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DISASTER NURSING
Introduction:
In the past two decades, there have been many natural and manmade disasters in
India. Natural disasters like floods, earthquakes, cyclones, droughts and humanmade such as terrorist acts, Nuclear or chemical war, fires and industrial accidents.
Disasters can significantly lead to a degradation of social and economic progress
achieved over decades of initiatives by the people. 80% of countries geographical
area is disaster prone and the majority of people live at or below the poverty line.
India has been devastated by three major disasters in last five years- Super Cyclone
in Orissa, earthquake in Gujarat and now the latest one the tsunami in the
Andaman and Nicober Islands,. Tamil nadu, Andhra Pradesh and Kerala. Each
disaster brought a great deal of miscarry to the affective population.
Definitions of Disaster:
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.
-(W.H.O.)
An occurrence of a severity and magnitude that normally results in death, injuries
and property damage that cannot be managed through the routine procedure andresources of government.
- FEMA (Federal Emergency Management Agency)
A disaster can be defined as an occurrence either nature or manmade that causes
human suffering and creates human needs that victims cannot alleviate without
assistance.
- American Red Cross (ARC)
United Nations defines disaster is the occurrence of a sudden or major misfortune
which disrupts the basic fabric and normal functioning of a society or community.
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
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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.
Disaster Nursing is nursing practiced in a situation where professional supplies,equipment, physical facilities and utilities are limited or not available.
DISASTER alphabetically means:
D - Destructions
I - Incidents
S - Sufferings
A - Administrative, Financial Failures.
S - Sentiments
T - Tragedies
E - Eruption of Communicable diseases.
R - Research programme and its implementation
The global scenario:
Impact of natural disaster in the last 30 years.
Death of 3 million people
Economic loss increased due to disaster like flood
In Indian scenario, 34jmijlion people affected per year and 5116 death per year.
In US, economic loss is 400 million dollar and 3 million people died.
Emergency:-
According to WHO, an emergency is a situation where a sudden incident or event
has occurred and normally used, local responses will suffice to care for the
situation without calling in outside help. E.g.: car accident or a water main
breaking.
Vulnerability:-
Vulnerability in this context can be defined as the diminished capacity of an
individual or group to anticipate, cope with, resist and recover from the impact of a
natural or man-made hazard. The concept is relative and dynamic. Vulnerability is
most often associated with poverty, but it can also arise when people are isolated,
insecure and defenseless in the face of risk, shock or stress.
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Hazard:-
Hazards are defined as phenomena that pose a threat to people, structures, or
economic assets and which may cause a disaster. They could either be manmade or
naturally occurring in our environment.
Epidemiology of Disaster:-
1.Agent
2.Environment
3.Host
Agents-
Primary Agents:
It includes falling of buildings, heat wind rising waters and smoke.
Secondary Agents:
It includes bacteria and viruses that produce contamination or infection after the
primary agent has caused injury or destruction.
Primary or secondary agent will vary according to the type of disaster.
For example: - A hurricane with rising water can cause flooding and high winds,
these are primary agents. The secondary agents would include damaged buildings
and bacteria or viruses that thrive as a result of the disaster. In an epidemic the
bacteria or virus causing a disease is the primary agent rather than the secondary
agent.
Host factors-
In the epidemiological frame work as applied to disaster the host is human-kind.
Host factors are those characteristics of humans that influence the severity of the
disaster effect. Host factors include
Age
Immunization status
Degree of mobility Emotional stability
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Environmental factors-
This includes,
1. Physical Factors
Weather conditions, the availability of food, time when the disaster occurs, theavailability of water and the functioning of utilities such as electricity and
telephone service.
2. Chemical Factors
Influencing disaster outcome include leakage of stored chemicals into the air, soil,
ground water or food supplies.
Eg: - Bhopal Gas Tragedy.
3. Biological Factors:
Are those that occur or increase as result of contaminated water, improper wastedisposal, insect or rodent proliferations improper food storage or lack of
refrigeration due to interrupted electrical services.
Bioterrorism: Release of viruses, bacteria or other agents caused illness or death.
4. Social Factors:
Are those that contribute to the individual social support systems. Loss of family
members, changes in roles and the questioning of religious beliefs are social
factors to be examined after a disaster.
5. Psychological Factors:
Psychological factors are closely related to agents, host and environmental
conditions. The nature and severity of the disaster affect the psychological distress
experienced by the victims.
Types of disasters:-
A. Natural disasters
B. Manmade disasters
C. Biological disasters
Natural disasters--Natural hazards are naturally occurring physical phenomena
caused either by rapid or slow onset events which can
be geophysical (earthquakes, landslides, tsunamis and volcanic
activity), hydrological (avalanches and floods), climatologically(extreme
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temperatures, drought and wildfires), meteorological (cyclones and storms/wave
surges.
Floods-
During a flood
- Turn off the electricity to reduce the risk of electrocution.
- Protect people and property:
- as soon as the flood begins, take any vulnerable people (children, the old, the
sick, and the disabled) to an upper floor;
- whenever possible, move personal belonging upstairs or go to raised shelters
provided for use in floods.
- Beware of water contamination - if the taste, colour, or smell of the water is
suspicious, it is vital to use some means of purification.- Evacuate danger zones as ordered by the local authorities it is essential to comply
strictly with the evacuation advice given. Authorities will recommend that families
take with them the emergency supplies they have prepared.
After a flood
When a flood is over, it is important that people do not return home until told to do
so by the local authorities, who will have ensured that buildings have not been
undermined by water. From then on it is essential to:- wait until the water is declared safe before drinking any that is untreated;
- clean and disinfect any room that has been flooded;
- sterilize or wash with boiling water all dishes and kitchen utensils;
- get rid of any food that has been in or near the water, including canned foods and
any food kept in refrigerators and freezers;
- get rid of all consumables (drinks, medicines, cosmetics, etc.).
Earthquakes-
Earthquakes are the result of forces deep within the earth's interior. Sudden breakwithin the upper layers of the earth, sometimes breaking the surface, resulting in
the vibration of the ground, which were strong enough will cause the collapse of
buildings and destruction of life and property.
Earthquakes are measured according to the Richter scale - the most devastating
effects are seen on level 6 and above, and if the epicenter of the earthquake is
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located in highly populated areas. Earthquakes can cause high numbers of deaths
and injuries as well as serious destruction of buildings and infrastructure.
What to do beforehand
The movement of the, ground in an earthquake is rarely the direct cause of injuries;
most are caused by falling objects or collapsing buildings. Many earthquakes are
followed (several hours or even days later) by further tremors, usually of
progressively decreasing intensity. To reduce the destructive effects of earthquakes
a number of precautions are essential for people living in risk areas:
- Build in accordance with urban planning regulations for risk areas.
- Ensure that all electrical and gas appliances in houses, together with all pipes
connected to them, are firmly fixed.
- Avoid storing heavy objects and materials in high positions.
- Hold family evacuation drills and ensure that the whole family knows what to doin case of an earthquake.
- Prepare a family emergency kit.
During an earthquake
- Keep calm, do no panic.
- People who are indoors should stay there but move to the central part of the
building.
- Keep away from the stairs, which might collapse suddenly.
- People who are outside should stay there, keeping away from buildings to avoid
collapsing walls and away from electric cables.
- Anyone in a vehicle should park it, keeping away from bridges and buildings.
After an earthquake
- Obey the authorities instructions.
- Do not go back into damaged buildings since tremors may start again at any
moment.
- Give first aid to the injured and alen the emergency services in case of fire, burst
pipes, etc.
- Do not go simply to look at the stricken areas: this will hamper rescue work.- Keep emergency packages and a radio near at hand.
- Make sure that water is safe to drink and food stored at home is fit to eat (in case
of electricity cuts affecting refrigerators and freezers).
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You cannot prevent earthquakes but you can reduce the potential damages:
y Development of possible warning indicators.
y Land-use regulations.
y Building regulations.
y Relocation of communities.
y Public awareness and education programs.
Tsunami-
A tsunami is a series of water waves (called a tsunami wave train[1]
) caused by the
displacement of a large volume of a body of water, such as an ocean. The originalJapanese term literally translates as "harbor wave."
Droughts- Drought is an insidious phenomenon. Unlike rapid onset disasters, ittightens its grip over time, gradually destroying an area. In severe cases, drought
can last for many years and have a devastating effect on agriculture and watersupplies.
Drought is defined as a deficiency of rainfall over an extended period a season, a
year or several years relative to the statistical multi-year average for the region.
Lack of rainfall leads to inadequate water supply for plants, animals and human
beings. A drought may result in other disasters: food insecurity, famine,
malnutrition, epidemics and displacement of populations.
Rural communities can sometimes cope with one or two successive rain failures
and crop or livestock losses: the situation becomes an emergency when people
have exhausted all their purchasing resources, food stocks, assets and normal
coping mechanisms.
In general, the Red Cross Red Crescent response to drought and food insecurity
prioritizes the provision of food, safe water and basic sanitation, basic health
services, along with food-security surveillance and nutritional monitoring.
In parallel, programmes are implemented to preserve and restore livelihoods. Suchassistance may take the following forms:
y distribution of seeds, tools and fertilizer;
y destocking or restocking of livestock;
y distribution of livestock fodder;
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y support to pastoralists in transporting livestock to alternative grazing areas
during severe dry spells;
y income-generating schemes that enable people to diversify their sources of
income on a small scale;
y training and education in relevant skills, for example in carpentry or bicycle
repair, to enable people to earn an income;
y vegetable-gardening, poultry and fish-pond projects;
y Small-scale irrigation schemes.
It is also important to ensure that populations have access to safe water and basic
sanitation in times of drought, as wells and other groundwater supplies dry up or
become polluted.
The International Federation is committed to reducing vulnerability to drought by
enhancing the availability of and access to food and by increasing communitiesresilience so that they are better able to deal with food insecurity.
Volcanic eruption-
Volcanic eruptions happen when lava and gas are discharged from a volcanic vent.
A volcano is an opening, or rupture, in a planet's surface or crust a crust is the
outermost solid shell of a rocky planet or moon, which allows hot magma
(paste), ash and gases to escape from below the surface. The word volcano is
derived from the name of Volcano island off Sicily which in turn, was namedafter Vulcan, the Roman god of fire.[1]
Manmade Technological disasters:-
Danger originating from technological or industrial accidents, dangerous
procedures, infrastructure failures or certain human activities, which may cause the
loss of life or injury, property damage, social and economic disruption or
environmental degradation.
Technological disasters are non-natural disastrous occurrences that include:
y Accident release
Occurring during the production, transportation or handling of hazardous
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chemical substances
y Explosions
Disasters will only be classified as explosions when the explosions is the
actual disaster. If the explosion is the cause of another disaster, the event
will be classified as the resulting disaster.
y Chemical explosion
Violent destruction caused by explosion of combustible material, nearly
always of chemical origin.
y Nuclear explosion/Radiation
Accidental release of radiation occurring in civil facilities, exceeding the
internationally established safety levels.
y Mine explosionAccidents which occur when natural gas or coal dust reacts with the air.
y Pollution
Degradation of one or more aspects in the environment by noxious
industrial, chemical or biological wastes, from debris or man-made products
and from mismanagement of natural and environmental resources.
Chemical pollution
A sudden pollution of water or air near industrial areas, leading to internal
body disorders with permanent damage of the skin.
Atmosphere pollution
Contamination of the atmosphere by large quantities of gases, solids and
radiation produced by the burning of natural and artificial fuels, chemicals and
other industrial processes and nuclear explosions
y Acid rain
A washout of an excessive concentration of acidic compounds in the
atmosphere, resulting from chemical pollutants such as sulphur and nitrogen
compounds. When deposited these increase the acidity of the soil and water
causing agricultural and ecological damage.
The Federation has more of an advocacy/information sharing role and does not
involve itself with the technical aspects, e.g. cleaning up, irradiation sickness or
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(advanced) treatment of people who have been exposed.
However, the Federation offers care to people that are displaced or flee from the
disasters, providing shelter, foods, basic health, water and sanitation. Psychological
support is also often vital. For more than twenty years on, the Federation is stillrunning a programme to assist victims of the Chernobyl nuclear reactor explosion
of 1986, providing medical assistance and check-ups, and psycho-social support.
Equally, in situations of chemical and biological warfare, the Federation provides
basic information about symptoms and effects of agents, antidotes and
protection. Again, National Societies and the Federation take care of people
displaced or fleeing from chemical or biological attacks, providing shelter, food,
basic medical care, water and sanitation.
Biological hazards:-
An epidemic is then unusual increase in the number of cases of an infectious
disease which already exists in a certain region or population. It can also refer to
the appearance of a significant number of cases of an infectious disease in a region
or population that is usually free from that disease.
Epidemics may be the consequence of disasters of another kind, such as floods,
earthquakes, droughts, etc
Cholera
Cholera is mainly spread by drinking water contaminated by faeces. The fatality
rate for severe, untreated cases is 50 per cent; when treated this drops to one per
cent.
The incubation period is 1-12 days and severe cases need hospitalisation. Less
severe cases can be treated with rehydration therapy on an outpatient basis. Only
10 per cent of those infected present symptoms.
Key control factors are: ensuring a safe water supply and rigorous hygiene (hand
washing and disposal of soiled items).
Crowded wards are not a hazard to staff or visitors, if good hygiene is observed.
Quarantine is unnecessary. Vaccine is inappropriate in an emergency.
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Swine flu
The WHO has raised the Influenza Pandemic Alert to the highest level which is 6.
Already India has seen over 60 confirmed cases of Swine Flu and the threat of afull blown epidemic in India is very real.
Some Vital Stats
Total Confirmed Cases in India 29904**
Total Deaths in India 1404**
Total Confirmed Cases Worldwide Over 622482*
Total Deaths Worldwide At least 16455*
In order to prevent epidemics, the community in general and families in particular
must take simple measures. Leaders can collaborate with health centers and other
relevant institutions present in the area.
Community activities Family activities
Inspect and repair watersupply network
Ensure hygienic watermanagement in the home
Ensure proper hygiene of
people who handle food
Ensure proper food
hygiene in the home
Maintain and clean public
latrines
Maintain and clean family
latrines
Manage solid waste in
public areas (vector
control)
Handle domestic solid
waste (vector control)
Control vectors (eliminaterefuse in public areas)
Control vectors (eliminaterefuse)
Coordinate with local
health center
Practice personal hygiene
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Responding to disasters
The elements of disaster response: emergency needs assessment
The first step in any emergency response is to assess the extent and impact of
the damage caused by the disaster (the needs) and the capacity of the affected
population to meet its immediate survival needs (degree of vulnerability).
Although the impact may vary considerably from one disaster to another,
typical needs that arise include:
y food;
y shelter;
y essential items, such as blankets, heaters, water containers;
y medical care;
y safe drinking water;
y sanitation and waste disposal;
y psychosocial support.
Such an assessment will identify the needs that require external interventionand the gaps to be filled. It is a vital component of the programme-planning
process. It provides the information on which key decisions affecting the lives
of the disaster victims will be made.
Assessments can take the following forms:
y Rapid assessment: Undertaken immediately after a disaster, rapid
assessment provides information on needs, possible courses of action
and resource requirements. It normally takes up to a week.
y Detailed assessment: A more detailed assessment is carried out after arapid assessment, if the situation is changing and more information is
needed. It takes about one month, depending on the size of the area and
the complexity of the situation.
y Continual assessment: Disaster situations can evolve rapidly and
include unexpected knock-on effects, such as population movements.
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Assessment should therefore be an ongoing process throughout the
emergency phase
Experience shows that a poorly conducted assessment is likely to lead to poorplanning decisions and an inadequate response.
Phases of Disaster:-
1) Preimpact:
a. Occurs prior to the onset of the disaster.
b. Includes the period of threat and warning.
c. May not occur in all disaster.
2) Impact Phase:
a. Period of time when disaster occurs, continuing to immediately following
disaster.b. Inventory and rescues period.
Assessment of extent of losses.
Identification of remaining sources.
Planning for
Use of resources
Rescue of victims
Minimizing further injuries and property damage.
May be brief when disasters strike suddenly and is over in minutes (air plane
clash, building collapse) or lengthy as incident continues (earthquake, flood,tsunami etc.)
3) Post impact phase
a. Occurs when majority of rescue operations are completed.
b. Remedy and recovery period.
c. Lengthy phase that may last for years.
Honeymoon phase - feeling of euphoria, appearances of little effect by disaster.
Disillusionment phase - feeling of anger, disappointment and resentment.
Reconstruction phase - acceptance of loss, copping with stereo, rebuilding.
4) Rehabilitation The final phase in a disaster should lead to restoration of the pre-disaster
conditions.
The pattern of healthy needs with change rapidly, moving from casualty
treatment to more primary health care.
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The Disaster Management Cycle:-
The fundamental aspects of Disaster Management Program-
Disaster Prevention
Disaster preparedness
Disaster response
Disaster mitigation
Rehabilitation
Reconstruction
4 Fundamental Aspects of Disaster Management-
1. Disaster mitigation
2. Disaster Preparedness
3 Disaster response
4. Disaster Recovery
Goals of Disaster Management-
Reduce, or avoid, losses from hazards;
Assure prompt assistance to victims;
Achieve rapid and effective recovery.
The Disaster management cycle illustrates the ongoing process by which
governments, businesses, and civil society plan for and reduce the impact of
disasters, react during and immediately following a disaster, and take steps to
recover after a disaster has occurred.
The four disaster management phases illustrated here do not always, or even
generally, occur in isolation or in this precise order. Often phases of the cycle
overlap and the length of each phase greatly depends on the severity of the disaster.
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Mitigation - Minimizing the effects of disaster. Lessen the impact of a disaster
before it strikes.
Activities that reduce or eliminate a hazard it includes prevention, risk
reduction.
Examples: building codes and zoning; vulnerability analyses; public
education
It is virtually impossible to prevent occurrence of most Natural Disasters, but it is
possible to minimize or mitigate their damage effects.
Mitigation measures aim to reduce the Vulnerability of the System [ e.g. Byimproving & enforcing building codes etc]
Disaster prevention implies complete elimination of damages from a hazard, but it
is not realistic in most hazards. [e.g. Relocating a population from a flood plain or
from beach front]
Medical Casualty could be drastically reduced by improving the Structural Quality
of Houses, Schools, and Public or Private buildings.
Also ensuring the Safety of Health facilities, Public Health Services, WaterSupply, Sewerage System etc.
Mitigation complements the Disaster Preparedness and Disaster Response
activities.
A Specialized Unit within the National Health Disaster Management Program
should coordinate the works of experts in the field of
Health, Public Policy & Public Health
Hospital Administration Water Systems
Engineering & Architecture
Planning, Education etc
The Mitigation Program will direct the following activities-
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1. Identify areas exposed to Natural Hazards and determine
the vulnerability of key health facilities and water systems
2. Coordinate the work of Multi Disciplinary teams in designing
and developing building codes and protect the waterdistribution from damages
3. Hospitals must remain operational to attend to disaster victims
4. Include Disaster Mitigation Measures in the planning and
development of New facilities
5. Identify priority hospitals and critical health facilities that
complies with current building codes and standards
6. Ensure that mitigation measures are taken into account in a
facilitys maintenance plans
7. Inform, sensitize and train those personnels who are involved in
planning, administration, operation, maintenance and use offacilities about disaster mitigation
8. Promote the inclusion of Disaster Mitigation in the curricula of
Professional training institutes
Preparedness - Planning how to respond.
Disaster preparedness refers to measures taken to prepare for and reduce the effectsof disasters. That is, to predict and, where possible, prevent disasters, mitigate their
impact on vulnerable populations, and respond to and effectively cope with their
consequences.
Disaster preparedness provides a platform to design effective, realistic
and coordinated planning, reduces duplication of efforts and increase the overall
effectiveness of National Societies, household and community members disaster
preparedness and response efforts. Disaster preparedness is a continuous and
integrated process resulting from a wide range of risk reduction activities andresources rather than from a distinct sectoral activity by itself. It requires the
contributions of many different areasranging from training and logistics, to
health care, recovery, livelihood to institutional development. Activities that are
taken to build capacity and identify resources that may be used. Emergency
communication plan. Preventive measures to prevent spread of disease. Public
education. Activities undertaken to handle a disaster when it strikes.
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The objectives of the disaster preparedness is to ensure that appropriate systems,
procedures and resources are in place to provide prompt, effective assistance to
disaster victims, thus facilitating relief measures and rehabilitation services.
Disaster preparedness is an ongoing, multi-sectoral activity to carry out thefollowing activities:
Evaluate the risk of the country or particular region to disasters.
Adopt standards and regulations
Organize communication, information and warning systems
Ensure coordination and response mechanisms
Adopt measures to ensure that financial and other resources are available for
increased readiness and can be mobilized in disaster situations.
Develop public education programs
Coordinate information sessions with news media
Organize disaster simulation exercises that test response mechanisms
Response - Efforts to minimize the hazards created by a disaster.
Examples: search and rescue; emergency relief .
Search and rescue, clearing debris and feeding and sheltering victims.
OBJECTIVES-
Appropriate application of current technology can prevent much of the death,
injury, and economic disruption resulting from disasters
Morbidity and mortality resulting from disasters differ according to the type
and location of the event.
In any disaster, prevention should be directed towards reducing
(1) Losses due to the disaster event itself
(2) Losses resulting from the Mismanagement of disaster relief.
Recovery - Returning the community to normal. Getting a community back to its
pre-disaster status.
Examples: temporary housing; grants; medical care.
As the emergency is brought under control, the affected population is
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capable of undertaking a growing number of activities aimed at restoring
their lives and the infrastructure that supports them. There is no distinct
point at which immediate relief changes into recovery and then into long-
term sustainable development. There will be many opportunities during the
recovery period to enhance prevention and increase preparedness, thusreducing vulnerability. Ideally, there should be a smooth transition from
recovery to on-going development.
Recovery activities continue until all systems return to normal or better.
Recovery measures, both short and long term, include returning vital life-
support systems to minimum operating standards; temporary housing; public
information; health and safety education; reconstruction; counseling
programs; and economic impact studies. Information resources and services
include data collection related to rebuilding, and documentation of lessons
learned.
Triage system:-
French verb Trier means to sort. Assigns priorities when resources limited. Do
the best for the greatest number of patients.
Advantages of triage-
1. Helps to bring order and organization to a chaotic scene.
2. It identifies and provides care to those who are in greatest need.3. Helps make the difficult decisions easier.
4. Assure that resources are used in the most effective manner.
When the quantity and severity of injuries overwhelm the operative capacity of
health facilities, a different approach to medical treatment must be adopted. The
principle of "first come, first treated", is not followed in mass emergencies. Triage
consists of rapidly classifying the injured on the basis of the severity of their
injuries and the likelihood of their survival with prompt medical intervention. It
must be adopted to locally available skills. Higher priority is granted to victims
whose immediate or long-term prognosis can be dramatically affected by simple
intensive care. Moribund patients who require a great deal of attention, with
questionable benefit, have the lowest priority. Triage is the only approach that can
provide maximum benefit to the greatest number of injured in a major disaster
situation.
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Although different triage systems have been adopted and. are still in use in some
countries, the most common classification uses the internationally accepted four
colour code system. Red indicates high priority treatment or transfer, yellow
signals medium priority; green indicates ambulatory patients and black for dead or
moribund patients.
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Triage system
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START SYSTEM
Created in the 1980s by Hoag Hospital
and the Newport Beach CA Fire Dept
Allows rapid assessment of victims
It should not take more than 15 sec/ Pt
Once victim is in treatment area more
detailed assessment should be made
START SYSTEM
Clasification is based on three items
Respiratory
Perfusion
Mental status evaluation
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START First Step
Can the Patient Walk?
YES NO
Green
(Minor)
EvaluateVentilation
(Step-2)
START Step-2Ventilation Present?
YESNO
> 30/Min < 30/min
Evaluate Circulation
(Step-3)
Open Airway
Ventilation Present?
NO YES
Black Red/ Immediate
Red/ Immediate
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START Step-3
Circulation
Absent Radial Pulse
Control Hemorrhage
Present Radial Pulse
Evaluate Level of
ConsciousnessRed/ Immediate
START Step-4
Cant Follow SimpleCommands
Level of Consciousness
Can Follow SimpleCommands
Yellow/ DelayedRed/ Immediate
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Contaminated Patients
Patients with exposure (potential or
real) to contaminants should be tagged
as BLUE
This category will continue to stay until
patient is adequately decontaminated
then follow START as usual
Some recommend a double tagging
with blue and the standard START color
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In the federal structure of India, the state governments are responsible for the
execution of relief work in wake of natural disasters. Government of India plays a
supportive role, in terms of supplementation of final resources to the states. An
administrative system has been developed to combat and minimize the adverseimpact of the natural disasters. At the centre, the Ministry of Agriculture is the
nodal ministry for coordination of all activities during a natural disaster. Since
health is an important part of disaster management, in the DGHS under the
ministry of Health and Family Welfare there is a special wing called the
Emergency Medical Relief Wing which coordinates all activities related to health?
In a vast country like India, it is not practicable for the government machinery
alone, to undertake disaster reduction programmes without involvement of NGOs.
Public education and community involvement plays a vital role here. As part of the
International Decade for Natural Disaster Reduction activities, every year, thesecond Wednesday of October has been designated as World Disaster Reduction
Day.
Indian Meteorological Department (IMD) plays a key role in forewarning the
disaster. It has five centers in Kolkata, Bhubaneswar, Vishakhapatnam, Chennai
and Mumbai for detection and tracing of cyclone storms. Satellite imagery
facilities and cyclone warning radars are provided to various Cyclone Warning
Centers. In addition, it has 31 special observation posts set up along east coast of
India. For all ships out at sea, warnings are issued six times a day. Inset Disaster
Warning System (DWS) receivers have been installed primarily in the coastal areas
of Tamil Nadu and Andhra Pradesh. This has proved very reliable form ofcommunication system. The Snow and Avalanche Study Establishment (SASE) in
Manali has been issuing warning to people about avalanches 24 to 48 hours in
advance.
MAN MADE DISASTERS INTERNATIONAL AGENCIES PROVIDING
HEALTH HUMANITARIAN ASSISTANCE
every country is a potential source of health humanitarian assistance for some other
disaster-stricken nation. Bilateral assistance, whether personnel, supplies or cash is
probably the most important source of external aid. Several international or rregional agencies have established special funds, procedures and offices to provide
humanitarian assistance. United Nation's Agencies are United Nations Office for
the Coordination of Humanitarian Affairs (OCHA), World Health Organization
(WHO), UNICEF, World Food Programme (WFP), Food and Agriculture
Organization (FAO). Inter-governmental organizations are European Community
Humanitarian Office (ECHO), Organization of American States (OAS), Centre of
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Coordination for Prevention of Natural Disasters in Central America, Caribbean
Disaster Emergency Response Agency. Some Non-Governmental Organizations
are CARE, International Committee of Red Cross, International Council of
Voluntary Agencies (1CVA), International Federation of Red Cross and RedCrescent 2 Societies (IFRC) etc.
Disaster Nursing:-
Disaster nursing refers to nursing services offered to the victims of disaster who
experiences trauma caused by disaster produce several kinds of trauma.
a. Physical - Fractures, burns, injuries and infections.
b. Physiological - Shock and electrolyte imbalance
c. Psychological- Anxiety, depression, substance abuse, stress
reaction.
d. Socio-economic- Unemployment, Homelessness, Environmentaldestruction, disorganization.
The Symptoms related to Trauma Produced by disaster usually occurs in Five
Phases.
a. Impact Phase: It includes event itself and is characterized by shock, extreme
b. Heroic Phase: Characterized by co-operative spirit exist between friends,
neighbor and emergency teams. Constructive activity at this time can help to
overcome feelings of anxiety and depression.
c. The honeymoon phase: It begins to appear one week to several months after thedisaster, the need to help others is sustained, and the money, resources and support
received from varying agencies allow life to begin again in the community.
d. Disillusionment phase: It last from two months to one year._ A time of
disappointment, resentment, frustration and anger. Victims often begin to compare
their neighbors with their own and may start to resent or show hostility towards
others.
e. Reconstruction and reorganization phase: In this individual recognize that
they must adjust with their own problems. They begin to rebuild their homes,
business and lives in constructive fashion. This ... period may last for year after the
disaster. Nurse along with the health team needs to utilize primary health care
intervention in acute emergencies as follows:-
Immunization and preventive health
Management of diarrheas and dehydration.
Management of acute respiratory infections.
Setting up a health information system.
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Safe drinking water supply.
Sanitation.
Training and support for health workers.
Other basic services.
In addition to above the following psychosocial intervention are provided by the
nurses:
Crises intervention / counseling
Group work
Telephone contact services.
Disaster response managements
Health education
Community services like facilitation of self help groups etc.
Community measures in Disaster
Pre disaster phase, appropriate management of disaster requires advance planning.A nurse should be the part of the team for disaster planning.
a. Community Participation: It is the process by which individuals, families and
communities assume the responsibility of promoting their own health and welfare.
The community health nurse maintains the link between professional group of
experts in disaster management and community.
b. Mock trails/training: The training of various inter-disciplinary forces like school
children, voluntary organizations can be imparted by community health nurse and
her team,
c. Mass awareness: The community should have the knowledge of all the Channel
communication system, stand by equipment supplies and other resources;
otherwise disaster preparedness will be failure.
d. Education: Mass awareness through media, booklets, panel discussion, films and
televisions information is very essential.
Basic community Education should incorporate the following essentials:
a. Setting up the first aid post
b. Causality evaluation
c. Basic hygiene and sanitation
d. Safety measurese. Maintenance of food and water supply
f. Maintenance of law and order.
g. Provision of shelters
h. Rescue streaming
i. Significance of traffic control and communication
j. Use of fire services
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k. Hazards of radiation and preventive measures
l. Prevention of future disasters.
m. Grant in aidn. Rehabilitation
CONCLUSION
Disasters are of different types which can happen any time, any where, in the
world causing tremendous after effects such as loss of human life ,economical
imbalances, food scarcity epidemics , forced relocation of population etc. Disasters
usually affect the developing countries comparing with the developed countries.
While deserting the matter we could come to the conclusion that the adverse
effects of natural disasters can be minimized by proper preventive measures alert
technologies at high risk areas, proper mobilization of resources, and decreased
corruption in the field and also the mock training programmes in the community.