NURSING Cherry Joyce G. Basco, RN, LPT INTRODUCTION TO DISASTER NURSING Historical Perspective ■ Florence Nightingale ➢ the pioneer of modern nursing, functioned as a disaster nurse during the Crimean War. ➢ Taking 38 other women with her to Turkey, she assumed the management responsibilities of the barracks hospital. ➢ Wartime health care is similar to disaster health care in that the needs far outweigh the resources. Nightingale worked tirelessly to develop a rudimentary standard of care for the soldiers. ➢ This required adaptation of previous knowledge and skills in order to provide care to these soldiers. ➢ This ability to adapt is one of the building blocks required for disaster nurses.
■ Clara Barton, another pioneering nurse, worked diligently during the Civil War providing care to soldiers and then founded the American Red Cross in 1881. ➢ Barton had a keen understanding of the needs of the soldiers and what she could do to help. ➢ She came to be known as “the angel of the battlefield.” ➢ By her example, and the establishment of the American Red Cross, a new precedent for volunteerism was set. Historical Perspective ■ Over the last century the specialty of emergency nursing has developed because the rapid evaluation and treatment of patients during wartime was noted to save lives. ■ Prior to this time it would have been the responsibility of a nurse in the community to respond to a disaster. ■ The development of the specialty of emergency medicine, emergency departments, and emergency medical systems has redirected small disasters to be cared for directly in emergency departments. ■ These few examples chronicle the development of disaster medicine and disaster nursing, both created out of necessity. ■ Although these sub-specialties are needed sporadically, when an event occurs they become essential. ■ It is important to explore the relatively new sub-specialties and develop the fundamental knowledge and the skill sets necessary for the nursing personnel to function at the time of disaster. BRIEF HISTORY OF THE PHILIPPINE DISASTER MANAGEMENT IN THE PHILIPPINES
➢ 1941 – Executive Order (EO) No. 35 was created President Manuel
L. Quezon, establishing National Emergency Commission and implementing measures to control and coordinate civilian participation to meet serious crises. ➢ 1954 – National Civil Defense Administration (NCDA) was established through Republic Act (RA) No. 1190, which also created national and local civil defense councils. ➢ 1968 – the NCDA was designated as the national coordinator to oversee and implement Executive Order (EO) No. 159 requiring all departments, bureaus, offices, agencies, instrumentalities and political subdivisions of the government, including corporations owned or controlled by the government, the armed forces, government hospitals, and public educational institutions, to establish their respective disaster control organization. BRIEF HISTORY OF THE PHILIPPINE DISASTER MANAGEMENT IN THE PHILIPPINES ➢ 1970 – President Ferdinand E. Marcos saw the need to establish a Disaster and Calamities Plan prepared by an Inter-Departmental Planning Group on Disasters and Calamities. ➢ 1972 - Letter of Instruction 19 established Office of Civil Defense (OCD). ➢ 1978 - Presidential Decree (PD) 1566, the National Disaster Coordinating Council (NDCC) was established as the highest policy-making body and the focal organization for disaster management in the country. The law also provided for the establishment of regional, provincial, city, municipal, and barangay disaster coordinating councils. ➢ 2009 – Republic Act (RA) No. 9729 otherwise known as Climate Change Act of 2009 was enacted by the Congress. ➢ 2010 – Republic Act (RA) No. 10121 or the Philippine Disaster Risk Reduction and Management (PDRRM) Act was signed into law by President Gloria Macapagal-Arroyo on May 27, 2010. It is a consolidation of Senate Bill No. 3086 and House Bill No.6985 passed by the Senate and House of Representatives on February 1, 2010. BRIEF HISTORY OF THE PHILIPPINE DISASTER MANAGEMENT IN THE PHILIPPINES ■ The Congress enacted the Climate Change Act of 2009 and in 2010, RA 10121 or the Philippine Disaster Risk Reduction and Management (PDRRM) Act. These twin laws on DRRM have common goals and objectives: ➢ 1) to increase the resilience of vulnerable communities and the country against natural disasters and ➢ 2) to reduce damage and loss of lives and properties due to disasters. ■ In particular, RA 10121 provides for the development of policies and plans and the implementation of actions and measures pertaining to all aspects of DRRM, including good governance, risk assessment and early warning, knowledge building and awareness raising, reducing underlying risk factors, and preparedness for effective response and early recovery. ■ The law acknowledges that there is a need to “adopt a disaster risk reduction and management approach that is holistic, comprehensive, integrated, and proactive in lessening the socioeconomic and environmental impacts of disasters including climate change, and promote the involvement and participation of all sectors and all stakeholders concerned, at all levels, especially the local community.” ■ Through the years, the Philippines has adopted various approaches from disaster preparedness and response in the 1970s, to disaster management in the 1980s, to disaster risk management in the 1990s and eventually disaster risk reduction in the years 2005 and beyond. WHAT IS DISASTER? A serious disruption of the functioning of a community or a society at any scale due to hazardous events interacting with conditions of exposure, vulnerability and capacity, leading to one or more of the following: human, material, economic and environmental losses and impacts. (https://www.undrr.org/terminology/disaster) WHAT IS 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 defines Disaster as "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." WHAT IS DISASTER? Red Cross (1975) defines Disaster as “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) defines “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.” WHAT IS DISASTER? Disaster can be defined as “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.” WHAT IS DISASTER NURSING?
Disaster nursing can be defined as “the adaptation
of professional nursing knowledge, skills and attitude in recognizing and meeting the nursing, health and emotional needs of disaster victims.” THUS, A DISASTER MAY HAVE THE FOLLOWING MAIN FEATURES:-
· Unpredictability
· Unfamiliarity
· Speed
· Urgency
· Uncertainty
· Threat GOALS OF DISASTER NURSING
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.
Other goals of disaster nursing are the following:
1. To meet the immediate basic survival needs of populations affected by disasters (water, food, shelter, and security). 2. To identify the potential for a secondary disaster. 3. To appraise both risks and resources in the environment. GOALS OF DISASTER NURSING
4. To correct inequalities in access to health care or
appropriate resources. 5. To empower survivors to participate in and advocate for their own health and well-being. 6. To respect cultural, lingual, and religious diversity in individuals and families and to apply this principle in all health promotion activities. 7. To promote the highest achievable quality of life for survivors. PRINCIPLES OF DISASTER NURSING
1. Rapid assessment of the situation and of nursing care
needs. 2. Triage and initiation of life-saving measures first. 3. The selected use of essential nursing interventions and the elimination of nonessential nursing activities. 4. 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. PRINCIPLES OF DISASTER NURSING
5. Evaluation of the environment and the mitigation
(removal of any health hazards). 6. Prevention of further injury or illness. 7. Leadership in coordinating patient triage, care, and transport during times of crisis. 8. The teaching, supervision, and utilization of auxiliary medical personnel and volunteers. 9. Provision of understanding, compassion, and emotional support to all victims and their families. 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. Disasters affect the health status of a community in the following ways: ➢ 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. HEALTH EFFECTS OF DISASTERS ➢ Disasters may create environmental imbalances, increasing the risk of communicable diseases and environmental hazards. ➢ Disasters may affect the psychological, emotional, and social well-being of the population in the affected community. Depending on the specific nature of the disaster, responses may range from fear, anxiety, and depression to 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. DISASTER
■ D – Destruction ■ I – Incidents ■ S – Sufferings ■ A – Administrative, Financial Failures ■ S - Sentiments ■ T – Tragedies ■ E – Eruption of Communicable Diseases ■ R – Research program and its implementation Roles and Responsibilities of a Disaster Nurse ■ D – disseminate information on the prevention and control of environmental hazards ■ I – interpret health laws and regulations ■ S – serve yourself of self – survival ■ A – accepts directions and take orders from an organized authority ■ S – serve the best of the most ■ T – teach the meaning of warning signals ■ E – exercise leadership ■ R – refer to appropriate agencies Nurses’ Roles in Disaster
1. Determine magnitude of the event
2. Define health needs of the affected groups 3. Establish priorities & objectives 4. Identify actual & potential public health problems 5. Determine resources needed to respond to the needs identified 6. Collaborate with other professional disciplines, governmental & non-governmental agencies 7. Determine magnitude of the event 8. Define health needs of the affected groups Types of Disaster TYPES OF DISASTER Disasters are classified in various ways, on the basis of its origin/cause. 1. Natural disasters 2. Man-made disasters
And On the basis of speed of onset-
1.Sudden onset disasters 2. Slow onset disasters NATURAL DISASTERS A serious disruption triggered by a natural hazard (hydro- metrological, geological or biological in origin) causing human, material, economic or environmental losses, which exceed the ability of those affected to cope. Natural hazards can be classified according to their: (1) hydro meteorological, (2) geological or (3) biological origins. Hydrometer logical disaster
Natural processes or phenomena of
atmospheric hydrological or oceanographic nature. 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. Biological Disaster Processes of organic organs or those conveyed by biological vectors, including exposure to pathogenic, microorganism, toxins and bioactive substances. HUMAN-INDUCED DISASTERS 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.
These can be classified into –
(1)Technological Disaster and (2)Environmental Degradation. Technological disaster Danger associated with technological or industrial accidents, infrastructure failures or certain human activities which may cause the loss of life or injury, property damage, social or economic disruption or environmental degradation, sometimes referred to as anthropological hazards. 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. LEVELS OF DISASTER Disasters are classified by the following levels: 1) Level I: If the organization, agency, or community is able to contain the event and respond effectively utilizing its own resources. 2) Level II: If the disaster requires assistance from external sources, but these can be obtained from nearby agencies. 3) 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. PREPARING NURSES FOR DISASTERS The ICN report describes three levels of preparation:
➢ Level 1 competencies apply to all nurses.
➢ Level 2 is for those who have the Level 1 skills and who are in leadership positions or who could then go on to become a designated disaster responder within their organization. ➢ Level 3 competencies are those for nurses who will be deployed in teams to respond to a range of emergency situations. The Level 3 competencies are not included in the new ICN report and will be developed in the future. The competencies are divided into eight domains: preparation and planning, communication, incident management systems, safety and security, assessment, intervention, recovery, and law and ethics. ■ • Preparation and planning - actions taken apart from any specific emergency to increase readiness and confidence in actions to be taken during an event. ■ • Communication - approaches to conveying essential information within one’s place of work or emergency assignment and documenting decisions made ■ • Incident management systems - the structure of disaster/emergency response required by countries/organizations/institutions and actions to make them effective ■ • Safety and security - assuring that nurses, their colleagues and patients do not add to the burden of response by unsafe practices The competencies are divided into eight domains: preparation and planning, communication, incident management systems, safety and security, assessment, intervention, recovery, and law and ethics. ■ • Assessment - gathering data about assigned patients/families/communities on which to base subsequent nursing actions ■ • Intervention - clinical or other actions taken in response to assessment of patients/families/communities within the incident management of the disaster event ■ • Recovery - any steps taken to facilitate resumption of pre-event individual/family/community/organisation functioning or moving it to a higher level ■ • Law and ethics - the legal and ethical framework for disaster/emergency nursing KEY ELEMENTS OF DISASTERS
Disasters result from the combination of
hazards, conditions of vulnerability and insufficient capacity or measures to reduce the potential negative consequences of risk. HAZARDS Hazards are defined as “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.” 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
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 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 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) Definition of Disaster Management Terms • 1. Hazards. A situation that poses a level of threat to life, health, property or environment. • 2. Risks. A probability or threat f a damage, injury, loss, or other negative occurrence that is caused by external or internal vulnerabilities, and that may be neutralized through preemptive action. • 3. Vulnerability. The level of susceptibility or resiliency of the people and communities against the impact of the prevailing hazards based on the stat of physical, social, and economic conditions in a given area. • 4. Disasters. A serious disruption of the functioning of a community or a society involving widespread human, material, economic or environmental losses and impacts, which exceeds the ability of the affected community or society to cope using its own resources. The Disaster Equation ➢ Hazards (H). Physical impact of disturbance ➢ Risk (R). Likelihood of harm, loss, disaster ➢ People or Community (Exposure). Elements affected by hazard ➢ Vulnerability (V). Susceptibility and capacity to prepare, absorb, and recover from hazard
H x R + V = Disaster
Where:
➢ Hazards (H) ➢ Risk (R) ➢ People or Community ➢ Vulnerability (V) ➢ Exposure. Elements affected by hazard
