Download - Disaster Nursing
DISASTER NURSING GOLDEN LECTUREKawkab Shishani, RN, PhDCommunity Health [email protected]
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
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/
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