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DISASTER NURSING

Introduction:

In the past two decades, there have been many natural and manmade disasters in

India. Natural disasters like floods, earthquakes, cyclones, droughts and humanmade such as terrorist acts, Nuclear or chemical war, fires and industrial accidents.

Disasters can significantly lead to a degradation of social and economic progress

achieved over decades of initiatives by the people. 80% of countries geographical

area is disaster prone and the majority of people live at or below the poverty line.

India has been devastated by three major disasters in last five years- Super Cyclone

in Orissa, earthquake in Gujarat and now the latest one the tsunami in the

Andaman and Nicober Islands,. Tamil nadu, Andhra Pradesh and Kerala. Each

disaster brought a great deal of miscarry to the affective population.

Definitions of Disaster:

A disaster can be defined as any occurrence that cause damage, ecological

disruption, loss of human life, deterioration of health and health services, Vs a

scale sufficient to warrant as extraordinary response from outside the affected

community or area.

-(W.H.O.)

An occurrence of a severity and magnitude that normally results in death, injuries

and property damage that cannot be managed through the routine procedure andresources of government.

- FEMA (Federal Emergency Management Agency)

A disaster can be defined as an occurrence either nature or manmade that causes

human suffering and creates human needs that victims cannot alleviate without

assistance.

- American Red Cross (ARC)

United Nations defines disaster is the occurrence of a sudden or major misfortune

which disrupts the basic fabric and normal functioning of a society or community.

Definitions of Disaster Nursing:

Disaster Nursing can be defined as the adaptation of professional nursing skills in

recognizing and meeting the nursing physical and emotional needs resulting from a

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disaster. The overall goal of disaster nursing is to achieve the best possible level of

health for the people and the community involved in the disaster.

Disaster Nursing is nursing practiced in a situation where professional supplies,equipment, physical facilities and utilities are limited or not available.

DISASTER alphabetically means:

D - Destructions

I - Incidents

S - Sufferings

A - Administrative, Financial Failures.

S - Sentiments

T - Tragedies

E - Eruption of Communicable diseases.

R - Research programme and its implementation

The global scenario:

Impact of natural disaster in the last 30 years.

Death of 3 million people

Economic loss increased due to disaster like flood

In Indian scenario, 34jmijlion people affected per year and 5116 death per year.

In US, economic loss is 400 million dollar and 3 million people died.

Emergency:-

According to WHO, an emergency is a situation where a sudden incident or event

has occurred and normally used, local responses will suffice to care for the

situation without calling in outside help. E.g.: car accident or a water main

breaking.

Vulnerability:-

Vulnerability in this context can be defined as the diminished capacity of an

individual or group to anticipate, cope with, resist and recover from the impact of a

natural or man-made hazard. The concept is relative and dynamic. Vulnerability is

most often associated with poverty, but it can also arise when people are isolated,

insecure and defenseless in the face of risk, shock or stress.

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Hazard:-

Hazards are defined as phenomena that pose a threat to people, structures, or

economic assets and which may cause a disaster. They could either be manmade or

naturally occurring in our environment.

Epidemiology of Disaster:-

1.Agent

2.Environment

3.Host

Agents-

Primary Agents:

It includes falling of buildings, heat wind rising waters and smoke.

Secondary Agents:

It includes bacteria and viruses that produce contamination or infection after the

primary agent has caused injury or destruction.

Primary or secondary agent will vary according to the type of disaster.

For example: - A hurricane with rising water can cause flooding and high winds,

these are primary agents. The secondary agents would include damaged buildings

and bacteria or viruses that thrive as a result of the disaster. In an epidemic the

bacteria or virus causing a disease is the primary agent rather than the secondary

agent.

Host factors-

In the epidemiological frame work as applied to disaster the host is human-kind.

Host factors are those characteristics of humans that influence the severity of the

disaster effect. Host factors include

Age

Immunization status

Degree of mobility Emotional stability

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Environmental factors-

This includes,

1. Physical Factors

Weather conditions, the availability of food, time when the disaster occurs, theavailability of water and the functioning of utilities such as electricity and

telephone service.

2. Chemical Factors

Influencing disaster outcome include leakage of stored chemicals into the air, soil,

ground water or food supplies.

Eg: - Bhopal Gas Tragedy.

3. Biological Factors:

Are those that occur or increase as result of contaminated water, improper wastedisposal, insect or rodent proliferations improper food storage or lack of

refrigeration due to interrupted electrical services.

Bioterrorism: Release of viruses, bacteria or other agents caused illness or death.

4. Social Factors:

Are those that contribute to the individual social support systems. Loss of family

members, changes in roles and the questioning of religious beliefs are social

factors to be examined after a disaster.

5. Psychological Factors:

Psychological factors are closely related to agents, host and environmental

conditions. The nature and severity of the disaster affect the psychological distress

experienced by the victims.

Types of disasters:-

A. Natural disasters

B. Manmade disasters

C. Biological disasters

Natural disasters--Natural hazards are naturally occurring physical phenomena

caused either by rapid or slow onset events which can

be geophysical (earthquakes, landslides, tsunamis and volcanic

activity), hydrological (avalanches and floods), climatologically(extreme

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temperatures, drought and wildfires), meteorological (cyclones and storms/wave

surges.

Floods-

During a flood

- Turn off the electricity to reduce the risk of electrocution.

- Protect people and property:

- as soon as the flood begins, take any vulnerable people (children, the old, the

sick, and the disabled) to an upper floor;

- whenever possible, move personal belonging upstairs or go to raised shelters

provided for use in floods.

- Beware of water contamination - if the taste, colour, or smell of the water is

suspicious, it is vital to use some means of purification.- Evacuate danger zones as ordered by the local authorities it is essential to comply

strictly with the evacuation advice given. Authorities will recommend that families

take with them the emergency supplies they have prepared.

After a flood

When a flood is over, it is important that people do not return home until told to do

so by the local authorities, who will have ensured that buildings have not been

undermined by water. From then on it is essential to:- wait until the water is declared safe before drinking any that is untreated;

- clean and disinfect any room that has been flooded;

- sterilize or wash with boiling water all dishes and kitchen utensils;

- get rid of any food that has been in or near the water, including canned foods and

any food kept in refrigerators and freezers;

- get rid of all consumables (drinks, medicines, cosmetics, etc.).

Earthquakes-

Earthquakes are the result of forces deep within the earth's interior. Sudden breakwithin the upper layers of the earth, sometimes breaking the surface, resulting in

the vibration of the ground, which were strong enough will cause the collapse of

buildings and destruction of life and property.

Earthquakes are measured according to the Richter scale - the most devastating

effects are seen on level 6 and above, and if the epicenter of the earthquake is

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located in highly populated areas. Earthquakes can cause high numbers of deaths

and injuries as well as serious destruction of buildings and infrastructure.

What to do beforehand

The movement of the, ground in an earthquake is rarely the direct cause of injuries;

most are caused by falling objects or collapsing buildings. Many earthquakes are

followed (several hours or even days later) by further tremors, usually of

progressively decreasing intensity. To reduce the destructive effects of earthquakes

a number of precautions are essential for people living in risk areas:

- Build in accordance with urban planning regulations for risk areas.

- Ensure that all electrical and gas appliances in houses, together with all pipes

connected to them, are firmly fixed.

- Avoid storing heavy objects and materials in high positions.

- Hold family evacuation drills and ensure that the whole family knows what to doin case of an earthquake.

- Prepare a family emergency kit.

During an earthquake

- Keep calm, do no panic.

- People who are indoors should stay there but move to the central part of the

building.

- Keep away from the stairs, which might collapse suddenly.

- People who are outside should stay there, keeping away from buildings to avoid

collapsing walls and away from electric cables.

- Anyone in a vehicle should park it, keeping away from bridges and buildings.

After an earthquake

- Obey the authorities instructions.

- Do not go back into damaged buildings since tremors may start again at any

moment.

- Give first aid to the injured and alen the emergency services in case of fire, burst

pipes, etc.

- Do not go simply to look at the stricken areas: this will hamper rescue work.- Keep emergency packages and a radio near at hand.

- Make sure that water is safe to drink and food stored at home is fit to eat (in case

of electricity cuts affecting refrigerators and freezers).

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You cannot prevent earthquakes but you can reduce the potential damages:

y Development of possible warning indicators.

y Land-use regulations.

y Building regulations.

y Relocation of communities.

y Public awareness and education programs.

Tsunami-

A tsunami is a series of water waves (called a tsunami wave train[1]

) caused by the

displacement of a large volume of a body of water, such as an ocean. The originalJapanese term literally translates as "harbor wave."

Droughts- Drought is an insidious phenomenon. Unlike rapid onset disasters, ittightens its grip over time, gradually destroying an area. In severe cases, drought

can last for many years and have a devastating effect on agriculture and watersupplies.

Drought is defined as a deficiency of rainfall over an extended period a season, a

year or several years relative to the statistical multi-year average for the region.

Lack of rainfall leads to inadequate water supply for plants, animals and human

beings. A drought may result in other disasters: food insecurity, famine,

malnutrition, epidemics and displacement of populations.

Rural communities can sometimes cope with one or two successive rain failures

and crop or livestock losses: the situation becomes an emergency when people

have exhausted all their purchasing resources, food stocks, assets and normal

coping mechanisms.

In general, the Red Cross Red Crescent response to drought and food insecurity

prioritizes the provision of food, safe water and basic sanitation, basic health

services, along with food-security surveillance and nutritional monitoring.

In parallel, programmes are implemented to preserve and restore livelihoods. Suchassistance may take the following forms:

y distribution of seeds, tools and fertilizer;

y destocking or restocking of livestock;

y distribution of livestock fodder;

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y support to pastoralists in transporting livestock to alternative grazing areas

during severe dry spells;

y income-generating schemes that enable people to diversify their sources of

income on a small scale;

y training and education in relevant skills, for example in carpentry or bicycle

repair, to enable people to earn an income;

y vegetable-gardening, poultry and fish-pond projects;

y Small-scale irrigation schemes.

It is also important to ensure that populations have access to safe water and basic

sanitation in times of drought, as wells and other groundwater supplies dry up or

become polluted.

The International Federation is committed to reducing vulnerability to drought by

enhancing the availability of and access to food and by increasing communitiesresilience so that they are better able to deal with food insecurity.

Volcanic eruption-

Volcanic eruptions happen when lava and gas are discharged from a volcanic vent.

A volcano is an opening, or rupture, in a planet's surface or crust a crust is the

outermost solid shell of a rocky planet or moon, which allows hot magma

(paste), ash and gases to escape from below the surface. The word volcano is

derived from the name of Volcano island off Sicily which in turn, was namedafter Vulcan, the Roman god of fire.[1]

Manmade Technological disasters:-

Danger originating from technological or industrial accidents, dangerous

procedures, infrastructure failures or certain human activities, which may cause the

loss of life or injury, property damage, social and economic disruption or

environmental degradation.

Technological disasters are non-natural disastrous occurrences that include:

y Accident release

Occurring during the production, transportation or handling of hazardous

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chemical substances

y Explosions

Disasters will only be classified as explosions when the explosions is the

actual disaster. If the explosion is the cause of another disaster, the event

will be classified as the resulting disaster.

y Chemical explosion

Violent destruction caused by explosion of combustible material, nearly

always of chemical origin.

y Nuclear explosion/Radiation

Accidental release of radiation occurring in civil facilities, exceeding the

internationally established safety levels.

y Mine explosionAccidents which occur when natural gas or coal dust reacts with the air.

y Pollution

Degradation of one or more aspects in the environment by noxious

industrial, chemical or biological wastes, from debris or man-made products

and from mismanagement of natural and environmental resources.

Chemical pollution

A sudden pollution of water or air near industrial areas, leading to internal

body disorders with permanent damage of the skin.

Atmosphere pollution

Contamination of the atmosphere by large quantities of gases, solids and

radiation produced by the burning of natural and artificial fuels, chemicals and

other industrial processes and nuclear explosions

y Acid rain

A washout of an excessive concentration of acidic compounds in the

atmosphere, resulting from chemical pollutants such as sulphur and nitrogen

compounds. When deposited these increase the acidity of the soil and water

causing agricultural and ecological damage.

The Federation has more of an advocacy/information sharing role and does not

involve itself with the technical aspects, e.g. cleaning up, irradiation sickness or

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(advanced) treatment of people who have been exposed.

However, the Federation offers care to people that are displaced or flee from the

disasters, providing shelter, foods, basic health, water and sanitation. Psychological

support is also often vital. For more than twenty years on, the Federation is stillrunning a programme to assist victims of the Chernobyl nuclear reactor explosion

of 1986, providing medical assistance and check-ups, and psycho-social support.

Equally, in situations of chemical and biological warfare, the Federation provides

basic information about symptoms and effects of agents, antidotes and

protection. Again, National Societies and the Federation take care of people

displaced or fleeing from chemical or biological attacks, providing shelter, food,

basic medical care, water and sanitation.

Biological hazards:-

An epidemic is then unusual increase in the number of cases of an infectious

disease which already exists in a certain region or population. It can also refer to

the appearance of a significant number of cases of an infectious disease in a region

or population that is usually free from that disease.

Epidemics may be the consequence of disasters of another kind, such as floods,

earthquakes, droughts, etc

Cholera

Cholera is mainly spread by drinking water contaminated by faeces. The fatality

rate for severe, untreated cases is 50 per cent; when treated this drops to one per

cent.

The incubation period is 1-12 days and severe cases need hospitalisation. Less

severe cases can be treated with rehydration therapy on an outpatient basis. Only

10 per cent of those infected present symptoms.

Key control factors are: ensuring a safe water supply and rigorous hygiene (hand

washing and disposal of soiled items).

Crowded wards are not a hazard to staff or visitors, if good hygiene is observed.

Quarantine is unnecessary. Vaccine is inappropriate in an emergency.

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Swine flu

The WHO has raised the Influenza Pandemic Alert to the highest level which is 6.

Already India has seen over 60 confirmed cases of Swine Flu and the threat of afull blown epidemic in India is very real.

Some Vital Stats

Total Confirmed Cases in India 29904**

Total Deaths in India 1404**

Total Confirmed Cases Worldwide Over 622482*

Total Deaths Worldwide At least 16455*

In order to prevent epidemics, the community in general and families in particular

must take simple measures. Leaders can collaborate with health centers and other

relevant institutions present in the area.

Community activities Family activities

Inspect and repair watersupply network

Ensure hygienic watermanagement in the home

Ensure proper hygiene of

people who handle food

Ensure proper food

hygiene in the home

Maintain and clean public

latrines

Maintain and clean family

latrines

Manage solid waste in

public areas (vector

control)

Handle domestic solid

waste (vector control)

Control vectors (eliminaterefuse in public areas)

Control vectors (eliminaterefuse)

Coordinate with local

health center

Practice personal hygiene

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Responding to disasters

The elements of disaster response: emergency needs assessment

The first step in any emergency response is to assess the extent and impact of

the damage caused by the disaster (the needs) and the capacity of the affected

population to meet its immediate survival needs (degree of vulnerability).

Although the impact may vary considerably from one disaster to another,

typical needs that arise include:

y food;

y shelter;

y essential items, such as blankets, heaters, water containers;

y medical care;

y safe drinking water;

y sanitation and waste disposal;

y psychosocial support.

Such an assessment will identify the needs that require external interventionand the gaps to be filled. It is a vital component of the programme-planning

process. It provides the information on which key decisions affecting the lives

of the disaster victims will be made.

Assessments can take the following forms:

y Rapid assessment: Undertaken immediately after a disaster, rapid

assessment provides information on needs, possible courses of action

and resource requirements. It normally takes up to a week.

y Detailed assessment: A more detailed assessment is carried out after arapid assessment, if the situation is changing and more information is

needed. It takes about one month, depending on the size of the area and

the complexity of the situation.

y Continual assessment: Disaster situations can evolve rapidly and

include unexpected knock-on effects, such as population movements.

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Assessment should therefore be an ongoing process throughout the

emergency phase

Experience shows that a poorly conducted assessment is likely to lead to poorplanning decisions and an inadequate response.

Phases of Disaster:-

1) Preimpact:

a. Occurs prior to the onset of the disaster.

b. Includes the period of threat and warning.

c. May not occur in all disaster.

2) Impact Phase:

a. Period of time when disaster occurs, continuing to immediately following

disaster.b. Inventory and rescues period.

Assessment of extent of losses.

Identification of remaining sources.

Planning for

Use of resources

Rescue of victims

Minimizing further injuries and property damage.

May be brief when disasters strike suddenly and is over in minutes (air plane

clash, building collapse) or lengthy as incident continues (earthquake, flood,tsunami etc.)

3) Post impact phase

a. Occurs when majority of rescue operations are completed.

b. Remedy and recovery period.

c. Lengthy phase that may last for years.

Honeymoon phase - feeling of euphoria, appearances of little effect by disaster.

Disillusionment phase - feeling of anger, disappointment and resentment.

Reconstruction phase - acceptance of loss, copping with stereo, rebuilding.

4) Rehabilitation The final phase in a disaster should lead to restoration of the pre-disaster

conditions.

The pattern of healthy needs with change rapidly, moving from casualty

treatment to more primary health care.

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The Disaster Management Cycle:-

The fundamental aspects of Disaster Management Program-

Disaster Prevention

Disaster preparedness

Disaster response

Disaster mitigation

Rehabilitation

Reconstruction

4 Fundamental Aspects of Disaster Management-

1. Disaster mitigation

2. Disaster Preparedness

3 Disaster response

4. Disaster Recovery

Goals of Disaster Management-

Reduce, or avoid, losses from hazards;

Assure prompt assistance to victims;

Achieve rapid and effective recovery.

The Disaster management cycle illustrates the ongoing process by which

governments, businesses, and civil society plan for and reduce the impact of

disasters, react during and immediately following a disaster, and take steps to

recover after a disaster has occurred.

The four disaster management phases illustrated here do not always, or even

generally, occur in isolation or in this precise order. Often phases of the cycle

overlap and the length of each phase greatly depends on the severity of the disaster.

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Mitigation - Minimizing the effects of disaster. Lessen the impact of a disaster

before it strikes.

Activities that reduce or eliminate a hazard it includes prevention, risk

reduction.

Examples: building codes and zoning; vulnerability analyses; public

education

It is virtually impossible to prevent occurrence of most Natural Disasters, but it is

possible to minimize or mitigate their damage effects.

Mitigation measures aim to reduce the Vulnerability of the System [ e.g. Byimproving & enforcing building codes etc]

Disaster prevention implies complete elimination of damages from a hazard, but it

is not realistic in most hazards. [e.g. Relocating a population from a flood plain or

from beach front]

Medical Casualty could be drastically reduced by improving the Structural Quality

of Houses, Schools, and Public or Private buildings.

Also ensuring the Safety of Health facilities, Public Health Services, WaterSupply, Sewerage System etc.

Mitigation complements the Disaster Preparedness and Disaster Response

activities.

A Specialized Unit within the National Health Disaster Management Program

should coordinate the works of experts in the field of

Health, Public Policy & Public Health

Hospital Administration Water Systems

Engineering & Architecture

Planning, Education etc

The Mitigation Program will direct the following activities-

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1. Identify areas exposed to Natural Hazards and determine

the vulnerability of key health facilities and water systems

2. Coordinate the work of Multi Disciplinary teams in designing

and developing building codes and protect the waterdistribution from damages

3. Hospitals must remain operational to attend to disaster victims

4. Include Disaster Mitigation Measures in the planning and

development of New facilities

5. Identify priority hospitals and critical health facilities that

complies with current building codes and standards

6. Ensure that mitigation measures are taken into account in a

facilitys maintenance plans

7. Inform, sensitize and train those personnels who are involved in

planning, administration, operation, maintenance and use offacilities about disaster mitigation

8. Promote the inclusion of Disaster Mitigation in the curricula of

Professional training institutes

Preparedness - Planning how to respond.

Disaster preparedness refers to measures taken to prepare for and reduce the effectsof disasters. That is, to predict and, where possible, prevent disasters, mitigate their

impact on vulnerable populations, and respond to and effectively cope with their

consequences.

Disaster preparedness provides a platform to design effective, realistic

and coordinated planning, reduces duplication of efforts and increase the overall

effectiveness of National Societies, household and community members disaster

preparedness and response efforts. Disaster preparedness is a continuous and

integrated process resulting from a wide range of risk reduction activities andresources rather than from a distinct sectoral activity by itself. It requires the

contributions of many different areasranging from training and logistics, to

health care, recovery, livelihood to institutional development. Activities that are

taken to build capacity and identify resources that may be used. Emergency

communication plan. Preventive measures to prevent spread of disease. Public

education. Activities undertaken to handle a disaster when it strikes.

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The objectives of the disaster preparedness is to ensure that appropriate systems,

procedures and resources are in place to provide prompt, effective assistance to

disaster victims, thus facilitating relief measures and rehabilitation services.

Disaster preparedness is an ongoing, multi-sectoral activity to carry out thefollowing activities:

Evaluate the risk of the country or particular region to disasters.

Adopt standards and regulations

Organize communication, information and warning systems

Ensure coordination and response mechanisms

Adopt measures to ensure that financial and other resources are available for

increased readiness and can be mobilized in disaster situations.

Develop public education programs

Coordinate information sessions with news media

Organize disaster simulation exercises that test response mechanisms

Response - Efforts to minimize the hazards created by a disaster.

Examples: search and rescue; emergency relief .

Search and rescue, clearing debris and feeding and sheltering victims.

OBJECTIVES-

Appropriate application of current technology can prevent much of the death,

injury, and economic disruption resulting from disasters

Morbidity and mortality resulting from disasters differ according to the type

and location of the event.

In any disaster, prevention should be directed towards reducing

(1) Losses due to the disaster event itself

(2) Losses resulting from the Mismanagement of disaster relief.

Recovery - Returning the community to normal. Getting a community back to its

pre-disaster status.

Examples: temporary housing; grants; medical care.

As the emergency is brought under control, the affected population is

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capable of undertaking a growing number of activities aimed at restoring

their lives and the infrastructure that supports them. There is no distinct

point at which immediate relief changes into recovery and then into long-

term sustainable development. There will be many opportunities during the

recovery period to enhance prevention and increase preparedness, thusreducing vulnerability. Ideally, there should be a smooth transition from

recovery to on-going development.

Recovery activities continue until all systems return to normal or better.

Recovery measures, both short and long term, include returning vital life-

support systems to minimum operating standards; temporary housing; public

information; health and safety education; reconstruction; counseling

programs; and economic impact studies. Information resources and services

include data collection related to rebuilding, and documentation of lessons

learned.

Triage system:-

French verb Trier means to sort. Assigns priorities when resources limited. Do

the best for the greatest number of patients.

Advantages of triage-

1. Helps to bring order and organization to a chaotic scene.

2. It identifies and provides care to those who are in greatest need.3. Helps make the difficult decisions easier.

4. Assure that resources are used in the most effective manner.

When the quantity and severity of injuries overwhelm the operative capacity of

health facilities, a different approach to medical treatment must be adopted. The

principle of "first come, first treated", is not followed in mass emergencies. Triage

consists of rapidly classifying the injured on the basis of the severity of their

injuries and the likelihood of their survival with prompt medical intervention. It

must be adopted to locally available skills. Higher priority is granted to victims

whose immediate or long-term prognosis can be dramatically affected by simple

intensive care. Moribund patients who require a great deal of attention, with

questionable benefit, have the lowest priority. Triage is the only approach that can

provide maximum benefit to the greatest number of injured in a major disaster

situation.

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Although different triage systems have been adopted and. are still in use in some

countries, the most common classification uses the internationally accepted four

colour code system. Red indicates high priority treatment or transfer, yellow

signals medium priority; green indicates ambulatory patients and black for dead or

moribund patients.

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Triage system

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START SYSTEM

Created in the 1980s by Hoag Hospital

and the Newport Beach CA Fire Dept

Allows rapid assessment of victims

It should not take more than 15 sec/ Pt

Once victim is in treatment area more

detailed assessment should be made

START SYSTEM

Clasification is based on three items

Respiratory

Perfusion

Mental status evaluation

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START First Step

Can the Patient Walk?

YES NO

Green

(Minor)

EvaluateVentilation

(Step-2)

START Step-2Ventilation Present?

YESNO

> 30/Min < 30/min

Evaluate Circulation

(Step-3)

Open Airway

Ventilation Present?

NO YES

Black Red/ Immediate

Red/ Immediate

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START Step-3

Circulation

Absent Radial Pulse

Control Hemorrhage

Present Radial Pulse

Evaluate Level of

ConsciousnessRed/ Immediate

START Step-4

Cant Follow SimpleCommands

Level of Consciousness

Can Follow SimpleCommands

Yellow/ DelayedRed/ Immediate

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Contaminated Patients

Patients with exposure (potential or

real) to contaminants should be tagged

as BLUE

This category will continue to stay until

patient is adequately decontaminated

then follow START as usual

Some recommend a double tagging

with blue and the standard START color

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In the federal structure of India, the state governments are responsible for the

execution of relief work in wake of natural disasters. Government of India plays a

supportive role, in terms of supplementation of final resources to the states. An

administrative system has been developed to combat and minimize the adverseimpact of the natural disasters. At the centre, the Ministry of Agriculture is the

nodal ministry for coordination of all activities during a natural disaster. Since

health is an important part of disaster management, in the DGHS under the

ministry of Health and Family Welfare there is a special wing called the

Emergency Medical Relief Wing which coordinates all activities related to health?

In a vast country like India, it is not practicable for the government machinery

alone, to undertake disaster reduction programmes without involvement of NGOs.

Public education and community involvement plays a vital role here. As part of the

International Decade for Natural Disaster Reduction activities, every year, thesecond Wednesday of October has been designated as World Disaster Reduction

Day.

Indian Meteorological Department (IMD) plays a key role in forewarning the

disaster. It has five centers in Kolkata, Bhubaneswar, Vishakhapatnam, Chennai

and Mumbai for detection and tracing of cyclone storms. Satellite imagery

facilities and cyclone warning radars are provided to various Cyclone Warning

Centers. In addition, it has 31 special observation posts set up along east coast of

India. For all ships out at sea, warnings are issued six times a day. Inset Disaster

Warning System (DWS) receivers have been installed primarily in the coastal areas

of Tamil Nadu and Andhra Pradesh. This has proved very reliable form ofcommunication system. The Snow and Avalanche Study Establishment (SASE) in

Manali has been issuing warning to people about avalanches 24 to 48 hours in

advance.

MAN MADE DISASTERS INTERNATIONAL AGENCIES PROVIDING

HEALTH HUMANITARIAN ASSISTANCE

every country is a potential source of health humanitarian assistance for some other

disaster-stricken nation. Bilateral assistance, whether personnel, supplies or cash is

probably the most important source of external aid. Several international or rregional agencies have established special funds, procedures and offices to provide

humanitarian assistance. United Nation's Agencies are United Nations Office for

the Coordination of Humanitarian Affairs (OCHA), World Health Organization

(WHO), UNICEF, World Food Programme (WFP), Food and Agriculture

Organization (FAO). Inter-governmental organizations are European Community

Humanitarian Office (ECHO), Organization of American States (OAS), Centre of

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Coordination for Prevention of Natural Disasters in Central America, Caribbean

Disaster Emergency Response Agency. Some Non-Governmental Organizations

are CARE, International Committee of Red Cross, International Council of

Voluntary Agencies (1CVA), International Federation of Red Cross and RedCrescent 2 Societies (IFRC) etc.

Disaster Nursing:-

Disaster nursing refers to nursing services offered to the victims of disaster who

experiences trauma caused by disaster produce several kinds of trauma.

a. Physical - Fractures, burns, injuries and infections.

b. Physiological - Shock and electrolyte imbalance

c. Psychological- Anxiety, depression, substance abuse, stress

reaction.

d. Socio-economic- Unemployment, Homelessness, Environmentaldestruction, disorganization.

The Symptoms related to Trauma Produced by disaster usually occurs in Five

Phases.

a. Impact Phase: It includes event itself and is characterized by shock, extreme

b. Heroic Phase: Characterized by co-operative spirit exist between friends,

neighbor and emergency teams. Constructive activity at this time can help to

overcome feelings of anxiety and depression.

c. The honeymoon phase: It begins to appear one week to several months after thedisaster, the need to help others is sustained, and the money, resources and support

received from varying agencies allow life to begin again in the community.

d. Disillusionment phase: It last from two months to one year._ A time of

disappointment, resentment, frustration and anger. Victims often begin to compare

their neighbors with their own and may start to resent or show hostility towards

others.

e. Reconstruction and reorganization phase: In this individual recognize that

they must adjust with their own problems. They begin to rebuild their homes,

business and lives in constructive fashion. This ... period may last for year after the

disaster. Nurse along with the health team needs to utilize primary health care

intervention in acute emergencies as follows:-

Immunization and preventive health

Management of diarrheas and dehydration.

Management of acute respiratory infections.

Setting up a health information system.

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Safe drinking water supply.

Sanitation.

Training and support for health workers.

Other basic services.

In addition to above the following psychosocial intervention are provided by the

nurses:

Crises intervention / counseling

Group work

Telephone contact services.

Disaster response managements

Health education

Community services like facilitation of self help groups etc.

Community measures in Disaster

Pre disaster phase, appropriate management of disaster requires advance planning.A nurse should be the part of the team for disaster planning.

a. Community Participation: It is the process by which individuals, families and

communities assume the responsibility of promoting their own health and welfare.

The community health nurse maintains the link between professional group of

experts in disaster management and community.

b. Mock trails/training: The training of various inter-disciplinary forces like school

children, voluntary organizations can be imparted by community health nurse and

her team,

c. Mass awareness: The community should have the knowledge of all the Channel

communication system, stand by equipment supplies and other resources;

otherwise disaster preparedness will be failure.

d. Education: Mass awareness through media, booklets, panel discussion, films and

televisions information is very essential.

Basic community Education should incorporate the following essentials:

a. Setting up the first aid post

b. Causality evaluation

c. Basic hygiene and sanitation

d. Safety measurese. Maintenance of food and water supply

f. Maintenance of law and order.

g. Provision of shelters

h. Rescue streaming

i. Significance of traffic control and communication

j. Use of fire services

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k. Hazards of radiation and preventive measures

l. Prevention of future disasters.

m. Grant in aidn. Rehabilitation

CONCLUSION

Disasters are of different types which can happen any time, any where, in the

world causing tremendous after effects such as loss of human life ,economical

imbalances, food scarcity epidemics , forced relocation of population etc. Disasters

usually affect the developing countries comparing with the developed countries.

While deserting the matter we could come to the conclusion that the adverse

effects of natural disasters can be minimized by proper preventive measures alert

technologies at high risk areas, proper mobilization of resources, and decreased

corruption in the field and also the mock training programmes in the community.