Disaster- Introduction

Dinesh Kumar. S
Assistant Professor, CON
Disaster
• A serious disruption of the functioning of a
community or a society involving widespread
human, material, economic, or environmental
losses and impacts, which exceeds the ability
of the affected community or society to cope
using its resources” -UNISDR 2009
• “DISASTER” is from a French word. Disaster is
combination of 2 terms – DES + ASTER. The
expression of term “DISASTER” is ‘Bad or Evil
Star
Emergency Events Database of
International Disaster

The following criteria fulfilled in an event

can be called Disaster.
• 10 or more people reported killed
• 100 or more people reported affected
Features
Levels of Disaster

Level 3 • Overwhelms district

and state authorities

• Needs mobilization
Level 2 of resources at State
level

Level 1 • District level

Types
Type Disaster Cause Events
Subgroup
Natural I. Geophysical Originating from solid earth Earthquake, Volcano, Mass
Movement (dry)
II. Meteorological Short‐lived/small to meso Storm
scale atmospheric processes
III. Hydrological Deviations in the normal Flood, Mass Movement (wet)
water cycle
IV. Climatological Long‐lived/meso to macro Extreme Temperature, Drought,
scale processes Wildfire
V. Biological Exposure of living organisms Epidemic, Insect Infestation,
to germs and toxic substances Animal Stampede
VI. Extraterrestrial caused by asteroids, Impact, space weather
meteoroids, and comets as
they pass near-earth, enter
the Earth’s atmosphere
Technological VI. Industrial, Human errors Motor vehicle crash, Building
Transportation (Air, Water, collapse, Bhopal gas tragedy,
Road), Others etc.
Disaster Nursing
• Defined as the adaptation of professional
nursing knowledge, skills and attitude in
recognizing and meeting the nursing,
health and emotional needs of disaster
victims
Goals
• To meet the immediate basic survival needs
of populations affected by disasters (water,
food, shelter, and security).
• To identify the potential for a secondary
disaster.
• To appraise both risks and resources in the
environment.
• To correct inequalities in access to health
care or appropriate resources.
• To empower survivors to participate in and
advocate for their own health and well-
being.
• To respect cultural, lingual, and religious
diversity in individuals and families and to
apply this principle in all health promotion
activities.
• To promote the highest achievable quality of
life for survivors.
Principles
• 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.
• Adaptation of necessary nursing skills to
disaster and other emergency situations. The
nurse must use imagination and resourcefulness
in dealing with a lack of supplies, equipment,
and personnel.
• Evaluation of the environment and the
mitigation or removal of any health hazards.
• Prevention of further injury or illness.
• 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.
Disaster Management
HIRA
• A risk assessment tool that used to assess which
hazards pose the greatest risk in terms of how
likely they are to occur how great their
potential impact may be.
• It is not intended to be used as a prediction tool
to determine which hazard will cause the next
emergency
Steps in HIRA
Hazard Identification

Risk Assessment

Risk Analysis

Monitor and Review

Hazard Identification
• Hazard is a physical or human made event
that can potentially trigger a disaster.
• Reviewing all hazards and their causes to
determine whether they may be a threat.
• Separate the Hazards that could impact your
community from those that cannot.
• Require the consultation of the scientific
community, historical records and
government agencies
Risk Assessment • Risk is defined as the frequency of
an event happening and its impact.
• Examine the level of risk for each
hazard
• Examine the potential impacts of
the hazard on people, property,
the environment, business and
finance and critical infrastructure.
• May involve speaking with hazard
experts, researching past
occurrences and possible scenarios
• Vulnerability is susceptibility • Capacities are the qualities and
of harm to those at risk. resources of the community or
Physical, social, economic individual to anticipate, cope
and environmental factors with, resist and recover from the
or processes which impact of hazards.
increases susceptibility of • Strengths and resources
an area or a community to available within a community,
damage and loss. society or organisation that can
reduce the level of risk or the
effects of a disaster
Risk Assessment = (Hazard * Vulnerability)
Capacity
Risk Analysis
Risk Level Rating Required Action

Critical Immediate action needed. Access to the hazard

should be restricted until the risk can be lowered
to an acceptable level.
High Action needed quickly (within 1-2 days). The task
should not proceed unless the risk is assessed,
and control options selected
Moderate Action required this week to eliminate or
minimise the risk
Low Action required within a reasonable timeframe
(2-4 weeks) to eliminate or minimize the risk
Very Low Risk to be eliminated or lowered when possible
Monitor & Review
• HIRA is an ongoing process. Hazards,
their associated risks and the risk
analysis process must be monitored and
reviewed periodically
MITIGATION

• Action taken to reduce the harmful

effects of the disaster on human health,
property and protection of vulnerable
population
Activities in Mitigation
• Awareness about disaster
• Training people – disaster drills
• Mass health education
• Warning signs of disaster
• Proper communication system
• Improving structural qualities
• Safe water supply
• Good sewage system
PREPAREDNESS

• Efforts are taken at every level to design

a structure for disaster response before it
occurs
 Person
al

Profes
sional

Community
Personal
• Physical fitness
• Knowing what type of disaster most likely
to happen in the community/ hospital
• Being trained in emergency response as
volunteer/ Nurse
• Keep emergency phone numbers in
mobile as ICE- In Case of Emergency
Professional
• Good health & willingness participate in disaster
• First aid, CPR, Trauma care & disaster training
• BLS certified
• Awareness on Hospital emergency response
plan
• Knowledge on functional roles & responsibilities
of the nurse in disaster management team
• Skill in correct use of equipment
• Knowing the professional limitations
• Update knowledge in disaster
Hospital/Community
• Hazard mapping for community/
Institution
• Prepare and disseminate emergency
response plan
• Train volunteers and health professionals
• Plan and conduct regular mock drills
RESPONSE

Response includes action taken to save lives

and prevent further damage.
Activities listed out in the response are
a) First responder – triage & medical care
b) Extrication, evacuation & transportation
c) Providing food and shelter
d) Ongoing surveillance of the epidemic
Need for Disaster Triage
• Inadequate resource to meet immediate
needs
• Infrastructure limitations
• Limited transport capabilities
• Multiple agencies responding
• Hospital resources overwhelmed
Qualities
• Clinically experienced
• Good judgment and leadership
• Decisive
• Being available and cool under stress
• Good organizing ability
• Knowledgeable regarding available
resources, anticipated victims
• Sense of humor
• Imaginative and creative in problem solving
Triage Categories
• Injury is critical
Priority 1
• Can be cared for with minimal time and resources
Immediate
• Good chance for survival
• Injury is significant
Priority 2
• Can tolerate the delay
Delayed
• Less risk of substantial morbidity
• Injuries are minor
Priority 3
• Can wait for treatment
Minimal or Nonurgent
• Directed self care
• Injuries are very severe
Priority 4
• Very minimal chance of survival
Expectant
• Already dead
Problems in Triage
Over triage
Noncritical patient is termed as critical
Adverse impact on the outcome of
immediate victims
Acceptable rate is 50%

Under Triage
Underestimates the severity of injuries
Impact on mortality and morbidity
Acceptable rate 5%
Disaster Triage Tag
SALT- Sort, Assess, Lifesaving intervention, Treatment/ Transport
MASS Triage
Move- Minimal, delayed

Assess- Initiate interventions

Sort- immediate, expectant

Send- Transport
RECOVERY

Action taken to return to normal or even

safer situation
• Rehabilitation of victims
• Continuous assessment of the
community
• Community education about hazards
• Provide psychosocial support
• Ongoing surveillance for epidemic
• In a disaster scene, Mr. L is able to come
and approach the nurse for treatment.
He will be labelled as
• R-34, P- 98/mt, M- stable
• R-24/mt, P- 88/mt, M- not obeying
•
• R- 24/mt, P-90/mt, M- obeying
• R- 28/mt, P- pulse not palpable, M-
obeying
• R- 34/mt, P-110/mt, M- obeying
• R- absent, P- not felt, M- not obeying