DISASTER NURSING

DISASTER NURSING

DisasterDisaster is an occurrence arising with little or no warning, which causes serious disruption of life and perhaps death or injury to large number of people.It is may be a man made or natural event that causes destruction and devastation which cannot be relieved without assistance.

Types of disasterNatural. Eg : earthquake, floods, hurricane, tsunami.

Manmade.Eg: nuclear accidents, industrial accidents

Hybrid Eg: spread of disease in community, global warming.

Levels of disasterLevel iii disaster considered a minor disaster. These are involves minimal level of damageLevel ii disaster- considered a moderate disaster. The local and community resources has to be mobilized to manage this situationLevel i disaster- considered a massive disaster- this involves a massive level of damage with severe impact.

Disaster mitigationDisaster mitigation refers to actions or measures that can either prevent the occurrence of a disaster or reduce the severity of its effects. (American Red Cross).Mitigation activities include awareness and education and disaster prevention measures.

Phases of disaster managementRecovery phase

Prevention phasePreparedness phaseResponse phasePrevention phaseIdentify community risk factors and to develop and implement programs to prevent disasters from occurring.

Preparedness phasePersonal preparednessProfessional preparedness

Key organizations and professionals in disaster managementHealth care communityHospitalsHealth professionalsPharmaciesPublic health departmentsRescue personnelNon-health care communityFire fightersMunicipal or government officialsMediaMedical examinersMedical supply manufacturesPoliceCommunity preparednessThe level of community preparedness for a disaster is only as high as the people and organization in the community make it.Community must have adequate warning system and a back up evaluation plan to remove people from the area of danger

Response phaseThe level of disaster varies and the management plans mainly based on the severity or extent of the disaster.

Recovery phaseDuring this phase actions are taken to repair, rebuilt, or reallocate damaged homes and businesses and restore health and economic vitality to the community.Psychological recovery must be addressed. Both victims and relief workers should be offered mental health activities and services.

Disaster management plansAims of disaster plansto provide prompt and effective medical care to the maximum possible in order to minimize morbidity and mortality

ObjectivesTo optimally prepare the staff and institutional resources for effective performance in disaster situationTo make the community aware of the sequential steps that could be taken at individual and organizational levels

Disaster management committeeThe following members would comprise the disaster management committee under the chairmanship of medical superintendent/ directorMedical superintendent/ directorAdditional medical superintendentNursing superintendent/ chief nursing officerChief medical officer (casualty)Head of departments- surgery, medicine, orthopedics, radiology, anesthesiology, neurosurgeryBlood bank in chargeSecurity officersTransport officerSanitary personnelDisaster control roomthe existing casualty may be referred as the disaster control room.

Rapid response teamThe medical superintendent will identify various specialists, nurses and pharmacological staff to respond within a short notice depending up on the time and type of disaster.The list of members and their telephone numbers should be displayed in the disaster control room.

Information and communicationthe disaster control team would be responsible for collecting, coordinating and disseminating the information about the disaster situation to the all concerned.

Disaster bedsRequirement of beds depends up on the magnitude of the disaster.Utilization of vacant beds, day care beds, and pre-operative bedsConvalescing patients, elective surgical cases and patients who can have domiciliary care or opd management should be dischargedUtility areas to be converted in to temporary wards such as wards with side rooms, corridors, seminar rooms etc.Creating additional bed capacity by using trolleys, folding beds and floor beds

Logistic support systemResuscitation equipmentsIv sets, iv fluids,Disposable needles, syringes and glovesDressing and suturing materials and splintsOxygen masks, nasal catheters, suction machine and suction cathetersEcg monitors, defibrillators, ventilatorsCut down sets, tracheostomy sets and lumbar puncture setsLinen and blanketsKeys of these cupboards should be readily available at the time of disaster

Training and drillsMock exercise and drills at regular intervals are conducted to ensure that all the staff in the general and those associated with management of causalities are fully prepared and aware of their responsibilitiesElements of disaster planA disaster plan should have the following elementsChain of authorityLines of communicationRoutes and modes of transportMobilizationWarningEvacuationRescue and recoveryTriageTreatmentSupport of victims and familiesCare of dead bodiesDisaster worker rehabilitation

Activation of disaster management plansStandard operating procedures (SOPs)Reception areaTriagePriority one- needing immediate resuscitation, after emergency treatment shifted to intensive care unitPriority two- immediate surgery, transferred immediately to operation theatre.Priority three- needing first aid and possible surgery- give first aid and admit if bed is available or shift to hospitalPriority four- needing only first aid-discharge after first aid.DocumentationPublic relations.Essential services.Crowd management/ security arrangement.

Disaster management- nurses role in communityAssess the communityAssessment - the local climate conducive for disaster occurrence, past history of disasters in the community, available community disaster plans and resources, personnel available in the community for the disaster plans and management, local agencies and organizations involved in the disaster management activities, availability of health care facilities in the community etc.

Diagnose community disaster threatsDetermine the actual and potential disaster threats (eg; explosions, mass accidents, tornados, floods, earthquakes etc).

Community disaster planningDevelop a disaster plan to prevent or deal with identified disaster threatsIdentify local community communication systemIdentify disaster personnel, including private and professional volunteers, local emergency personnel, agencies and resourcesIdentify regional back up agencies and personnelIdentify specific responsibilities for various personnel involved in the disaster plansSet up an emergency medical system and chain for activationIdentify location and accessibility of equipment and suppliesCheck proper functioning of emergency equipmentsIdentify outdated supplies and replenish for appropriate use.

Implement disaster plansFocus on primary prevention activities to prevent occurrence of manmade disastersPractice community disaster plans with all personnel carrying out their previously identified responsibilities (eg: emergency triage , providing supplies such as food, water, medicine, crises and grief counseling)Practice using equipment; obtaining and distributing suppliesEvaluate effectiveness of disaster planCritically evaluate all aspects of disaster plans and practice drills for speed, effectiveness, gaps and revisions.Evaluate the disaster impact on community and surrounding regionsEvaluate the response of personnel involved in disaster relief efforts.