TOPIC : DISASTER MANAGEMENTINTRODUCTION

Disaster, caused by nature’s fury is not uncommon in this planet, Earth. In fact, scientists believe that the birth of this planet Earth was the result of explosion that occurred in the solar system. In the past men used to view these natural disasters as the ‘Act of God’. Gradually they understand the mysteries of nature. Disaster has the adverse effects on health in terms of variety of disease, injuries and health problems, etc.,so nurses have an important role to play during a disaster to save the lives and to provide health care to the victims.

DEFINITIONS

1. Disaster as “any occurrence that causes damage, economic disruption, loss of human life and deterioration of health and health service on a scale sufficient to warrant an extraordinary response from outside the affected community or area”. (WHO)

2. Disaster as “An occurrence such as hurricane, tornado, storm, flood, high water, wind-driven water, tidal wave, earthquake, drought, blizzard, pestilence, famine, fire, explosion, building collapse, transportation wreck, or other situation that causes human suffering or creates human that the victims cannot alleviate without assistance”.-RED CROSS

3. “Disaster can be defined as an overwhelming ecological disruption, which exceeds the capacity of a community to adjust and consequently requires assistance from outside.-Pan American Health Organisation(PAHO)

4. “Disaster is an event, natural or manmade, sudden or progressive, which impacts with such severity that the affected community has to respond by taking exceptional measures.-W. Nick Carter

TYPES OF DISASTER

Disasters are commonly divided according to their causes into two distinct categories :

Natural disaster Man-made disaster

i. Natural disasters: natural disaster include the following types:

Metrological disaster: Storms(Cyclones, typhoons, hurricanes, tornados, hailstorms, snowstorms),cold spells, heat waves and droughts.

Typological Disaster: landslides, avalanches, mudflows and floods.

Telluric and Teutonic (Disaster originate underground): Earthquake, volcanic eruptions and tsunamis (seismic sea waves).

Biological Disaster: communicable disease, epidemics and insect swarms (locusts).

ii. Man Made Disasters Warfare: conventional warfare (bombardment,

blockade and singe) and non-conventional warfare (nuclear, chemical and biological).

Civil disasters: riots and demonstration. Accidents: transpotation (planes, trucks,

automobiles, trains and ships); structural collapse (building, dams, bridges, mines and other structures); explosions : fires; chemical (topic waste and pollution ), and biological(sanitation).

Technological failures:- A mishap at a nuclear power station, leak at a chemical plant causing pollution of atmosphere or the breakdown of a public sanitation.

IMPACT OF DISASTERDisaster has two types of impact:

a) Direct impact: It includes damage to property , loss of lives both human and animal, home and crops may be destroyed, disruption of food and water supply.

b)Indirect impact: this includes great emotional and psychological illness due to loss of family members, relatives, neighbours, people suffer and die from diseases caused by unhygienic conditions.Recognising the importance of action and relief to reduce the impact of disaster, the

WHO has declared the decade 1990-2000 as the international decade for natural disaster reduction, The theme was “should disaster strike, be prepared”.

READINESS FOR DISASTER

Readiness for disaster involves two aspects:

Resource for readiness . Disaster pre planning.

Resources for readiness:

RED CROSS: Its primary concern in a disaster situation is to provide relief for human suffering in the form of food, shelter, clothing, medical care, and occupational rehabilitation of victims.

COMMUNITY AND LOCAL GOVERNMENT: It share the responsibility in clearing rubble, maintaing law and order, determining the safety of a structure of habitation, repairing bridges, resuming transpotation, maintaining sanitation, providing safe food and drinking water, etc.

CIVIL DEFENCE SERVICES: The civil defence and its medical facility programmers provide for shelters, establishing communication linkage, post disaster services, assistance to affected community in the area of health, sanitation, maintaining law and order, fire

fighting, clearing debris, prevention and control of epidemic of various diseases etc.DISASTER PRE-PLANING: It is important to make the best possible use of the resources. Some of the pre-planing aspects for disaster related to medical care as follows:

HOSPITAL DISASTER PLANING: Depending upon the hospital’s , location and size, it mobilizes its resources to manage any disaster. It should provide for immediate action in the event of:

i. An internal disaster in hospital itself e.gfire , explosion, etc.

ii. Some minor external disaster.iii. Major external disaster.iv. Threat of disaster.v. Disaster in neighbouring communities/country.

EVACUATION: There is usually a system which on order of the medical superintendent, is activated e.g :

Percentage of evacuation (discharge) of the patient from the hospital.

Addition of extra beds. Prepration of emergency ward. Such facilities should be near to X-ray, operation

theatre, central supply, medical store, etc. ORDERLY FLOW OF CASUALITY: It is important to

minimize confusion in receiving causalities. A team of well qualified physician and nurses at the reception it

self sorts out causalities and make quick decisions of the treatment.

additional nursing staff volunteers may be called and posted.

Services of all departments of the hospital should be well integrated in the disaster plan vizdieatery department, laundry, public works department (PWD), engineering unit, etc.

The planning should also take into consideration other aspects like traffic control, types of medical records to be maintained, standardization of emergency medical tags, public information centers, controlled dissemination of information without or with minimum distortion, preparation of emergency supplies kept ready, all ambulance kept ready, arrangement of additional vehicles.

Communication system: Additional communicaton system should be planned. It is also important to keep the hospital informed about the inflow of the casualties from the scene.

DISASTER SITE

CASUALITY FLOWCHART

TRIAGE IDENTIFICATION

HOSPITAL

TRIAGE SORTING TAGGING INITIATE

DISASTERING

MORGUE

EMERGENCY DEPARTMENT

NON-URGENT DISCHARGE

O.T I.C.U.

WARDS

DISASTER IMPACT

RESPONSE

RECOVERY

DEVELOPMENTPREVENTION

MITIGATION

PREPAREDNESS

THE DISASTER MANAGEMENT CYCLE

1. DISASTER EVENT: This refers to the “REAL TIME” event of the hazard occurring and affecting elements of risk.

2. RESPONSE AND RELEIF: This refers to the first stage response to any calamity, which include setting up control rooms, putting the contingency plan in action, issue warnings, evacuating people to safe areas, rendering medical aid to the needy, etc.

3. RECOVERY: It has three overlapping phases of emergency relief rehabilitation and reconstructing.

4. DEVELOPMENT: Evolving economy and long-term prevention/disaster reduction measures like construction of houses capable of withstanding the on slought of heavy rains, wind speeds and shocks of earthquakes.

5. REDUCTION AND MITIGATION: Protective or preventing actions that lessons the scale of impact. Minimizing the effects of disaster.Examples: building codes and zoning; vulnerability analyses; public education.

6. PREPAREDNESS: Includes the formulation and development of viable emergency plans, of the warning system, the maintenance of inventories and the training of personnel.

Principle of Triage

The word triage is derived from French word “trier” which means sorting or choosing.Fitzgerald developed a scale for the triage which is commonly known as “Ispwich Scale”. The scale due to its characteristics feature of utility, reliability is adopted in emergency medical services worldwide according to this scale colour in brackets depicts the colour code allocated to patients.

ISPWICH TRIAGE SCALEThis patient should wait for medical care no longer than:

TIME COLOUR AND TAG

NUMERIC CODE

CATEGORY

Seconds Red 1 Resuscitaton

Minute Yellow 2 Emergency

An hour Green 3 Urgent

Hours Blue 4 Semi-urgent

Day White 5 Non-urgent

- Black 6 Dead

PRINCIPLES OF TRIAGE

The main principles of triage are as follows :

Every patient should received and triaged by appropriate skilled health-care professionals.

Triage is a clinic-managerial decision and must involve collaborative planning.

The triage process should not cause a delay in the delivery of effective clinical care.OBJECTIVES OF TRIAGEAn effective triage system should be able to achieve the following:

Ensure immediate medical intervention in life threatening situations.

Expedite the care of patents through a systematic initial assessment.

Ensure that patients are prioritised for treatment in accordance with the severity of their medical condition.

Reduce morbidity through early medical intervention.

Improve public relations by communicating appropriate information to friends and relatives who accompany patients.

Improve patients flow within emergency departments and/or disaster management situation.

Provide supervised learning for appropriate personnel.

Role of nurses

As we have already studied, there are varieties of disasters either natural or man-made. But to discuss the role of nurses I would prefer to discuss the Role of Nurses in Earthquake.

1. Safety Assurance

All personnel in earthquake site should have as their foremost consideration the protection of: (a) themselves ;(b)their fellow workers ;(c)their patients.

Quickly assess the scene of danger before rushing in. Stay at least 100 yards away from a danger structure. Never enter a burning structure an area containing toxic

gases.

2. Organizing an effective Disaster system

Nurse must be familiar with the personnel at the disaster scene and their roles and function. In addition, she must understand the roles and function; she must understand organizing of sites.

A disaster scene is usually broken-up into three zone:

a) Disaster zone Start resque operation as soon possible. Locate trapped victims by shouting the rubble Follow certain elementary rules:

- Do not trample over the ruins.- Do not move rubble before being sure of not causing

further collapses of building or falls of material.

Disaster zone Treatment zone Transportation zone

- Use manual methods preferably. Give necessary first to victim after they have been rescued

- Maintain an easy respiration.- Clear the victim’s airways by using fingers to clean

the mouth and throat.- Take out dentures; loosen collars, belts and clothing.- Using blankets to prevent the victims catching cold- Transfer to treatment zone.

b) Treatment zone Triage of patient in the treatment categories. Thorough assessment of each patient Treatment of injuries. Preparation for transport.

c) Transportation zone

While transportation the victims certain rules must be followed.

Movement must be calm and coordinated and carried out in accordance with the instructions of rescue worker.

The injured person must be moved as little as possible. The victims head, neck and trunk must be kept in the

same axis.

3. Delivering appropriate patient care

Normal priorities change in a disaster. For e.g. –a critical patient may have to be placed in a low priority category in order to save the patient with better prognosis in a disaster situation . The types of patients found in a disaster and their position in priority categories are follow:

Probable fatal : these are the patients with injuries or likeness which probably fatal regardless of the care they receive – e.g. massive head injuries, patient in cardiac arrest, extensive chest trauma. These are placed in one of the lowest priority categories during a disaster.

Critical: patients who may have life threatening conditions, but they receive hospital care within 30 to 60 minutes they have a good prognosis, if transported and treated at a hospital quickly they fit in high priority category.

Serious: the patients with best prognosis in a disaster are the patients in serious condition, e.g patients with multiple fracture or pneumothorax death is not imminent. This type of patient is placed in higher priority.

Stable: Patients who do not have life threatening conditions (e.g. closed leg fracture), patients with abrasions and confusion etc. are placed in a lower middle category.

Fatal: A patient who has died at the scene should be placed in the lowest priority category.

Health services for the Non-Injured Dislocated Population

1. Public education and setting up of reception centres.

2. Standing medical orders.3. Prevention of epidemics.4. Control of communicable diseases.

CONCLUSIONA disaster is a situation where the need of the public victims mounts over the medical and nursing resources or services available particularly in the developing countries like India where the resources are already short the situation becomes worst. So, in such a scenario a prudent nurse should be resourceful, making best use of the available resources like governmental , nongovernmental organisations, self help groups, public, etc. and should act ethically with best of her knowledge, patience and judgement to minimize the effect of disaster.

BIBLIOGRPHYDave, P.K. Emergency Medical Services and Disater Management : A Holistic Approch. New Delhi: Jaypee brothers Medical Publishers (p) Ltd; 2001