Disaster Prepareness

Lecture on Disaster Preparedness for Nursing

Objectives

  • Discuss the definitions relevant to disaster preparedness.

  • Describe types of disasters: natural and human-caused.

  • Cover the Response Framework, including the phases of disaster management and incident command response.

  • Explain methods of triage, focusing on the START triage model.

  • Analyze mental health considerations related to disaster response.

Definition of Disasters

  • Definition by the International Federation of the Red Cross and the World Health Organization:

    • A disaster is defined as a sudden, calamitous event that seriously disrupts the functioning of a community or society.

    • It causes human, material, economic, or environmental losses that exceed the community or society's ability to cope using its own resources.

    • In essence, a disaster leads to human suffering surpassing the local healthcare community's capabilities.

Mass Casualty Incidents

  • Definition: An event where the number of casualties exceeds local resources' ability to manage.

  • Contextual Evaluation:

    • The designation of a mass casualty incident varies by community:

    • Example:

      • In Geneva, 10-15 casualties might be considered a mass casualty.

      • In New York City, the threshold could be higher, closer to 50, 100, or 200 casualties.

  • Focus: The comparison of victim numbers to available resources defines mass casualty incidents.

Types of Disasters

Natural Disasters

  • Examples:

    • Floods

    • Earthquakes

    • Hurricanes

    • Tornadoes

    • Wildfires (notably in the western U.S.)

    • Winter storms (historical context of significant storms that caused substantial disruptions)

    • Heat waves (such as those with temperatures in the mid to upper 90s)

    • Tsunamis

    • Biological disasters (epidemics, pandemics):

    • Example: COVID-19 pandemic classified as a natural disaster.

    • Avalanches.

Human-Caused Disasters

  • Types:

    • Industrial Disasters:

    • Example:

      • Chemical disaster at the Union Carbide Pesticide Plant in Bhopal, India (1984):

      • Over 600,000 people exposed, 15,000 deaths due to exposure.

    • Chemical exposures are concerning due to possible vapor or liquid forms, leading to:

    • Sudden onset of symptoms.

    • Clusters of patients with similar symptoms.

    • Signs of environmental impact (e.g., dying animals, especially birds).

    • Nuclear Disasters:

    • Radiation sickness symptoms: nausea and vomiting in early stages.

    • Severity correlated with the amount of radiation absorbed.

      • Death typically occurs within 3 days in severe cases.

    • Transportation-related incidents:

    • Plane crashes, train crashes.

    • Mass shootings:

    • Examples: school shootings (Sandy Hook), movie theater shootings.

    • Terrorism and Bioterrorism:

    • Objective is to instigate terror rather than primarily kill.

    • Examples: anthrax, smallpox, nerve gas.

    • Wars:

    • Implications of war as a form of human-caused disaster.

Response Framework

  • National Incident Management System (NIMS):

    • Integral to the National Response Framework, ensuring effective collaboration across government and non-government organizations (e.g., FEMA, Red Cross).

    • Focus is on prevention, protection, mitigation, response, and recovery from disasters.

Phases of Disaster Management

  • The phases form a cyclic process:

    1. Mitigation:

    • Efforts to prevent or reduce the impact of emergencies (e.g., buying flood/fire insurance).

    1. Preparedness:

    • Actions taken in advance to stabilize situations (e.g., stocking food and water, planning evacuations).

    1. Response:

    • Immediate actions to save lives and prevent damage (e.g., seeking shelter, turning off gas valves).

    1. Recovery:

    • Steps taken to return to normalcy (e.g., repairs funded by FEMA).

      • Debriefing:

      • Continuous evaluation after response to assess effectiveness and learn from each disaster for future improvement.

START Triaging Method

  • Classification process for triage during disasters:

    • Walkable Patients:

    • Classified as green (minor injuries, can stabilize, called the walking wounded).

    • Non-Walkable Patients:

    • If not spontaneously breathing, prioritize airway management:

      • If positioning the airway helps, classified as red (immediate intervention needed).

      • If unsuccessful, classified as black (unlikely to survive).

    • If spontaneously breathing, assess respiratory rate:

      • > 30 breaths/min = red.

      • < 30 breaths/min leads to further checks on profusion and mental status:

      • May lead to classification in either red (immediate) or delayed categories.

Triage Challenges

  • A poignant quote from Carl Spengler, emergency medicine resident during the Oklahoma City bombing:

    • "We never saw a child come out of the Federal Building alive…"

    • Difficult decisions made during triage can provoke emotional responses, requiring calmness and objectiveness amidst chaos to allocate resources appropriately.

Mental Health Considerations

  • Groups affected by disasters:

    • Group A: Directly affected individuals (injured or killed).

    • Group B: Exposed individuals without direct injury.

    • Group C: Bereaved family and friends, local residents.

    • Group D: Responders (first responders, counselors, clergy, media).

    • Group E: Individuals identifying with targets of disaster (e.g., those who might have flown the same route).

Critical Incident Stress Debriefings

  • Purpose: Group intervention to help manage stress effects from exposure to traumatic events.

  • Target Group: First responders and healthcare providers should be included, not necessarily the lay public.

  • Key Characteristics:

    • Confidential, voluntary, and non-critique based assessments of what worked/didn't work in response efforts.

  • Focus on:

    • What worked well.

    • What could be improved for future responses (cyclical process).

Final Thoughts

  • Experiencing a disaster alters individuals, but it does not guarantee long-term psychological damage.

  • Some may experience psychological growth leading to greater purposes (e.g., community-driven efforts post-disasters).

  • Notably, resilience can be fostered through involvement in recovery and rebuilding processes.