DISASTER NURSING

DISASTERS Any catastrophic situation in which the normal patterns of life (or ecosystems) have been disrupted and extraordinary, emergency interventions are required to save and preserve human lives and/or the environment

HAZARD Rare or extreme event in the natural or man-made environment that adversely affect human life, property or activity to the extent of causing disaster

Phenomenon that poses threat (s) to people structure or economic asset that may cause a disaster either -human introduces or -naturally occurring in the environment

VULNERABILITY Extent to which the community, structure, service or geographic area is likely to be damaged or disrupted by the impact of a particular hazard

HAZARD+VULNERABILIT Y/CAPACITY=DISASTER RISK

PHYSICAL VULNERABILITY Extent of likely damage/disruption on account of nature/construction and proximity to man-made environment (buildings and natural environment, forest, aquaculture)

CAPABILITIES Resources and skills people posses, can develop, mobilize and have access to which allow them to have more control over shaping their future

TYPES OF DISASTERSAccording to CAUSE/OCCURRENCE Natural-caused by forces of nature e.g. earthquake, typhoons, volcanic eruptions

Man-made- caused by errors of man e.g. war, civil strife or other conflicts Technological e.g. air crashes, pollution, nuclear accidents, explosions

According to PREDICTABILITY Sudden Onset- no warning issued Slow Onset-disasters that come with warnings e.g. typhoons, volcanic eruptions

According to EXTENT OF DAMAGE

Large scale-effects not solely limited to the impact area Small scale-effects are localized;limited only to the impact area

HEALTH SERVICEConcept of Operations 1. An emergency of disaster necessitates the mobilization of all medical resources in order to protect and preserve human lives

DISASTER MANAGEMENT A collaborative term used to encompass all activities undertaken in anticipation of the occurrence of a potentially disastrous event, including prepareness and long term risk reduction measures

EMERGENCY RESPONSE The period immediately following a disaster when the exceptional measures have to be taken to search and find survivors as well as meet their basic needs for shelter, water, food and medical care

REHABILITATIONS Operations and decisions taken after the disaster with a view to restoring a stricken community to its formers living conditions while encouraging and acilitating the necessary adjustments caused by the disaster

AIM: Immediate repair and initial efforts to re establish the essential services associated with social and economic functions of a community

ALERT PERIOD Refers to the time when a disaster is developing and when it has not yert hit the community. Threats are detected, warnings are issued and evacuation is facilitated. Evacuation can take 3 forms: FORCED/VOLUNTARY/DISPLACE D

DISASTER NURSING The adaptation of Professional Nursing KNOWLEDGE , Skills and ATTITUDE in recognizing and MEETING the nursing and MEDICAL NEEDS of DISASTER VICTIMS

BASIC PRINCIPLES IN PLANNING FOR DISASTER NURSING

N- ursing Plans should be integrated and coordinated U- pdate physical and Psychological preaparedness R- esponsible for Organizing, Teaching and Supervision S- timulate Community Participation E- xercise Competence

BASIC PRINCIPLES OF NURSING CARE for DISASTER VICTIMS

A- daptation of Skills to Situation C- are for Disaster Victims C- ontinuous Awareness of the patients condition T- each AUXILLARY personnel S-election of Essential Care

ROLES and RESPONSIBILITIES of a DISASTER NURSE

D- isseminate information on the prevention and control of environmental Hazards I- nterpret health laws and regulations S- erve yourself of self-survival A- ccepts directions and take orders from an organized authority

S- erve the best of the MOST T- each the meaning of warning signals E- xercise leadership R- efer to appropriate agencies

NURSING PROCESS -a deliberate problem-solving approach that requires cognitive, technical and interpersonal skills and directed to meeting the needs of the client

Te chnical sk ill s which includes knowledge and skills needed to properly and safely manipulate and handle appropriate equipment needed by the patient in performing medical or diagnostic procedures, such as vital signs, and medication administrations. [

DISASTER HEALTH ASSESSMENT OUTLINE*

1. BACKGROUND ON THE DISASTER Type of disaster, occurrence Immediate effects in the areas Nature and extent of damage on population

Properties and environment Affected population Changes from pre-disaster period (area map, indicating the affected areas, existing hazards and location of affected population could be presented)

2. HEALTH EFFECTS & INITIAL RESPONSE Water supply availability, adequacy and distribution Sanitation conditions and existing sanitation facilities Psychological stress brought about by the disaster and mental health services provided

Evaluation and using health info RECORD all relevant information received, noting source and origin/date EVALUATE all health information consistent? Biases?influencing reports?

Establish specific purpose and evaluation Decide who will evaluate Fix time schedule: results should be produced quickly in order to be useful

PLANNING TO MEET DISASTER HEALTH NEEDS & PROBLEMS

Definition of terms Need/s- any material/provision that will sustain survival if such is lacking, either physical, or psychological, disequilibrium and ambivalence will result Problem-an unmet need

Need/Pr oble m: INJ URI ES Objectives: Minimize further injury and prevent complications Relieve pain and discomfort Provides means of transport to a safer area

Interventions: Provide immediate and appropriate treatment Proper handling and positioning Immediate evacuation to nearest medical facility Provide psychological support

Need/Problem: DEATH Objectives: Provide care of the dead Provide supportive care to the bereaved family

Interventions: Proper identification and disposal Notification of relatives Spiritual blessing to the dead Proper mark of the graves site must be done

Need/Problem: EPIDEMICS Objectives: Control of epidemics

Interventions: Initiate preventive measures (isolation, immunization, environmental sanitation) Treatment of cases Record and report known cases to proper authorities Accomplishment of terminal disinfections

Interventions: Initiate preventive measures (isolation, immunization, environmental sanitation) Treatment of cases Record and report known cases to proper authorities Accomplishment of terminal disinfections

Need/Problem: POOR SANITATIONObjectives: Maintenance of sanitary environmental condition conducive to healthful living

Interventions: Early identification of signs and symptoms indicative of stress Provide diversional, occupational and recreational activities Encourage hope. Trust in Gods steadfast love Refer to minister own faith

MODULE 7

MANAGEMENT OF MASS CASUALTIES: RESCUE,TRANSFER, TRIAGE and TAGGING

Objectives -Illustrate the application of triage and tagging procedures in the management of mass casualties

-Understand the priorities in triage and tagging, and orders of evacuation

MASS CASUALTY MANAGEMENT MCMS is a multi-sectoral coordination system based on daily utilized procedures, managed by skilled personnel in order to maximize the use of existing

resources;provide prompt and adapted care to the victims;ensure emergency services and emergency services and hospital return to routine operations as soon as possible

IMPORTANCE OF MCI MANAGEMENT Victims of MCI can be efficiently TRIAGED, TREATED and TRANSPORTED in a properly COMMANDED, CONTROLLED, COMMUNICATED, COORDINATED and orderly way that all tasks are carried out

MASS CASUALTY INCIDENT -produces several patients -as few as six or as many as several hundred -affects local hospitals -patients are greater than resources of the initial responders

PREPARATION FOR MASS CASUALTY -Pre-planning and training is critical -Establish guidelines and procedures -Early implementation of incident command -First five minutes will determine next five hours

MASS CASUALTY MANAGEMENT Simple Triage And Rapid Treatment/transport

TRIAGE -process used in sorting patients or victims into categories of priorities for care and transport based on the severity of injuries and medical emergencies

Tria ge (pronounced is a process of prioritizing patients based on the severity of their condition so as to treat as many as possible when resources are insufficient for all to be treated immediately. The term comes from the French verb trier, meaning to sort, sift or select..

There are two types of triage: simple triage and advanced triage

Sim ple t ria ge Simple triage is used in a scene of mass casualty, in order to sort patients into those who need critical attention and immediate transport to the hospital and those with less serious injuries. This step can be started before transportation becomes available. The categorization of patients based on the severity of their injuries can be aided with the use of printed triage tags or colored flagging.

S.T.A.R.T. (Simple Triage and Rapid Treatment) is a simple triage system that can be performed by lightly-trained lay and emergency personnel in emergencies. It is not intended to supersede or instruct medical personnel or techniques.

Triage separates the injured into four groups: The deceased who are beyond help The injured who can be helped by immediate transportation The injured whose transport can be delayed Those with minor injuries, who need help less urgently

However, these descriptive words are by no means standard; different regions use different designations. In the UK and Europe, the triage process used is similar to that of the United States, but the categories are different: Dead - those who are pronounced as such by a medically qualified person or paramedic who is legally qualified to pronounce death Immediate - patients who have a trauma score of 3 to 10 (RTS) and need immediate attention Urgent - patients who have a trauma score of 10 or 11 and can wait for a short time before transport to definitive medical attention Delayed - patients who have a trauma score of 12 (maximum score) and can be delayed before transport from the scene

Eva cuation Simple triage identifies which people need advanced medical care. In the field, triage also sets priorities for evacuation to hospitals. In S.T.A.R.T., casualties should be evacuated as follows: Deceased are left where they fell, covered if necessary; note that in S.T.A.R.T. a person is not triaged "deceased" unless they are not breathing and an effort to reposition their airway has been unsuccessful. Immediate or Priority 1 (red) evacuation by MEDEVAC if available or ambulance as they need advanced medical care at once or within 1 hour. These people are in critical condition and would die without immediate assistance.

Delayed or Priority 2 (yellow) can have their medical evacuation delayed until all immediate persons have been transported. These people are in stable condition but require medical assistance. Minor or Priority 3 (green) are not evacuated until all immediate and delayed persons have been evacuated. These will not need advanced medical care for at least several hours. Continue to re-triage in case their condition worsens. These people are able to walk, and may only require bandages and antiseptic.

Ad vanced triage In advanced triage, doctors may decide that some seriously injured people should not receive advanced care because they are unlikely to survive. Advanced care will be used on patients with less severe injuries. Because treatment is intentionally withheld from patients with certain injuries, advanced triage has ethical implications. It is used to divert scarce resources away from patients with little chance of survival in order to increase the chances of survival of others who are more likely to survive.

Principles: CARDINAL RULE: Do the greatest good for the greatest number Preservation of life takes precedence over preservation of limbs immediate threats to life: HEMORRHAGE

TRIAGE CATEGORIES FIRST PRIORITY -immediate, red tag -victims with serious injuries that are life threatening but has a high probability of survival if they received immediate care

They require immediate surgery or other life-saving intervention, and have first priority for surgical teams or transport to advanced facilities; they "cannot wait" but are likely to survive with immediate treatment.

SECOND PRIORITY -intermediate, observationyellow tag -victims who are seriously injured and whose life are not immediately threatened -can delay transport and treatment for 2 hours

Their condition is stable for the moment but requires watching by trained persons and frequent re-triage, will need hospital care (and would receive immediate priority care under "normal" circumstances).

LOW PRIORITY Wait (walking wounded) -delayed, green tag -patients/victims whose care and transport can be delayed until last. -hold care; can delay transport up to 3 hours

They will require a doctor's care in several hours or days but not immediately, may wait for a number of hours or be told to go home and come back the next day (broken bones without compound fractures, many soft tissue injuries).

LOWEST PRIORITY Dismiss (walking wounded) -patients/victims who doesnt require care They have minor injuries; first aid and home care are sufficient, a doctor's care is not required. Injuries are along the lines of cuts and scrapes, or minor burns.

Black / Expectant

They are so severely injured that they will die of their injuries, possibly in hours or days (large-body burns, severe trauma, lethal radiation dose), or in lifethreatening medical crisis that they are unlikely to survive given the care available (cardiac arrest, septic shock, severe head or chest wounds); they should be taken to a holding area and given painkillers as required to reduce suffering.

END of DISASTER NURSINGTENK YOU!!!

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UNIT EXAMINATION