Disaster Nursing DIDACTICS DISASTER CATEGORIES 1. Serious disruption of the functioning of a community or a society at any scale due to hazardous events interacting with conditions of exposure, vulnerability and capacity, leading to one or more of the following: human, material, economic, and environmental losses and impacts. - United nations International Strategy for Disaster Reduction, 2017 An ecological disruption or emergency, of a severity and magnitude that result in deaths, injuries, illness, and property damage that cannot be effectively managed using routine procedures or resources and that require outside assistance. Health Disaster is a catastrophic event that results in casualties that overwhelm the healthcare resources in that community and may result in a sudden unanticipated surge of patients, a change in standards of care, and a need to allocate scarce resources. b. 2. 3. 1. 2. TYPES 1. Natural Result of an ecological disruption or threat that exceeds the adjustment capacity of the affected community. Earthquakes, tornadoes, floods, hurricanes, volcanic eruptions, ice storms, tsunamis, etc. 2. Man-made/ Anthropogenic / Human generated The principal direct causes are identifiable human actions, deliberate, or otherwise. Biological and biochemical terrorism, chemical spills, radiological (nuclear) events, fire, explosions, transportation accidents, armed conflicts, and acts of war. a) Complex emergencies Casualties from war, civil strife, or other political conflict. Drought, famine, disease, and political unrest that displace millions of people from their homes. Ex. Genocide in Dafur (2003-2010); Rohingyas in Myanmar; refuges from conflict in Syria and Iraq. Onset a. 3. Sudden – triggered by a hazardous event that emerges quickly or unexpectedly (earthquake, tsunami) Slow – emerges gradually overtime (drought, weather disturbance, high-density population gatherings) Impact Duration CLASSIFICATION Hazard Potential threat to humans & their welfare. Present the possibility of occurrence of a disaster caused by natural phenomena (hurricane, earthquake), failure of man-made sources of energy (nuclear power plant), or human activity (war) Risk Actual exposure of something of human value & often measured as the product of probability & loss. Disaster an earthquake occurring in a sparsely populated area would not be considered a disaster if no people were injured or affected by loss of housing or essential services. HEALTHCARE CLASSIFICATION b) c) Technological disasters Large numbers of people, property, community infrastructure, and economic welfare are directly and adversely affected by major industrial accidents, unplanned release of nuclear energy, and fires or explosions from hazardous substances such as fuel, chemicals, or nuclear materials. Synergistic (natural + technological) Ex. Earthquake and tsunami caused damage to Fukushima Daiichi nuclear reactor, resulting in wide-scale evacuation, illness, and long-term population displacement. a) b) Internal Disaster Disruption of normal hospital function due to injuries or deaths of hospital personnel, or damage to facility itself, as with a hospital fire, power failure, or chemical spill. External Disaster Do not affect the hospital infrastructure but tax hospital resources due to numbers of patients or types of injuries. Epidemiology quantitative study of the distributions and determinants of health-related events in human populations. Disaster epidemiology measurement of the adverse health effects of natural and human-generated disasters and the factors that contribute to those effects, with the overall objective of assessing the needs of disaster-affected populations, matching available resources to needs, preventing further adverse health effects, evaluating program effectiveness, and planning for contingencies. EFFECTS OF DISASTERS may cause premature deaths, illnesses, and injuries in the affected community, generally exceeding the capacity of local healthcare system. Disaster Nursing DIDACTICS May destroy the local healthcare infrastructure – disrupting emergency response, healthcare services, and prevention initiatives – increased morbidity & mortality. May create environmental imbalances, increasing risk of communicable diseases and environmental air, soil, and water hazards. May cause psychological, emotional, and social problems (anxiety, fear, depression, panic, terror, etc.) May cause shortage of foods and cause severe nutritional deficiencies. May cause migration 5. Recovery Focuses on stabilizing and returning the community to normal. Rebuilding damaged buildings, repairing infrastructures, relocating populations, and instituting health interventions. 6. Evaluation To determine what worked, did not work, specific and what specific problems, issues, and challenges were identified. DISASTER CONTINUUM 3 MAJOR PHASES 1. Preimpact 2. Impact 3. Postimpact LIFE CYCLE OF DISASTER MANAGEMENT 1. 2. 3. 4. Preparedness Proactive planning efforts designed to structure the disaster response to its occurrence. Evaluating potential vulnerabilities, and propensity for a disaster to occur. Actions that are carried out within the context of disaster risk reduction and management with the aim of averting disaster. (NDRRMC) Aims to build the capacities needed to efficiently manage all types of emergencies and achieve orderly transitions from response to sustained recovery. Mitigation Measures taken to reduce harmful effects of a disaster by attempting to limit its impact on human health, community function, and economic infrastructure. Mitigation measures encompass engineering techniques and hazard-resistant construction as well as improved environmental policies and public awareness (NDRRMC) Prevention Broad range of activities to prevent disaster from occurring, and any actions taken to prevent further disease, disability, or loss of life. Ex: construction of dams or embankments that eliminate flood risks; land-use regulations that do not permit any settlements in high-risk zones; seismic engineering designs that ensure the survival and function of a critical building in any likely earthquake (RA 10121, NDRRMC) Response Actual implementation of disaster plan. Focuses on emergency relief: saving lives, first aid, minimizing and restoring damaged systems (communication & transportation), and providing care and basic life requirements (food, water, shelter) Emergency services and public assistance during or immediately after a disaster in order to save lives, reduce health impacts, ensure public safety and meet the basic subsistence needs of the people affected. (RA 10121, NDRRMC) Focused on immediate and short-term needs and is sometimes called “disaster relief”. (RA 10121, NDRRMC) DISASTER PLANNING Effective disaster planning addresses the problems posed by various potential events, ranging in scale from mass casualty incidents, such as motor vehicle collisions with multiple victims, to extensive flooding or earthquake damage, to armed conflicts and acts of terrorism (Burstein, 2014). Major Types of Disaster Planning 1. Agent-specific approach Focused their preparedness activities on the most likely threats to occur based on their geographic location. 2. All-hazards approach conceptual model for disaster preparedness recommended by FEMA that incorporates disaster management components that are consistent across all major types of disaster events to maximize resources, expenditures, and planning efforts DISASTER PLANNING AND PUBLIC HEALTH PREPAREDNESS SIX DOMAIN OF PREPAREDNESS 1. 2. 3. 4. 5. 6. Community resilience Preparing for and recovering from emergencies Incident management Coordinating an effective response Information management Making sure people have information to take action Countermeasures and mitigation Getting medicines and supplies where they are needed Surge management Expanding medical services to handle large events Biosurveillance Investigating and identifying health threats Disaster Nursing DIDACTICS HAZARD IDENTIFICATION, VULNERABILITY ANALYSIS, AND RISK ASSESSMENT HAZARD IDENTIFICATION AND MAPPING determine which events are most likely to affect a community and to make decisions about whom or what to protect as the basis of establishing measures for prevention, mitigation, and response. Historical data and data from other sources are collected to identify previous and potential hazards. Data are then mapped using aerial photography, satellite imagery, remote sensing, and geographic information systems. HAZARD ANALYSIS Drought Dust storm/sand storm Landslide/mudslide Winter storm/blizzard NATURAL EVENTS RISK ASSESSMENT Wildfire Avalanche Tsunami Earthquake Tornado Volcanic eruption Biological event Lighting storm Heat wave Extreme cold Flood or wind-driven water Hazardous material release Transportation accident Power or utility failure Radiological accident Fuel or resource shortage Communication disruption HUMAN EVENTS Economic failures Terrorism Hostage situation Enemy attack Mass hysteria/panic SPECIAL EVENTS Mass gatherings Sporting events CONTEXT HAZARDS Climate change Deforestation Explosion or fire Building or structure collapse Extreme air pollution Dam or levee failure Industrial collapse General strikes Sabotage, bombs Civil unrest Arson b) c) d) e) community’s risk of adverse health effects due to a specified disaster (i.e., traumatic deaths and injuries following an earthquake) major hazards facing the community and their sources (i.e., earthquakes, floods, industrial accidents) sections of the community most likely to be affected by a particular hazard (i.e., individuals living in or near floodplains) existing measures and resources that reduce the impact of a given hazard (i.e., building codes and regulations for earthquake mitigation) areas that require strengthening to prevent or mitigate the effects of the hazard DISASTER PREVENTION MEASURES 1. Prevention or removal of hazard closing down an aging industrial facility that cannot implement safety regulations 2. Containment of the hazard or implementation of mitigation strategies enforcing strict building regulations in an earthquakeprone zone, increased engineering codes for buildings in coastal areas 3. Removal of at-risk populations from the hazard evacuating populations prior to the impact of a hurricane; resettling communities away from floodprone areas 4. Provision of public information and education providing information concerning measures that the public can take to protect themselves during a tornado 5. Establishment of early warning systems using satellite data about an approaching hurricane for public service announcements Concerts Political gatherings Sea level rise Loss of natural resources Catastrophic earth changes VULNERABILITY ANALYSIS uses the results of the hazard identification and vulnerability analysis to determine the probability of a specified outcome from a given hazard that affects a community with known vulnerabilities and coping mechanisms (risk equals hazard times vulnerability). The probability may be presented as a numerical range (i.e., 30%–40% probability) or in relative terms (i.e., low, moderate, or high risk). Major objectives of risk assessment include the following: a) Hurricane/typhoon TECHNOLOGICAL EVENTS determine who is most likely to be affected, the property most likely to be damaged or destroyed, and the capacity of the community to deal with the effects of the disaster. Data are collected regarding the susceptibility of individuals, property, and the environment to potential hazards in order to develop prevention strategies. A separate vulnerability analysis should be conducted for each identified hazard. Disaster Nursing DIDACTICS 6. 6. Mitigation of vulnerabilities sensors for ventilation systems capable of detecting deviations from normal conditions; sensors to check food, water, currency, and mail for contamination 7. Reduction of risk posed by some hazards relocating a chemical depot farther away from a school to reduce the risk that children would be exposed to hazardous materials 8. Enhancement of a local community’s capacity to respond healthcare coordination across the entire health community, including health departments, hospitals, clinics, and home care agencies EVALUATING CAPACITY TO RESPOND RESOURCE IDENTIFICATION Essential feature of disaster planning. The capacity to withstand a disaster is directly related to the type & scope of resources available, the presence of adequate communication systems, structural integrity of its buildings & utilities, and size & sophistication of its healthcare system. Includes human & physical elements (organizations with specialized personnel & equipment). EVALUATION OF A DISASTER PLAN Methods: 1. Disaster drills Provide an excellent means of testing plans for their completeness and effectiveness. May be large, full-scale exercises, using triaged victims and requiring vast resources of supplies and personnel. May be limited to small segment of disaster response; assessing the effectiveness of communication protocols or notification procedures. 2. Table-top academic exercises presentation of disaster scenarios to key individuals who work together as a group to respond to the scenario as if it were a real event, but within the confines of the meeting room. provides staff an understanding of their roles and interactions with other members of the incident command structure 3. Computer simulations present a disaster scenario to individuals or groups of participants who respond to the situation through interactions with a computer program. The simulation allows staff to gain an understanding of their specific roles and responsibilities, and practice in making the types of decisions they will need to make during real events 4. 5. Academic exercises Mock patients Seminar sessions Periodic evaluations of disaster plans are essential to ensure that personnel are adequately familiar with their roles in disaster situations, as well as to accommodate changes in population demographics, regional emergency response operations, hospital renovations and closings, and other variables.
