DISASTER NURSING GOLDEN LECTUREKawkab Shishani, RN, PhDCommunity Health NursingKawkab.shishani@gmail.comJordan

Richard Garfield, RN, DrPH Director WHO/PAHO Collaborating Center School of Nursing, Columbia University in the City of New York

Nicolas Padilla, MDUniversidad de GuanajuatoMexico

Ronald LaPorte, PhDDirector Telecommunications and Disease Monitoring; WHO Collaborating CenterUniversity of Pittsburgh June 8, 2009

NURSES AND EDUCATION

Education is the most powerful weapon which you can use to change the world.

Nelson Mandela

MISSION STATEMENT

Disasters are a primary cause of morbidity and mortality. Nurses can play an important role in disaster mitigation, but they receive very little training. This lecture is designed to help to introduce to nursing the concepts of disasters and disaster mitigation. We propose that you teach this lecture to your nursing students to build awareness world wide.

OBJECTIVES 1. Define a disaster2. Discuss patterns of mortality and injury3. Understand impact of disasters on health 4. Describe the factors that contribute to

disasters severity5. Discuss role of nursing in disasters 6. Apply principles of triage in disaster7. Analyze the WHO components of effective

disaster nursing

WHAT IS DISASTER Is a result of vast ecological breakdown in

the relation between humans and their environment, as serious or sudden event on such scale that the stricken community needs extraordinary efforts to cope with outside help or international aid.

TYPES

Natural Pandemics Transportation Technological Terrorism

HURRICANES

The primary health hazard from hurricanes or cyclones lies in the risk of drowning from the storm surge associated with the landfall of the storm. Most deaths associated with hurricanes are drowning deaths.

Secondarily, a hazard exists for injuries from flying debris due to the high winds.

Nurses can be instrumental in providing direct emergency care to drowning and head injuries.

TORNADOES

The primary hazard from a health perspective in a tornado is the risk for injuries from flying debris. The high winds and circular nature of a tornado leads to the elevation and transport of anything that is not fastened down. Most victims of tornadoes are affected by head and chest trauma due to being struck by debris or from a structural collapse. Some individuals are injured while on the ground. Others are lifted into the air by the tornado and dropped at another location.

FLOODS

Floods may originate very quickly following a quick rain storm, or they may develop over a short period following an extended period of rain or quick snow melt

The primary hazard from flooding is drowning Longer term health concerns from flooding is the

development of disease from contaminated water and lack of hygiene.

EARTHQUAKES

A significant global concern The primary health concern:

• Injuries arising from structural collapse• Most injuries occur amongst individuals

trapped at the time of the earthquake Well known prevention strategy is to prevent

buildings from collapsing There is a recognized need to develop better

rescue strategies for retrieving individuals from collapsed buildings

VOLCANOES Rare, but can be catastrophic when they occur Over the 25 year period (1972-1996), there

was an average of 6 eruptions per year, causing an average of 1017 deaths and 285 injuries

Health outcomes are associated with volcanic eruptions:• Respiratory illnesses from the inhalation of

ash • For individuals close to the volcano, some

danger exists from lava flows, or more likely mud flows

VULNERABILITIES, NEEDS, AND ABILITIES VARY

0

1000000

2000000

3000000

4000000

5000000

6000000

7000000

8000000

9000000

10000000

1900

1905

1910

1915

1920

1925

1930

1935

1940

1945

1950

1955

1960

1965

1970

1975

1980

1985

1990

1995

2000

Conflict Natural Disasters

MAN-MADE THREATUnpredictable ChallengesDisruptive UnexpectedTargeting weaknesses Very rare, impossible to conceive before event Threats to Civilians, Information Infrastructure

COMPONENTS OF DISASTER DEBRIS Building Debris Household Debris Vegetative Debris Problem Waste Streams

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 ever 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 responses spontaneous and generous

The community is too shocked and helpless Cross-cultural dedication to common good is 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 times higher because of little preparedness, poorer infrastructure.

DISPLACEMENT OF DISASTER VICTIMS Mass Shelters Shelter management:

• Organized team (chain)• Sleeping area and necessities• Water and food handling• Sanitation (toilets, showers,..) • Special care to children and elderly • Health services (physical, mental)

DISASTER AND HEALTH In a major disaster water treatment plants,storage & pumping facilities, & distributionlines could be damaged, interrupted orcontaminated. Communicable diseases outbreak due to:

Changes affecting vector populations (increase vector),

Flooded sewer systems, The destruction of the health care infrastructure,

and The interruption of normal health services

geared towards communicable diseases

DISASTER AND HEALTH 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. play area)

MENTAL WELLNESS In any major disaster, people want to know

where their loved ones are, nurses can assist in making links.

In case of loss, people need to mourn:• Give them space, • Find family friends or local healers to

encourage and support them• Most are back to normal within 2 weeks•  About1% to 3%, may need additional help

THE MOST VULNERABLE

THE PHASES OF DISASTER Mitigation:

Lessen the impact of a disaster before it strikes Preparedness:

Activities undertaken to handle a disaster when it strikes

Response: Search and rescue, clearing debris, and feeding

and sheltering victims (and responders if necessary).

Recovery: Getting a community back to its pre-disaster

status

MITIGATION Activities that reduce or eliminate a hazard

Prevention Risk reduction

Examples Immunization programs Public education

PREPAREDNESS Activities that are taken to build capacity and

identify resources that may be used Know evacuation shelters Emergency communication plan Preventive measures to prevent spread of

disease Public Education

RESPONSE Activities a hospital, healthcare system, or

public health agency take immediately before, during, and after a disaster or emergency occurs

RECOVERY Activities undertaken by a community and its

components after an emergency or disaster to restore minimum services and move towards long-term restoration. Debris Removal Care and Shelter Damage Assessments Funding Assistance

WHAT IS TRIAGE? French verb “trier” means to

sort Assigns priorities when

resources limited Do the best for the greatest

number of patients

WHY IS DISASTER TRIAGE NEEDED Inadequate resource to meet immediate

needs Infrastructure limitations Inadequate hazard preparation Limited transport capabilities Multiple agencies responding Hospital Resources Overwhelmed

ADVANTAGES OF TRIAGE Helps to bring order and organization to a

chaotic scene. It identifies and provides care to those who

are in greatest need Helps make the difficult decisions easier Assure that resources are used in the most

effective manner May take some of the emotional burden

away from those doing triage

WHO DECIDES IN TRIAGE Nurses don’t act for legal fears of being

blamed for deaths, and lack of clarity on where they fit in the command structure

Nurses function to the level of their training and experience.

If nurses they are the most trained personnel the site, they are in charge.

ARE NURSES PREPARED??

HEALTH WORKER DENSITY BY REGION

2.3

2.6

4.2

6.9

8.7

9.9

10.3

0.8

0 2 4 6 8 10 12

Europe

North America

Western Pacific

Middle East

Global

S&Central America

Asia

Sub-Saharan Africa

Workers per 1,000 population

NURSES

KILLED BY DISASTERS

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)

NURSES’ ROLES IN DISASTERS

Determine magnitude of the event Define health needs of the affected groups Establish priorities and objectives Identify actual and potential public health

problems Determine resources needed to respond to the

needs identified Collaborate with other professional disciplines,

governmental and non-governmental agencies Maintain a unified chain of command Communication

COMMUNICATION IS A SUCCESS KEY Nursing organizations must have a

comprehensive and accurate registry for all members

Have a structured plan:• Collaborate and coordinate with local authorities • Have a hotline 24x7• Inform nurses where to report and how (keep

records)• Make sure have a coordinator to prevent chaos• Ensure ways to maintain communication

between nurses and their families

THE NEED FOR DISASTER NURSING TRAINING 11 million nurses world wide:

• Form the backbone of the health care system

• Are the frontline health care workers who are in direct contact with the public

• Contribute to health of individuals, families, communities, and the globe

Schools of nursing offer little or no information on disaster nursing (WHO, 2008)

Shortage of trained instructors/faculty (WHO, 2008)

CORE COMPETENCIES IN DISASTER NURSING TRAINING Ethical and legal issues, and decision making; Care principles; Nursing care; Needs assessment and planning; Safety and security; Communication and interpersonal

relationships; Public health; and Health care systems and policies in emergency

situations(WHO, 2008)

TOPICS THAT MUST BE COVERED BY DISASTER NURSING TRAINING Basic life support System and planning for settings where nurses

work Communications (what to report and to whom) Working in the damaged facilities and with

damaged equipment Safety of clients and practitioners Working within a team (understand each

member’s role and responsibility) Infection control Mental and psychosocial support

(WHO, 2006)

SUPERCOURSE INITIATIVE

BUILDING DISASTER NURSING SUPERCOURSE

BUILDING DISASTER NURSING SUPERCOURSE

BUILDING DISASTER NURSING SUPERCOURSE

“Most of all, if gains in health and nutrition during emergencies are to be sustained, graduates need to understand the importance of capacity building of national staff and institutions.”

Salama et al, Lessons Learned from Complex Emergencies

DISASTER NURSING SUPERCOURSE o To join the Nursing Supercourse, please visit

www.pitt.edu/~super1 or e-mail

super2@pitt.edu.

o Membership in the Global Health Network Supercourse will allow you to receive free Supercourse CDs, just in time lecture, and annual prevention lectureso Note: “send this lecture to a friend” button works from PowerPoint slide show mode

More information This lecture is available at: http://www.pitt.edu/~super1/lecture/lec35051/

index.htm

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