ch 16 disaster mgmt

disaster

as a serious disruption to a community or society that goes beyond the affected community's ability to cope using its own resources

• any natural or human-made incident that causes disruption, destruction, or devastation requiring external assistance

natural disaster

earthquakes, volcanoes, floods, deadly storms, infectious diseases [bubonic plague by yersinia pestis, COVID-19, ebola pandemic

• ex texas flooding 2025, fire los angeles 2025

man-made disaster

bombing, chemical/biological warfare, mass casualty event

• ex vegas shooting 2017

heat exhaustion

• move to cooler area

• loosen clothes

• seek medical attention if symptoms don’t improve

• symptoms: dizziness, thirst, sweating, nausea, weakness

heat stroke

• move person to cooler area asap

• loosen clothing

• cool w/ water/ice

• CALL 911

• symptoms: confusion, dizziness, loss of consciousness

protect yourself from heat/sun

• water

• sunscreen

• avoid alc

• bevs with electrolytes

• light loose clothing

• breaks in shade

trend of global disaster/economic loss

on a steady rise since 1980

• 711 events in 1970 → 3,500 in 2000s

• climate related disasters → doubled since previous two decades

• intensity/frequency/duration of droughts → doubled over the past 5 years

• global losses from natural disasters average $250 to $300 billion annually and are expected to rise further by 2030

what people do disasters impact?

disasters disproportionately strike at-risk individuals, including the poor, elderly, women, children, and ethnic minorities in developing communities

role of nursing in disaster mgmt

• disaster care is often unexpected and not something providers choose, except for those on specialized teams (e.g., dmat or who emergency medical teams)

• because disasters are unpredictable, any healthcare provider may be involved

• all healthcare workers need basic knowledge of disaster medicine

• nurses play a major role as the largest part of the healthcare team

duties in disaster

• all nurses can be called upon when disaster occurs (typically public health and ED nurses)

• many have volunteered from far away to respond

florence nightingale

• disaster nurse during crimean war

• took 38 nurses w/ her to turkey

• assumed responsibility in barracks hospital

clara barton

• worked during u.s. civil war to provide care to soldiers

• founded american red cross in 1881

• “angel of battlefield”

disaster cycle

1. prevention

2. mitigation

3. preparedness

4. response

5. recovery

prevention

• physical planning: reduce risk through land use control, infrastructure design, and managing population density

• economic measures: support stability with diversification, incentives, and insurance

• societal measures: educate the public, promote awareness, and involve communities with training and drills

• management/institutional: strengthen systems through training, research, expertise, and local capacity building

• engineering/construction: build safer structures and hazard-resistant infrastructure

• HSEEP: planning and drills strategies to mitigate disaster impact and enhance community resilience

mitigation

• mitigation focuses on assessing risks and reducing the chance of disasters

• uses hazard vulnerability analysis (hva) to evaluate risks and update disaster plans regularly

• requires an interdisciplinary approach to understand system strengths and limits

• emphasizes hygiene and vaccinations to prevent disease outbreaks

• nurses play a key role in prevention, education, and community training

preparedness

• during preparedness, nurses should be involved as key team members and subject matter experts in disaster planning

• they play an essential role in both planning and carrying out drills

• nurses are critical to effective disaster response due to their frontline role

self-preparedness

• develop a personal and family preparedness plan, as nurses may be away for an unknown time

• be mentally prepared for separation from family during disasters

• do not self-deploy to disasters

• volunteer through official organizations that verify credentials

response

• “all disasters are local” means communities respond first using local people and resources

• neighbors and local responders provide initial help before outside aid arrives

• START triage, JumpSTART triage (for peds)

• nursing in sheltering are ideal due to skills in emotional support

“red cross ready” and go bag

families should store at least 3 days of nonperishable food and water (1 gallon per person per day), a radio, a flashlight, and extra batteries.

• in addition to standard items, nurses should include an identification badge, proof of licensure, stethoscope, BP cuff, PPE, and record-keeping materials.

triage

• disaster triage is sorting patients by priority for treatment and transport

• focuses on doing the greatest good for the greatest number

• red: immediate care (life-threatening)

• yellow: delayed care (serious but not immediate)

• green: minor injuries (can wait)

• black: expectant/deceased (unlikely to survive with available resources)

key international triage systems

• start: simple triage and rapid treatment, commonly used in mass casualty events

• jumpstart: pediatric version of start for children

• salt triage: sort, assess, lifesaving interventions, treatment/transport

• careflight: rapid triage system using color tagging

START triage steps

role of nurses in triage

• perform rapid assessments under pressure

• work as part of multidisciplinary teams

• handle communication and documentation

• take on leadership and coordination roles

triage scenarios pt.1

1. 5-year-old → green (minor)

2. 8-year-old → red (immediate)

3. 3-year-old → red (immediate)

4. 6-year-old → yellow (delayed)

5. 12-year-old → green (minor)

triage scenarios pt.2

1. 35-year-old male → red (immediate)

2. 60-year-old female → yellow (delayed)

3. 10-year-old boy → green (minimal)

4. 40-year-old male → black (expectant/deceased)

5. 25-year-old female → red (immediate)

triage scenarios pt.3

• 45-year-old truck driver → red (immediate)

• 32-year-old pregnant female → yellow (urgent)

• 18-year-old male → green (delayed)

• 70-year-old female → red (immediate)

• 50-year-old male → red (immediate)

stop the bleed

• “stop the bleed” teaches that anyone nearby can act immediately to save lives before help arrives

• developed after the 2012 sandy hook tragedy, where many victims died from preventable blood loss

• the 2013 hartford consensus (acs, fbi, trauma experts) created national strategies to reduce bleeding deaths

• emphasizes rapid hemorrhage control by bystanders (direct pressure, tourniquets, dressings)

• promotes widespread availability of bleeding control kits

• encourages coordination with ems and law enforcement response

• key actions: apply direct pressure, use a tourniquet if needed, and call 911

ethical/psych considerations

• moral distress during resource scarcity

• balancing fairness and urgency

• cultural considerations in prioritization

levels of disaster response

• disaster response occurs at three levels: local, regional, and international

• local responders provide immediate care and are the first line of response

• outside help (regional/international) may take days to arrive

• all healthcare workers need basic disaster knowledge to respond effectively

• coordination across healthcare and other disciplines is essential

teams for response

• local: mrc (medical reserve corps)

• regional: dmat (disaster medical assistance team)

• national: ndms (national disaster medical system), usphs (u.s. public health service)

• international: médecins sans frontières, imc

• nurses must understand disaster plans, where to report, and their role in the response system

dmat teams

• dmat teams are part of ndms under dhhs and provide medical care and triage during disasters

• teams include a wide range of professionals (nurses, physicians, emts, pharmacists, etc.) and are deployed to federal disaster sites

• they work in difficult, high-stress environments and are identified by region/state

• role: support overwhelmed hospitals by providing care onsite or in alternative locations

• early phase: treat acute injuries (lacerations, fractures, trauma, cardiac events, strokes, respiratory issues)

• later phase: manage chronic conditions (diabetes, renal failure, chf, copd, asthma, hypertension)

other orgs that aid in disasters

• red cross

• salvation army

• CERTs

• citizen’s corps

intraoperability of civilians and military

• military nursing involves extensive training in trauma care (burns, blasts, penetrating injuries) along with ongoing drills and hospital-based experience

• civilian-military coordination requires healthcare providers to work within larger, multidisciplinary response systems

• disaster care often occurs in resource-limited environments

• interoperability means both systems must work together effectively during disaster response

available resources in the community

• blood bank

• pharmacy stockpiles

• alternate care sites

• shelters

recovery

• after a disaster, communities work to return to normal both physically and emotionally

• nurses monitor and support mental, emotional, and physical recovery of the community

• healthcare workers must also address their own stress and recovery

• nurses help create after-action reports to evaluate response efforts

• lessons learned are used to improve future disaster preparedness and response

stress reactions and phases

• heroic phase: intense drive to help, often ignoring personal needs

• honeymoon phase: relief and strong community bonding among survivors

• disillusionment phase: frustration, burnout, and disappointment as support declines

• reconstruction phase: long-term rebuilding and return to a new norma

psychological stress of disaster nurses

• risk factors: chaotic environments, long hours, constant changes, and neglect of self-care

• symptoms of stress: irritability, fatigue, headaches, tremors, nausea, and poor focus

• delayed reactions: exhaustion and difficulty adjusting after the disaster ends

• coping strategies: debrief with mental health support and prioritize rest, nutrition, and family connection

basics

• national response framework (nrf): guides how the u.s. responds to all disasters using a flexible, coordinated approach based on nims

• incident command system (ics): organizes disaster response into five areas—command, planning, logistics, operations, and finance/administration

• both systems improve coordination, organization, and interoperability during emergencies

ics and heics principles

• incident command is the overall leader of the response

• command staff includes safety officer, information officer, and liaison officer

• operations: carries out the response actions

• planning: develops plans and tracks information

• logistics: provides supplies, staff, and resources

• finance/administration: manages costs, records, and administrative tasks

nrda

beyond the basics

• nurses need understanding of disaster plans and injury/disease processes they may encounter

• responsibilities include patient care, managing patient flow, and handling surge capacity

• disaster triage is a simplified system focused on prioritizing by acuity

• goal is to use limited resources efficiently and save the greatest number of patients

• our profession however has limited opportunities for developing this expertise

training for disaster

• training healthcare workers for disaster response is a major priority but standardized programs are still limited

• icn and who developed a framework of nursing competencies to guide disaster training

• there is a strong need to build nursing skills to reduce injuries and deaths

• global challenges like epidemics, pandemics, and violence highlight the importance of this training

• countries can use these frameworks to address their own disaster preparedness needs

nurses in crisis leadership

• nurses in leadership roles help design disaster response plans and drive improvements

• disaster nursing leadership models continue to evolve for future challenges

• planning often overlooks how to recruit, screen, and mobilize nurses during disasters