emergency nursing

DISASTER NURSING GOLDEN LECTURE
Kawkab Shishani, RN, PhD Community Health Nursing [email protected] Jordan Richard Garfield, RN, DrPH Director WHO/PAHO Collaborating Center School of Nursing, Columbia University in the City of New York Nicolas Padilla, MD Universidad de Guanajuato Mexico Ronald LaPorte, PhD Director Telecommunications and Disease Monitoring; WHO Collaborating Center University of Pittsburgh June 8, 2009

NURSES AND EDUCATION


Education is the most powerful weapon which you can use to change the world. Nelson Mandela

MISSION STATEMENT


Disasters are a primary cause of morbidity and mortality. Nurses can play an important role in disaster mitigation, but they receive very little training. This lecture is designed to help to introduce to nursing the concepts of disasters and disaster mitigation. We propose that you teach this lecture to your nursing students to build awareness world wide.

OBJECTIVES
1.

2.
3. 4.

5. 6. 7.

Define a disaster Discuss patterns of mortality and injury Understand impact of disasters on health Describe the factors that contribute to disasters severity Discuss role of nursing in disasters Apply principles of triage in disaster Analyze the WHO components of effective disaster nursing

WHAT IS 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.

TYPES
Natural  Pandemics  Transportation  Technological  Terrorism


HURRICANES

The primary health hazard from hurricanes or cyclones lies in the risk of drowning from the storm surge associated with the landfall of the storm. Most deaths associated with hurricanes are drowning deaths.  Secondarily, a hazard exists for injuries from flying debris due to the high winds.
 

Nurses can be instrumental in providing direct emergency care to drowning and head injuries.

TORNADOES


The primary hazard from a health perspective in a tornado is the risk for injuries from flying debris. The high winds and circular nature of a tornado leads to the elevation and transport of anything that is not fastened down. Most victims of tornadoes are affected by head and chest trauma due to being struck by debris or from a structural collapse. Some individuals are injured while on the ground. Others are lifted into the air by the tornado and dropped at another location.

FLOODS

Floods may originate very quickly following a quick rain storm, or they may develop over a short period following an extended period of rain or quick snow melt  The primary hazard from flooding is drowning  Longer term health concerns from flooding is the development of disease from contaminated water and lack of hygiene.


EARTHQUAKES
A significant global concern  The primary health concern: • Injuries arising from structural collapse • Most injuries occur amongst individuals trapped at the time of the earthquake  Well known prevention strategy is to prevent buildings from collapsing  There is a recognized need to develop better rescue strategies for retrieving individuals from collapsed buildings


VOLCANOES
Rare, but can be catastrophic when they occur  Over the 25 year period (1972-1996), there was an average of 6 eruptions per year, causing an average of 1017 deaths and 285 injuries  Health outcomes are associated with volcanic eruptions: • Respiratory illnesses from the inhalation of ash • For individuals close to the volcano, some danger exists from lava flows, or more likely mud flows


VULNERABILITIES, NEEDS, AND ABILITIES VARY

10000000 9000000 8000000 7000000 6000000 5000000 4000000 3000000 2000000 1000000 0
1900 1905 1910 1915 1920 1925 1930 1935 1940 1945 1950 1955 1960 1965 1970 1975 1980 1985 1990 1995 2000

Conflict

Natural Disasters

MAN-MADE THREAT
Unpredictable Challenges Disruptive Unexpected Targeting weaknesses Very rare, impossible to conceive before event Threats to Civilians, Information Infrastructure

COMPONENTS OF DISASTER DEBRIS
Building Debris  Household Debris  Vegetative Debris  Problem Waste Streams


MYTHS ASSOCIATED WITH DISASTERS


Any kind of assistance needed in disasters


A response not based on impartial evaluation contributes to chaos



Epidemics and plagues are inevitable after every disaster
 

Epidemics rarely ever occur after a disaster Dead bodies will not lead to catastrophic outbreaks of exotic disease  Proper resumption of public health services will ensure the public’s safety (sanitation, waste disposal, water quality, and food safety)
 

Disasters bring out the worst in human behavior



The majority responses spontaneous and generous
Cross-cultural dedication to common good is most common response to natural disasters

The community is too shocked and helpless

PATTERNS OF MORTALITY AND INJURY
Disaster events that involve water are the most significant in terms of mortality  Floods, storm surges, and tsunamis all have a higher proportion of deaths relative to injuries  Earthquakes and events associated with high winds tend to exhibit more injuries than deaths  The risk of injury and death is much higher in developing countries – at least 10 times higher because of little preparedness, poorer infrastructure.


DISPLACEMENT OF DISASTER VICTIMS
Mass Shelters  Shelter management:
 • • • • • •

Organized team (chain) Sleeping area and necessities Water and food handling Sanitation (toilets, showers,..) Special care to children and elderly Health services (physical, mental)

DISASTER AND HEALTH
In a major disaster water treatment plants, storage & pumping facilities, & distribution lines could be damaged, interrupted or contaminated.  Communicable diseases outbreak 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


DISASTER AND HEALTH
Injuries from the event  Environmental exposure after the event (no shelter)  Malnutrition after the event (feeding the population affected)  Excess NCD mortality following a disaster  Mental health (disaster syndrome)


MENTAL WELLNESS
Little attention is paid to the children  Listen attentively to children without denying their feelings  Give easy-to-understand answers to their questions  In the shelter, create an environment in which children can feel safe and secure (e.g. play area)


MENTAL WELLNESS
In any major disaster, people want to know where their loved ones are, nurses can assist in making links.  In case of loss, people need to mourn: • Give them space, • Find family friends or local healers to encourage and support them • Most are back to normal within 2 weeks • About1% to 3%, may need additional help


THE MOST VULNERABLE

THE PHASES OF DISASTER


Mitigation:


Lessen the impact of a disaster before it strikes
Activities undertaken to handle a disaster when it strikes Search and rescue, clearing debris, and feeding and sheltering victims (and responders if necessary). Getting a community back to its pre-disaster status



Preparedness:




Response:




Recovery:


MITIGATION


Activities that reduce or eliminate a hazard



Prevention Risk reduction



Examples
Immunization programs  Public education


PREPAREDNESS


Activities that are taken to build capacity and identify resources that may be used
Know evacuation shelters  Emergency communication plan  Preventive measures to prevent spread of disease  Public Education


RESPONSE


Activities a hospital, healthcare system, or public health agency take immediately before, during, and after a disaster or emergency occurs

RECOVERY


Activities undertaken by a community and its components after an emergency or disaster to restore minimum services and move towards longterm restoration.
Debris Removal  Care and Shelter  Damage Assessments  Funding Assistance


WHAT IS TRIAGE?
French verb “trier” means to sort  Assigns priorities when resources limited  Do the best for the greatest number of patients


WHY IS DISASTER TRIAGE NEEDED
Inadequate resource to meet immediate needs  Infrastructure limitations  Inadequate hazard preparation  Limited transport capabilities  Multiple agencies responding  Hospital Resources Overwhelmed


ADVANTAGES OF


TRIAGE

Helps to bring order and organization to a chaotic scene.  It identifies and provides care to those who are in greatest need  Helps make the difficult decisions easier  Assure that resources are used in the most effective manner  May take some of the emotional burden away from those doing triage

WHO DECIDES IN TRIAGE
Nurses don’t act for legal fears of being blamed for deaths, and lack of clarity on where they fit in the command structure  Nurses function to the level of their training and experience.  If nurses they are the most trained personnel the site, they are in charge.


ARE NURSES PREPARED??

HEALTH WORKER DENSITY BY REGION
Sub - Sahar an A f r ica A sia S&C ent r al A mer ica
4. 2 0. 8 2. 3

2. 6

Glo b al
6. 9

M id d le East
8. 7

W est er n Pacif ic
9. 9

N o r t h A mer ica
10. 3

Eur o p e
0 2 4 6 8 10 12

Workers per 1,000 population

NURSES

KILLED BY DISASTERS

ROLE OF NURSING IN DISASTERS
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)

NURSES’ ROLES 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


COMMUNICATION IS A SUCCESS KEY
Nursing organizations must have a comprehensive and accurate registry for all members  Have a structured plan:
 • • • • •

Collaborate and coordinate with local authorities Have a hotline 24x7 Inform nurses where to report and how (keep records) Make sure have a coordinator to prevent chaos Ensure ways to maintain communication between nurses and their families

THE NEED FOR DISASTER NURSING TRAINING
11 million nurses world wide: • Form the backbone of the health care system • Are the frontline health care workers who are in direct contact with the public • Contribute to health of individuals, families, communities, and the globe  Schools of nursing offer little or no information on disaster nursing (WHO, 2008)  Shortage of trained instructors/faculty (WHO, 2008)


CORE COMPETENCIES IN DISASTER NURSING
TRAINING Ethical and legal issues, and decision making;  Care principles;  Nursing care;  Needs assessment and planning;  Safety and security;  Communication and interpersonal relationships;  Public health; and  Health care systems and policies in emergency situations (WHO, 2008)


TOPICS THAT MUST BE COVERED BY DISASTER
NURSING TRAINING Basic life support  System and planning for settings where nurses work  Communications (what to report and to whom)  Working in the damaged facilities and with damaged equipment  Safety of clients and practitioners  Working within a team (understand each member’s role and responsibility)  Infection control  Mental and psychosocial support (WHO, 2006)


SUPERCOURSE






INITIATIVE Supercourse is a “Library of Lectures” to empower educators Twenty Nobel Prize winners, 60 IOM members and other top people contributed lectures. Gil Omenn, AAAS former president, Vint Cerf, the father of the Internet, Elias Zerhouni, head of NIH, etc. , Ala Alwan, Assistant Director General of the WHO With the growing number of nurses in the network, there was a need to establish a DisasterNursing Supercourse to emphasize the contribution of nursing to global health

BUILDING DISASTER NURSING SUPERCOURSE
Reasons:  Nurses form the largest health care professional group  Nurses are the main health professionals in touch with the community  Shortage in number of structured nursing programs in disaster preparedness  Nurses deal with the physical stresses of a disaster, and more importantly the fear, stress and uncertainties of disasters

BUILDING DISASTER NURSING SUPERCOURSE
Reasons:  Nurses receive little training in disaster preparedness, prevention and Mitigation (general not specialized training)  Expected increase in disasters and in numbers of causalities in particular in developing countries  Developing countries has the highest burden and has limited resources

BUILDING DISASTER NURSING SUPERCOURSE
How:
1.

2. 3.

4.

5.

Provide training for future generations of nurses who might be engaged in a disaster Collaborate with WHO Build disaster nursing lectures to train nurses worldwide Promote partnerships among instructors at schools of nursing in the world in the area of disaster nursing Offer up to date evidence based scientific knowledge to enhance faculty training



“Most of all, if gains in health and nutrition during emergencies are to be sustained, graduates need to understand the importance of capacity building of national staff and institutions.”

Salama et al, Lessons Learned from Complex Emergencies

DISASTER NURSING SUPERCOURSE
o To join the Nursing Supercourse, please visit www.pitt.edu/~super1 or e-mail [email protected]. o Membership in the Global Health Network Supercourse will allow you to receive free Supercourse CDs, just in time lecture, and annual prevention lectures o Note: “send this lecture to a friend” button works from PowerPoint slide show mode

More information


This lecture is available at:

http://www.pitt.edu/~super1/lecture/lec35051/index.htm


Please fee free to e-mail at: [email protected]