Disaster Nursing

Patterns of mortality and injury

- Disaster events that involve water are the most significant in terms of mortality - Floods, storm surges, and tsunamis all have a higher proportion of deaths relative to injuries - Earthquakes and events associated with high winds tend to exhibit more injuries than deaths - The risk of injury and death is much higher in developing countries - at least 10 times higher because of little preparedness, poorer infrastructure.

What we know about disasters

- Disasters are a primary cause of morbidity and mortality - Nurses can play an important role in disaster mitigation, but they receive very little training (planning & preparation) - Nurses know about the area know about the community

Disaster and Health

- In a major disaster water treatment plants, storage & pumping facilities & distribution lines could be damaged, interrupted or contaminated Communicable diseases outbreak due to: - changes affecting vector populations (increase vector) - flooded sewer systems - the destruction of the health care infrastructure - the interruption of normal health services geared towards communicable diseases

Disaster Management

- Mass casualty predictor (total expected casualties = number of casualties arriving in 1hx2) - 1 hr window begins when the first casualty arrives at the facility - 50-85% of acute casualties will arrive in the first 90 minutes

Types of Disasters

- Natural - Pandemics - Transportation - Technological (electrical outages) - Terrorism

Disillusionment

- Survivors recognize limits of aid - physically exhausted - multiple demands - financial pressures - relocation - assistance orgs pull out (abandonment feelings) - exacerbation of preexisting health conditions - resentment of unequal distribution of aid - violence

Bioterrorism

- a deliberate release of viruses, bacterias or other germs (agents) to cause illness or death in people, animals or plants - these agents are typically found in nature, but it is possible that they could be changed to increase their ability to cause disease - easily spread through air, water or in food - difficult to detect and do not cause illness for several hours to days - three categories (based on how easily they can be spread from person to person)

Components of disaster debris

- building debris - household debris - vegetative debris - problem with waste streams - each has different clean up and has different dangers

Floods

- floods may originate very quickly following a quick rain storm, or they may develop over a short period of rain or quick snow melt - the primary hazard from flooding is drowning - longer term health concerns from flooding is the development of disease from contaminated water and lack of hygiene

Impact

- greater the scope, community destruction and personal losses - the greater the psychological effects - reactions: range from stunned, shock-like to overt panic and hysteria - most: confusion, disbelief, focus on survival and personal/family well being

Advantages of Triage

- helps to bring order to organization to a chaotic scene - it identifies and provides care to those who are in greatest need - helps make the difficult decisions easier - assure that resources are used in the most effective manner - may take some of the emotional burden away from those doing triage

Triage

- highest priorities preserve life, limb and eyesight - an ongoing process, repeated at each level of care and with each procedure, patient has to be continually reassessed

Mental Wellness

- in any major disaster, people want to know where their loved ones are, nurses can assist in making links - in case of loss, people need to mourn - give them space - find family friends or local healers to encourage and support them - most are back to normal within 2 weeks - about 1% - 3% may need additional help

Why is Disaster Triage needed

- inadequate resource to meet immediate needs - infrastructure limitations - inadequate hazard preparation - limited transport capabilities - multiple agencies responding - hospital resources overwhelmed

Disaster Phases

- individuals and communities pass through phases at different rates - progression is not linear or sequential - influences: psychological resilience, social support and financial resources

Disaster and Health

- injuries from the event - environmental exposure after the event (no shelter) - malnutrition after the event (feeding the population affected) - excess non-communicable disease mortality following a disaster (chronic disease) - mental health (disaster syndrome)

What is Disaster

- is a result of an ecological breakdown in the relation between humans and their environment - a sudden event on such scale that the stricken community needs extraordinary efforts to cope with outside help or international aid

Mental Wellness

- little attention is paid to the children - listen attentively to children without denying their feelings - give easy to understand answers to their questions - in the shelter, create an environment in which children can feel safe and secure (eg play area)

Displacement of disaster victims

- mass shelters Shelter management: - organized team (chain) - sleeping area and necessities - water and food handling - sanitation (toilets, showers etc.) - special care to children and elderly - health services (physical and mental)

Who decides in triage

- nurses don't act for legal fears of being blamed for deaths, and lack of clarity on where they fit in the command structure - function to the level of their training and experience - they are the most trained personnel on the site, they are in charge

Tornadoes

- primary hazard from a health perspective: is risk for injuries from flying debris -the high winds and circular nature of a tornado leads to the elevation and transport of anything that is not fastened down - most victims of tornadoes are affected by head and chest trauma due to being struck by debris or from a structural collapse. some individuals are injured while on the ground others are lifted into the air by the tornado and dropped at another location

Volcanoes

- rare, but can be catastrophic when they occur - over the 25 year period (1972-1996) there was an average of 6 eruptions per year, causing an average of 1017 deaths and 285 injuries - health outcomes are associated with volcanic eruptions: respiratory illnesses from the inhalation of ash, for individuals close to the volcano, some danger exists from lava flows, or more likely mud flows

Heroic

- survival, rescuing other and promoting safety is priority - post impact disorientation - high energy low productivity (capacity to assess risk is impaired) - PTS reactions occur if family not kept together

Earthquakes

- the primary health concern: injuries arising fro structural collapse, most injuries occur amongst the individuals trapped at the time of the earthquake. secondary group: first responders who go into unstable buildings - prevention strategy: STOP buildings from collapsing - Develop better rescue strategies for retrieving individuals from collapsed buildings

Hurricanes or Cyclones

- the primary health hazard: the risk of drowning from the storm surge associated with the landfall of the storm - Secondary: a hazard exists for injuries from flying debris due to high winds - Nurses can be instrumental in providing direct emergency care to drowning and head injuries

Man-Made Threats

- unpredictable challenges - disruptive - unexpected - targeting weaknesses - very rare, impossible to conceive before event - threats to civilians, information infrastructure (seren gas put into tubes in Japan)

Honeymoon

- weeks to months post disaster - formal govt and volunteer assistance - community bonding - common experience - survivor optimism - MH workers on the scene

Reconstruction

- years - physical property and emotional well being - must assume responsibility themselves - people come to see meaning personal growth and opportunity with their loss/pain - re-examine life priorities

Humanitarian Emergency

A complex multiparty, intra-state conflict resulting in a humanitarian disaster which might constitute multi-dimensional risks or threats to regional and international security. - frequently within such conflicts, state institutions collapse, law and order breakdown, banditry and chaos prevail,and portions of the civilian population migrate

Response

Activities a hospital, healthcare system,or public health agency take immediately before, during and after a disaster or emergency occurs

Preparedness

Activities that are taken to build capacity and identify resources that may be used: - know evacuation shelters - emergency communication plan - preventative measures to prevent spread of disease - public education

Mitigation

Activities that reduce or eliminate a hazard - prevention - risk reduction Examples - immunization programs - public education

Recovery

Activities undertaken by a community and its components after an emergency or disaster to restore minimum services and move towards long-term restoration - debris removal - care and shelter - damage assessments - funding assistance

Severity Predictor

All Casualties: 1/3 critical casualties dead on scene or die at hospital, require emergency surgery or require hospitalization - black (dead/expectant) - red (immediate) - yellow (delayed - admitted) 2/3 noncritical casualties: treated and released from ED - yellow (delayed - released) - green (minimal)

Role of nursing in disasters

Disaster preparedness: including risk assessment and multi-disciplinary management, strategies at all system levels, is critical to all delivery of effective responses to the short, medium and long-term health needs of a disaster-stricken population

The Phases of Disaster

Mitigation: - lessen the impact of a disaster before it strikes Preparedness: -activities undertaken to handle a disaster when it strikes Response: - search and rescue, clearing debris, and feeding and sheltering victims (and responders if necessary) Recovery: - getting a community back to its predisaster status

Changes to pattern of casualty

Occurs with: - military ordinance - explosion in confined places - collapse of buildings or other structures **if any one of these factors is present double casualties**

Bioterrorism Category B

-Modestly easy to spread - result in moderate illness rates and low death rates - require specific enhancements of CDC lab capacity and enhanced disease monitoring - examples: food safety (salmonella, ecoli) water safety (cryptosporidium) ricin toxin (castor beans) brucellosis

Myths associated with disasters

Any kind of assistance needed in disasters - A response not based on impartial evaluation contributes to chaos Epidemics and plagues are inevitable after every disaster - Epidemics rarely ever occur after a disaster - Dead bodies will not lead to catastrophic outbreaks of exotic disease - Proper resumption of public health services will ensure the public's safety (sanitation, waste disposal, water quality, and food safety) Disasters bring out the worst in human behavior - The majority of responses are spontaneous and generous The community is too shocked and helpless - Cross-cultural dedication to common good is most common response to natural disasters

What is Triage

Assigns priorities when resources are limited -do the best for the greatest number of patients

Bioterrorism Category A

Category A: high priority organisms and toxins that pose the highest risk to the public or country - easily transmitted person to person - high death rates and major public health (PH) issue - cause public panic and social disruption - require special action for PH preparedness - examples: anthrax, botulism, plague, small pox,viral hemorrhagic fever (ebola,marborg,lassa fever)

Bioterrorism Category C

Category C: emerging pathogens that could be engineered for mass spread in the future because: - they are easily available - easily produced and spread - have potential for high morbidity and mortality and major health impacts examples: Hanta, Nipah virus

The most vulnerable

Elderly unable to look after themselves and dependence on medications Children

What patterns tell us

If you understand the threat you can understand the impacts to community and take preparation and prevention measures for your community What are you going to do with bodies, identified, place in an appropriate site in order to provide information about casualties

Pre-disaster

Warnings varies - earthquakes - none - hurricanes, floods - hours to days of warning - perceptions - no control - guilt and self blame - if not heeding warnings