MAMATA COLLEGE OF NURSINGKHAMMAM

SUBJECT: NURSING MANAGEMENTGUIDED BY: Mrs. Dr. Ratna Philip, Principal DATE: PRESENTED BY: Mrs. Udaya Sree.G, M.Sc. (N) II year TIME:UNIT-III: MANAGEMENT OF NURSING SERVICES IN THE

HOSPITAL AND COMMUNITY

SEMINAR ON DISASTER MANAGEMENT

INTRODUCTIONEmergency and disasters do not only affect health and well being of the people; frequently large no of people are displaced, killed or injured, or subjected to greater risk of epidemics. Disaster is not confined to a particular part of the world; they can occur anywhere and at any time. Major emergencies and disasters have occurred throughout history and as the world’s population grows and resources become more limited, communities are increasingly becoming vulnerable to the hazards that cause disaster. The disaster is a global phenomenon and no country is spared from the disaster, whether natural or manmade.

MEANING A calamitous event, especially one occurring suddenly andcausing great loss of life, damage, or hardship, as a flood, airplane crash, or business failure.

DEFINITIONS A disaster can be defined as any occurrence that causes damage, ecological disruption, loss of human life or deterioration of health and health services on a scale sufficient to warrant an extraordinary response from outside the affected community or area.

-BT Basavanthappa

A disaster is an occurrence such as hurricane, tornado, storm, flood, higher water, wind-driven water, tidal wave, earthquake, drought, blizzard, pestilence, famine, fire, explosion, volcanic eruption, building collapse, transportation wreck, or other situation that causes human suffering or creates human needs that the victims cannot alleviate without assistance

-American Red Cross

DISASTER MANAGEMENTDisaster management can be defined as the effective organization, direction and utilization of available counter disaster recourses.

CLASSIFICATION OF DISASTER

The disaster can be classified into various ways

1. Natural disaster

2. Meteorological disaster Storms (cyclones, hail storms, hurricanes, tornadoes, typhoons and snow

storms) Cold spells, heat waves and drought

3. Typological disasters Avalanches, landslides, floods

4. Telluric and Teutonic disaster Earthquake, tsunamis and volcanic eruption

5. Biological disaster Insect swarms (Eg: Locust) epidemics of communicable diseases.

MAN MADE DISASTERS

1. Civil disturbance: Riots, demonstration

2. Non conventional warfare: Nuclear, Biological and chemical warfare, guerrilla warfare, terrorism

3. Warfare: Bombardinats, blockage and siege

4. Refugees: Forced movements of large number of people across the border

5. Accidents: Transportation accidents like rail, road, air or sea, building collapse, collapse dams and mines disaster

6. Technology failure: Nuclear power station mishap like Chernobyl, Bhopal gas leakage like disasters, breaks down of sanitarian system.

DISTINGUISHING BETWEEN AN EMERGENCY AND A DISASTER SITUATION An emergency and a disaster are two different situations:

An emergency is a situation in which the community is capable of coping. It is a situation generated by the real or imminent occurrence of an event that requires immediate attention and that requires immediate attention of emergency resources.

A disaster is a situation in which the community is incapable of coping. It is a natural or human-caused event which causes intense negative impacts on people, goods, services and/or the environment, exceeding the affected community’s capability to respond; therefore the community

PHASES OF MANAGEMENT OF DISASTERIn developing strategies to address the problem of disasters, it is helpful for the community health nurse to consider each of the four phases of disaster management: prevention, preparedness, response and recovery.

1. PREVENTION PHASEDuring the prevention phase, no disaster is expected or anticipated. The take off during this phase is to identify community risk factors and to development and implement programs to prevent disaster from occurring. Prevention of disaster is related to the long term activities, formulation and implementation long range policies and programs. The responsibility of the biological disaster prevention lies with ministry of health.

Disaster prevention may be considered on 3 levels

a) Primary prevention Health promotion – increase community awareness Increase community preparation through education Each person is as prepared as possible both physically and emotionally Health protection –community member know what to do and where to go, whether

at home, work, school, or elsewhere in the community Get to safety before the impact- Southwest corner of a home’s basement or an

interior room away from windows and under heavy functions

b) Secondary prevention Early diagnosis- Remain in your position of safety until a community all- clear

warning signal is sounded or until rescued. Leave a damaged building cautionary, if able and not seriously injured, and do not

return until it is declared safe.

Prompt treatment- Rescue individuals properly and get appropriate care for those injured as soon as possible.

The infrastructure of the community becomes remains intact, keeping community members safe from hazards such as live wires, broken gas lines and fallen debris

c) Tertiary prevention Rehabilitation- Remain safe during the immediate recovery period other Accept help from others, friends, family and community Rebuild family lives through counseling and other services to re-stabilize life

physically, emotionally, spiritually and financially.

2. PREPAREDNESS PHASEIt includes formulation of disaster plans, the maintenance of resources, training of personnel, planning, organizing.

a. Personal preparednessHealth care professionals with client responsibilities can also become disaster victims. Conflicts arise between client related and work related responsibilities. Personal and family preparation can help to care of some of the conflicts.

b. Professional preparednessProfessional preparedness requires that health care professionals become aware of and understand the disaster plans at their work place and community. Adequately prepared professionals can function as leaders in the disaster management areas. Personal items that are recommended for a professional to keep for the disaster management are copy of professional license, personal equipments such as stethoscope, flash light and extra batteries, cellular phone, warm clothing or heavy jackets, protective shoes, packet sized reference books, watch ect.

c. Community preparednessThe level of community preparedness for a disaster is only as high as the people and organization in the community make it. Some communities stay prepare for disaster with written plans and by participating in disaster drills. Community must have adequate warning system and a back up evaluation plan to remove people from the area of danger.

d. Health preparednessA 200 bedded mobile hospital, fully trained and equipped is set up and attached to a leading government hospital in Delhi. Three additional mobile hospital with all medical and emergency equipments are proposed to be located in different parts of the country. e. Hospital preparedness

Hospital preparedness is crucial to any disaster response system. Each hospital need to have an emergency preparedness plan to deal with mass casualty incidents and the hospital administration/ doctor trained for this emergency. Therefore, capacity building through in service training of the current health manager and medical personnel in hospital preparedness for emergencies or mass casualty incident management is essential.

3. RESPONSE PHASEAt the disaster sites policies, fire fighters, nurses and relief workers develop a coordinated response to rescue, triage, and treat disaster victims

a. RescueOne of the first obligations of relief workers is to remove victims from danger. This job typically falls to firefighters and personnel with special training in search and rescue. Depending on the disaster agent, protective wear, heavy equipment and special vehicle may be needed and dogs trained to locate dead bodies may be brought.

b. TriageWhereas emergency nurses daily determine which clients require priority care, the community health nurse may be at a loss as to where to start when faced with multiple victims of disaster.

Triage is the process of strong multiple casualties in the event of a war or major disaster. It is required when the number of causalities exceeds immediately resources. The goal of triage is to affect the greatest amount of good for the greatest number of people.

c. Disaster victims

Red: Urgent / CriticalVictims in this category have injuries or medical problems that will likely lead to death if not treated (Eg: An unconscious victim signs of internal bleeding)

Yellow: Delayed Victims in the category have injuries that will require medical attention. However, time to medical treatment is not yet critical (Eg: Conscious patient with fracture femur)

Green: Minor/ Walking WoundedVictims in this category have sustained minor injury or are presenting with minimal signs of illness. Prolonged delay in care most likely will not adversely affect their long term outcome. (Eg: A conscious victim with superficial cute, scrapes)

Black: Dead

Victims in this category are obviously dead or have suffered mortal wounds becomes of which death is imminent (Eg: An unconscious victim with an open skull fracture with brain matter showing)

Immediate treatment and support. Care of bodies and notification of families

4. RECOVERY PHASEDuring this phase the community takes actions to repair, rebuilt or reallocates damaged homes and business and restores health and economic vitality to the community. Psychological recovery must be addressed. The emotional scars of witnessing a disaster may persist for long duration. Both victims and relief workers should be offered mental health and services.

DISASTER MANAGEEMENT PLANSAlthough no disaster management plans can be made to fit every emergency but protocols and chronological action plans to prove to deal emergency situation efficiently if executed in coordinated manner.

AIMS 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 at individual and organizational levels.

CONSTITUTION OF DISASTER MANAGEMENT COMMITTEEThe following members would comprise the disaster management committee under the chairmanship of medical superintendent / director

Medical superintendent / director Additional medical superintendent Nursing superintendent / chief nursing officer Chief medical officer Head of the departments-Surgery, medicine, orthopedics, radiology, anesthesiology,

neurosurgery Blood bank in charge Security officers

Dietician Transport officer Sanitary personnel

The disaster management committee is overall responsible for managing the disaster situation, take administrative decisions, review the disaster plans and inform authorities.

DISASTER CONTROL ROOMIn the eventuality of a disaster the existing casualty would referred as the disaster control room. It would be managed round the clock.

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 disaster control room.

INFORMATION AND COMMUNICATIONThe disaster control team would be responsible for collecting, coordinating and disseminating the information about the disaster situation to all the concerned. Information would be sort on time, place and nature of the disaster, approximately number of casualties.

EFFECTIVE COMMUNICATIONTo be effective communication during disaster must elicit action. Communication that elicits action provides information that is:

Believable Current Authoritative Predictive of the probability of future events (what is going to happen next?) Interactive – it allows for and address questions Conclusive- it eliminates room for speculation and catastrophizing Urgent – conveys seriousness without resorting to fear tactics Clear, simple and repetitive Characterized by solutions and suggestions for success Personal- it uses people’s names if possible and addresses their real and perceived

needs

DISASTER BEDS

Requirements of beds depend up on the magnitude of the disaster. Some beds can ear marked as disaster beds. The efforts should be created to allocated additional beds by

Utilization of vacant beds, day care beds, and pre operative beds Convalescing patients, elective surgical cases and patients who can have domiciliary

care or OPD management should be discharged Utility areas to be converted into temporary wards such as wards with side rooms,

corridors, seminar halls etc Creating additional bed capacity by using trolley, folding beds and floor beds.

LOGISTIC SUPPORT SYSTEMSeparate cupboard marked as disaster shelf and should be kept in disaster control rooms, equipped with all essential medicine and surgical supplies.

EMERGENCY HEALTH SERVICES IN DISASTERS During the first few days following a disaster, the priority is usually to treat casualties and the sick or injured. Disasters like earthquakes often involve the management of mass casualties which normally requires the following activities: Search, rescue and first aid; Transport of health facilities and treatment; Triage; Tagging; and redistribution of patients between hospitals when necessary. Usually within 30 minutes of a disaster, up to 75% of the healthy survivors are actually engaged in urgent rescue activities.

The demand for curative care is highest during the acute emergency stage, when the affected population is most vulnerable to their new environment and before basic public health measures (e.g., water, sanitation and shelter) have been implemented. Thereafter, the priority should shift toward preventive measures, which can dramatically improve the overall health of the affected population. Otherwise, any prolonged. Introduction to Disaster Management interruption in routine immunisations and other disease-control measures may result in serious outbreaks of measles, cholera etc.

EMERGENCY MANAGEMENT Emergency management is a discipline that involves the avoidance of risks, while simultaneously putting plans in place to deal with disasters and emergency situations if and when they do occur with a view to rebuild and restore society to a functional level in as short a time as possible after a disaster. Emergency management is therefore a shared responsibility between government and citizens of a country towards building a sustainable, disaster-resilient society.

PURPOSE OF EMERGENCY MANAGEMENT

Save lives Preserve the environment Protect property Protect the economy

EMERGENCY MANAGEMENT SYSTEMS (EMS)Emergency management systems are technological aids that facilitate the effective management of disasters. EMS technology can assist in several areas that are critical to effective disaster management, such as:

Drafting and testing of evacuation and general disaster plans (Evacuation Plans).

Establishment of shelters as well as informing the public of shelter locations, items that should be taken to the shelter and general “shelter behaviour”.

Training personnel in effective shelter management, basic first aid and other “response” skills (Manpower).

Establish a national warehouse and ensure that it is stocked with items for national survival in the immediate aftermath of the disaster, before the arrival of overseas help (Materials).

Setting-up reliable communication systems, such as, the traditional two-way CB-type radios (Communication). 100 Unit 8 The Role of Technology in Disaster Management

Putting transportation plans in place, which should include air transportation to facilitate air-lifts and rescues, delivery of food supplies to severely affected areas cut-off from vehicular traffic and comprehensive damage assessment activity (Transportation).

USEFUL IS EMS EMS can also add tremendous value to disaster management in the following generic areas:

Hazardous Materials Management Emergency Medical Services Response and Recovery

ORGANISATIONS INVOLVED IN DISASTER MANAGEMENT

Disaster management is a complex process involving international, national and local organisations each with a distinct role to play. To respond to disaster situations a coordinated effort is required.

The United Nations and its organisations The International Federation of Red Cross and Red Crescent Societies The International Committee of the Red Cross International non-governmental agencies National organisations

CONCLUSIONDisaster Management has to be a multi-disciplinary and pro-active approach. Besides various measures for putting in place institutional and policy framework, disaster prevention, mitigation and preparedness enunciated and initiatives being taken by the Government, the community, civil society organizations and media also have a key role to play in achieving our goal of moving together, towards a safer country. The message being put across is that, in order to move towards safer and sustainable national development, development projects should be sensitive towards disaster mitigation.

Disasters call for a co-ordinated response between curative and preventive health services, including food supply, water and sanitation, etc. In order to minimise mortality and morbidity it is also necessary to organize the relief response according to three levels of preventive health measures; namely primary, secondary and tertiary prevention.

BIBLIOGRAPHY Gabriel Carrillo (2010), Introduction to Disaster Management, 1ST edition, Canada.

Don Schramm and Richard Hansen (1993), Aim & Scope of Disaster Management, Prehospital and Disaster Medicine publications, USA.

www.wikipedia.com

MAMATA COLLEGE OF NURSING

KHAMMAM

SUBJECT: NURSING MANAGEMENT

GUIDED BY: Mrs. Dr. Ratna Philip, Principal DATE:

PRESENTED BY: Mrs. Udaya Sree.G, M.Sc. (N) II year TIME:

UNIT-III: MANAGEMENT OF NURSING SERVICES IN THE

HOSPITAL AND COMMUNITY

MASTER PLAN ON DISASTER MANAGEMENT

I. INTRODUCTION

II. MEANING

III. DEFINITION

According to BT. Basavanthappa

According to American Red Cross

IV. DISASTER MANAGEMENT

V. CLASSIFICATION OF DISASTER

VI. MAN MADE DISASTERS

VII. DISTINGUISHING BETWEEN AN EMERGENCY AND A DISASTER SITUATION

VIII. PHASES OF MANAGEMENT OF DISASTER

IX. DISASTER MANAGEEMENT PLANS

X. CONSTITUTION OF DISASTER MANAGEMENT COMMITTEE

XI. DISASTER CONTROL ROOM

XII. RAPID RESPONSE TEAM

XIII. INFORMATION AND COMMUNICATION

XIV. EFFECTIVE COMMUNICATION

XV. DISASTER BEDS

XVI. LOGISTIC SUPPORT SYSTEM

XVII. EMERGENCY HEALTH SERVICES IN DISASTERS

XVIII. EMERGENCY MANAGEMENT

XIX. PURPOSE OF EMERGENCY MANAGEMENT

XX. EMERGENCY MANAGEMENT SYSTEMS (EMS)

XXI. USEFUL IS EMS

XXII. ORGANISATIONS INVOLVED IN DISASTER MANAGEMENT

XXIII. CONCLUSION

XXIV. BIBLIOGRAPHY

SEMINAR ONDISASTER MANAGEMENT

SUBMITTED TO SUBMITTED BYMRS. Dr. Ratna Philip. M.Sc (N), Ph.D., MRS.UDAYA SREE.G

Principal M.Sc. (N) II YEARMAMATA COLLEGE OF NURSING MAMATA COLLEGE OF

NURSING KHAMMAM KHAMMAM

SEMINAR ONHUMAN RESOURCE FOR HEALTH

SUBMITTED TO SUBMITTED BYMRS. Dr. Ratna Philip. M.Sc (N), Ph.D., MRS.UDAYA SREE.G

Principal M.Sc. (N) II YEARMAMATA COLLEGE OF NURSING MAMATA COLLEGE OF NURSING KHAMMAM KHAMMAM