DISASTER NURSING and emergency services.

It is a different age, professional nursing skill, knowledge, attitude in recognizing and meeting the nursing health, emotional needs of disaster victim.

1. EMERGENCIES & . DISASTER NURSING MARKAD RAVINDRA A. BROTHER TUTOR, SCHOOL OF NURSING, K.E.M. HOSPITAL PAREL MUMBAI -12

2. DEFINITION OF DISASTER. An occurrence, either the natural or man-made that causes human suffering and Creates human needs that victims cannot alleviate without assistance. -The American Red Cross.

3. What is disaster W.H.O : A disaster can be defined as any occurrence that cause damage, ecological disruption, loss of human life, deterioration of health and health services, Vs a scale sufficient to warrant as extraordinary response from outside the affected community or area.

4. DISASTER NURSING

5. Definitions of Disaster Nursing Disaster Nursing can be defined as the adaptation of professional nursing skills in recognizing and meeting the nursing 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 the disaster.

6. DISASTER alphabetically means . D - Destruction. I- Incident. S- Suffering. A -Administrative. S- Sentiments. T- Tragedies. E – eruption of communicable diseases. R – Research program and its implementation.

7. Mission statement Disasters are a primary cause of morbidity and mortality. Nurses can play an important role in disaster mitigation, but they receive very little training. This lecture is designed to help to introduce to nursing the concepts of disasters and disaster mitigation.

8. GOALS OF DISASTER NURSING. To provide basic survival needs of affected population. To identify the possibility of a secondary disaster. Estimate the risk and resource in the environment. To create inequality in access to healthcare or appropriate resource Encourages survivors to participate in their own health plans and well-being. To promote the highest. Achievable quality of life for survivors.

9. Effects of Disaster It completely disturbs the normal day to day life It negatively influences the emergency systems. Normal life process deteriorates Fundamental needs like food, shelter, health etc are affected

10. Types NATURAL -flood -earthquake -volcano etc. MANMADE Explosion War Fire Accidents etc.

11. Hurricanes The primary health hazard from hurricanes or cyclones lies in the risk of drowning from the storm surge associated with the landfall of the storm. Most deaths associated with hurricanes are drowning deaths. Secondarily, a hazard exists for injuries from flying debris due to the high winds. Nurses can be instrumental in providing direct emergency care to drowning and head injuries.

12. Tornadoes The primary hazard from a health perspective in a tornado is the risk for injuries from flying debris. The high winds and circular nature of a tornado leads to the elevation and transport of anything that is not fastened down. Most victims of tornadoes are affected by head and chest trauma due to being struck by debris or from a structural collapse. Some individuals are injured while on the ground. Others are lifted into the air by the tornado and dropped at another location.

13. Floods Floods may originate very quickly following a quick rain storm, or they may develop over a short period following an extended period of rain or quick snow melt The primary hazard from flooding is drowning Longer term health concerns from flooding is the development of disease from contaminated water and lack of hygiene.

14. Earthquakes A significant global concern The primary health concern: Injuries arising from structural collapse Most injuries occur amongst individuals trapped at the time of the earthquake Well known prevention strategy is to prevent buildings from collapsing There is a recognized need to develop better rescue strategies for retrieving individuals from collapsed buildings

15. Volcanoes Rare, but can be catastrophic when they occur Over the 25 year period (1972-1996), there was an average of 6 eruptions per year, causing an average of 1017 deaths and 285 injuries Health outcomes are associated with volcanic eruptions: Respiratory illnesses from the inhalation of ash For individuals close to the volcano, some danger exists from lava flows, or more likely mud flows

16. A few Disasters of the past 3

17. LANDSLIDE IN JUIEE,DIST RAIGAD

18. MANMADE

19. Bomb Blast in W.R. local train - 11July 06 Dead – 156 Injured - 487

20. TRAIN ACCIDENTS

21. Man-made Threat Unpredictable Challenges Disruptive Unexpected Targeting weaknesses Very rare, impossible to conceive before event Threats to Civilians, Information Infrastructure

22. Patterns of mortality and injury Disaster events that involve water are the most significant in terms of mortality Floods, storm surges, and tsunamis all have a higher proportion of deaths relative to injuries Earthquakes and events associated with high winds tend to exhibit more injuries than deaths The risk of injury and death is much higher in developing countries – at least 10 times higher because of little preparedness, poorer infrastructure.

23. Displacement of disaster victims Mass Shelters Shelter management: Organized team (chain) Sleeping area and necessities Water and food handling Sanitation (toilets, showers,..) Special care to children and elderly Health services (physical, mental)

24. Disaster and health In a major disaster water treatment plants, storage & pumping facilities, & distribution lines could be damaged, interrupted or contaminated. Communicable diseases outbreak due to: Changes affecting vector populations (increase vector), Flooded sewer systems, The destruction of the health care infrastructure, and The interruption of normal health services geared towards communicable diseases

25. Disaster and health Injuries from the event Environmental exposure after the event (no shelter) Malnutrition after the event (feeding the population affected) Excess NCD mortality following a disaster Mental health (disaster syndrome)

26. Mental wellness Little attention is paid to the children Listen attentively to children without denying their feelings Give easy-to-understand answers to their questions In the shelter, create an environment in which children can feel safe and secure (e.g. play area)

27. Mental wellness In any major disaster, people want to know where their loved ones are, nurses can assist in making links. In case of loss, people need to mourn: Give them space, Find family friends or local healers to encourage and support them Most are back to normal within 2 weeks  About1% to 3%, may need additional help

28. The most vulnerable

29. TYPES OF DISATER Natural :- Man-made :-

30. INTERMEDIATE MANAGEMENT OR RELIEF PHASE.

31. EMERGENCY NURSING MANAGEMENT. 1) Initial crisis management . A)Search and Rescue: The top priority in disaster management is to search for the afflicted people in the affected areas transport them. To save, place this process known as SAR (Search and Rescue ) B)Transportation of victims: Immediately after the disaster, every person rushed to health services. C) classification of injured triage: Yeah, the principle of first come, first created is not applicable. Due to lack of resources to meet the needs of injured people the priority of treatment is decided by the process of instant classification.

32. D) identification of death and care of dead bodies: Therefore identification and care of dead bodies is an important part in disaster. To remove the dead bodies from disaster site, determine their identity, keep them in maturity, arrange the postmortem proper care of dead bodies, ensuring them to their relative, performing last rites to unclaimed the bodies. Are the importance aspect of disaster management. It should kept in mind that dear always lies or risk of epidemics spreading due to the decades and infected bodies.

33. POST DISASTER ACTIVITY. Evaluation of harm and damages. Rehabilitation. After occurrence of disaster, rehabilitation programme can be classified following heads. Development of infrastructure and housing. 2) Social and psychological rehabilitation. 3) Economical rehabilitation. 4) Environmental rehabilitation.

34. Community health nurse ROLE in disaster management. Communicators. Team coordinators. Rescuer. Healthcare provider. Health educator and councillor. Damage assessor. Rehabilitator

35. What is Triage? French verb “trier” means to sort Assigns priorities when resources limited Do the best for the greatest number of patients

36. TRIAGE system

37. TRIAGE TAG. Price tag is prefabricated label place on each patient that helps. Identify the patient. Content record assessment findings. Identify priority of patient needs for medical treatment and transport from emergencies scenes. Identify additional hazards.

38. Why is Disaster Triage needed Inadequate resource to meet immediate needs Infrastructure limitations Inadequate hazard preparation Limited transport capabilities Multiple agencies responding Hospital Resources Overwhelmed

39. advantages of Triage Helps to bring order and organization to a chaotic scene. It identifies and provides care to those who are in greatest need Helps make the difficult decisions easier Assure that resources are used in the most effective manner May take some of the emotional burden away from those doing triage

40. Who decides in triage Nurses don’t act for legal fears of being blamed for deaths, and lack of clarity on where they fit in the command structure Nurses function to the level of their training and experience. If nurses they are the most trained personnel the site, they are in charge.

41. Are nurses prepared??

42. Health Worker Density by Region

43. CHARACTERISTICS OF DISASTER NURSING Caring for the Community During a Disaster Personal Impact Adverse Conditions Lack of Recognition

44. Essential nursing abilities needed for the appropriate management of disaster victims Critical thinking, Adaptability, Teamwork, and Leadership.

45. Role of nursing in disasters Disaster preparedness, including risk assessment and multi-disciplinary management strategies at all system levels, is critical to the delivery of effective responses to the short, medium, and long-term health needs of a disaster-stricken population. I nternational Council of Nurses (2006)

46. Nurses’ roles in disasters Determine magnitude of the event Define health needs of the affected groups Establish priorities and objectives Identify actual and potential public health problems Determine resources needed to respond to the needs identified Collaborate with other professional disciplines, governmental and non-governmental agencies Maintain a unified chain of command Communication

47. Communication is a success key Nursing organizations must have a comprehensive and accurate registry for all members Have a structured plan: Collaborate and coordinate with local authorities Have a hotline 24x7 Inform nurses where to report and how (keep records) Make sure have a coordinator to prevent chaos Ensure ways to maintain communication between nurses and their families

48. The Need for disaster Nursing training 11 million nurses world wide: Form the backbone of the health care system Are the frontline health care workers who are in direct contact with the public Contribute to health of individuals, families, communities, and the globe Schools of nursing offer little or no information on disaster nursing (WHO, 2008) Shortage of trained instructors/faculty (WHO, 2008)

49. Core competencies in disaster nursing training Ethical and legal issues, and decision making; Care principles; Nursing care; Needs assessment and planning; Safety and security; Communication and interpersonal relationships; Public health; and Health care systems and policies in emergency situations (WHO, 2008)

50. Topics that must be covered by disaster nursing training Basic life support System and planning for settings where nurses work Communications (what to report and to whom) Working in the damaged facilities and with damaged equipment Safety of clients and practitioners Working within a team (understand each member’s role and responsibility) Infection control Mental and psychosocial support (WHO, 2006)

51. The Phases of Disaster Mitigation: Lessen the impact of a disaster before it strikes Preparedness: Activities undertaken to handle a disaster when it strikes Response: Search and rescue, clearing debris, and feeding and sheltering victims (and responders if necessary). Recovery: Getting a community back to its pre-disaster status

52. Mitigation Activities that reduce or eliminate a hazard Prevention Risk reduction Examples Immunization programs Public education

53. Preparedness Activities that are taken to build capacity and identify resources that may be used Know evacuation shelters Emergency communication plan Preventive measures to prevent spread of disease Public Education

54. Recovery 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 Funding Assistance

55. REHABILITATION. After disaster Rehabilitation of affected people is an important part of disaster management. The restoration of normal life is possible through only the rehabilitation. Rehabilitation program classified as follows. A) Development of infrastructure and housing. B) Social and psychological rehabilitation. C) Economical rehabilitation. D) Environmental rehabilitation.

56. A ) Development of infrastructure and housing. Provide housing facility :- priority should be given construction and allocation of permanent houses in place of temporary housing. To reinstate the road, bridges and railway service and other transport system. To restore electricity and water supply Incorporating latest techniques. To normalize communication system. To reconduct community buildings .

57. B) Social and psychological rehabilitation. Giving psychotherapy and mental support to the injured fractured and people who suffering from the physical disorder due to the disaster. Activating and straightening exhibiting health facility and infrastructure. Reestablish the educational activity in affected areas. Rehabilitate homeless children, women, affected people.

58. C)Economical rehabilitation. To get start business activity immediately. To provide employment to people who become jobless due to the disaster. Arrange the for the government jobs for them. To restart the agriculture and framing. To rehabilitated small businessmen and masons. To bring occupational activity in line through financial grants and loans.

59. D) Environmental rehabilitation. Due to disaster, environmental and biological balance, affected areas gets disturbed. Therefore, with other activities of rehabilitation is necessary to take ecological balance and development. Main features are environmental rehabilitation. To do dance plantation. To develop artificial ponds, Lakes, gardens. To prevent bio pollution. To do Effective surveillance of these factors which are responsible for the air, water and land pollution.

60. Organization providing assistance in disaster management International Agency, government and non governmental organization, voluntary associations. Etc. plays an important. Role in disaster management migration and it’s management. Somewhere below listed. UNDP- United Nation development program. FAO – Food and Agriculture organization. UNCHS – United Nations Center for Human Settlements. RDRU – regional disaster with revolution unit this is reginal development units of united nation. UNEP - United National environmental program. UNIE –NET- United nation national Emergency network. UNHCR – United Nations high. Commissioners of refugees.

61. Organization providing assistance in disaster management WFO – World food organization. WMO – World Meteorological Organization. WHO – World Health Organization. ADPC – Asian Disaster Preparedness center. Red Cross society . NDMA – National Disaster Management Authority, India.