- Disasters have been integral parts of the human experience since the beginning of time, causing premature death, impaired quality of life, and altered health status. The recent dramatic increase in natural disasters, their intensity, the number of people affected by them, the human and economic losses associated with these events have placed an imperative on disaster planning for emergency preparedness.
- Disaster can be defined as “Any catastrophic situation in which the normal patterns of life (or ecosystems) have been disrupted and extraordinary, emergency interventions are required to save and preserve human lives and/or the environment.”
- According to WHO:-A disaster is any occurrence that causes damage, economic disruption, loss of human life, property, or deterioration in health and services on a scale sufficient to warrant an extraordinary response from outside the affected area or community.”
- The Red –Cross has defined a disaster as, “ An occurrence such as a hurricane, tornado, storm, flood, high water, wind-driven water, tidal wave, earthquake, drought, blizzard, pestilence, famine, fire, explosion, building collapse, transportation wreck, or other situation that causes human suffering or creates human that the victims cannot alleviate without assistance.”
Meaning of disaster words:
- D – Destructions
- I – Incidents
- S – Sufferings
- A – Administrative, Financial Failures.
- S – Sentiments
- T – Tragedies
- E – Eruption of Communicable diseases.
- R – Research program and its implementation
Features of Disaster
Classification of Disaster
Disasters are classified in various ways, on the basis of its origin/cause.
1. Natural disasters
2. Man-made disasters
And On the basis of speed of onset-
- Sudden onset disasters (geological and climate hazards):
Earthquakes, tsunamis, floods, tropical storms, volcano, landslides.
- Slow onset disasters (Environmental Hazards):
Droughts, famine ,environmental degradation, desertification, deforestation
Different Levels of Disaster.
- Level I: If the organization, agency, or community is able to contain the event and respond effectively utilizing its own resources.
- Level II: If the disaster requires assistance from external sources, but these can be obtained from nearby agencies.
- Level III: If the disaster is of a magnitude that exceeds the capacity of the local community or region and requires assistance from state-level or even federal assets.
Key elements of Disasters
Disaster nursing can be defined as “the adaptation of professional nursing knowledge, skills, and attitude in recognizing and meeting the nursing, health and emotional needs of disaster victims.”
Disaster Management & their Principles.
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 (Grab and Eng 1969):
- 1. Prevent the occurrence of the 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 reconstruction of lives.
How to Manage Disaster\PHASES OF DISASTER )
There are six different phases of sudden impact disaster :
- Non-disaster or Inter – disaster phase
- Pre- Impact Phase (Pre Disaster or warning Phase)
- Impact Phase
- Emergency Phase
- Post- Impact Phase
- Rehabilitation or Reconstruction Phase.
- THE NON – DISASTER OR INTER DISASTER PHASE :-
This is the phase for PREPAREDNESS. Before the disaster strikes the officials should 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. PRE-IMPACT PHASE
It is the initial phase of disaster, prior to the actual occurrence. A warning is given at the sign of the first possible danger to a community with the aid of weather networks and satellite many meteorological disasters can be predicted.
The earliest possible warning is crucial in preventing loss of life and minimizing damage. This is the period when the emergency preparedness plan is put into effect emergency centers are opened by the local civil, detention authority. Communication is a very important factor during this phase; disaster personnel will call on amateur radio operators, radio and television stations.
a. Occurs prior to the onset of the disaster.
b. Includes the period of threat and warning.
c. May not occur in all disaster.
3. IMPACT PHASE
The impact phase occurs when the disaster actually happens.
The impact phase may last for several minutes (e.g. after an earthquake, plane crash or explosion.) or for days or weeks (eg in a flood, famine or epidemic).
The impact phase continues until the threat of further destruction has passed and emergency plan is in effect. This is the time when the emergency operation center is established and put in operation. It serves as the center for communication and other government agencies of health tears care healthcare providers to staff shelters. Every shelter has a nurse as a member of disaster action team. The nurse is responsible for psychological support to victims in the shelter.
a .Inventory and rescues period.
b. Planning for
· Use of resources
· Rescue of victims
· Minimizing further injuries and property damage.
- 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 action that are necessary to save lives, including
- Search and rescue operation
- First aids
- Emergency medical assistance
- Restoration of emergency communication and transportation network
- Public health surveillance
In some cases, evacuation from areas still vulnerable to the hazards
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. POST- IMPACT PHASE
Recovery begins during the emergency phase and ends with the return of normal community order and functioning. For persons in the impact area this phase may last a lifetime (e.g. – victims of the atomic bomb of Hiroshima). The victims of disaster in go through four stages of emotional response.
1. Denial – during the stage the victims may deny the magnitude of the problem or have not fully registered. The victims may appear usually unconcerned.
2. Strong Emotional Response – in the second stage, the person is aware of the problem but regards it as overwhelming and unbearable. Common reaction during this stage is trembling, tightening of muscles, speaking with the difficulty, weeping heightened, sensitivity, restlessness sadness, anger and passivity. The victim may want to retell or relieve the disaster experience over and over.
3. Acceptance – During the third stage, the victim begins to accept the problems caused by the disaster and makes a concentrated effect to solve them. It is important for victims to take specific action to help themselves and their families.
4. Recovery – The fourth stage represent a recovery from the crisis reaction. Victims feel that they are back to normal. A sense of well-being is restored. Victims develop the realistic memory of the experience.
a. Occurs when the majority of rescue operations are completed.
b. Remedy and recovery period.
c. Lengthy phase that may last for years.
6. THE 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 re-establishing 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.
READINESS FOR DISASTER :-
Effective handling of disasters requires combined efforts of the local agencies in the area such as public and private hospitals, public health divisions, public welfares departments, public works departments, police and fire departments, red Cross and civil defence services, if these exist in the area.
- Resources for readiness
- Disaster pre planning
- Resources for readiness :-
- Red cross :- we are familiar with red cross services, it is primary concern in a disaster situation is to provide relief for human suffering in the form of food, shelter, clothing, medical care and occupational rehabilitation of victims.
- Community and local government : they share responsibility in clearing rubble, maintaining law and order, determining the safety of structure for habitation, repairing bridges, resuming transportation, maintaining sanitation, providing safe food and drinking water etc.
- Civil defence services :- The civil defence and medical facilities programs provide for shelters, established communication linkage, post disaster services, assistance to affected community in the area of health, sanitation, maintaining law and order, fire fighting, Clearing debris, provision for safe drinking water, prevention and control of epidemics of various disease etc. An emergency planning section at both central and state government level is established; this is a combine effort of various ministries/departments like meteorology, health and environment, food and supply, transport, housing , finance, home etc.
Medical facilities are designed to cater for :-
- Organizing resuscitation and first aid at the site of disaster
- Arrangement for hospitalization
- Setting up blood donor centre
- Organizing equipment and supply stores etc.
- Disaster pre-planning :-
Pre-planning to manage disaster is very important to make the best possible use of the resources. It is also require at all levels to minimize inadequacy in distribution of facilities of resources and also confusion at disaster site. Some of the pre – planning aspects for disaster related to medical care as follows-
- Hospital Disaster planning-
Depending upon the hospital location and size, Hospital mobilizes its resources to manage any disaster. It should provide for immediate action in the event of
- An internal disaster in hospital in itself. E.g. fire, explosion etc.
- Some minor external disaster like transport, accidents, fire, explosion etc.
- Major external disaster involving large number of casualty in fire outbreak, tornado, tidal wave, train wreck, Epidemics of life threatening diseases, food poisoning, earthquake etc.
- Threat of disaster : a fire threatening damage to the building, warnings for tornado, volcanic eruption, war etc
- Disaster in neighbourhood communities/country etc in which hospital may be required to receive casualty from the site of disaster; this will necessitate the expansion of facilities to care for casualty and their treatment.
- Evacuation :-
There is usually a system, which on order of the Medical Superintendent is activated e.g.
- percentage of evacuation (discharge) of the patient from the hospital
- Addition of extra beds that would be required with necessary facilities to accommodate expected number of casualties.
- Preparation of an emergency Ward as first priority area to receive casualties, establishing secondary priority areas in case additional facilities are required.
- Such facilities should be near to X-ray, operation theatre, central supply, medical store etc.
- Orderly flow of casualty :-
Planning orderly flow of casualty into the hospitals is important to minimize confusion in receiving them. The team of well qualified physicians and nurses at the reception itself shorts out casualties and makes quick decisions of the treatment which can be given in first priority area in cases of shock, fractures, burns or those requiring resuscitation.
- Additional nursing staff volunteers may be called and posted wherever these are most useful.
- In such situations the services of all departments of the hospitals should be well integrated in the disaster plan viz, dietary dept , laundry and public works dept (PWD) or engine leering unit etc
- Planning should also take into consideration, other aspects like problems of traffic control, types of medical records to be maintained, standardization of emergency medical tags; public information centre to handle official announcement and news releases; controlled dissemination of information without or with minimum distortion; preparation of emergency supplies kept ready for immediate transportation. In time of mass disaster all ambulances are directed to report on the scene. Arrangement for additional vehicles should be made in case more of these are required at the scene.
Planning provision for additional communication system would take into consideration the fixing of an additional switch board, messenger runner services under central direction and also planning of any other communication means that may be required, it is important to keep the hospital informed about the inflow of the casualty from the scene.