DISASTER NURSING Objectives: After 4 hours of varied teaching-learning activities, the Level III Nursing students will be able

to: 1. define disaster 2. enumerate the three phases of responses to disaster 3. explain the triage of disaster 4. determine the characteristics of disaster agents 5. identify the types of disaster 6. enumerate the roles of a nurse in a disaster site 7. state the principles of disaster management 8. identify physical and psychological management of disaster victim

I. Definition Disaster - a sudden and serious disruption of life caused by nature or humans that create or threaten to create injuries to a number of persons or properties II. Three Phases of Responses to Disaster 1. Alarm Phase - which is concerned with the immediate activation of adequate and appropriate resources. 2. Work Phase - or implementation phase - it is subdivided into four overlapping steps LAST Locate find or determine where the victim is Access means of going the victim Stabilize life threatening cases are already given necessary care or victim is already out of danger Transport transfer the victim to medical facility 3. Let Down Phase - after the work is completed, all personnel must recover from the stress of the disaster.

III. Triage A process used in sorting patients / victims in to categories of priority for care and transport based on the severity of injuries and medical emergencies. 1. Highest Priority patients requiring immediate care and transport - Airways and breathing difficulties - Exanguinating hemorrhage - Open chest and abdominal wound - Severe head injuries or head injuries with decreasing level of consciousness - Major complicated burns - Tension pneumothorax - Impending shock - Complicating severe medical problems diabetes with complications, cardiac disease, pregnancy

2. Intermediate Priority patients whose care/treatments and transportation can be delayed temporarily - Burns without complications - Back injuries with or without spinal injuries - Major, open or multiple fractures - Eye injuries - Stable abdominal injuries 3. Delayed or Low Priority (the walking wounded) patients whose care and victim is already out of danger a. b. c. d. Fracture or Sprain Laceration Soft tissue injuries Other lesser tissues

4. Lowest Priority patients/victims who are dead or near death a. Devastating injuries b. Little chance of survival (if resources are limited, these patients must be ignored to enable these resources used on salvageable patients) IV. Characteristics of Disaster Agents Natural vs. Causation

In human-caused disasters such as bombings and other acts of terrorism, technological accidents, or airline crashes, survivors grapple with deliberate human violence and human error as casual agents. In true natural disasters, the casual agent is seen beyond human control and without evil intent. Many disasters occur or are worsened through an interaction of natural and human elements. For example, damage from the natural event of flooding may be increased due to human factors such as inadequate planning, governmental policies, or faulty warning systems. Degree of Natural Impact

Researchers have consistently shown that more personal exposure a survivor has to the disasters impact, the greater his or her post-disaster reactions. Death of a family member, loss of ones home, and destruction of ones community exemplify high impact factors. In each of these, the intertwining of grief and trauma processes compounds the effects and extend the duration of recovery period for many survivors. High exposure survivors experience more anxiety, depression, sadness, post trauma symptoms, somatic symptoms, and, in some studies, alcohol abuse.

Size and Scope of Disaster

Survivors become disoriented at the most basic levels. Researchers have found higher levels of anxiety, depression, post traumatic stress, somatic symptoms, and generalized distress associated with widespread community destruction. When some fabric of community life is left intact (eg. schools, churches, commercial areas), there is a foundation from which recovery can occur. Social supports occur more readily when community-gathering places remain. Visual Impact / Low Point

Most disasters have a clearly defined end point that signals the beginning of the recovery period. After a tornado, hurricane, or wildfire has passed through an area, the community sees the total extent of resulting physician destructions and begins the recovery and rebuilding process. The disaster threat is over and healing can begin. V. Types of Disaster Disasters are not uniform events. Each disaster, be it flood, earthquake, hurricane or human-caused disaster, has intrinsic unique elements. These elements have psychological implications for survivors and communities. The disaster characteristics discussed in this section are: natural vs. human causation, degree of personal impact, size and scope, visible impact/low point, and the probability of recurrence. Each of these individually or collectively, has the potential for shaping and influencing the nature, intensity and duration of post disaster stress.

VI. Roles of a Nurse in Disaster Site 1. Care Provider the nurse supports the client by attitudes and actions that show concern for the client welfare and acceptance of the client as a person. 2. Client Advocate the nurse promotes what is best for the client, ensures that the clients needs are met, and protects the clients right. 3. Counselor the nurse helps the client to recognize and cope with stressful psychologic or social problems to develop improved personal relationships to promote personal growth. 4. Change Agent the nurse changes and assists the client makes modifications in the lifestyle to promote health. Involves identifying the problem, assessing the clients motivations and capacities for change and exploring possible outcomes.

VII. PRINCIPLES OF DISASTER MANAGEMENT

1. Being aware of community hazards and vulnerabilities, as well as being familiar with the community health care system and its level of preparedness. 2. Have a personal and family disaster plan. 3. Nurse should be familiar with the disaster plan at their workplaces, including their role in its execution. It is also important to increase ones knowledge base, especially in relation to bioterrorism, since nurses may be called upon to educate patients and community members. 4. Hurricanes and slow-rising floods, generally tend to have fewer injuries and deaths during the impact phase. 5. Those disasters will little or no advance notice, such as natural disasters such as earthquakes will have more casualties, since victims have little time to make preparations or to evacuate the endangered areas before disaster strikes. 6. Specific injuries and illnesses will depend on the type of disaster. Those with warnings carry their own dangers, since individuals can be injured attempting to prepare for the disaster or while evacuating. 7. In the post-disaster phase, the threat shifts to clean-up injuries, which can be quite common after widespread disasters such as hurricanes.

VIII. PHYSICAL AND PSYCHOLOGICAL MANAGEMENT OF A DISASTER VICTIM. Physical management of a disaster victim would depend upon the physical injuries that he or she had acquired during the incident. Generally speaking, the primary interventions to a disaster victim would be giving him FIRST AID measures and then later on, he would be given advance medical attention once he reached the hospital for proper care from the medical team. Disaster can cause trauma and great deal of stress to a victim. It may also lead to certain disorders if not intervened in a right way. To avoid this, we should keep in mind the proper steps or interventions to avoid the disaster making a negative long time effect to our patients.

Post Trauma Disorder Post Traumatic stress syndrome disorder or PTSD, is a psychiatric disorder that occur following the experience or witnessing life threatening event such as military combat, natural disaster, terrorist accidents, serious accidents, or violent personal assaults like rape. Most survivors of trauma return to normal time. However, some people will have stress reactions that do not go away on their own, or may even get worse over time. Recover of PTSD is an ongoing, daily, gradual process. It doesnt happen though sudden insight or cure. Healing doesnt mean that a survivor will forget war experiences or have emotional pain when remembering them. Calm level of continuing reaction of fewer reactions is normal and reflects a normal body and mind. Recover may lead to fewer reactions that are less intense. It leads to a greater ability to manage trauma related emotions and to greater confidence in ones ability to cope. Positive coping actions are those that help reduce anxiety and lessen other distressing reactions. Positive coping actions also improve the situation in a way that does not harm. Positive Coping Methods include: Learning about trauma and PTSD

It is useful for survivors to learn more about PTSD and how it affects them. By learning PTSD is common and that their problems are shared by hundreds of thousands of others, survivors recognize that they are not alone, weak or crazy. When survivors seeks treatment and learns to recognize and understand what upsets him or her, he or she is in better position to cope with the symptoms of PTSD. Talking to another person for support

When survivors are unable to talk about their problems with others, something helpful often occurs. Survivors must choose their support from people carefully and clearly ask for what they need. With support from others, survivors feel less alone, feel supported or understood. Often it is best to talk to professional counselors about issues related to the traumatic experience itself; they are more likely friends or family to understand trauma and its effect. It is also helpful to seek support from support group. Being in a group with others who have PTSD may help reduce ones sense of isolation, rebuilds trust in others and provide an important opportunity to contribute to the recovery of other survivors of trauma. Talking to your doctor about trauma and PTSD

Part of taking care of your self means mobilizing the helping resources around you. Your doctor can take care of your physical health better if he or she knows about your PTSD and doctors can refer you to more specialized and expert. Practicing relaxation methods

These can include muscular relaxation exercises, breathing exercises, medication, swimming, stretching, yoga, listening to quiet music, spending time in nature and so on. While relaxation technique can be helpful, they can sometimes increase distress by focusing attention on disturbing physical sensations or by reducing contact with the external environment. Increasing positive distracting activities

Positive recreational or work activities help distract a person from his or her memories and reactions. Artistic endeavors have also been in a way for many trauma survivors to express their feelings in a positive, creative way. Calling a counselor for help

Sometimes PTSD symptoms worsen and ordinary efforts at coping doesnt seem to work. Survivors may feel fearful or depressed. At these times, it is important to reach out and telephone a counselor, who can help turn things around. Taking prescribe medications to tackle PTSD

One tool that many with PTSD have found helpful is medication treatment. By taking medications, some survivors of trauma are able to improve their sleep, anxiety and irritability.