INTRODUCTION

Disasters are sudden catastrophic events that disrupt born pattern of life and in which there is
possible loss of grief, life and property and addition to multiple injuries.
No community is immune to the emergencies caused by disasters. The disaster events result in
number of deaths, injuries amongst the community, wide spread destruction of property,
economic loses etc and community requires immediate assistance to overcome wing its effects.
Both in man-made disasters and natural disasters the role of nurse shifts from direct care to that
of providing directions to and teaching and supervision of non-personnel available to tackle the
disaster.

DEFINITIONS OF DISASTER
 According to WHO, "Any occurrence, that causes damage, ecological disruption, loss of human
life, deterioration of health and health services, on a scale sufficient to warrant an extra
ordinary response from outside the affected community or area."
 A disaster is an event located in time and space which produces conditions whereby the
continuity of life and process of social units becomes problematic.
 A disaster is an overwhelming ecological disruption occurring on a scale sufficient to require
outside assistance.
 It is an event or series of events which seriously disrupts normal activities.
 Any catastrophic situation in which the normal patterns of life have been disrupted and
extraordinary, emergency interventions are required to save and preserve human lives and or
the environment.
 Disaster nursing can be defined as the adaptation of professional nursing skills in recognizing
and meeting the nursing physical and emotional needs resulting from the disaster.

TYPES OF DISASTER
 Natural
 Manmade

Cause
 Slow onset → Onset
 Sudden
Extent of damage
 Minor
 Moderate
 Massive

1. NATURAL DISASTERS (CAUSED BY NATURAL PHENOMENON)

Natural disasters (caused by natural phenomenon).
 Meteorological Disasters: Storms (Like Cyclones, Hailstorms, Hurricanes, Tornados, Typhoons,
& Snow Storms) cold spells, heat waves & droughts
 Typological Disasters: Avalanches, Land Slides& Floods.
 Telluric and Teutonic Disasters: Earth Quakes. Tsunamis & Volcanic Eruptions.
 Biological Disasters: Insect Swarms, (e.g. Locust) and Epidemics of Communicable diseases.
 Civil disturbances: Riots & Demonstrations.
 Epidemic of diseases
 Increase in indigenous diseases
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  Earthquakes

2. MANMADE DISASTER
 Warfare: Conventional Warfare (Bombardment, Blockage, & Siege).
 Non-conventional warfare: Nuclear, Biological and Chemical Warfare, Guerrilla Warfare
Including Terrorism.
 Refugees: Forced movement of large people usually across frontiers.
 Accidents: Transportation Calamities (Land, Air, & Sea). Collapse of Building, Dams &
Other Structures, Mine Disasters
 Technological failures: e.g. A mishap at nuclear power station, a leak at a chemical plant
causing pollution of atmosphere or a breakdown of a public sanitation system.

GOALS OF THE DISASTER NURSING

 To meet the immediate basic survival needs of populations affected by disasters.

 To identify the potential for a secondary disaster.
 To appraise both risks and resources in the environment.
 To correct inequalities in access to health care or appropriate resource.
 To empower survivors to participate in and advocate for their own health and well-being.
 To promote the highest achievable quality of life for survivors.

PRINCIPLES OF DISASTER NURSING

 Rapid assessment of the situation and of nursing care needs. Triage and initiation of life-saving
measures first.
 The selected use of essential nursing interventions and the elimination of nonessential nursing
activities.
 Evaluation of the environment and the mitigation or removal of any health hazards.
 Prevention of further injury or illness.
 Leadership in coordinating patient triage, care, and transport during times of crisis.
 Provision of understanding, compassion and emotional support to all victims and their families.

CAUSES OF DISASTERS AND THEIR IMPACT ON HEALTH

DISASTERS & HEALTH PROBLEMS

 Disasters invariably have health consequences. The health problems in disasters

could be due to either or any combination of factors given below:
 Directly due to impact of drowning during floods, injuries during earth quake Due
to delay in evacuation
 Due to non-availability or inadequate immediate medical care
 Due to disorganization or non availability of centers for advanced medical care
 Due to delay in transportation to medical centers

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 The health hazards resulting from the disaster events depends upon a large number
of factors such as Population density and Population displacement
 Disruption of pre-existing facilities
 Disruption of normal health programmes
 Increased vector breeding
 Climate exposure
 Inadequacy of food & nutrition
 Injuries
 Emotional stress

PHASES OF DISASTER

There are five different phases of sudden impact disasters: inter-disaster, pre-disaster, impact,
emergency and rehabilitation. These phases may last from just a few seconds to months or years, with
one phase merging into the next.

1. The Non-disaster or Inter-disaster Phase

 This is the phase for preparedness. Before the disaster strikes the officials should have in place
disaster prevention measures and should conduct disaster training and education programmes
for the community.
 Several activities should be undertaken in this phase:
 Mapping the potential locations for disasters and associated risks Vulnerability analysis
 Taking an inventory of existing resources Planning appropriate preventive, preparedness and
mitigation measures
 Conducting education and training of health personnel and the community.

2. The Pre-disaster or Warning Phase

 Before a disaster strikes, officials should issue timely warnings, take protective actions, and
possibly evacuate the population
 The effectiveness of protective actions will depend largely on the level of emergency-
management activities should be undertaken preparedness of the population, particularly at the
community level.
 During Issuing early sanitation facilities in the shelter places this phase, several essential
warnings on the basis of predictions of the impending disaster implementing protective
measures evacuation, preparing temporary shelters (Sale water)

3. The Impact Phase

 When disaster strikes, destruction, injuries, and death occur.
 It may last for a few seconds (earthquakes) or for several days (floods).

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 The impact on human health varies according to the nature of the disaster itself, population
density, pre disaster health and nutritional status, climate, and the organization of health
services.

4. The Emergency Phase (also called the Relief or Isolation Phase)

The emergency phase starts immediately after impact and is the time for providing relief and
assistance to the victims. This phase requires actions that are necessary to save lives, including:
 Search and rescue operations
 First aid
 Emergency medical assistance
 Restoration of emergency communications and transportation network
 Public health surveillance in some cases, evacuation from areas still vulnerable to the hazard.
 In the immediate post impact period the local community is isolated and the survivors
themselves` accomplish many of the most pressing rescue tasks, by using locally available
resources.
 The existence of district-and community preparedness plans greatly increases the self-reliance
and effectiveness of assistance, contributing to the reduction of disaster-related mortality and
morbidity.

5. The Reconstruction or Rehabilitation Phase

 As the emergency or relief phase ends, restoration of pre-disaster conditions begins.

 The reconstruction phase, which should lead to the restoration of pre-disaster conditions,
includes reestablishing normal health services and assessing, repairing, and reconstructing
damaged facilities and buildings.
 This phase is also the time for thinking about the lessons learned from the recent disaster that
could assist in improving current emergency-preparedness plans
 This phase actually represents the beginning of a new inter-disaster phase.
 The time span for reconstruction or recovery is often difficult to define. It may start fairly early
even during the emergency period, and may last for many years.

NATIONAL POLICY ON DISASTER MANAGEMENT 2009

On 23rd December 2005, the Government of India took a defining step by enacting the disaster
management act, 2005 which envisaged the creation of the National disaster management
authority, headed by Prime Minister, state disaster management authorities, headed by the chief
ministers and district disaster management authorities headed by District Collector to spearhead
and adopt a holistic and integrated approach to disaster management.

VISION
To build a safe and disaster resilient India by developing a holistic, proactive, multi-disaster
driven strategy through a culture of prevention, mitigation, preparedness and response.

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 DISASTER MANAGEMENT
 A disaster refers to a catastrophe, mishap, calamity or grave occurrence from
natural or manmade causes, which is beyond the affected community.
 Disaster management involves a continuous and integrated process of planning,
organizing, coordinating and implementing measures which are necessary or
expedient for:
 Prevention of danger or threat of any disaster
 Mitigation or reduction of risk of any disaster or its severity or consequences
Capacity building including research and knowledge management
 Preparedness to led with any disaster
 Prompt response to any threatening disaster situation or disaster
 Assessing the severity or magnitude of effects of any disaster Evacuation, rescue
and relief

DISASTER MANAGEMENT CYCLE/PROCESS

DISASTER MANAGEMENT PROGRAM

ASPECTS
1. Disaster mitigation

2. Disaster preparedness

3. Disaster response

4. Recovery/Rehabilitation

1.DISASTER PREVENTION/MITIGATION
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  Prevention/mitigation is the process designed to prevent or minimize the risks related to
disaster.
 Identifying risk and taking appropriate action may prevent a disaster altogether or reduce the
effects of the disaster.
MITIGATION ACTIVITIES INCLUDING THE FOLLOWING.

1. Awareness and education such as holding community meeting on disaster preparation.

2. Disaster relief such as building retaining walls to divert flood water away from a residence.
3. Advocacy such as supporting actions and efforts for effective building codes and prudent land
use.

Mitigation involves reducing the actual or probable effects of extreme disaster on man and his
environment.

2. DISASTER PREPAREDNESS
Preparedness is the phase of disaster management where planning and readiness are a priority.
Preparedness can be defined as, activities and measures taken in advance to ensure effective
response to the impact of hazards, including the issuance of timely and effective early warnings
and the temporary evacuation of people and property from threatened locations. It includes a
variety of measures to insure that a community is prepared to react to any emergency.
Preparedness Include:
 Recruiting volunteers
 Training Public Education
 Evaluating
 Planning Equipping
 Exercising

Preparedness it a continuous process that requires periodic review and revision based on changes
in the environment, staff changes, new information and technology.

3.DISASTER RESPONSE

Disaster mitigation is a collective term used to encompass all activities undertaken in

anticipation of the occurrence of a potentially disaster event including preparation and long
term risk reduction measures

OBJECTIVES

 Prevent unnecessary morbidity, mortality and economic loss resulting directly from the
disaster Eliminate morbidity, mortality and economic loss directly attributable to
mismanagement of disaster relief efforts
 Provide quality care to victims
 Response phase incorporate the immediate action taken during the disaster It includes
mobilization of responders and resources to the disaster area.
 This phase may last a few days to several weeks depending on the magnitude of the disaster

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 INTERVENTIONS IN A DISASTER SITUATION

 Relief refers to the period immediately following the occurrence of all disaster when steps are
taken to meet the need of survivors with respect to shelter, water and medical care.
Rehabilitation includes activities that are undertaken to support the victims return to normal
life and reintegration in to regular community functions.

DISASTER MANAGEMENT
In disaster reconstitution of the following critical substrates is mandatory to restore institutional
function.
1. Personnel

2. The physical Plan

3. Supplies and Equipment Communication

4. Supervision

5. Transportation

The key to effective disaster management is pre disaster planning and preparation disaster. The
principles of disaster planning have been but lined in a publication from the civil Defense
preparedness Agency..
The plans should include activities for disasters that occur internally as well as externally.

TRIAGE

Triage is a French word meaning ‘sorting’ or ‘categorizing’. During the disaster, the goal is to
maximize the number of survivors by sorting the treatable from the untreatable victims.
American Red Cross (1982) gives colour coding probably the best and most easily understood
system is the first priority, second priority, third priority, dying or dead system.

I. RED MOST URGENT 1ST PRIORITY

These clients have reasonable chance of survival only if they receive immediate treatment.
Emergency treatment is initiated immediately and continued during the transportation. This
includes victims with
 Respiratory insufficiency.
 Cardiac arrest
 Hemorrhage
 Severe abdominal injury.

II. YELLOW-2ND PRIORITY

These victims can wait for transportation after they receive initial emergency treatment.

 Immobilized closed fracture:

 Soft tissue injury without haemorrhage.

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  Burns less than 40% of the body.

III. GREEN-3RD PRIORITY

 Victims in this category are ambulatory have minor tissue injuries and may be dazed.
They can be treated by non-professionals and held for observations if necessary.

IV. BLACK - DYING OR DEAD.

 At the disaster site or primary triage point simple support measures can alleviate the
psychological trauma experienced by survivors. These measures
 Establishing lines of communication with the health include the following.
 Keeping families together, especially children with parents
 Assigning a companion to frightened or injured help each other service officer

 Arranging with the mass care supervisor for the purchases and replacement of essential
prescription for persons in the shelter..

 victims or placing victims in group when they can Nurse Role in Psychological Needs of
Victims Disaster produces physical, social and psychological

 Giving survivor's tasks to keep them busy and reduce trauma to their self-esteem Provide
adequate shelter food and rest

 Establishing and maintaining a communication network to reduce rumors.

 Encouraging individuals to share their feelings and support each other.

 Isolating victims who demonstrate hysterical or panic behavior

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4. RECOVERY/REHABILITATION

When immediate needs are met. The recovery phase can begin. This phase include,
 Assisting community
 Restoration of vital functions
 Rebuilding housing
 Recovery phase is a long-term phase
 Assisting affected people
 Rebuilding infrastructure

NURSE'S PREPARATION TO FACE DISASTER

PERSONAL PREPAREDNESS

Conflict between family and work related responsibilities abound. The nurse assisting in disaster
relief efforts must be as healthy as possible both physically and mentally. Personal and family
preparations can help ease some of the conflicts that arise and will allow nurses to attend to
client needs sooner than one way anticipates.
The following are the emergency supplies that should be prepared and stored in an easy to carry
container.

 A 3-days supply of water.

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 One change of clothing and footwear per person and one blanket per person.
 A first aid kit that includes your family prescription medications.
 Emergency tools including a battery powered radio, flashlight and plenty of extra batteries.
 Candles and matches.
 An extra set of car keys and credit cards, cash or traveler's cheques.
 Sanitation supplies, including toilet paper soap feminine hygiene items and plastic garbage bags.
 Special items for infant elderly or disabled family members.
 An extra pair of eyeglasses important documents should always be kept in a waterproof
container.

PROFESSIONAL PREPAREDNESS

Professional preparation requires that nurses become aware of and understand the disaster plans
at their work place and community nurses who take disaster preparation will read and
understand will participate in disaster drills arid community mock disasters. Adequately
prepared nurses can function in a leadership capacity and assist others towards smoother
recovery phase; Personal items that are recommended for nurses preparing to help in a disaster
include the following:
 Copy of professional license Personal equipment such as stethoscope Flash light and extra
batteries
 Cash
 Warm clothing and a heavy jacket for weather appropriate clothing. Record keeping materials
 Pocket sized references books

PRINCIPLES OF DISASTER MANAGEMENT

According to Gach and Eng. (1969) there are eight fundamental principles that should be
followed by all who have a responsibility for helping the victims of a disaster.

THE EIGHT BASIC PRINCIPLES ARE AS FOLLOWS:

1. Prevent the occurrence of disaster whenever possible.

2. Minimize the number of casualties if the disaster cannot be prevented.
3. Prevent further casualties from occurring after the initial impact of the disaster.
4. Rescue the victims
5. Provide first aid to the injured
6. Evacuate the injured to medical facilities.
7. Provide definitive medical care.
8. Promote re-construction of live

NURSING CARE GOALS FOR DISASTER NURSING

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 Hospital nurses will be needed to care for disaster victims as they are brought in for acute care
problems.
Nurses Role at Emergency Aid Stations
Nurses are involved in providing care at emergency aid stations. At least one registered nurse
must be present at all times while the emergency aid station is opened.

The responsibilities of nurse in charge

1. Arranging with the volunteer medical consultant for initial and daily health checks based on
the health needs of shelter residents.
2. Establishing nursing priority and planning for health care supervision.
3. Planning for appropriate transfer of patients to community health care facilities as necessary.
4. Evaluating health care needs.
5. Arranging for secure storage of supplies. equipment records and medications and periodically
checking to see whether material. goods must be ordered.
6. Requesting and assigning volunteer staff to appropriate duties and providing on the job
training and supervision.
7. Consultation with the food supervisor regarding the preparation and distribution of special
diets including infant formulas.
8. Planning and recommending adequate staff and facilities when local health departments
initiate an immunization program for shelter residents.
9. Establishing lines of communication with the health service officer
10. Arranging with the mass care supervisor for the purchases and replacement of essential
prescription for persons in the shelter.

NURSE ROLE IN PSYCHOLOGICAL NEEDS OF VICTIMS

Disaster produces physical, psychological and social consequences that are exhibited to various
degrees in different persons, Families communities and cultures depending on their past
experiences, coping skills and the scope and nature of disaster. Because most people affected by
a disaster pass through predictable stages of psychological response, nurses and other health
care, professionals can anticipate and prepare for the needs of the victims.

 To function effectively the nurses and health workers use some of the defense mechanisms. The
nursing interventions more helpful here is
 crisis reduction and counselling crisis intervention.
 Defusing (clearing the disillusions)
 Debriefing (discuss the event, feeling and reduction coping strategies etc.)
 A quick psychological assessment guide is a useful tool to help emergency personnel determine
the psychological state of victims. After disaster the victims who are suffering psychological
crisis will not seek for help. Therefore it is essential that the nurse to assess the stress level of
victims.

ETHICAL AND LEGAL IMPLICATIONS

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 Standing Medical Orders: A nurse trained in disaster nursing is in a position to give first aid
treatment and take decisions to transport casualties to the hospital.
 Standing orders guidelines
 Initial treatment and medication for expected general illness.
 Establishment of an infirmary for those who are ill but do not require hospitalization.
 Organization of immunization programmes against notifiable diseases for the area under their
care.
 Responsibility for providing adequate and safe food at least an 1800 calories diet and take
special care of people having diabetes, hypertension, infant and others with therapeutic dietary
needs.
There are no laws specifically defining the scope of practice for nurses, during a disaster
however there are guidelines sources, including the states Nurses Practice Act, Professional
Organization standards, a state attorney's opinions and current and common practice laws
nursing, the American Nurses Association has Standards for emergency nursing practice.

As a volunteer during a disaster a nurse in most situations would be covered by the 'Good
Samaritan' Acts of the state, The purpose of the Good Samaritan acts are to encourage medically
trained persons to respond to medical emergencies by protecting them from liability through
grants of immunity.

CONCLUSION

Disaster management depends upon all personnel performing right task at right time. Disaster
can be natural or man-made Individuals respond in many different ways to the disaster
experience, and emergency care providers are not immune to personal responses to the
experience. Community health nurses provide encouragement, care and support to community
members during a disaster and are equally qualified to meet the challenges of disaster nursing.

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BIBLIOGRAPHY

1. S. Soni. Textbook of Advance Nursing Practice; Jaypee publications; New

Delhi;2013;1st Edition’s 80 – 92
2. Basheer. P . Shabeer; Advanced Nursing Practice;Emmess
Publications;Bangalore;2017; 2nd Edition; p 686 – 699
3. Module of Disaster Management for Nursing staff
4. Slideshare.com

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 Emergency Operation Centre and Emergency Medical System
In the event of a disaster situation, the Emergency, Operation Center (EOC) becomes
operational. Each community determines the local and personnel involved in their EOC. These
personnel will be involved in treating people at the scene of the disaster as well as at other
designated locations, including local hospitals.

National Executive Committee

It Comprises
• Union home secretary (Chair Person)
• Secretary agriculture
• Secretary atomic energy Secretary defence
• Secretary drinking water supply
• Secretary environment and forests
• Secretary finance
• Secretary health
• Secretary rural development
• Secretary science and technology, space Secretary tele communication
• Secretary urban development
• Chief of integrated defense staff.

State disaster management authority

• Chief Minister (Head)
• SEC (State executive committee) Chief Secretary [Head]
• District Disaster Management Authority
• Headed by District Collector
• Local Authorities
• Panchayatic Raj Institutions
• Municipalities
• Town Planning Authorities

National Institute of Disaster Management

National Disaster Response Force
Mitigation Reserves
Existing Institutional Arrangements
Cabinet Committee of management of Natural calamities and cabinet committee on security
[CCMNC )
CCMNC deals with the all aspects relating to the management of natural calarnities which
includes
• Assessment of the situation
• Identification of measures and program
• Action to reduce its impact
• Monitor and Suggest long-term measure for prevention
• Formulate program for public awareness
• The CCS needs with issues related to defense of the country, law and order and internal security.

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 High Level Committee

• High level committee includes the interministerial teams which deputed in case of severe
calamities
• Interministerial group is headed by union home secretary.
• High level committee comprising the finance minister as chairman. Members of high level
committee are calamities
• Home minister.
• Agriculture ministe
• Deputy Chairman of planning commission

National Crisis Management Committee

Cabinet Secretary (Head)

Secretary NDMA (Member)

CMG NEC

Armed Forces
• Conceptually, the Armed forces are called upon to assist the civil administration only when the
situation beyond their coping capabilities.

Central Paramilitary Forces –

• CPMF play a key role at the time of immediate response to disasters

State Police Forces and Fire Services

• They are crucial immediate responders to disasters

Civil Defense and Home Guards

• They will deployed for community preparedness and public

State Disaster Response Force

• States will be encouraged to create response capabilities from within their existing resources
• To start with each state may aim at equipping and training one battalion equivalent force

Financial Arrangements
• Planning commission will give due weightage to funds for disaster management while allocating
resources
• National disaster response and mitigation funds Central Ministenes and departments
• States and district level arrangements
• Mitigation projects.

Disaster Prevention and Mitigation

A multi-pronged approach needs to be adopted to undertake measures

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• Building mitigation measure into all development projects Initiating of national level mitigation
projects by the NDMA in high priority areas with the help of central ministries, departments
concerns and states.
• Encouraging and assisting state level mitigation projects. Indigenous knowledge on disaster and
coping mechanisms adopted by various states will be given due weight age with special focus on
protection of heritage structures

Risk Assessment and Vulnerability Mapping

• Hazard zonation, mapping and vulnerability analysis in a geographic information system base
databases multi-hazard framework will be carried out utilizing geographical information system
base database.
• Hazard zonation mapping and vulnerability analysis based on GIS and remote sensing data,
needs to mandatorily include a ground check component.
• Hazard and consequence mapping on GIS platforms will be prepared for all chemical accident
prone districts

Increasing Trend of Disasters in Urban Areas

• Disasters in urban areas are distinct in many ways and intensity of damage is usually very high.
• Action plans for checking unplanned urbanization and ensuring safer human habitat against all
forms of disasters will be recognized as priority areas.

Critical Infrastructure
It is of utmost importance that critical infrastructure like dams, roads, bridges, flyovers, railway
lines, power stations, water storage towers, irrigation canals, ports are constantly monitored for
safety standards in consonance with worldwide safety benchmarks and strengthened where
deficient.

Environmentally Sustainable Development

• Environmental considerations and developmental efforts, need to go hand in hand for ensuring
sustainability
• Ecosystems of forests, islands, coastal areas, rivers and the agricultural, urban and industrial
environment are also to be considered for restoration of ecological balances and sustainable
development.

Climate Change Adaptation

• Climate change is impacting glacial reserves, water balance, agriculture, forestry, coastal
ecology, biodiversity human and animal health.
• To reduce the impact, synergies in approach and strategies for climate change adaptation and
disaster reduction shall be encouraged and promoted
Preparedness
Role of central ministries and departments and states have to accord the highest priority to building
up their own stress management capabilities plans at all levels will be made in consonance with the
guidelines and provisions in the DM Act 2005.

Forecasting and Early Warning Systems

It is most essential to establish, upgrade and modernize the forecasting and early warning systems
for all types of disasters. The nodal agencies responsible for monitoring and carrying our

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surveillance for specific natural disasters will identifying technological gaps and formulate projects
for their upgradation in a time bound manner.

Communication and Information Technology

The basic communication and IT support requirements for disaster management correspond to
the following three levels.
1. Decision- makers and disaster managers at all levels.
2. Real time dissemination of advance warning and information to the authorities concerned at
various levels and the threatened community.
3. Last mile connectivity at the disaster site for control and conduct of rescue and relief
operations.

Strengthening of the Emergency Operations Centers

The establishment of emergency operations centers at the National State, Metro and District level
and equipping them with contemporary technologies and communication facilities and their
periodic upgradation, will be accorded priority.

Medical Preparedness and Mass Casualty Management

Medical preparedness includes:
Developing and training of medical teams and paramedical workers
• Capacity building
• Trauma and psychosocial care
• Mass casualty management and triage
Creation of mobile surgical teams, mobile hospitals and heli-ambulances for evacuation of patients
is crucial component of DM efforts.

Training, Simulation and Mock Drills

Efficacy of plans and standard operating procedures are tested and redefined through training
seminars and mock drill. The NDMA will assist the states/UTS in these areas and will also
conduct mock drills in different parts of the country.
Partnerships for mitigation and Preparedness
• Community based disaster preparedness
• Stakeholders participation

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