DISASTER MANAGEMENT

NTRODUCTION:-
As we know disaster is a destructive event that need a wide range of emergency
resources to assist the survival. Any Disaster is an emergency situation and the
health sector alone can not tackle it in isolation. Local community,army, police,
fire brigade, government organization, non-governmental bodies and voluntary
organizations should combine to tackle the effect of disaster. like:
• The attack on buildings of “World Trade Centre in New
York” in which about 6000 people lost their lives and thousands
were injured.

Disasters In India
• India is the highly disaster-prone country . In which
floods, cyclones, draughts, earthquakes and epidemics are
frequent from time to time,

• Major earthquake in Jammu & Kashmir (7.4 RS) left 2100

dead and 30,000 injured.

• On 29th October 1999, Orissa had super cyclone on when

thousands lost their lives and many more became homeless.

• In Dec. 2004 Tsunami killed more than 200,000 persons

• On 3rd December 1984, India also saw “world's worst

man-made disaster” when “methyl isocyanate gas” leaked at
“Union Carbide Pesticide Plant” in Bhopal - About 2 million
people were exposed to the gas - that killed about 3000
people. People are still suffering from variety of diseases, as an
after effect of this tragedy.

DEFINITION OF DISASTER:-
WHO defines disaster as “any occurrence that causes damage, economic
disruption, loss of human life, deterioration of health and health services on a
scale sufficient to warrant an extraordinary response outside the affected
community or “area”.
Disaster defines as an “act of nature or of man which may mean a serious or
great enough to justify, emergency aid, in which extensive material damage is
followed by tragic loss of human lives and large numbers of victims whose
injuries are invariably.
TYPES OF DISASTER
NATURAL DISASTER
1. Earthquake – is the violent shaking of earth’s
surface caused by the individual plates moving
against each other. These plates make up the outer
most shell of the earth’s crust and move relative to
each other and to the Earth’s interior. The intensity
of an earthquake is measured by the Richter scale where
a earthquake of a magnitude of 2.5 represents a mild
tremor and little to damage while an magnitude of 7.0 or
greater represents a major tremor where changes to the
Earth’s surface occur and vast damage is expected.

2. Floods – Among all natural disaster flood is regarded as

most damaging in terms of human lives and property. The
flood is an annual feature in respect of major rivers and
rather tributaries during monsoon season. Population
living on alluvial plains liable to flooding are worst
affected. Mortality is high in case of sudden
flooding due to drowning. Besides fracture,
injuries, bruises cases of accidental hypothermia
also occur during cold weather. Deaths to
poisonous snakes and insects are also common.

3. Drought – Factors responsible for drought are low rainfall,

reduction in vegetation,soil erosion and surface
evaporation. In rural community, economic and socio -
economic factors city migration affects health and survival
of the families. Draughts cause PEM, Vitamin A
Deficiencies, Measles, ARI, Diarrhea with
Dehydration. Drought affected population who
migrate and settle down as outs marts of cities and
towns face the problem of poor hygiene and
sanitation, over crowding, further exposes them to
communicable disease like diarrhea, TB, parasitic
infestation and malaria.
4. Volcano Eruptions – A vent to the earth’s surface from
the earth’s crust and the cone formed by it. This vent
extends to the layers of molten material called magma.
 The cone is called a volcanic orifice and is formed
by the material thrown from the vent.

5. Tropical Cyclone – Large, rotating storms form over

tropical oceans. Storm characteristics include winds
faster than 75 miles per hour,a storm surge that
causes flooding in costal areas, heavy rain and
storm durations for 1 to 2 weeks. Cyclones that form
in the Atlantic Carribean and Eastern Pacific oceans are
known as hurricanes. Saffir/Simpon hurricane scale used
in rating system for determining the severity of topical
cyclones.

MAN- MADE DISASTERS

1. Nuclear warfare -- when a nuclear bomb is

exploded in the air it causes blast heat and
radiation.

Blast – is the sudden tremondous increase in air

pressure which spreads out rapidly from the
bomb as do the waves from a stone focibly
dropped in a pond. The blast waves knock down
houses and factories ,shatters window panes. People
are hurt by crushed in falling buildings or struck by
flying glass and rubble. These persons suffer cuts,
bruises, sprains and fractures of exactly the
same types as occur in peace time accidents.

Heat –A flash of instense heat lasting only a few

seconds is capable of scortching the exposed skin of
persons upto several miles away from the exploding
bomb.

Radiation – the atomic explosion produces an

instantaneous discharge of radiation similar to X-rays.

These rays are capable of producing a serious degree

or radiation sickness in exposed persons upto a mile
 from the bomb center. The vast majority of nuclear
bomb causalities suffer from blast injuries or burns.

2. Biological warfare—One possible method of enemy

attack is by an attempts to introduce diseases which
affect humans,domestic animals or food, crops such as
grain. Either “germs”or certain

“toxins ” (poisons) produced by germs may be spread

by bombs or aerial sprays or any other means , who
add the dangerous organisms directly to food or water
supplies.

3. Chemical warfare – in case of massive attacks upon

civilian population the most likely chemical agents are
nerve gas and mustard gas.

Nerve gas ---- these are a group of highly poisonous

chemiccals which are colorless and odourless. They are
likely to be introduced in the form of a liquid spray from
planes, bombs or shells. The liquid can quickly
penetrate clothing and get absorbed through the skin.
Speed is essential in dealing with nerve gas. Since even
in low concentrarion they can produce serious illness or
death within a few minutes. Mustard gas --- these are
a group of oily liquids ranging in color from yellow to
brown and smelling like garlic, shoe polish or rotten
fish. They are used in a form of liquid spray from
aircraft , bombs or shells. Drops of the skin quickly
produce blisters which is very slow to heal liquid slowly
evaporates producing a gas which is very harmful to
the eyes causing redness, soreness and ulceration. If
the vapor is inhaled it dangers the lungs, leading to
coughing, difficulty in breathing etc.

4. Conventional warfare – The coventional arms have

used for a long time, which include explosive and fire
bombs. They produce the following effects:
 a) Wounds and fractures of different parts may be
caused by flying splinters of the explosives.

b) The power waves set up by blasting may rupture ear

drums, lungs and small intestines.

c) The falling of building, houses, and factories may

cause multiple injuries and fractures.

d) The fire caught by the destroyed houses and

buildings may cause severe burns.

PSYCHOLOGICAL REACTION TO A DISASTER

People are different age groups tend to react to a disaster in different

ways, although appetite and sleep disturbances are common at all ages. Other
common reaction in each age group include.

Preschool (1 to 5 years)
1. Fearfulness

2. Night terrors

3. Clinging to parents.

Early Childhood (5 to 11 years)

1. Night terrors, nightmares, fear of the dark

2. Aggressive behavior at home or at school

3. Stomachaches and headaches

4. Poor concentration in school.

Preadolescence (11 to 14 years)

1. Rebellion in the home, such as refusal to do chores

2. Stomachaches or headaches

3. Loss of interest in friends

 4. School problems such as loss of interest or attention
seeking behavior.

Adolescence (14 to 18 years)

1. Loss of interest in dating

2. Irresponsible and/or delinquent behavior

3. Poor concentration

4. Hypochondria.

Adulthood
1. Distressing

2. Intrusive memories of the disaster

3. Flashbacks of upsetting feelings

4. Intense distress at reminders

5. Irritability, blunting of feelings

6. Lack of interest in pleasures

7. Troubling dreams, insomnia and poor concentration.

Disaster trauma ---- People who are attacked by a disaster may have
individual and collective trauma. Individual trauma manifests itself in stress
and grief reactions while collective trauma results in survivors serving their
social ties with each other. Stress and grief reactions are normal response to
any abnormal situation. Stresses reaction and grief responses are common in
disaster survivors.
The common elements of any disasters are casualities, homeless persons,
disruption of sanitary facilities, some degree of panic and need for emergency
medical services. The people affected by any such event are panic struck and
they need first aid care, emergency treatment, food, shelter, clothing and the
basic requirements of life which are not easily available in such circumstances.
Any community when faced with a disaster of whatever magnitude responds to
situation in its own way. Disaster brings grief anxiety and anger caused by loss
of life and property.
DISASTER MANAGEMENT
There are three fundamental aspect of disaster management :
A. Disaster response;

B. Disaster preparedness; and

C. Disaster mitigation

These three aspects of disaster management correspond to different phases

in the so-called “disaster cycle” .
A. DISASTER IMPACT AND RESPONSE
Medical treatment for large number of casualities is likely to be needed only
after certain types of disaster. Most injuries are sustained during the impact,
and thus, the greatest need for emergency care occurs in the first few hours.
The management of mass casualties can be further divided into search and
rescue, first aid, triage and stabilization of victims, hospital treatment and
redistribution of patient
Search, rescue and first aid
. After a major disaster, the need for search, rescue and first aid is likely to be
so great that organized relief services . Most immediate help comes from the
uninjured survivors.
Field care
Most injured persons converge spontaneously to health facilities, using
whatever transport is available, regardless of the facilities, operating status.
Providing proper care to casualities requires, that the health service resources
be redirected to this new priority. Bed availability and surgical services should
be maximized. Redistribution of patients to other hospitals if necessary.
Provision should be made for food and shelter. A centre should be established
to respond to inquiries from patient’s relatives and friends. Priority should be
given to victim’s identification and adequate mortuary space should be
provided.
Triage
When the quantity and severity of injuries overwhelm the operative capacity of
health facilities, a different approach to medical treatment must be adopted.
The principal of “first come, first treated”, is not followed in mass
emergencies. Triage consist of rapidly classifying the injured on the basis of
the severity of their injuries and the likelyhood 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.
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 tretment or transfer,
• Yellow signals medium priority,
• Green indicates ambulatory patients and
• Black for dead or moribund patients.
Triage should be carried out at the site of disaster, in order to determine
transportation priority, and admission to the hospital for treatment.where the
patient’s needs and priority of medical care will be reassessed. Ideally, local
health workers should be taught the principles of triage as part of disaster
training.
Persons with minor or moderate injuries should be treated at their own homes
to avoid social dislocation and the added drain on resources of transporting
them to central facilities. The seriously injured should be transported to
hospitals with specialized treatment facilities.
Tagging
All patients should be identified with tags stating their names, age, place of
origin, triage category, diagnosis, and initial treatment.
Identification of dead
Taking care of the dead is an essential part of the disaster management. A large
number of dead can also impede the efficiency of the rescue activities at the site
of the disaster. Care of the dead includes: (1) removal of the dead from the
disaster scene; (2) shifting to the mortuary; (3) identification; (4) reception of
relatives. Proper respect for the dead is of great importance. The dead bodies
represent a delicate social problem
Relief Phase
.This phase begins when assistance from outside starts to reach the
disaster area. The type and quantity of humanitarian relief supplies are usually
determined by two main factors :
(1) the type and severity of disaster.
(2) the type and quantity of supplies available locally.
Immediately following a disaster, the most critical health supplies are:
 those needed for treating casualties.
  preventing the spread of communicable diseases, following the
initial emergency phase, will include food, blankets, clothing’s,
shelter, sanitary , engineering equipment and construction
material.
A rapid damage assessment must be carried out in order to identify needs and
large quantities of donations.
 There are four principal components in managing humanitarian
supplies: -
(a) Acquisition of supplies.
(b) Transportation.
(c) Storage; and
(d) Distribution.
Epidemiologic surveillance and disease control
Disasters can increase the transmission of communicable diseases
through following mechanisms:-
1. Overcrowding and poor sanitation in temporary resettlements. These
accounts in part, for reported increase in acute respiratory infections etc.
following the disasters.
2. Population displacement may lead to introduction of communicable
diseases to which either the migrant or indigenous population are
susceptible.
3. Disruption and the contamination of water supply, damage to
sewerage system and power systems are common in natural disasters.
4. Disruption of routine control programmes as funds and personnel are
usually diverted to relief work.
5. Ecological changes may favors breeding of vectors and increase the
vector population density.
6. Displacement of domestic and wild animals, who carry with them
zoonoses that can be transmitted to humans as well as to other animals.
Leptospirosis cases have been reported following large floods (as in
Orissa, India, after super cyclone in 1999) Anthrax has been reported
occasionally.
7. Provision of emergency food, water and shelter in disaster situation
from different or new source may itself be a source of infectious disease.
Outbreak of gastroenteritis, which is the most commonly reported disease
in the post disaster period,
 The principals or preventing and controlling communicable diseases
after a disaster are to –
(a) implement as soon as possible all public health measures, to reduce the
risk of disease transmission;
(b) organize a reliable disease reporting system to identify outbreaks and to
promptly initiate control measures; and
(c) investigate all reports of disease outbreaks rapidly.

(a) implement as soon as possible all public health measures, to reduce the
risk of disease transmission;
(b) Vaccination
Health authorities are often under considerable public and political
pressure to begin mass vaccination programmes, usually against typhoid,
cholera and tetanus. The pressure may be increased by the press media and
offer of vaccines from abroad.

Vaccination programme required large number of workers who could be better

employed elsewhere. mass vaccination may lead to false sense of security about
the risk of the disease and to the neglect of effective control measures. However
these vaccinations are recommended for health workers. Supplying safe
drinking water and proper disposal of excreta continue to be the most practical
and effective strategy.

The best protection is maintenance of a high level of immunity in the general

population by routine vaccination before the disaster occurs, and adequate
wound cleaning and treatment. If tatanus immunization was received more than
5 years ago in a patient who has sustained an open wound a tetanus toxoid
booster is an effective preventive measure. In previously un immunized injured
patients tetanus toxioid should be given. patient who has sustained an open
wound a tetanus toxoid booster is an effective preventive measure

Natural disasters may negatively affect the maintenance of on going

national or regional eradication programmers against polio and measles.
Disruption of these programmes should be monitored closely.

The vaccination policy to be adopted should be decided at senior level only.

Nutrition
A natural disaster may affect the nutritional status of the population by
affecting one or more components of food chain depending on the
type.children ,women (pregnant & lactating mothers) are more prone to
nutritional deficiency after prolonged drought or after certain types of disasters
like hurricanes, floods land or mudslides, volcanic eruptions and sea surges
involving damages to crops to stocks or to food distribution systems.

The immediate steps for ensuring that the food relief programme will
be effective include :
(a) assessing the food supplies after the disaster :
(b) assessing the nutritional needs of the affected population :
(c) calculating daily food rations and need for large population groups :
(d) monitoring the nutritional status of the affected population.
Water supply
A survey of all public water supplies should be made. This includes
distribution system and water source. It is essential to determine
physical integrity or system components, the remaining capacities, and
bacteriological and chemical quality of water supplied.
The main public safety aspect is of water quality is microbial
contamination. The First priority of ensuring water quality in emergency
situations is chlorination. It is the best way of disinfecting water. Repaired
mains, reservoirs and other units require cleaning and disinfection.
Chemical contamination and toxicity are a second concern in water
quality and potential chemical contaminants have to be identified and analyzed.
In many emergency situations, water has to be trucked to disaster site or
camps. All water tankers should be inspected to determine fitness, and should
be cleaned and disinfected before transporting water.

Rehabilitation:
The final phase in a disaster should lead to restoration of the pre-disaster
conditions. Rehabilitation starts from the very first moment of a disaster. Too
often, measures decided in a hurry. Tend to obstruct re- establishment of
normal conditions of life. Provision by external agencies of sophisticated
medical care for a temporary period has negative effects. On the withdrawal of
such care the population is left with a new level of expectation which simply
cannot be fulfilled.
In first weeks after disaster, the pattern of health needs, will change
rapidly, moving from casualty treatment to more routine primary health care
services should be reorganized and restructured. Priorities also will shift from
health care towards environmental health measures. Some of them are as
follows :
Food safety
Poor hygiene is the major cause of food borne diseases in disaster
situations. Where feeding programmes are used (as in shelters or camps)
kitchen sanitation is of utmost importance. Personal hygiene should be
monitored in individuals involved in food preparation.
Basic sanitation and personal hygiene
communicable diseases are spread through faecal, contamination of
drinking water and food. Hence every effort should be made to ensure the
sanitary disposal of excreta. Many Emergency latrines should be made
available to the displaced, where toilet facilities have been destroyed. Washing
cleaning and bathing facilities should be provided to the displaced persons.

Vector control
Control programme for vector borne diseases should be intensified in the
emergency and rehabilitation period, especially in areas where such diseases
are known to be endemic. Contaminated food & stagnant water provides ample
breeding opportunities for mosquitoes,special concern are dengue fever
,malaria rate bite fever, plague and typhoid fever.
A major disaster with high mortality leaves a substantial displaced population,
among whom are those requiring medical treatment and orphaned children,
When it is not possible through institutional programmes coordinated by
ministries of health and family welfare, social welfare education and NGOs.
 It is also an important element to organize a reliable disease reporting
system to identify outbreaks and to promptly initiate control measures;
and
 Investigate all reports of disease outbreaks rapidly.

B. DISASTER PREPAREDNESS
 Emergency preparedness is “a programme of long term development
activities whose goals are to strengthen the overall capacity and capability of a
country to manage efficiently all types emergency.

The objective of 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 of services.

The individuals are responsible for maintaining their well being. Community
members resources organization and administration should be the cornerstone
of an emvergency preparedness are:-

(a) Members of the community have the most to lose from being vulnerable to
disasters and the most to gain from an effective and appropriate emergency
preparedness.

(b) Those who first respond to an emergency come from within the community,
when transport and communications are disrupted an external emergency
response may not arrive for days.

(c) Resources are most easily pooled at the community level and every
community possesses capabilities failure to exploit these capabilities is poor
resource management.

(d) Sustained development is best achieved by allowing emergency affected

communities to design manage and implement internal and external
assistance programme.

Disaster preparedness is an on going multicultural activity it forms an

integral part of the national system responsible for development plans and
prgrammes for disaster management prevention mitigation preparedness
response, rehabilitation and reconstruction. The system known by a variety of
names depending on the country depends on the coordination of a variety of
sectors to carry out the following tasks.

1. Evaluate the risk of the country or particular region to disaster.

2. Adopt standards and regulations.
 3. Organize communication, information and warning systems.
4. Ensure coordination and response mechanisms.
5. Adopt measures to ensure that financial and other resources are
available for increased readiness and can be mobilized in disaster situation.
6. Develop public education programmes.
7. Coordinate information sessions with media; and
8. Organize disaster simulation exercises that test response mechanisms.

The emergency preparedness and emergency management do not exist in a

vacuum. To succeed, emergency programmes must be appropriate their context.
This context will vary from county to country and from community to
community.
C. DISASTER MITIGATION IN HEALTH SECTOR
Emergency prevention and mitigation involves measures designed either
to prevent hazards from causing emergency or to lessen hazards the likely
effects of emergencies. These measures include flood mitigation works,
appropriate land use planning improved building codes and reduction or
protection of vulnerable population and structures.

In most cases mitigation measures aim to reduce the vulnerability of the

system medical casualties can be drastically reduced by improving the
structural quality of houses, school and other public and private buildings.
Although mitigation in these sectors has clear health implications the direct
responsibility of the health sector is limited to ensuring the safety of health
facilities and public health services, including water supply and sewerage
systems. when water supplies are contaminated or interrupted, in addition to
the social cost of such damage, the cost of rehabilitation and reconstruction
severely strains the economy. Mitigation complements the disaster
preparedness and disaster response activities.

Impact of Disaster on Community

1. People in a community can be affected both physically and

emotionally depending on the type, cause, and location of the disaster,
its magnitude extent of damage duration and the amount of warning
that was provided. For example an earthquake may not result in any
deaths; however the structural damage to building and the continuous
 after shocks, which may last for weeks, can cause intense
psychological stress.

2. In addition the longer it takes for structural repairs and other clean
up, the longer the psychological effects can last. Individuals react to
the same disaster in different ways depending on their age, cultural
background, health status, social support structure and general
adaptability to crisis. The typical first reaction to being struck by a
disaster however is an extreme sense of urgency.

3. Victims become obsessed with personal losses. Other initial reactions

include fear, panic, disbelief, reluctance to abandon difficulty in
making decisions, need for information, and seeking help to other
disaster victims. Disturbances in bodily functions such as
gastrointestinal upsets, diarrhea, nausea, and vomiting are also
common.

4. The effects of young children can be especially disruptive. Regressive

behaviors such as thumb sucking. bed wetting , crying and cliging to
parents can occur. Fantasies that the disaster never occurred and
nightmares are common as well. Finally school related problems may
also occur, including an inability to concentrate andeven refusal to go
back to school.

5. An elderly person’s reaction to disaster depends greatly on physical

health, strength, mobility, self – sufficiency income source and
amount. They react more deeply to loss of personal possessions
because of the high sentimental value attached to the items and the
limited time left to replace them. Common reactions to disaster by
adults are panic and fear, disbelief, disorientation and numbing,
reluctance to abandon property, difficulty in making decisions anger
and blaming.

ROLE OF NURSES DURING DISASTER:-

International council of nurses (ICN) encourages nurses to increase the
professions ability to provide adequate health services before and after a
 disaster occurs by their participation in prevention, preparedness and relief
operations

INC position in disaster preparedness :-

1. To help ensure that crucial immediate relief services are to be avoided in
the chaotic post disaster period. ICN urges that realistic scenarios be used as
the basis for relief operations and contingency plans.
2. ICN condemns violations of human rights that often occur during and
after disaster this further threatening recovery.
3. ICN strongly believes that here must be a link between relief and
development planning.
4. Further more, relief operations must develop and adhere to credible
accountability systems to prevent an abusive use of financial and human
resources.
5. INC calls on government and relief organizations to establish the support
systems required to address the health needs of relief workers as well as the
direct disaster victims.
6. INC will actively assist countries in their planning to integrate disaster
prevention and impact reduction within existing machinery and strategies,
while establishing contingency plans so that dissaster prone areas have faster
to alternative care services.
7. INC promotes strategies that support social justice and equity of access
to needed health and social services.
Nurses with their technical skills and knowledge of epidemiology,
physiology, pharmacology, cultural familial structures and physiological issues
familial structures and physiological issues can assist in disaster preparedness
programmers as well as during disasters. Nurse as team members can play a
strategic role co-operating with health and social disciplines, government
bodies, community groups and non-government bodies’ community groups and
non-governmental agencies including humanitarian organization.
Care and support must also be provided for the relief workers who are
experiencing human tragedy first hand and may be stressed, fatigued and trying
to provide services with too resources in physically unsafe circumstances.
Nurses have a vital role to play in prevention, mitigation, preparedness and
relief.

ROLE OF COMMUNITY HEALTH NURSE IN DISASTER MANAGEMENT

Disaster Preparedness
1. The role of the community health nurse in disaster preparedness is to
facilitate preparation within community and place of employment
within the employing organization, the nurse can help initiate of
update the disaster plan, provide educational programmes and
material regarding disasters specific to the areas, and organize
disaster drills.

2. The community health nurse is also in a unique position to provide

updated record of vulnerable populations within the community the
community health nurse should be involved in educating these
populations about what impact the disaster might have on them.
Individualized strategies should be reviewed, including the
availability of specific resources, in the event of an emergency.

3. The nurse who leads a preparedness effort can help recruit others
within the organization that will help if and when a response is
required. Although there is no psychological profile of a disaster
leader it is wise to involve persons in these efforts who have
demonstrated flexibility, decisiveness, stamina, endurance and
emotional stability. The leader should also possess and intimate
knowledge of the institution and familiarity with the individuals who
work there.

4. Within the community the nurse might be involved in many roles. As a

community advocate, the community health nurse should always seek
to keep a safe environment. Recalling that disasters are not only
natural but also man made. The nurse in the community has an
obligation to assess for and report environmental hazards. For
example the nurse should be aware of and report unsafe equipment,
faculty structures and with beginning of diseases epidemics such as
measles of flu.

5. The community health nurse hold also have an understanding of what

community resources will be available after a disaster strikes and
most important how the community will work together. A community
 wide disaster plan will guide the nurse in understanding what should
occur before, during and after the response and his or her role within
the plan.

6. The community health nurse who seeks greater involvement or a more

in depth understanding of disaster management can become involved
in any number of community organizations that are part of the
official response team, such as the American Red Cross, Salvation
Army or Emergency Medical System / Ambulance Corps.