DISASTER NURSING

August 2, 2012 College of Nursing & School of Midwifery De La Salle Health Sciences Institute

DISASTER

NATURAL DISASTER ENVIRONMENTAL

EFFECTS LANDSLIDE,ROCK FALL,AVALANCE FLOODING,LANDSLIDE,LOSS OF PLANT AND ANIMALS

EARTHQUAKE

THYPOON

TSUNAMI

FLOODING, EROSION,LOSS OF ANIMALS AND PLANTS

LOSS OF PLANTS AND ANIMALS, DETERIORATION OF SOIL ,AIR WATER POLLUTION

VOLCANIC ERUPTION

FIRE

AIR POLLUTION, LOSS OF PROPERTY

PRECAUTIONARY MEASURES:
STORM

PUBLIC STORM SIGNAL NO. 1

Winds of 30 - 60 kph may be expected in at least 36 hours. IMPACT OF THE WINDS:
small trees - branches may be broken banana trees - tilt or flat on ground Light material partially unroofed

 PRECAUTIONARY MEASURES

GENERAL NOTE: >Business may be carried out as usual. When the tropical cyclone is strong, intensifying or is moving closer, this signal may be gradually increased. >Disaster preparedness is activated to alert status.

People are advised to listen to the latest Severe Weather Bulletin issued by PAGASA every six hours 5:00 a.m., 11:00 a.m., 5:00 p.m., 11:00 p.m.

PUBLIC STORM SIGNAL NO. 2

A moderate tropical cyclone will affect the locality. Winds of greater than 60 kph to 100 kph may be expected in at least 24 hours. IMPACT OF THE WINDS:
coconut trees - may be tilted /
broken big trees uprooted banana trees - maybe destroyed large houses partially/totally unroofed old galvanized iron roofing - may roll off

 PRECAUTIONARY MEASURES

GENERAL NOTE: >Special attention should be given to the latest position, direction and speed of movement and intensity of the tropical cyclone as it may intensify and move towards the locality. >Disaster preparedness agencies and other organization are alerted.

The sea and coastal waters are dangerous to smaller sea crafts. Fishermen are advised not to go to the sea. Avoid necessary risks. Traveling by sea or air is risky. Stay indoors. Secure properties.

PUBLIC STORM SIGNAL NO. 3

IMPACT OF THE WINDS:
large # of trees uprooted

A strong tropical cyclone will affect the locality. Winds of greater than 100 kph to 185 kph may be expected in at least 18 hours

banana trees - maybe destroyed

light to medium construction may be uprooted/ damage to structure / destroyed

widespread disruption

very risky

 PRECAUTIONARY MEASURES: >People are advised to evacuate and stay in strong buildings. >Stay away from coasts and river banks. >Watch out for the passage of the "eye" do not venture away from shelter. >Suspend classes in all level and make sure the children stay in the safety of strong buildings.

GENERAL NOTE: >The disturbance is dangerous to threatened or affected communities. >The passage of the "eye" of the typhoon is indicated by a sudden change from bad to fair weather. Fair weather may last for one or two hours after which the worst weather will resume with very strong winds generally coming from the opposite direction. >Disaster preparedness and response agencies/organization are activated to respond appropriately.

PUBLIC STORM SIGNAL NO. 4

IMPACT OF THE WINDS:

A very intense typhoon will affect the locality. Very strong winds of more than 185 kph may be expected in at least 12 hours.

large # of trees -

uprooted

coconut trees - extensive damage

may be severely damage

widespread disruption

 PRECAUTIONARY MEASURES: Cancel all travel and other outdoor activities. Stay in safety of houses or evacuation centers.

GENERAL NOTE: The situation is potentially very destructive to the community. Disaster coordinating councils concerned and other disaster response organizations must respond to emergencies.

TROPICAL CYCLONE WARNING PRECAUTIONARY MEASURES before the storm comes...

Reinforce your home to withstand wind and flooding.

Learn about typhoon and other disturbances, their signs and warning, effects and dangers, and how to protect your family, yourself and your property. Educate the members of your family on preparedness and protection from tropical cyclones.

 Store adequate supply of food and drinking water. Prepare flashlights, batteries, matches, kerosene lamps or candles in anticipation of power failure.

During the emergency, keep your radio on and listen to the latest report and PAGASA bulletin and announcement.
When a typhoon, tropical depression or tropical storm strikes, stay indoors and do not go near windows. Check on everything that may be blown away or turned loose. Flying objects become dangerous during typhoons.

 If the "eye" of the storm passes over your place, there may be a lull lasting for a few minutes to half an hour. Stay in safe place. Make emergency repairs if necessary, but remember the wind will blow suddenly from the opposite direction, frequently with even greater violence.

Cut off loose tree branches and excessive foliage or leaves. Severe flooding may follow typhoon. Stay away from river banks and streams. If your house is not safe, move to a designated evacuation center and stay there until the storm has completely subsided. Slightly open a window or door at the side of the house opposite form where the wind comes from to avoid pressure build up. Be calm. Your ability to meet the emergency will inspire and help others.
Hurricane Opal hit Florida in 1995

PRECAUTIONARY MEASURES:
FLOOD

 BEFORE THE FLOODS Find out the frequency of occurrence of floods in your locality. All family members must know the flood warning system in your community. Keep informed of daily weather condition. Inquire on designated evacuation areas for families and livestock.

Flooding in Mississippi

 Keep a stock of food which requires little cooking and refrigeration; electric power may be interrupted. Keep a transistor radio, flashlight with spare batteries, emergency cooking equipment, candles, matches and first aid kit handy in case of emergency. Store supplies and other household effects above expected flood water level. Securely anchor weak dwellings and items.

Flooding in Bangladesh

 WHEN WARNED OF FLOOD Watch for rapidly rising waters. Listen to your radio for emergency instructions. If necessary, evacuate to a safe area before access is cut-off by flood waters.

Store drinking water in containers, water service may be interrupted.

Move household belongings to higher levels. Get livestock to higher grounds. Turn off electricity at the main switch in the building before evacuating and also lock your house.

 DURING THE FLOOD Avoid areas subject to sudden flooding.

Do not attempt to cross rivers of flowing streams where water is above the knee.
Beware of water-covered roads and bridges. Do not go swimming or boating in swollen rivers.

Eat only well-cooked food. Protect left-over against contamination. Drink clean or preferably boiled water ONLY.

 AFTER THE FLOOD

Re-enter dwellings with caution using flashlights, not lanterns or torches. There may be flammable materials inside. Be alert of fire hazards like broken wires. Do not eat food or drink water until they have been checked for flood water contamination. Report broken utility lines (electricity, water, gas and telephone) to appropriate agencies/authorities.

 Do not turn on the main switch or use appliances and other equipment until they have been checked by a competent electrician.
If necessary, consult health authorities for immunization requirements. Do not go "sight-seeing" in disaster areas. Your presence might hamper rescue and other emergency operations.

Precautionary Measures:
Landslides

Precautionary Measures: Landslides

Plan ground cover on slopes or else build retaining walls. In mudflow areas, construct channels to divert mudflows from your homes. If you are warned of an impending landslide or mudflow, evacuate at once.

 If your are caught outside and cannot get inside a building, stay away from the path of the landslide, or seek refuge behind a sturdy tree or boulder. Curl into a tight ball and protect your head. In places where landslides or mudflows occur repeatedly, dredge rivers and waterways to minimize flooding.

Precautionary Measures:
Tsunami

TSUNAMI
Series of giant sea waves generated by under the sea earthquakes
Tidal waves

 A strong earthquake in your area is a natural tsunami warning. Do not stay in low-lying coastal areas after a local earthquake

 During the retreat of sea level, interesting sights are often revealed. Fishes may be stranded on dry land thereby attracting people to collect them. Also, sandbars and coral flats may be exposed. These scenes tempt people to flock to the shoreline thereby increasing the numbers of people at risk when the on rushing waves of tsunami hit the area.

 If unusual sea conditions like extreme lowering of sea level are observed, it is best to regard this as warning for an approaching tsunami and immediately move towards high grounds.

 Approaching tsunami waves are sometimes heralded by noticeable rise or fall of coastal water. This is natures tsunami warning and should be heeded

 Never go down to the beach to watch for a tsunami. When you can see the wave, you are too close to escape it.

 A tsunami is not a single wave but a series of waves. Stay out of danger areas until an all clear is issued by competent authority

PSYCHOSOCIAL EFFECTS OF DISASTER

DISASTER OF MENTAL HEALTH RESPONSE PRINCIPLES Mental Health Interventions must be taken to the survivors in a disaster Survivors and the bereaved are particularly susceptible to efforts that appear voyeuristic Never separate children from their families Limit exposure to dead and mutilated Give accurate, truthful information to victims Protect victim privacy and limit exposure to the media Use naturally occurring support systems Avoid medicalizing reactions Minimize retraumatization Mandatory psychological debriefing is clinically contraindicated

PSYCHOSOCIAL EFFECTS OF DISASTER

MENTAL HEALTH REFERAL DISORIENTATI ON INABILITY TO CARE FOR SELF

DEPRESSION

PSYCHOSIS

SUICIDAL THOUGHTS PROBLEMATIC USE OF ALCOHOL/DRUG S

ANXIETY

ABUSE

Post Traumatic Stress Disorder

Hallmarks of PTSD: (symptoms of persistent.) 1. re xperiencing of traumatic event 2. avoidance of situation/stimuli that are associated with trauma 3. increased arousal

CRITICAL STRESS INCIDENT MANAGEMENT

Crisis intervention program to mitigate the psychological distress among emergency services personnel and assist them in returning to normal duties

CSIM STRATEGIES
Pre incident education/mental preparedness training Individual crisis intervention and on scene support Demobilization after large scale events Defusing Debriefing - CISD significant others support for families and children Follow up services and referrals

Critical Incident Stress Debriefing (CISD)

psychological first aid Goals: 1. reduction of distress 2. group cohesion emphasis: to inform and empower theoretical foundation: crisis intervention and group therapy

7 Phases of CISD
1. 2. 3. 4. 5. 6. 7. Introduction Fact Thought Reaction-feelings Symptoms of distress Teaching Re entry

CISD
1. Introduction * orientation to CISD procedure and approach * rules of the session

2. Fact * allows client to talk about extremely brief overview of the fact * WHAT HAPPENED? * WHAT DID YOU DO AT THE SCENE?

Sample Introduction
Everyone reacts to critical incidents differently. The purpose of this meeting is to help you better understand any reactions you may have regarding the incident. Please understand that what is done in this meeting is not therapy and is not designed to prevent serious complications like post traumatic stress disorder. This is also not meant to be a critique of the event or judgment of others. Your participation in this group is voluntary. You are not required to participate. Everything said in this room stays in this room. Finally, it is important that only emergency service personnel who were involved in the incident are now in the room. Is there anyone here who was not involved or who you do not recognize as part of the incident?

3. Thought * touching on the emotional aspect begins * WHAT WENT THROUGH YOUR MIND? 4. Reaction * most intense phase; focuses on the impact of crisis to the participants * WHAT WAS THE WORST PART OF THE INCIDENT FOR YOU? * WITHOUT CHANGING THE OUTCOME, WHAT PART WOULD YOU ELIMINATE?

CISD

CISD
5. Symptoms of Distress * allows participant to describe the physical, cognitive, emotional & behavioral s/s of distress * WHAT HAVE YOU BEEN EXPERIENCING SINCE THE INCIDENT? 6. Teaching * provides explanation of participants reactions and stress mgt info

CISD
* other pertinent topics may be addressed (suicide, communication, isolation, etc) * The ff. may be given as concrete advice (ARC): 1. Do not isolate self from others. 2. Prevent self from becoming obsessed/fixated with the incident. 3. Eat well, exercise. 4. Assess the need for time off. 5. Dont have unrealistic expectations for healing & recovery. 6. Learn about what you are going through. 7. Get help if necessary.

CISD
7. Re entry * summarizing what have been discussed * emphasis on positive learning aspects * reminding of confidentiality

DISASTER NURSING TIMELINE

DISASTER PHASE

PREIMPACT
TIME

IMPACT

POST IMPACT

GREATER THAN 72HRS (0-24HRS) DISASTER CONTINUU M (24-72HRS)

PLANNING PREPAREDNESS PREVENTION WARNING

RESPONSE EMERGENCY MANAGEMENT MITIGATION

Activate disaster response plan Establish safe shelter and Mitigate all ongoing hazards delivery of adequate food Activate agency disaster and water supplies plans Provide for sanitation needs and waste mutual Establish need for removal aid relationships Establish disease surveillance Integrate government Establish vector control resources Evaluate the need Ongoing triage and for/activate additional provision staff nursing of nursing care Evaluate public health needs

RECOVERY REHABILITATION RECONSTRUCTIO N EVALUATION

Continue provision of nursing and medical care Continue disaster surveillance Monitor long term physical health safety of for Monitoroutcomes the food survivors and water supply Withdraw mentaldisaster Monitor from health status of survivors scene Provide counseling and Restore public health debriefing for staff infrastructure Evaluate Disaster Nursing Response Action Re-triage and transport of patient to appropriate level Revise original disaster preparedness care facilities plan Reunite family members

NURSING ACTION

Participation in the development of community disaster plans Participate in the community risk assessment Initiate disaster prevention measures Perform disaster drills and table top exercises Identify educational and training needs for all nurses Develop disaster nursing databases for notification, mobilization and triage of emergency nurse s5taffing resources Develop evaluation plans for all components of Disaster Nursing Response

Thank you for listening