Module 1: Understanding Disaster and Disaster Nursing

WHAT IS A DISASTER?

Definitions of disaster
• 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.
• WHO definition: any occurrence that causes damage, ecological disruption, loss of human
life, deterioration of health and health services, on a scale sufficient to warrant an
extraordinary response from outside the affected community or area."
• Red Cross (1975) definition: “An occurrence such as hurricane, tornado, storm, flood, high
water, wind-driven water, tidal wave, earthquake, drought, blizzard, pestilence, famine, fire,
explosion, building collapse, transportation wreck, or other situation that causes human
suffering or creates human that the victims cannot alleviate without assistance.”
• UNDP (2004) definition: “Disaster is a serious disruption triggered by a hazard, causing
human, material, economic or (and) environmental losses, which exceed the ability of those
affected to cope.”
• “Any catastrophic situation in which the normal patterns of life (or ecosystems) have been
disrupted and extraordinary, emergency interventions are required to save and preserve
human lives and/or the environment.”
• Disaster may also be termed as “a serious disruption of the functioning of society, causing
widespread human, material or environmental losses which exceed the ability of the affected
society to cope using its own resources.”
• Important features of a disaster:
o Unpredictability
o Unfamiliarity
o Speed
o Urgency
o Uncertainty
o Threat

Based on the different definitions presented, it can be agreed that disasters

are events that cause significant change or disruption in the day-to-day life of
people and the society in which they live in. Moreover, the event should need
extraordinary measures, measures that are not usually or routinely
performed, in order to cope or address the effects of the event. Thinking
about this, can we consider this current COVID-19 pandemic a disaster? Why
or why not?

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Medical disaster

• A catastrophic event that results in causalities that overwhelm the health care resources in
that community (Al-Madhari & Zeller, 1997)

Key Elements of a Disaster

Disasters result from the combination of hazards, conditions of vulnerability and insufficient
capacity or measures to reduce the potential negative consequences of risk.

• Hazards
o “Phenomena that pose a threat to people, structures, or economic assets and
which may cause a disaster. They could be either manmade or naturally occurring
in our environment.”
o Hazard is a potentially damaging physical event, phenomenon or human activity
that may cause the loss of life or injury, property damage, social and economic
disruption or environmental degradation. (UN ISDR 2002)
• Vulnerability
o Vulnerability is the condition determined by physical, social, economic and
environmental factors or processes, which increase the susceptibility of a
community to the impact of hazards. (UN ISDR 2002)
• Capacity
o Capacity is the combination of all the strengths and resources available within a
community, society or organization that can reduce the level of risk, or the effects
of a disaster. Capacity may include physical, institutional, social or economic
means as well as skilled personal or collective attributes such as 'leadership' and
'management.' Capacity may also be described as capability. (UN ISDR 2002)
• Risk
o Risk is the probability of harmful consequences, or expected losses (deaths,
injuries, property, livelihoods, economic activity disrupted or environment
damaged) resulting from interactions between natural or human-induced hazards
and vulnerable conditions. (UNDP 2004)
o Risk is conventionally expressed by the equation:

Risk = Hazard x Vulnerability

o Some professionals use the notation:

Risk = (Hazards x Vulnerability) - Capacity

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 o They identify capacity as an element that can drastically reduce the effects of
hazards, and vulnerabilities and thus reduce risk.

Classification of Disasters

Disasters are classified in various ways. Disasters can be classified on the basis
of its origin/cause, they can either be natural disasters or man-made
disasters. They can also be classified on the basis of speed of onset, they can
either be sudden-onset or slow-onset disasters.

• Natural Disasters
o A serious disruption triggered by a natural hazard (hydro-metrological, geological or
biological in origin)
o Causes human, material, economic or environmental losses, which exceed the ability
of those affected to cope.
o Classification (according to origin)
§ Hydro-meteorological disaster
• Natural processes or phenomena of atmospheric hydrological or
oceanographic nature.
• Examples: Cyclones, typhoons, hurricanes, tornados, Storms,
hailstorms, snowstorms, cold spells, heat waves and droughts.
§ Geographical disaster
• Natural earth processes or phenomena that include processes of
endogenous origin or tectonic or exogenous origin such as mass
movements, Permafrost, snow avalanches.
• Examples: Earthquake, tsunami, volcanic activity, Mass
movements landslides, Surface collapse, geographical fault
activities etc.
§ Biological Disaster
• Processes of organic organs or those conveyed by biological
vectors, including exposure to pathogenic, microorganism, toxins
and bioactive substances.
• Examples: Outbreaks of epidemics Diseases, plant or animal
contagion and extensive infestation etc.

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• Human-Induced Disasters
o A serious disruption triggered by a human-induced hazard causing human, material,
economic or environmental losses, which exceed the ability of those affected to
cope.
o Classifications
§ Technological disaster
• Danger associated with technological or industrial accidents,
infrastructure failures or certain human activities
• May cause the loss of life or injury, property damage, social or
economic disruption or environmental degradation, sometimes
referred to as anthropological hazards.
• Examples: industrial pollution, nuclear release and radioactivity,
toxic waste, dam failure, transport industrial or technological
accidents (explosions fires spills).
§ Environmental Degradation
• Processes induced by human behaviors and activities that damage
the natural resources base on adversely alter nature processes or
ecosystems.
• Potentials effects are varied and may contribute to the increase in
vulnerability, frequency and the intensity of natural hazards.
• Examples include land degradation, deforestation, desertification,
wild land fire, loss of biodiversity, land, water and air pollution
climate change, sea level rise and ozone depletion.
• Levels of Disaster (Goolsby & Kulkarni, 2006)
o Level I
§ If the organization, agency, or community is able to contain the event and
respond effectively utilizing its own resources.
o Level II
§ If the disaster requires assistance from external sources, but these can be
obtained from nearby agencies.
o Level III
§ If the disaster is of a magnitude that exceeds the capacity of the local
community or region and requires assistance from state-level or even
federal assets.

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Phases of Disaster

• Pre-Impact Phase
o It is the initial phase of disaster, prior to the actual occurrence. A warning is given at
the sign of the first possible danger to a community with the aid of weather networks
and satellite many meteorological disasters can be predicted.
o The earliest possible warning is crucial in preventing toss of life and minimizing
damage. This is the period when the emergency preparedness plan is put into effect
emergency centers are opened by the local civil, detention authority. Communication
is a very important factor during this phase; disaster personnel will call on amateur
radio operators, radio and television stations.
o The role of the nurse during this warning phase is to assist in preparing shelters and
emergency aid stations and establishing contact with other emergency service group.
• Impact Phase
o The impact phase occurs when the disaster actually happens. It is a time of enduring
hardship or injury end of trying to survive.
o The impact phase may last for several minutes (e.g. after an earthquake, plane crash
or explosion.) or for days or weeks (eg in a flood, famine or epidemic).
o The impact phase continues until the threat of further destruction has passed and
emergency plan is in effect. This is the time when the emergency operation center is
established and put in operation. It serves as the center for communication and other
government agencies of health tears care healthcare providers to staff shelters. Every
shelter has a nurse as a member of disaster action team. The nurse is responsible for
psychological support to victims in the shelter.
• Post – Impact Phase
o Recovery begins during the emergency phase and ends with the return of normal
community order and functioning. For persons in the impact area this phase may last
a lifetime (e.g. - victims of the atomic bomb of Hiroshima).
o The victims of disaster in go through four stages of emotional response.
§ Denial - during the stage the victims may deny the magnitude of the
problem or have not fully registered. The victims may appear usually
unconcerned.
§ Strong Emotional Response - in the second stage, the person is aware of
the problem but regards it as overwhelming and unbearable. Common
reaction during this stage is trembling, tightening of muscles, speaking
with the difficulty, weeping heightened, sensitivity, restlessness sadness,
anger and passivity. The victim may want to retell or relieve the disaster
experience over and over.

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 § Acceptance - During the third stage, the victim begins to accept the
problems caused by the disaster and makes a concentrated effect to solve
them. It is important for victims to take specific action to help themselves
and their families.
§ Recovery - The fourth stage represent a recovery from the crisis reaction.
Victims feel that they are back to normal. A sense of well-being is restored.
Victims develop the realistic memory of the experience.

WHAT ARE THE HEALTH EFFECTS OF DISASTERS

The health effects of disasters may be extensive and broad in their

distribution across populations. In addition to causing illness and injury,
disasters disrupt access to primary care and preventive services. Depending
on the nature and location of the disaster, its effects on the short- and long-
term health of a population may be difficult to measure. The effects may also
depend on certain factors like the nature and intensity of the disaster
experienced, disaster preparedness measures implemented and the overall
level of health of the population.

• Disasters may cause premature deaths, illnesses, and injuries in the affected community,
generally exceeding the capacity of the local health care system.
• Disasters may destroy the local health care infrastructure, which will therefore be unable to
respond to the emergency. Disruption of routine health care services and prevention
initiatives may lead to long-term consequences in health outcomes in terms of increased
morbidity and mortality.
• Disasters may create environmental imbalances, increasing the risk of communicable
diseases and environmental hazards.
o Communicable diseases outbreak during disasters may be 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
• Disasters may affect the psychological, emotional, and social well-being of the population in
the affected community.
o Psychological responses may include
§ Fear

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 § Anxiety
§ Depression
§ Widespread panic and terror
• Disasters may cause shortages of food and cause severe nutritional deficiencies.
• Disasters may cause large population movements (refugees) creating a burden on other
health care systems and communities. Displaced populations and their host communities are
at increased risk for communicable diseases and the health consequences of crowded living
conditions.

WHAT IS DISASTER NURSING?

• Disaster nursing
o The adaptation of professional nursing knowledge, skills and attitude in
recognizing and meeting the nursing, health and emotional needs of disaster
victims.

Disaster and emergency nursing go hand-in-hand because a great portion of

disaster response is also responding to mass emergencies that occur during
disaster events and crisis situations. Nurses who are involved in disaster
response must also be well trained in aspects of emergency and critical care.

• Goals of Disaster Nursing

o Overall goal: To achieve the best possible level of health for the people and the
community involved in the disaster.
o To meet the immediate basic survival needs of populations affected by disasters
(water, food, shelter, and security).
o To identify the potential for a secondary disaster.
o To appraise both risks and resources in the environment.
o To correct inequalities in access to health care or appropriate resources.
o To empower survivors to participate in and advocate for their own health and well-
being.
o To respect cultural, lingual, and religious diversity in individuals and families and to
apply this principle in all health promotion activities.
o To promote the highest achievable quality of life for survivors.
• Principles of Disaster Nursing
o Rapid assessment of the situation and of nursing care needs.

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 o Triage and initiation of life-saving measures first.
o The selected use of essential nursing interventions and the elimination of
nonessential nursing activities.
o Adaptation of necessary nursing skills to disaster and other emergency situations. The
nurse must use imagination and resourcefulness in dealing with a lack of supplies,
equipment, and personnel.
o Evaluation of the environment and the mitigation or removal of any health hazards.
o Prevention of further injury or illness.
o Leadership in coordinating patient triage, care, and transport during times of crisis.
o The teaching, supervision, and utilization of auxiliary medical personnel and
volunteers.
o Provision of understanding, compassion, and emotional support to all victims and
their families.
• Roles of Nursing in Disasters
o “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)
o Major roles of nurses 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

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References Textbooks

Berman, A., Snyder, S. J., Kozier, B., Erb, G., Levett-Jones, T., Dwyer, T., ...
& Park, T. (2010). Kozier and Erb's fundamentals of nursing (Vol. 1).
Pearson Australia.
Potter, P. A., Perry, A. G. E., Hall, A. E., & Stockert, P. A.
(2009). Fundamentals of nursing. Elsevier Mosby.
Powers, R. & Daily, E. (2010). International Disaster Nursing. Cambridge
University Press: Singapore.
Smeltzer, S.E., et.al., Brunner & Suddarth’s Textbook of Medical-Surgical
Nursing Vol. 1 & 2. (12th Edition) USA.Woltters Kluwer Health/ Lippincott
Williams and Wilkins. 2010.
Veenema, T. G. (3rd Ed.). (2018). Disaster nursing and emergency
preparedness. Springer Publishing Company.
Timby, B.K., Smith, N.E. Introductory Medical-Surgical Nursing. (9th Edition)
USA. Lippincott Williams and Wilkins. 2007.

Electronic Resources

Banatin, C. A., Go, M. V., Peňafiel, A. M. R. M., & Bituin, R. A. (2009). Safe
Hospitals in Emergencies and Disasters: Philippine
Indicators. Administrative Order.
International Federation of the Red Cross and Red Crescent Societies. (2000).
Introduction to disaster preparedness.
International Federation of the Red Cross and Red Crescent Societies.
(2008). Guidelines for assessment in emergencies.
Lung Center of the Philippines. (2014). Health Emergency Preparedness,
Response and Recovery Plan.
Richards, D. A., Hilli, A., Pentecost, C., Goodwin, V. A., & Frost, J. (2018).
Fundamental nursing care: A systematic review of the evidence on the
effect of nursing care interventions for nutrition, elimination, mobility and
hygiene. Journal of clinical nursing, 27(11-12), 2179-2188.
Feo, Rebecca; Kitson, Alison; Conroy, Tiffany. Journal of
Clinical Nursing. Jun2018, Vol. 27 Issue 11-12, p2189-2229. 41p. 1
Diagram, 5 Charts. DOI: 10.1111/jocn.14313. , Database: Academic
Search Premier.
Grochtdreis, T., de Jong, N., Harenberg, N., Görres, S., & Schröder-Bäck, P.
(2016). Nurses’ roles, knowledge and experience in national disaster
preparedness and emergency response: A literature review. South
Eastern European Journal of Public Health (SEEJPH).
Yoost, B. L., & Crawford, L. R. (2019). Fundamentals of Nursing E-Book:
Active Learning for Collaborative Practice. Mosby.

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