Introduction

Disaster is an occurrence arising with little or no warning, which causes serious disruption of life and perhaps death or injury to large number of people. It is may be a man made or natural event that causes destruction and devastation which cannot be relieved without assistance.

Types of disaster

Natural. Eg : earthquake, floods, hurricane, tsunami. Manmade.Eg: nuclear accidents, industrial accidents Hybrid Eg: spread of disease in community, global warming.

Levels of disaster

Level iii disaster considered a minor disaster. These are involves minimal level of damage Level ii disaster- considered a moderate disaster. The local and community resources has to be mobilized to manage this situation Level i disaster- considered a massive disaster- this involves a massive level of damage with severe impact.

Disaster mitigation

Disaster mitigation refers to actions or measures that can either prevent the occurrence of a disaster or reduce the severity of its effects. (American Red Cross). Mitigation activities include awareness and education and disaster prevention measures.

Phases of disaster management

Prevention phase Preparedness phase Response phase Recovery phase

Prevention phase

Identify community risk factors and to develop and implement programs to prevent disasters from occurring.

Preparedness phase

Personal preparedness Professional preparedness

Key organizations and professionals in disaster management Health care community

Hospitals Health professionals Pharmacies Public health departments Rescue personnel

Non-health care community

Fire fighters Municipal or government officials Media Medical examiners Medical supply manufactures Police

Community preparedness

The level of community preparedness for a disaster is only as high as the people and organization in the community make it. Community must have adequate warning system and a back up evaluation plan to remove people from the area of danger

Response phase The level of disaster varies and the management plans mainly based on the severity or extent of the disaster. Recovery phase

During this phase actions are taken to repair, rebuilt, or reallocate damaged homes and businesses and restore health and economic vitality to the community. Psychological recovery must be addressed.Both victims and relief workers should be offered mental health activities and services.

Disaster management cycle Prevention I Recovery <--------response ------> preparedness v

Disaster management plans Aims of disaster plans

to provide prompt and effective medical care to the maximum possible in order to minimize morbidity and mortality

Objectives

To optimally prepare the staff and institutional resources for effective performance in disaster situation To make the community aware of the sequential steps that could be taken at individual and organizational levels

Disaster management committee The following members would comprise the disaster management committee under the chairmanship of medical superintendent/ director

Medical superintendent/ director Additional medical superintendent Nursing superintendent/ chief nursing officer Chief medical officer (casualty) Head of departments- surgery, medicine, orthopedics, radiology, anesthesiology, neurosurgery Blood bank in charge Security officers Transport officer Sanitary personnel

Disaster control room

the existing casualty may be referred as the disaster control room.

Rapid response team

The medical superintendent will identify various specialists, nurses and pharmacological staff to respond within a short notice depending up on the time and type of disaster. The list of members and their telephone numbers should be displayed in the disaster control room.

Information and communication

the disaster control team would be responsible for collecting, coordinating and disseminating the information about the disaster situation to the all concerned.

Disaster beds

Requirement of beds depends up on the magnitude of the disaster. Utilization of vacant beds, day care beds, and pre-operative beds Convalescing patients, elective surgical cases and patients who can have domiciliary care or opd management should be discharged Utility areas to be converted in to temporary wards such as wards with side rooms, corridors, seminar rooms etc. Creating additional bed capacity by using trolleys, folding beds and floor beds

Logistic support system

Resuscitation equipments Iv sets, iv fluids, Disposable needles, syringes and gloves Dressing and suturing materials and splints Oxygen masks, nasal catheters, suction machine and suction catheters Ecg monitors, defibrillators, ventilators Cut down sets, tracheostomy sets and lumbar puncture sets Linen and blankets Keys of these cupboards should be readily available at the time of disaster

Training and drills

Mock exercise and drills at regular intervals are conducted to ensure that all the staff in the general and those associated with management of causalities are fully prepared and aware of their responsibilities.

Elements of disaster plan A disaster plan should have the following elements

Chain of authority Lines of communication Routes and modes of transport Mobilization Warning Evacuation Rescue and recovery Triage Treatment Support of victims and families Care of dead bodies Disaster worker rehabilitation

Activation of disaster management plans

Standard operating procedures (SOPs) Reception area Triage o Priority one- needing immediate resuscitation, after emergency treatment shifted to intensive care unit o Priority two- immediate surgery, transferred immediately to operation theatre. o Priority three- needing first aid and possible surgery- give first aid and admit if bed is available or shift to hospital o Priority four- needing only first aid-discharge after first aid. Documentation Public relations. Essential services. Crowd management/ security arrangement.

Disaster management- nurses role in community Assess the community

Assessment - the local climate conducive for disaster occurrence, past history of disasters in the community, available community disaster plans and resources, personnel available in the community for the disaster plans and management, local agencies and organizations involved in the disaster management activities, availability of health care facilities in the community etc.

Diagnose community disaster threats

Determine the actual and potential disaster threats (eg; explosions, mass accidents, tornados, floods, earthquakes etc).

Community disaster planning

Develop a disaster plan to prevent or deal with identified disaster threats Identify local community communication system Identify disaster personnel, including private and professional volunteers, local emergency personnel, agencies and resources Identify regional back up agencies and personnel Identify specific responsibilities for various personnel involved in the disaster plans Set up an emergency medical system and chain for activation Identify location and accessibility of equipment and supplies Check proper functioning of emergency equipments Identify outdated supplies and replenish for appropriate use.

Implement disaster plans

Focus on primary prevention activities to prevent occurrence of manmade disasters

Practice community disaster plans with all personnel carrying out their previously identified responsibilities (eg: emergency triage , providing supplies such as food, water, medicine, crises and grief counseling) Practice using equipment; obtaining and distributing supplies

Evaluate effectiveness of disaster plan

Critically evaluate all aspects of disaster plans and practice drills for speed, effectiveness, gaps and revisions. Evaluate the disaster impact on community and surrounding regions Evaluate the response of personnel involved in disaster relief efforts.

Conclusion Disaster is an emergency situation, therefore coordination of actions and various departments is an essential requisite for efficient management of mass casualties. References 1. Stanhope M, Lancaster J. Community health nursing- process and practice for promoting health. 3rd edn. Mosby year book. St.louis. 1992. 2. Allender j a, spradly bw. Community health nursing- promoting and practicing the publics health. 6th edn. Lippincott williams and wilkins. London. 2005 3. Clemenstone s, mcguire sl, eigsti dg. Comprehensive community health nursingfamily aggregate and community practice. 6th edn. Mosby publishers. St louis. 2002 4. Stanhope m, lancaster j. Community and public health nursing. 6th edn. Mosby publishers. London. 2004. 5. Lewis sl, heitkemper mm. Medical surgical nursing- assessment and management of problems. Mosby publishers. Philadelphia. 2007. 6. Taylor c, lillis c, lemone p. Fundamentals of nursing- the art and science of nursing care. 5th edn. Lippincott williams and wilkins. London. 2006.