Disaster management

NURSING MANAGEMENT

1. DISASTER MANAGEMENT Presented by, Hitha Udayabhanu 2 nd year MSc Nursing

2. INTRODUCTION According to WHO (2005), an emergency is a situation where a sudden incident or event has occurred and normally used local responses will suffice to care for this situation without calling in outside help .

3. DISASTER MANAGEMENT Disaster is a natural damage occuring to the people in the community and environment, causing complications and altering their normal life. The disaster occuring in the community cannot be handled alone, therefore it requires combined team force.

4. DEFINITION Hazard Hazard is an unusual drastic event that can be natural or can be caused by humans and affects the survival of human life.

5. Disaster Disaster is the destructive event that causes loss of human life, affecting the health of the humans and causing financial loss.

6. The United Nations Office for Disaster Risk Reduction (UNISDR,2009) defines disaster as: “A serious disruption of the functioning of a community or a society involving widespread human, material, economic or environmental losses and impacts which exceed the ability of the affected community or society to cope using its own resources.”

7. TYPES OF DISASTERS Unexpected onset of hazards or geological and climatic hazards Manmade environmental hazards Industrial and Technological hazards Wars and civil strives Epidemic hazards Natural disasters Man-made disasters

8. ORGANISATIONAL RESPONSE TO DISASTERS During a disaster, healthcare organisations must ensure the safety of staff members, volunteers and patients, state and federal accreditation standards. These standards ensure that health care organisations have disaster management plans including plans for assessment and mitigation and potential hazards planning and evaluation.

9. DISASTER PLAN Every hospital should create a disaster plan to manage disaster conditions including enhancement and coordination of medical performance and additional important skills.

10. PRINCIPLES Mobilization of manpower within short notice. Predefined and prepared site with required infrastructure. Delegation of competencies. Ensuring smooth run of the routine hospital work. Availability of resources on the existing base.

11. JOINT COMMISSION STANDARDS FOR HEALTH CARE ORGANIZATION DISASTER PLANNING The standards cover 5 areas defined as critical to disaster operation plans. It includes: Communication Resources and assets Safety and security Staff responsibilities Utilities management Patient clinical and support activities

12. COMMUNICATION Communication includes the surveillance, identification and communication of emergencies to appropriate authorities. Organisations has to plan methods of communication within the organisation and within the community emergency response infrastructure. Loss of phone lines, fax and computer access can seriously disrupt the communication.

13. RESOURCES AND ASSETS Management of resources and assets is critical to provide care and services. It requires the organization to identify the culture of the organization and its role within the community. The disaster response plans should have open access for food and shelter to the community.

14. Disaster management plans should include the necessary pharmaceutical supplies, non-medical supplies like food, water and linens. Budgeting and planning should be made to upgrade the infrastructure, PPE, disaster surveillance monitoring resources and decontamination of equipment during nuclear, biological or chemical exposure.

15. SAFETY AND SECURITY In establishing the plans, the safety and security of staff, patients and volunteers and the management of resources and supplies must be considered. Security measures may be the responsibility of the organization to involve in the local, state or federal agencies at various intervals. Provisions for management, isolation and decontamination of potential hazardous radioactive, biological and chemical products need to be defined in the emergency plans.

16. STAFF RESPONSIBILITIES During the disaster, the staff roles and expectations are determined by the emergency needs, report routes etc Prior to an actual disaster, staff are expected to take disaster training and disaster practice scenarios to provide effective care during the disaster.

17. UTILITIES MANAGEMENT The disaster management plan needs to include how healthcare organisations will continue to provide essential utilities to support care. Supplies of water, fuel, electricity, waste disposal, medical gases, ventilation and vacuum systems must be identified. Include an estimate of how long care can be provided with the current resources and what may be needed depending on the type of disaster. Alternative vendor sources, resource sharing and resource management need to be addressed in the plan.

18. PATIENT CLINICAL AND SUPPORT ACTIVITIES During a disaster, the health care organizations focus is to provide emergency services to protect life and to prevent further disability. Basic sanitation needs must be addressed. Plans must include provision of care for special needs population, mental health care and mortuary services.

19. The health care organizations must have plans to manage patients through all phases of expected assessment, treatment, admissions, discharge, transfer or evacuation.

20. ROLE OF LOCAL GOVERNMENT IN A DISASTER The local governments has the first hand knowledge of your communities, social, economic, infrastructure and environmental needs, helping them to provide support in a disaster.

21. The role of local government under the D isaster M anagement Act 2003 is to: Have a disaster response capability. Approve a local disaster management plan. Ensure local disaster information is promptly given to the district disaster coordinator.

22. Local Disaster Management Group Local governments appoint local disaster management groups. Their role is to: Develop review and assess effective disaster management practices. Help local government to prepare a local disaster management plan. Ensure the community knows how to respond in a disaster.

23. Identify and coordinate disaster resources. Manage local disaster operations . Ensure local disaster management and disaster operations integrate with state disaster management.

24. DISASTER MANGEMENT PLAN

25. PRACTISING AND EVALUATING DISASTER DRILLS Disaster plans provide the framework for disaster response, without practice and drills. Disaster training should be included in all staff orientation sessions, included in annual competency updates. These should be evaluated for changes and plans redesigned based on lessons learned during drills to ensure continuous quality improvement.

26. Drills are a vital way to test new equipment and to provide additional training to staff. Disaster response drills should occur on weekends, holidays and non-day light hours. Apart from the drill experiences, the evaluators who are part of health organizations and from outside observe and record positive and negative observations.

27. Being sensitive to feelings of failure, assuring staff that their honest feedback is vital to eventual safe and effective care during a disaster drill. If changes to the disaster response plan are made, it should be clearly communicated to the staff. Staging a disaster drill may point out potential disaster plan failures.

28. LEADERSHIP AND MANAGEMENT IN A DISASTER Leadership is essential to successful outcomes, whether in an established organization or during periods of crisis. Management is also essential to an organization but leadership and management skills are not the same set of competencies.

29. LEADERSHIP SKILLS DURING A DISASTER Leadership and communication Motivation and trust Flexibility Developing self and others

30. 1) Leadership and Communication Leadership may arise from unexpected sources and clear communication between all levels of authority. Communication skills are an integral part of every leadership competency. Strong written verbal communication skills are integral to importing plans and expected outcomes throughout the groups.

31. 2) Motivation and Trust During initial disaster situation, responders are highly motivated to succeed. Trust and confidence in leadership is essential in disaster situations. Leadership gains trust and confidence from followers partially by the role assigned and training for the assigned role. Leaders must appear decisive, thoughtful and confident.

32. 3) Flexibility The leader must assess the plan for improving the opportunity and proceed with updated and new information. Unexpected obstacles and incomplete or inaccurate information must be reassessed and improvements are made. In disaster situations, thoughtful but rapid response is needed and creative thinking is essential.

33. 4) Developing self and others Development of self and others are skills that are instituted and fostered by effective leaders. The effective leader seeks continuous self-improvement and must be comfortable with change. Although common disaster scenarios can be anticipated and practiced, the real event rarely follows the same planning scenerio .

34. LEGAL AND ETHICAL CONSIDERATIONS IN A DISASTER Legal issues present an area of concern for all nurses practising disaster nursing care. The legal framework affecting disaster nursing is complex and constantly evolving. Hence it is imperative, that the nurse intending to practice in a disaster situation should well aware of the potential legal issues that can affect the practice. The nurses must stay up-to-date on changes in the laws affecting the practice.

35. Ethical considerations Before engaging in the legal and ethical discussions surrounding disaster nurses, it is important for volunteer responders to understand the laws and ethics behind the disaster response. Social values, medical practice and the law are not static creatures. In the course of normal medical practice, several issues arise requiring consultations from lawyers, risk mangers or ethicists.

36. PSYCHOLOGICAL REACTION TO A DISASTER 1) Pre-School (1-5years) Fearfulness Nightmares Clinging to parents 2) Early childhood (5-11 years) Night terrors, nightmares, fear of dark. Aggressive behaviour at home or at school. Poor concentration in school.

37. 3) Adolescence (14-18 years) Irresponsible Poor concentration Hypochondria 4) Adulthood Distress and depression Irritability, blunting of feelings Lack of interest Insomnia, poor concentration

38. HEALTH SECTOR INVOLVEMENT IN DISASTER MANAGEMENT National organization It is important responsibility of all the state cabinet to provide protection from all kinds of disaster. There is a team of members such as cabinet secretary, who have the team contacts. The assessments of the disaster and releases the funds and makes plan to provide relief to the affected people.

39. State level organization There is usually the in-charge staff from state cabinet to provide relief activities for the people affected from the disaster. District level organization A district level coordination and review committee is constituted, it is headed by the Collector as Chairman with participation of all other related agencies and departments.

40. Community level Helper (CLH) Any community when faced with a disaster displays a response to the situation by the local people who immediately come forward to help. They are called community level helper. They play a vital link between the affected population and the helping agencies. The CLH provides psychological support during their daily visits like health education, discuss health problems, motivate individuals, hold group meetings, organize educational activities etc.

41. NATIONAL ORGANIZATION STATE ORGANIZATION DISTRICT LEVEL ORGANIZATION COMMUNITY LEVEL HELPERS

42. ROLE OF A NURSE DURING DISASTERS Immediate care provider ICN, INC initiates and motivates the nursing community to provide care immediately by training disaster team nurses in every health centre Government and V oluntary organizations The concerned state government and the voluntary organization constitute a core team, which manages the team of disaster nurses, health team members, paramedical workers.

43. Human rights The rights of the affected victims should not be violated at any time during and after the disaster. Maintain social justice and equality All the victims should receive equal core impartially in terms of social class, caste or race or religion.

44. Accountability Every member in the health team should be responsible in the administration of the disaster care and should keep the case recorded. The members are accountable for the health of the victims during the disaster. Relief development and planning Plan effectively to manage the disaster by receiving the resources in time for providing relief to the victims who experienced the disaster.

45. Prevention, mitigation and preparedness activities It is necessary to: Be familiar with methods of raising public awareness. Be informed of disease and behaviour patterns associated with the disaster. Be aware of associated physical and mental health and socio-economic and nursing needs. Actively participate in strategic planning and implementing disaster plans.

46. Urge the development and implementation of relevant policies, procedures and legislation. Celebrate World Disaster Reduction Day every October.

47. Relief response Assist in efforts to mobilize the necessary resources. Work with existing capacities, skills, resources and organizational structure. Assist with resettlement programme, psychosocial, economic and legal needs. Partner with independent, objective media, local and national branches of government, international agencies and non-governmental organisation. Provide care for those who are providing direct services.

48. HOSPITAL DISASTER MANUAL Introduction Distribution of responsibilities Chronological action plan

49. MANGERIAL ISSUES IN DISASTER MANAGEMENT Clinical issues Administrative issues Documentation Police documentation Communication Friends and relatives

50. Involvement of voluntary workers Blood donation activity Donation of foods, clothes, drugs etc Patients property

51. Press and broadcasting services Ambulance services Emergency lights Disposal of dead VIP visits Uneccessary crowding