Disaster Nursing: Key Concepts and Historical Figures

• A disaster is a serious disruption of a community's functioning at any scale due to hazardous interactions with exposure, vulnerability, and capacity conditions.
• This results in human, material, economic, and environmental losses/impacts.
• A disaster can also be the result of vast ecological breakdown between humans and their environment.

Disaster Nursing

• Focuses on adapting professional nursing knowledge, skills, and attitude to meet the physical and emotional needs of disaster victims

Goals of Disaster Nursing

• To prepare nurses physically and psychologically to respond to disasters
• Develop self-confidence and efficacy in nurses for disaster preparedness.
• Enhance psychological preparedness by strengthening psychological capacity and mental well-being.

Historical Figures in Nursing

• Florence Nightingale functioned as a disaster nurse during the Crimean War, where wartime health care resembled disaster health care
• Clara Barton worked during the Civil War providing care to soldiers, later founding the American Red Cross in 1881 and was known as the "angel of the battlefield."
• The flu pandemic of 1918-1919 affected millions globally

Basic Principles of Nursing during Special Events

• Rapid assessment of the situation and nursing care needs; triage and initiation of life-saving measures first.
• Selected use of essential nursing interventions, eliminating nonessential activities.
• Adaptation of skills to disaster situations, using imagination due to potential lack of supplies/personnel.
• Evaluation of environment and mitigation of health hazards; prevention of further injury/illness.
• Leadership in patient triage, care, and transport; teaching, supervising auxiliary personnel/volunteers.
• Provision of understanding, compassion and emotional support to all victims/families.

NURSE Acronym

• Nursing plan should be integrated and coordinated.
• Update physical and psychological preparedness.
• Responsible for organizing, teaching, and supervision.
• Stimulate community participation.
• Exercise competence.

Natural Disasters

• May result in mass casualties and occur anywhere, anytime
• Include events like tornadoes, hurricanes, floods, avalanches, tidal waves, earthquakes, volcanic eruptions

Man-Made vs Natural Disasters

• Man-Made: Direct result of human activity, potentially preventable, occur at unanticipated localities, duration not easily calculated.
• Include climate change, radioactivity releases, chemical/bio-weapon threats, terrorist attacks, cyber attacks
• Natural: Caused by natural forces, not preventable, predictable localities, duration can be estimated.
• Include hurricanes, earthquakes, wildfires, tsunamis, extreme heat, droughts, landslides, floods, hail storms and sinkholes.

Hazard Classifications

• Natural Geophysical: Originates from solid earth (earthquakes, mass movement, volcanic activity).
• Meteorological: Short-lived, extreme weather (extreme temperature, fog, storms).
• Hydrological: Occurrence/movement of freshwater/saltwater (floods, landslides, wave action).
• Climatological: Long-lived atmospheric processes (drought, extreme temperature, glacial lake outburst, wildfire).
• Biological: Exposure to organisms/toxic substances (epidemics, insect infestation, animal accidents).
• Extraterrestrial: Asteroids/meteoroids entering Earth's atmosphere (impact, space weather).

Disaster Definitions

• Fatality: Number of people who lost their life because of natural hazards.
• Injured: People suffering physical injuries, requiring medical.

Man-Made Disasters

• Include human intent, negligence, or error vs natural disasters

Disaster Phases

• Mitigation involves preventive laws/regulations, implementing codes, zoning requirements.
• Preparedness includes disaster supplies, mutual aid agreements, response personnel training.
• Response includes search and rescue, damage assessment, first aid, shelter management.
• Recovery involves debris removal, damage assessment, infrastructure reconstruction, restoring livelihoods.

Disaster Psychosocial Reactions

• Threat phase is the time before impact involving potential community hazards/threats.
• Warning phase is when communities receive disaster notice
• Disasters without warning leave survivors feeling vulnerable/unsafe/fearful.
• Impact phase's destruction level affects survivor reactions.
• Heroic phase focuses on intense rescue efforts; altruism is prominent
• Safety issues are an important consideration
• Honeymoon phase occurs weeks/months after a disaster when assistance is available and survivors have optimism.
• Inventory phase:
• Resources become limited and optimism fades
• Disillusionment phase occurs when survivors feel abandoned by agencies/volunteers.
• Recovery phase involves rebuilding property, recovery of well-being, which can take years

Disaster Characteristics

• Intensity of impact
• Intense destruction/disruption causes emotional distress
• Impact Ration
• Fewer material and emotional support exists when population is impacted
• Potential of Recurrence
• Threat causes anxiety and heightened stress
• Social & Cultural Aspects
• Can be profoundly disturbing and can disrupt culture.

Key Disaster Elements

• Hazards are sources that can potentially cause harm.
• Vulnerability is the inability to withstand a hostile environment/potential for physical/emotional harm.
• Capacity/Capability combines community strengths/resources to reduce risk/effects of disaster

Immediate Reactions to Trauma, Victimization, Bereavement

• Physical reactions include faintness, agitation, appetite changes, headaches, and pre-existing health conditions
• Emotional reactions encompass shock, anxiety, numbness, sadness, loss, helplessness etc
• Behavioral reactions include sleep disturbances, jumpiness, isolation, conflicts, increased alcohol/drug use.
• Cognitive changes involve confusion, concentration problems, impaired thinking/decision-making, amnesia, flashbacks, preoccupation.

Children's Reactions by Age

• Young children (1-5): helplessness, agitation, fears, sleep disturbances, anxious attachment, regressive/somatic symptoms.
• School-aged children (6-11): sleep disturbances, angry outbursts, safety concerns, guilt, learning problems, school avoidance
• Pre-adolescents/adolescents: Depression, social withdrawal, acting out, revenge focus, rebellion, self-consciousness, school performance decline.

Communication During Disasters

• Plays a big role in ensuring effective sharing of information
• Help connects family, support systems, first responders and the public

DMIS Disaster Management Information system

• A software using a GIS to provide info on environmental situations and natural resources for efficient decision making
• Not web based, so uses VPN for privacy

DMIS - Tools Capabilities

• Tactical Information Exchange:
• Mapping w/ marks, Incident Information Sharing:
• Weather Observations
• DMIS Messenger
• Common Alerting Protocol (CAP) Alerts
• NOAA HazCollect Interface

Philippine Disaster Resilience Foundation

• Implements DIM integrating information for disaster management
• The DIM System employs the customized ArcGIS
• PDRF-HANDA serves and unifies a platform that eliminates waiting time and provides focus
• Various phases happen to go through a DISASTER MANAGEMENT CYCLE and include
• Mitigation -> Preparation -> Response -> Recovery

Types of Communications during Disaster

• Mobile apps: NDRRMC, PAG-ASA, FEMA
• Social media, mobile phones and landlines

Role of Communication during Disaster

• Connects first responders, family, support services and public
• Coordinates responses
• Prevent panic and prevent potential mass casualties
• Mobilizes resources
• Promote appropriate behavioral response
• Disseminate relevant information

Role of Media during Disaster

• Television, radio, newspaper, social media

Positive Role of the Media

• Supplies direction and information to the affected public
• Stimulates volunteers and donations like blood donation
• Provides real time information
• Disclose need for improvements in governmental response
• Disseminate information for preparedness measures for future similar events.
• Sometimes withholds potentially counterproductive information.

Importance of the Media

• Reassure that what needs to be done is being done
• Communicate the process and provide correct information

Major Roles of Nurse in Disaster

• Determine magnitude of event
• Define health needs of the affected groups
• Identify actual/potential public health problems
• Determine resources needed to respond to needs identified
• Collaborate w/ other professionals, governmental organizations and NGOs
• Maintain unified chain of command
• Communicate

Principles of Effective Disaster Preparedness Plan

• Planning must address collaboration, preparations, needs assessments, event management/recovery
• Plan must be targeted to the needs of the situation (mitigation, prevention, protection, respone and recovery)
• Plan must be accurately informed, realistic, goal oriented, efficient, time based, and accessible

domains of preparedness

• Community resilience: Preparing for emergenicies
• Incident management: Coordinating effective response
• Information Management: Making sure people have information to take action
• Countermeasures and Mitigation: Getting supplies where the need is
• Surge Management: Expanding medical services
• Biosurveillance: Health safety

Issues & Challenges Addressed in Disaster Planning

• Anticipate communication problems
• Address operational issues related to triage, transport and evacuation
• Accommodate management/security/distribution of resources at disaster site
• Implement advanced warning systems and warning messages
• Enhance coordination for search and rescue efforts
• Effective treatment w/ prioritization for care and transportation
• establish plans for distribution of patients to hospitals
• Patient identification and tracking
• Damage or destruction to helathcare infastructure
• Volunteer management
• Response
• overall resistance

Core Preparedness Activities

• Prepare theoretical foundation of disaster planning
• Disaster planning is effective as assumption upon
• Core activities must be beyond routine
• Have community assessment
• identify leadership and command post
• design local response for the first 72 hours
• Identify and accommodate vulnerable populations
• need and know about state and federal assistance
• Identify training/educational needs, resources, and protective equipment
• early conduction of damage assessment

(JCAHO) Joint Commission on Accreditation of Healthcare Organizations

• requires that all hospitals have comprehensive plans for disasters
• Nurses should be aware of the current standards.
• facilities and health workes
• Ensure that health facilities and helath functions
• Improve staff competence on health

critical hopstial emergency functions

• Communicating during emergency conditions
• Managing resources and assets
• Managing safety and security
• staff roless
• Managing utilities
• Clinical activities During response the role of nurses may include
• function at the scene
• rapid needs
• care by working in a locale
• assuming a leadership to activity