Disaster Management in

Nursing
Community Nursing Class Notes on Disaster
Preparation and Management

Disasters and Community

Nursing
Disasters
Types of Natural Disasters
Earthquake: collision of tectonic plates

Drought
 Flood

Heat wave

Hurricane

Thunderstorm

Tornado

Volcano

Wildfire

Infamous Natural Disasters

Hurricane Katrina in 2005, brought devastation to the Atlantic coast, especially in the city of New Orleans,
Louisiana

Superstorm Sandy on the East Coast

The Japan Earthquake and Tsunami

The Haiti Earthquake

The Indonesia Tsunami

Mount Saint Helens

Types of Man-Made Disasters

Chemical; example: the nuclear explosion of Chernobyl, Russia

Drought (human factors can contribute to drought in certain cases, such as the Dust Bowl Famine)

Epidemic

Famine; examples: Rwanda, Darfur, Somalia

Landslide

Oil Spills; example: British Petroleum Oil Spill on the Gulf Coast

Power outage; example: the great Power Outage of Chicago

Terrorism; example: 9/11 World Trade Towers Attack

 War: world war, civil war, wars between two countries

Wildfires; example: the Great Wildfires of San Francisco, various Arizona wildfires

Infectious Disasters
Epidemic: the rates exceed the normal incidents

Endemic: the rates are consistent within a certain range (example: tuberculosis in the U.S.)

Pandemic: global outbreak

Pandemic Examples
Spanish flu of 1918: killed 20-50 million people

Asian flu of 1957: killed 70,000 people in the U.S. and another 2 million worldwide

Hong Kong flu of 1968: killed 1 million people globally

Defining Disasters
Measurements of Disasters
Multiple Causality Event

Mass Casualty Event

Multiple Causality Event

Over 2 deaths but less than 100 casualties

Strains the emergency response

Mass Casualty Event

Over 100 casualties

Overwhelms the emergency response

American Red Cross Definition of Disaster

A situation in which many losses of lives occur or are at risk of occurring

Considerations for Disaster

Three Major Sections of Disasters in Public Health
Epidemiological application

Extend of devastation

Disaster response and management

Epidemiological Applications
Epidemiology and Disaster
Agents of harm: primary and secondary

Application of the epidemiological triangle

Primary and Secondary Agents of Harm

Primary agents: Physical entity causing injury or destruction

Secondary agents: aftermath effects that are dependent upon the primary

Primary Epidemiological Agents

The physical or microbial entity causing injury or destruction

Heat, wind, water, infectious agent

Secondary Epidemiological Agents

Varies depending upon the type of primary agent

Example: people in Japan fell ill after drinking contaminated water following the 2009 tsunami; agent:
microbes in water, environmental: water supply was contaminated following the disaster, host: residents of
Japan

Example: women were raped in the Super Dome following Hurricane Katrina in New Orleans; agent: rape,
environmental: trapped in a facility with minimal security and a large population, host: women

Epidemiological Triangle
Agent: Physical entity causing injury or destruction

Primary agent: Heat, wind, water

Secondary agent: vary depending on type of disaster

Extent of Disaster Devastation
Themes of Disaster Devastation
Factors of Impact: Severity and scope

Dimensions of a disaster

Phases of community reaction

Be aware of the concept of mitigation, or increasing factors

that can cause harm during a disaster

Factors that Impact a Disaster: VEPP

V: Vulnerability

E: Environment

P: Proximity

P: Perception

Vulnerability Factors of Disaster

Vulnerability or susceptibility of community members

Young children, elderly, and disabled are the most vulnerable

Environmental Factors of Disaster

Includes physical, chemical, biological and social factors

Escape and evacuation routes, The landscape

Perceptual Factors of Disaster

How serious the community members perceive the disaster to be

How well the community is prepared for disaster

The Boy Who Cried Wolf Effect: people become desensitized after repeat warnings without action

Proximity and Warning Factors

 How close the origin is to the community

Location is important for two reasons: not only how close but also how densely populated; rural
communities tend to fare better as escape routes are less congested

The amount of time the community members have from the start of the initial warning to the impact

Sirens, radio alerts, newscasts communicate warnings

Disaster Phases
The Three Phases of a Disaster
Pre-Impact Phase

Impact Phase

Post-Impact Phase: includes emergency response and recovery

Community Reaction to Disaster

Phases of Community Reaction to Disaster
Heroic phase: active rescue and adrenaline

Honeymoon phase: community pulls together

Disillusionment phase: delays in assistance leads to disappointment

Reconstruction phase: rebuilding of infrastructure, the return of a new a new form of normalcy

Disaster Response and Management

Themes of Disaster Management
Agencies involved

People involved

Communication systems
 The Eight Principles of Disaster Management

The nurses role in disaster

Those Involved in Disaster

Who Prepare and Respond to Disasters
Federal agencies

State agencies

Local agencies

Volunteer organizations

Virtually every member of the community

Which Agencies Prepare and Respond to Disasters?

Department of Homeland Safety

Federal Emergency Management Agency (FEMA)

National Guard
Red Cross

FEMAs Definitions of Disaster

Who is FEMA?
The major governmental organization of the U.S. responsible for disaster management in States, Tribes,
Territorial and local jurisdictions

Responds to emergencies declared by the President

Facilitates interagency orchestration of resources to administer actions related to disaster

FEMA states five major elements to its mission: Prevention, Protection, Mitigation, Response, and
Recovery

FEMA Disaster Response

 Organizes response through the Disaster Emergency Communications Division

Mobile Emergency Response Support (MERS) detachments

Mobile Communications Office Vehicles (MCOV)

Four components are required to be granted funds for public assistance: applicant, cost, facility, and work
(FEMA, June 17, 2013)

Assistance is organized through the EMAC, or Emergency Management Activation Compact

A region must meet one of the 3 Disaster Phases to activate EMAC

National Disaster Recovery Framework

A guide for disaster management set forth through the Presidential Policy Directive (PPD)-8, National
Preparedness
Recently introduced 6 new Recovery Support Functions
http://www.fema.gov/national-disaster-recovery-framework
FEMAs Phases of Disaster
Phase III Disaster instigates the lowest level of EMAC activation

Phase II Disaster instigates the mid-level of EMAC activation. It may involve a single state or multiple
states

Phase I Disaster instigates the highest level of EMAC activation. It may involve a single state or multiple
states

The Red Cross

What is the Red Cross?
The Red Cross is a volunteer humanitarian organization that provides national and international
assistance through disaster relief, community-based programs, and vaccinations against communicable
diseases such as measles and rubella
In 1863, the International Red Cross and Red Crescent movement was founded in Geneva, Switzerland

Clara Barton established the American chapter in 1881

 The American Red Cross retains its global affiliation with the Red Crescent network

The Red Cross is a leader in international health issues and is often one of the first organizations to respond
when disaster strikes a community

It offers many resources on its website such as downloadable checklists for specific disasters

Red Cross Recommendations on Who Should Prepare for

Disasters
Families and individuals, with special emphasis placed on vulnerable populations

Schools

Workplace

Tips on Being Prepared

Maintain an emergency preparedness kit

Have an emergency plan in place

Communication Response to Disasters

Local Disaster Communications
Incident Command System (ICS)

Emergency Operations Center (EOC)

Federal Disaster Communications

FEMA manages Mobile Emergency Response Support (MERS) detachments

Mobile Communications Office Vehicles (MCOV) are directed by MERS

Principles of Disaster Management

The Eight Principles of Disaster Management
1. Prevention
2. Minimize casualties from primary agent of harm
3. Minimize casualties from secondary agents or sources of harm
4. Rescue victims
5. First aid and triage
6. Evacuation
7. Definitive medical treatment
8. Reconstruction

Nursing Responsibilities in Disasters

The Nurses Five Primary Roles in Disasters
1. Planning and prevention
2. Emergency care
3. Triage of victims
4. Direct care of victims
5. Recovery and revitalization of communities
Prevention and Planning by Nurses
Personal protection of the self and family members

Prevention of disaster, whenever plausible

Planning for disaster management before one occurs; ask yourself: What type of disasters may occur in my
community?

When disaster strikes, the nurse is involved in developing a response plan

Always have a plan in place!

As a nurse in a disaster, your first role is to save yourself and
your family first; after all, you must help yourself before you
can help others

Emergency Care by Nurses

Preparing for care through a disaster assessment

First aid to community members

Triage of Victims by Nurses
Triage involves preservation of the most lives possible by prioritizing to determine the immediacy of care
The need to allocate limited resources and determining who can be saved can be emotionally and
spiritually challenging

A color coding system is used to organize care management

Triage Colors
Red is first priority, they need care immediately
Yellow is second priority
Green is third priority; examples: fracture, contusions, abrasions
Black is dying or dead: no care is usually given
Direct Care by Nurses
Provide direct care of victims

Perform care of victims in an unified and collaborative manner with other rescue workers

Most hospitals have an emergency plan in place for a variety of potential disasters

Recovery Actions by Nurses

Nurses work with other recovery coordinators to restore, redevelop and revitalize communities impacted by
disaster

Nurses assist in policy development to prevent future disasters or implement quality control in response

Health Disparities and Disasters

Does Race Impact Disaster Response?
Many people criticized FEMAs response of Katrina, feeling that assistance was delayed, inadequate, and
poorly managed. As the people impacted by Katrina the worse were mostly inter-city African Americans, it led
to questions about health disparities linked to race. Would the response have been different had the disaster
affected affluent Caucasians?

Feeling like Katrina with no FEMA Mr. Kayne West

Celebrity Quotes
 In one of his songs, rapper artist Kayne West lyrics states that hes Feeling like Katrina with no FEMA
Following Katrina, Mr. Wests quote has grew to represent the sentiments of health disparity among
race George Bush doesnt care about black people! http://rapgenius.com/Kanye-west-flashing-lights-
lyrics#note-18201
As New Orleans native, Hip Hop artist Lil Wayne contributed generously to Katrina victims. He
makes references to the disaster felt in his home town in several songs, including through the lyric in which
he refers to F, the middle initial in his name: Now the F stands for FEMA http://rapgenius.com/Lil-
wayne-feel-me-lyrics#note-36660
Resources for Nursing Students on Disaster Management
American Red Cross (2013). Disaster Relief. Retrieved from http://www.redcross.org/what-we-do/disaster-
relief
American Red Cross (2013). Tools and Resources. Retrieved fromhttp://www.redcross.org/prepare/disaster-
safety-library
American Red Cross (2013). Types of Emergency. Retrieved from http://www.redcross.org/prepare/disaster
FEMA (August 17, 2012). Disaster Emergency Communications. Retrieved
fromhttp://www.fema.gov/disaster-emergency-communications
FEMA (nd). Emergency Management Assistance Compact (EMAC). Retrieved
fromhttp://www.fema.gov/pdf/emergency/nrf/EMACoverviewForNRF.pdf
FEMA (September 9, 2013). National Disaster Recovery Framework. Retrieved
fromhttp://www.fema.gov/national-disaster-recovery-framework
FEMA (June 21, 2013). Public Assistance: Eligibility. Retrieved from http://www.fema.gov/public-assistance-
eligibility
Mpolya, E. A., Furuse, Y., Nukiwa, N., Suzuki, A., Kamigaki, T., & Oshitani, H. (2009). Pandemic
(H1N1) 2009 Virus viewed from an epidemiological triangle model. Journal of Disaster Research, 4(5).
Retrieved
fromhttp://www.academia.edu/1308173/Pandemic_H1N1_2009_virus_viewed_from_an_epidemiological_tria
ngle_model
Ramirez, M., & Peek-Asa, C. (2010). Epidemiology of traumatic injuries from earthquakes.Epidemiological
Reviews, 27(1), 47-55. Retrieved fromhttp://epirev.oxfordjournals.org/content/27/1/47.full