Disaster Definitions
A disaster is any event that causes a level of destruction, death, or injury that affects the abilities of the community to respond to the incident using available resources.
Mass casualty involves 100+ individuals
Multiple casualty involves 2 to 99 individuals
Casualties can be classified as a direct victim, indirect victim, displaced person, or refugee
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Types of Disasters
Natural disasters
Man-made disasters
Combination disasters
NA-TECH (natural/technological) disaster: a natural disaster that creates or results in a widespread technological problem
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Types of Disasters (Cont.) (from Textbook, Box 28-1)
Natural Disasters
Avalanches
Blizzards
Communicable disease epidemics
Droughts, wildfires
Earthquakes, tsunamis
Hailstorms
Heat waves
Hurricanes
Tornados, cyclones
Volcanic eruptions
Man-Made Disasters
Terrorism
Civil unrest (riots)
Explosions, bombings
Fires
Structural collapse (bridges)
Airplane crashes
Toxic or hazardous spills
Mass transit accidents
Pollution
Wars
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Acts of Terrorism
Terrorism is
“the unlawful use of force and or violence against persons or property to intimidate or coerce a government, the civilian population, or any segment thereof, in furtherance of political or social objectives.” (FBI, 2013)
“is premeditated, politically motivated violence perpetrated against noncombatant targets by sub-national groups or clandestine agents.” (CIA, 2013)
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Weapons of Mass Destruction
Any weapon that is designed or intended to cause death or serious bodily injury through release, dissemination, or impact of toxic or poisonous chemicals, or their precursors
Any weapon involving a disease organism (biological agents)
Any weapon that is designed to release radiation or radioactivity at a level dangerous to human life (chemical agents)
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Characteristics of Disasters
Frequency
Predictability
Preventability/mitigation
Imminence
Scope and number of casualties
Intensity
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Prevention in Disasters
Primary prevention
Aimed at preventing the occurrence of a disaster or limiting the consequences when the event itself cannot be prevented (mitigation)
Nondisaster stage: period before a disaster occurs
Predisaster stage: actions taken when a disaster is pending
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Prevention in Disasters (Cont.)
Nondisaster activities include:
Assessing communities to determine potential disaster hazards
Developing disaster plans at local, state, and federal levels
Conducting drills to test the plan
Training volunteers and health care providers
Providing educational programs of all kinds
Developing risk maps and resource maps
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Prevention in Disasters (Cont.)
Predisaster activities include:
Notification of the appropriate officials
Warning the population
Advising what response to take
voluntary or mandatory evacuation
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Prevention in Disasters (Cont.)
Secondary prevention
Implemented once the disaster occurs
Aimed at preventing further injury or destruction
“Safety before search and rescue.”
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Prevention in Disasters (Cont.)
Tertiary prevention
Focuses on recovery and restoring the community to previous levels of functioning and its residents to their maximum functioning
Aimed at preventing a recurrence or minimizing the effects of future disasters through debriefing meetings to identify problems with the plan and making revisions
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Nurses Need to …
… be involved in all stages of prevention and related activities
… educate others about disasters and how to prepare for and respond to them
… keep up to date on latest recommendations and advances in life-saving measures
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Questions Nurses Should Ask
What kind of disasters threaten the communities where I live?
What injuries should I expect from different disaster scenarios?
What are the evacuation routes?
Where are shelters located?
What warning systems are used so I can respond effectively, personally, and professionally during different types of disasters?
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Disaster Management
A collaborative interdisciplinary team effort is needed between a network of agencies and individuals.
Develop a disaster plan.
Communities can respond more quickly, more effectively, and with less confusion.
Ensures that resources are available.
Delineates roles and responsibilities of all personnel and agencies, both official and unofficial.
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Governmental Responsibilities
Local government (first responders)
Responsible for the safety and welfare of its citizens.
State government (Office of Emergency Management)
Involved when a disaster overwhelms the local community’s resources.
Federal government (Department of Homeland Security and CDC)
A single department focusing on protecting the American people and their homeland
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U.S. Department of Homeland Security (DHS)
DHS has three primary missions:
Lead the unified national effort to secure America
Prevent and deter terrorist attacks
Protect against and respond to threats and hazards to the nation
DHS goal (2011):
Sets the “vision for nationwide preparedness”
Identifies the core capabilities and targets necessary to achieve preparedness across five mission areas: Prevention, Protection, Mitigation, Response, and Recovery.
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NIMS
NIMS (National Incident Management System) provides a systematic, proactive approach for all levels of governmental and nongovernmental agencies to work seamlessly to prevent, protect against, respond to, recover from, and prevent the effects of disasters.
– Federal Emergency Management Agency (FEMA) (2012)
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FEMA
Mission is to support citizens and first responders to ensure that, as a nation, everyone works together to build, sustain, and improve the capacity to prepare for, protect against, respond to, recover from, and mitigate all hazards.
Established National Terrorism Advisory System
Threat alert: elevated or imminent threat
FEMA published in-depth guide for citizen preparedness: Are You Ready?
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Partnerships in Disasters
Department of Homeland Security (DHS)
Federal Emergency Management Agency (FEMA)
Department of Health and Human Services/ Centers for Disease Control and Prevention
Public Health System (PHS)
American Red Cross (ARC)
Other local, state, and federal agencies
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Disaster Management Stages
Prevention stage
Preparedness and planning stage
Response stage
Recovery stage
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Prevention Stage
Identify potential disaster risks.
Create risk maps
Educate citizens regarding what actions to take to prepare for disasters.
Individual, family, and community level
Develop a plan for meeting the potential disasters identified.
Create resource maps
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Community Risk Map (from Textbook, Figure 28-1)
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Community Resource Map (from Textbook, Figure 28-2)
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Preparedness/Planning Stage: Individual and Family Preparedness
Training in first aid
Assembling a disaster emergency kit
Establishing a predetermined meeting place away from home
Making a family communication plan
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Preparedness/Planning Stage: Community Disaster Planning
Plans must include:
Authority
Communication
Logistical coordination of:
Supplies and equipment
Human resources
Evacuation and rescue
Plans must be dynamic and change as needed.
Plans must be tested in different disaster scenario drills.
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Disaster Planning Principles (from Textbook, Box 28-8)
Measures usually taken are not sufficient for major disasters.
Plans should be adjusted to people’s needs.
Planning does not stop with development of a written plan.
Lack of information causes inappropriate responses by community members.
People should be able to respond with or without direction.
Plans should coordinate efforts of the entire community, so large segments of the citizenry should be involved in the planning.
Plans should be linked to surrounding areas.
Plans should be general enough to cover all potential disaster events.
As much as possible, plans should be based on everyday work methods and procedures.
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Disaster Planning Principles (Cont.) (from Textbook, Box 28-8, Cont.)
Plans should specify a person’s responsibility for implementing segments by position or title rather than by name.
Plans should develop a record-keeping system before a disaster occurs, regarding:
Supplies and equipment
Records of all present at any given time (to account for everyone and to identify the missing)
Identification of victims and deceased, conditions and treatment documented, and to which facility victims are sent
Backup plans need to be in place for the following:
Disruption of telephone and cell phone lines
Disruption of computer data (should be downloaded weekly and stored off site)
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Response Stage
Response stage begins immediately after the disaster incident occurs.
May include:
Shelter in place
Evacuation
Search and rescue
Staging area
Disaster triage
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Areas of Operation in Disaster Response
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Figure 28-3
Disaster Triage
START triage system
“Simple Triage And Rapid Treatment”
Used in multicasualty or mass casualty incident
Triage of injured person should occur in less than 1 minute based on:
Respirations
Perfusion
Mental status
Uses people with minor injuries to assist
Person is tagged with a colored triage tag
Victims moved to the treatment area
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START Color-Coded Triage Tag
Green = walking wounded
Yellow = systemic but not yet life-threatening complications
Red = life-threatening conditions that can be stabilized and have a high probability of survival
Black = deceased or injuries so extensive that nothing can be done to save them
Hazmat tag = contaminated
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Figure 28-4
Source: http://www.mettag.com. Reprinted with permission.
Psychological Triage
Four keys to gauging mental health impact:
Extreme and widespread property damage
Serious and ongoing financial problems
High prevalence of trauma in the form of injuries, threat to life, and loss of life
When human intent caused the disaster
In addition, panic during the disaster, horror, separation from family, and relocation or displacement may play a part
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Public Health Activities
While search and rescue is going on …
Surveil for threats (e.g., contaminated water, vectors, and air quality).
Disseminate data on what has been found.
Relate health information to officials, the media, and the public as appropriate.
Gather epidemiological information.
Allocate resources and work to prevent further adverse health problems.
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Responses to Disasters
Community
Heroic phase
Honeymoon phase
Disillusionment phase
Reconstruction phase
Individual
Cognitive
Emotional
Physical
Behavioral
PTSD
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Recovery Stage
Begins when the danger from the disaster has passed.
All local, state, and federal agencies are present in the area.
Help victims rebuild their lives
Restore public services
Cleanup of damage and repair begins
Evaluation and revision of the disaster plans
Understand the financial impact