaping of thoughts regarding disasters, and
new appreciation of how people's lives are totally disrupted.
Findings showed a need for change in nursing education,
practice, training, policy, and recommendations for higher
education and how the military may better educate its
personnel.

52. Disaster ManagementAct
Art.53
Disaster Management Act & Its Provisions 2016632004.

54.  The Disaster Management Act, 2005, (23 December 2005)
No. 53 of 2005, was passed by the Rajya Sabha, the upper
house of the Parliament of India on 28 November, and by the
Lok Sabha, the lower house of the Parliament, on 12 December
2005.
 It received the assent of The President of India on 9
January 2006. The Disaster Management Act, 2005 has 11
chapters and 79 sections.
 The Act extends to the whole of India. The Act provides for
"the effective management of disasters and for matters
connected therewith or incidental thereto

55.  HPC on Disaster Management set up in August 1999.
 Disaster cause Innumerable loss of human life and property;
retardation of developmental growth of the nation Orissa
Cyclone was happen at 29thOctober 1999, Gujarat Earthquake
(26th January 2001),Tsunami(26th December 2004),Kashmir
Earthquake (8th October 2005) so the disaster Management Act
was started at 2005 (23rd December 2005)

56. Authorities
 NationalAuthority
 State Disaster ManagementAuthority
 District Disaster ManagementAuthority
 National Disaster Response Force
(NDRF)

57.  . The NDMA which was initially established on 30 May 2005
by an executive order, was constituted under Section-3(1) of
the Disaster Management Act, on 27 September 2006.
 The NDMA is responsible for "laying down the policies, plans
and guidelines for disaster management" and to ensure "timely
and effective response to disaster". Under section 6 of the Act it
is responsible for laying "down guidelines to be followed by
the State Authorities in drawing up the State Plans".

59. National Disaster Management Guidelines
 Earthquakes
 Chemical (Industrial) Disasters
 Medical Preparedness and Mass Casualty
Management
 Floods
 Cyclones
 Biological Disasters
 Nuclear and Radiological Disasters
 Chemical Terrorism Disasters
 Landslide andAvalanches

60. State Disaster ManagementAuthority
• All State Governments are mandated under Section 14 of the
act to establish a State Disaster Management Authority
(SDMA).
• ter. State Executive Committee is responsible (Section 22) for
drawing up the state disaster management plan, and
implementing the National Plan.
• The SDMA is mandated under section 28 to ensure that all the
departments of the State prepare disaster management plans
as prescribed by the National and StateAuthoritie.
• Recently in september 2014 kashmir-floods NDRF played a
vital role in rescuing the armed forces and tourists, for which
NDRF was awaded by the govt of India.

61. District Disaster ManagementAuthority
 The Chairperson of District Disaster Management Authority
(DDMA) will be the Collector or District Magistrate or
Deputy Commissioner of the district. The elected

62. National Disaster Response Force (NDRF)
 The Section 44-45 of the Act provides for constituting a
National Disaster Response Force "for the purpose of specialist
response to a threatening disaster situation or disaster" under a
Director General to be appointed by the Central Government.
Other Provisions
 Section 42 of the Act calls for establishing a National Institute
of Disaster Management. Section 46-50, mandates funds for
Disaster Mitigation at various levels. The Act provides for civil
and criminal liabilities for those who violate the provision of the
Act.

63. PSSMHS in Disasters PSYCHOSOCIAL SUPPORT AND
MENTAL HEALTH SERVICES
 PSSMHS in disaster was first time initiated in Bangalore
circus fire.
 ICMR studied the psychological impact and intervention.After
the lattur earth quake more importance was given to the
PSSMHS. In Bhopal medical model. No mental health resources
 GP were trained to Provide PSC Identification and referral of
the victims with mental health problems.
National Guidelines on PSSMHS
 The present status of the management of PSSMHS during the
disasters in the country was discussed and important gaps
were identified
 Identified priority areas for prevention, mitigation
and preparedness for PSSMHS in disasters
 Provided an outline of comprehensive guidelines to be
formulated as a guide for the preparation of action plans by
ministries/departments/states.

64. National Disaster Management Guidelines in progress
• PSSMHS
• Tsunami
• Community Based Disaster Management
• Role of NGOs in Disaster Management
• Post-Disaster Reconstruction
• Protection of Heritage Monuments
• Integrating Disaster Management in Education
Curricula
• Nuclear and Radiological Emergencies Part II
• PSSMHS ---Final Stage
• Minimum Standards of Relief for Food, Water,

65. • Medical Cover & Sanitation during disaster
• Management and disposal of dead bodies
• Urban Flooding
• Drought
• Micro Finance
• Risk Insurance

66. Criticism of the Act
 The act has been criticized for marginalizing Non-governmental
organizations (NGOs), elected local representatives, local
communities and civic group; and for fostering a
hierarchical, bureaucratic, command and control, 'top down',
approach that gives the central, state, and district authorities
sweeping powers. It is also alleged that the "Act became a law
almost at the will of the bureaucrats who framed it."

67. References
1. Parliament of India (23 December 2005). "Disaster
Management Act, 2005, [23rd December, 2005.] NO.
53 OF 2005" (PDF). Ministry of Home. Retrieved 30
July 2013.
2. Aparna Meduri (2006). "The Disaster Management
Act, 2005". The ICFAI Journal of Environmental
Law. The ICFAI University Press,. pp. 9–11.
Retrieved 30 July 2013.
3. Ministry of Home (27 September 2006).
"Notification for constituting National Executive
Committee (NEC)" (PDF). The Gazette of India.
Ministry of Home. p. Section 3, sub section (ii).
Retrieved 30 July 2013.

68. CONCLUSION
Hardly a day now passes without news about a
major or complex emergency happening in
some part of the world. Disasters continue to
strike and cause destruction in developing and
developed countries about their vulnerability
to occurrences that can gravely affect their day
to day life and their future. Nurses in any
location will be on the frontline as care giver
and managers in the event of damaging
disaster.

69. Contd..
• So they need to have adequate knowledge and
framing to work in such a unique, chaotic
stressful situations and to identify and meet
the complex, multifarious health needs of
victims of disaster.

70. BIBLIOGRAPLY
 K PARK 24TH EDITION TEXT BOOK OF
PREVENTIVE AND SOCIAL MEDICINE BHANOT
PUBLICATION PAGE NO
 K.K. GULANI 2ND EDITION TEXT BOOK OF
COMMUNITY HEALTH NURSING PAGE NO
 Basavanthappa. B.T, Community Health Nursing,
First Edition,Jaypee Brothers, Mumbai, 2008,

71. …
 Journal of Community Medicine
 www. Ndrf.gov.in

72. Important
 World disaster Reduction Day 2nd Wednesday of
October
 Indian meteorological department
 Kolkata Bhubaneswar Vishakhapatnam Chennai
Mumbai
 Snow avalanche study establishment -Manali

73. EVALUATION MUHS
• Define the term Disaster and Disaster
Nursing.
• Explain the type of disaster.
• Enlist the goals of disaster nursing.
• List down the principles of disaster nursing.
• Explain about phases of disaster.
• Explain disaster Management cycle and how
to organize an effective disaster system
• Discuss about major roles of nurse in
disaster.