[NCM 420] DISASTER NURSING

DISASTER NURSING
2nd SEMESTER ┃A.Y. 2022-2023┃PRELIMS┃TRANS 1┃TRANSCRIBED BY APRIL TOM O. CUENCA
NAME OF LECTURER: MRS. MARY LOIS CHARITY C. ELICANO, RN, MAN
DATE OF LECTURE: FEBRUARY 03, 2022

MISSION STATEMENT D. LANDSLIDES

• Disasters are a primary cause of morbidity and mortality. Nurses • A landslide is defined as the movement of a mass of rock, debris, or
can play an important role in disaster mitigation, but they receive earth down a slope. Landslides are a type of “mass wasting,” which
very little training. This lecture is designed to help to introduce to denotes any down-slope movement of soil and rock under the direct
nursing the concepts of disasters and disaster mitigation. We influence of gravity.
propose you teach your nursing students this lecture to build • Landslides are caused by disturbances in the natural stability of a
awareness worldwide. slope. They can accompany heavy rains or follow droughts,
earthquakes, or volcanic eruptions. Mudslides develop when water
DISASTER rapidly accumulates in the ground and results in a surge of water-
• It is a result of vast ecological breakdown in the relation between saturated rock, earth and debris.
humans and their environment, as serious or sudden event on
such scale that the stricken community needs extraordinary efforts E. HURRICANES
to cope with outside help or international aid. • The primary health hazard from hurricanes or cyclones lies in the
risk of drowning from the storm surge associated with the landfall of
TYPES OF DISASTERS the storm. Most deaths associated with hurricanes are drowning
1. Natural disasters: Geographical, meteorological, hydrological, deaths.
climatological, and biological. • Secondarily, a hazard exists for injuries from flying debris due to the
2. Man-made disasters: Terrorism, technological, and transitional high winds.
human shelters. • Nurses can be instrumental in providing direct emergency care for
drowning and head injuries.
NATURAL DISASTERS
• Natural disasters are catastrophic events with atmospheric, F. TORNADOES
geological, and hydrological origins (e.g., droughts, earthquakes, • The primary hazard from a health perspective in a tornado is the risk
floods, hurricanes, and landslides) that can cause fatalities, of injuries from flying debris. The high winds and circular nature of
property damage and social environmental disruption. a tornado lead to the elevation and transport of anything that is not
fastened down. Most victims of tornadoes are affected by head and
1. GEOGRAPHICAL DISASTERS chest trauma due to being struck by debris or from a structural
collapse. Some individuals are injured while on the ground. Others
A. EARTHQUAKES are lifted into the air by the tornado and dropped at another location.
• A significant global concern.
• The primary health concern: 2. METEOROLOGICAL DISASTERS
✓ Injuries arising from structural collapse. • Violent, sudden and destructive change to the environment related
✓ Most injuries occur amongst individuals trapped at the time of to, produced by, or affecting the earth’s atmosphere, especially the
the earthquake. weather-forming processes.
• Well known prevention strategy is to prevent buildings from
collapsing. A. FLOODS
• There is a recognized need to develop better rescue strategies for • Floods may originate very quickly following a quick rain storm, or
retrieving individuals from collapsed buildings. they may develop over a short period following an extended period
of rain or quick snow melt.
B. TSUNAMI • The primary hazard from flooding is drowning.
• Is a series of extremely long waves caused by a large and sudden • Longer term health concerns from flooding are the development of
displacement of the ocean, usually the result of an earthquake the disease from contaminated water and lack of hygiene.
below or near the ocean floor.
• Tsunami is a Japanese word that means “harbour wave.” B. WILD FIRE
• Approximately 80% of tsunamis happen inside the Pacific Ocean’s • Also called wildland fire, uncontrolled fire in a forest, grassland,
Ring of Fire. brushland, or land sown to crops.
• An earthquake or volcano could cause a tsunami. • Naturally occurring wildfires are most frequently caused by lightning.
• Tsunamis can go about as fast as 500 miles (805 kilometers an There are also volcanic, meteor, and coal-seam fires, depending on
hour), nearly the same speed as a jet plane. the circumstances.
• Human-caused wildfires can be accidental, intentional (arson), or
C. VOLCANOES from an act of negligence.
• Rare, but can be catastrophic when they occur.
• Over the 25-year period (1972-1996), there was an average of six C. HEATWAVE
(6) eruptions per year, causing an average of 1017 deaths and 285 • A heat wave occurs when there is high pressure in the atmosphere
injuries. that forces hot air downward and traps it near the ground. This high-
• Health outcomes are associated with volcanic eruptions: pressure system acts like a lock that prevents the hot air from rising.
✓ Respiratory illnesses from the inhalation of ash.
✓ For individuals close to the volcano, some danger exists from
lava flows, or more likely mud flows.

TRANSCRIBED BY APRIL TOM O. CUENCA 1

D. DROUGHTS RESPONSE
• A drought is a period of time when an area or region experiences • Search and rescue, clearing debris, and feeding and sheltering
below-normal precipitation. The lack of adequate precipitation, victims (and responders if necessary).
either rain or snow, can cause reduced soil moisture or • Activities a hospital, healthcare system, or public health agency take
groundwater, diminished stream flow, crop damage, and a general immediately before, during, and after a disaster or emergency
water shortage. occurs.
• It is one of the most destructive natural disasters in terms of impacts
on agriculture and food security, ecosystems, human health and RECOVERY
water resources. • Getting a community back to its pre-disaster status.
• Activities are undertaken by a community and its components after
BIOLOGICAL DISASTERS an emergency or disaster to restore minimum services and move
• A pandemic is a rare but recurring communicable disease event towards long-term restoration.
that is more widespread than usual seasonal illness. It can occur • Debris Removal.
during any time of the year, not just when seasonal flu or other • Care and shelter
illness are expected. • Damage assessments.
• Funding assistance.
MAN-MADE THREAT AND DISASTERS
• Unpredictable challenges. 1. PRE-IMPACT PHASE
• Disruptive. • It is the initial phase of a disaster, prior to the actual occurrence. A
• Unexpected. warning is given at the sign of the first possible danger to a
• Targeting weaknesses. community; with the aid of weather networks and satellites, many
• Very rare, impossible to conceive before the event. meteorological disasters can be predicted.
• Threats to civilians and information infrastructure. • The role of the nurse during this warning phase is to assist in
preparing shelters and emergency aid stations and establishing
TERRORISM contact with other emergency service groups.
• It is the unlawful use of force or violence against persons or
property to intimidate or coerce a government or its citizens to 2. IMPACT PHASE
further certain political or social objectives. • The impact phase occurs when the disaster actually happens. It is
• Law enforcement generally recognizes two types of terrorism: a time of enduring hardship or injury end of trying to survive.
(1) domestic and (2) international. • This is the time when the emergency operation center is
established and put in operation. It serves as the center for
TECHNOLOGICAL DISASTERS communication and other government agencies of healthcare
• A technological disaster is one that brings on a major crisis, providers to staff shelters. Every shelter has a nurse as a member
threatens the viability of a technological system, causes massive of the disaster action team. The nurse is responsible for
losses of life and property, and may endanger the social psychological support to victims in the shelter.
environment in which it occurs.
• Examples include industrial pollution, ionizing radiation, toxic 3. PRE-IMPACT PHASE
wastes, dam failures, transport accidents, factory explosions, fires • Recovery begins during the emergency phase and ends with the
and chemical spills. Technological hazards also may arise directly return of normal community order and functioning.
as a result of the impacts of a natural hazard event. • The victims of disaster go through four (4) stages of emotional
response:
TRANSPORTATION ACCIDENTS 1. Denial: During this stage, the victims may deny the magnitude
• Transport accidents in view of technological hazards are disaster- of the problem or have not fully registered it.
type terms used to describe technological transport accidents 2. Strong emotional response: In the second stage, the
involving mechanized modes of transport. person is aware of the problem but regards it as overwhelming
• It is comprised of four disaster subsets: accidents involving air, and unbearable.
boat, rail transport and accidents involving motor vehicles on roads 3. Acceptance: During the third stage, the victim begins to
and tracks. accept the problems caused by the disaster and makes a
concentrated effect to solve them.
PHASES OF A DISASTER 4. Recovery: The fourth stage represent a recovery from the
crisis reaction. Victims feel that they are back to normal.
1. Pre-impact phase: Mitigation, prevention and preparedness.
2. Impact phase: Trans-impact, response and recovery.
3. Post-impact phase: Recovery, rehabilitation and development. COMPONENTS OF DISASTER DEBRIS
• Building debris: All waste resulting from the destruction of
MITIGATION structures or buildings.
• Lessen the impact of a disaster before it strikes. • Household debris: All waste resulting from the destruction of
residential materials generated by households.
• Activities that reduce or eliminate a hazard.
• Vegetative debris: All waste resulting from the destruction of dead
• Prevention.
and downed plant material.
• Risk reduction.
• Problem waste streams.
• Examples: Immunization programs and public education

PREPAREDNESS
• Activities are undertaken to handle a disaster when it strikes.
• Activities that are taken to build capacity and identify resources that
may be used.
• Know evacuation shelters.
• Emergency communication plan.
• Preventive measures to prevent the spread of disease.
• Public education.

TRANSCRIBED BY APRIL TOM O. CUENCA 2

 MYTHS ASSOCIATED WITH DISASTERS
• Any kind of assistance needed in disasters.
✓ A response not based on impartial evaluation contributes to
chaos.
• Epidemics and plagues are inevitable after every disaster.
✓ Epidemics rarely even occur after a disaster.
✓ Dead bodies will not lead to catastrophic outbreaks of exotic
disease.
✓ Proper resumption of public health services will ensure the
public’s safety (sanitation, waste disposal, water quality and
food safety).
• Disasters bring out the worst in human behavior.
✓ The majority of responses are spontaneous and generous.
• The community is too shocked and helpless.
✓ Cross-cultural dedication to the common good is the most
common response to natural disasters.

PATTERNS OF MORTALITY AND INJURY

• Disaster events that involve water are the most significant in terms
of mortality.
• Floods, storm surges, and tsunamis all have a higher proportion of
deaths relative to injuries.
• Earthquakes and events associated with high winds tend to exhibit
more injuries than deaths.
• The risk of injury and death is much higher in developing countries
– at least 10 (ten) times higher because of little preparedness and
poorer infrastructure.

DISPLACEMENT OF DISASTER VICTIMS

• Mass shelters.
• Shelter management:
1. Organized team (chain).
2. Sleeping area and necessities.
3. Water and food handling.
4. Sanitation (toilets, showers, etc.)
5. Special care to children and elderly.
6. Health services (physical and mental).

DISASTER AND HEALTH

• In a major disaster, water treatment plants, storage and pumping
facilities, and distribution lines could be damaged, interrupted or
contaminated.
• Communicable diseases outbreak due to:
1. Changes affecting vector populations (increase vector).
2. Flooded sewer systems.
3. The destruction of the healthcare infrastructure.
4. The interruption of normal health services geared towards
communicable diseases.
• Injuries from the event.
• Environmental exposure after the event (no shelter).
• Malnutrition after the event (feeding the population affected).
• Excess NCD mortality following a disaster.
• Mental health (disaster syndrome).

MENTAL WELLNESS
• Little attention is paid to the children.
• Listen attentively to children without denying their feelings.
• Give easy-to-understand answers to their questions.
• In the shelter, create an environment in which children can feel
safe and secure (e.g., a play area).
• In any major disaster, people want to know where their loved ones
are, and nurses can assist in making links.
• In case of loss, people need to mourn:
1. Give them space.
2. Find family friends or local healers to encourage and support
them.
3. Most are back to normal within 2 weeks.
4. About 1% to 3%, may need additional help.

TRANSCRIBED BY APRIL TOM O. CUENCA 3

 [NCM 420] DISASTER NURSING

ICN FRAMEWORK OF DISASTER NURSING COMPETENCIES

2nd SEMESTER ┃A.Y. 2022-2023┃PRELIMS┃TRANS 2┃TRANSCRIBED BY APRIL TOM O. CUENCA
NAME OF LECTURER: MRS. MARY LOIS CHARITY C. ELICANO, RN, MAN
DATE OF LECTURE: FEBRUARY 10, 2022

ICN FRAMEWORK OF DISASTER NURSING COMPETENCIES 4. RECOVERY

• Consists of four areas in the continuum of disaster management • Activities undertaken by a community and its components
that corresponds to the four (4) stages of disaster: the after an emergency or disaster to restore minimum services
prevention, preparedness, response, and recovery stages. and move towards long-term restoration.
a. Debris removal
b. Care and shelter
c. Damage assessments
d. Funding assistance

ICN CODE OF PROFESSIONAL CONDUCT FOR NURSES

• The ICN Code of Ethics for Nurses provides ethical guidance in
relation to nurses' roles, duties, responsibilities, behaviours,
professional judgement and relationships with patients, other
people who are receiving nursing care or services, co-workers and
allied professionals.
• Has four principal elements that provide a framework for
ethical conduct:
1. Nurses and patients or other people requiring care or services,
2. Nurses and practice,
3. Nurses and the profession,
4. Nurses and global health.

ROLE OF NURSING IN DISASTERS

• Disaster preparedness, including risk assessment and multi-
disciplinary management strategies at all system levels, is critical
to the delivery of effective responses to the short, medium, and
long-term health needs of a disaster-stricken population.
(International Council of Nurses, 2006).
PHASES OF THE ICN FRAMEWORK
1. Mitigation: Lessen the impact of a disaster before it strikes NURSES’ ROLES IN DISASTERS
2. Preparedness: Activities undertaken to handle a disaster when it
1. Determine magnitude of the event
strikes
2. Define health needs of the affected groups
3. Response: Search and rescue, clearing debris, and feeding and
3. Establish priorities and objectives
sheltering victims (and responders if necessary).
4. Identify actual and potential public health problems
4. Recovery: Getting a community back to its pre-disaster status
5. Determine resources needed to respond to the needs identified
6. Collaborate with other professional disciplines, governmental and
1. MITIGATION non-governmental agencies
• Activities that reduce or eliminate a hazard 7. Maintain a unified chain of command
a. Prevention 8. Communication
b. Risk reduction
COMMUNICATION IS A SUCCESS KEY
EXAMPLES • Nursing organizations must have a comprehensive and accurate
• Immunization programs registry for all members
• Public education (PAPE): Public awareness and public education • Have a structured plan:
for disaster reduction seek to turn available human knowledge into a. Collaborate and coordinate with local authorities
specific local action to reduce disaster risks. b. Have a hotline 24/7
c. Inform nurses where to report and how (keep records)
2. PREPAREDNESS d. Make sure have a coordinator to prevent chaos
• Activities that are taken to build capacity and identify e. Ensure ways to maintain communication between nurses and
resources that may be used their families
a. Know evacuation shelters
b. Emergency communication plan THE NEED FOR DISASER NURSING TRAINING
c. Preventive measures to prevent spread of disease • 11 million nurses world wide:
d. Public education a. Form the backbone of the health care system
b. Are the frontline health care workers who are in direct contact
3. RESPONSE with the public
• Activities a hospital, healthcare system, or public health c. Contribute to health of individuals, families, communities, and
agency take immediately before, during, and after a disaster the globe
or emergency occurs • Schools of nursing offer little or no information on disaster nursing
(WHO, 2008)
• Shortage of trained instructors/faculty (WHO, 2008)

TRANSCRIBED BY APRIL TOM O. CUENCA 1

 CORE COMPETENCIES DISASER NURSING TRAINING
(WHO, 2018)
1. Ethical and legal issues, and decision making;
2. Care principles;
3. Nursing care;
4. Needs assessment and planning;
5. Safety and security;
6. Communication and interpersonal relationships;
7. Public health; and
8. Health care systems and policies in emergency situations.

NURSES’ ROLES IN DISASTERS

1. Basic life support
2. System and planning for settings where nurses work
3. Communications (what to report and to whom)
4. Working in the damaged facilities and with damaged equipment
5. Safety of clients and practitioners
6. Working within a team (understand each member’s role and
responsibility)
7. Infection control
8. Mental and psychosocial support

CONCLUSION
• Hardly a day now passes without news about a major or complex
emergency happening in some part of the world. Disasters
continue to strike and cause destruction in developing and
developed countries about their vulnerability to occurrences that
can gravely affect their day to day life and their future. Nurses in
any location will be on the frontline as care giver and managers
in the event of damaging disaster.
• So they need to have adequate knowledge and framing to work in
such a unique, chaotic stressful situations and to identify and meet
the complex, multifarious health needs of victims of disaster.

TRANSCRIBED BY APRIL TOM O. CUENCA 2