DISASTER NURSING

Caring for Vulnerable Populations in the Community During a Disaster

Shirley P. Smith, PhD, RN, CRNP,

Duquesne University, School of Nursing,

Pittsburgh, PA

DEFINITION

• Natural or man-made event that significantly disrupts and harms the people and environment

• ...causes human suffering and creates human needs that victims cannot alleviate without assistance (ARC, 1975)

• Multiple casualty incident• Mass casualty incident (MCI)• Chemical, Biological, Radiation, Nuclear,

Explosive (CBRNE)

HISTORICAL FACTORS

• The Plague– 1346—Tatar army hurled corpse infected with

plague at enemy; Russian used same against Sweden—1710;

• Assyrians poison well water• Smallpox infected blankets: English to Native

Americans during French/American War—1754-1767

• 1984-- Oregon Salmonella

Biological Weapons Convention, 1972

– Agreement to prohibit development, production, stockpiling of Bacteria, Viruses, Biological toxins

BE ALERT! BE VIGILANT!

• Smallpox– Lesions in mouth and throat– Differs from Varicella (chicken pox) which usually

begins on the trunk

• Anthrax– Inhalation: Flu like symptoms—followed by

improvement– Malaise, fever, rigors, vomiting, headache, backache,

delirium

PHASES OF A DISASTER

1. PreImpact a. Mitigation 1) Reduce the effect/prevent damages b. Planning 1) disaster training 2) supplies/equipment storage 3) emergency management

c. Warning system 1) line of authority 2) communication

PHASES OF A DISASTER

2. Impacta. Response 1) Assessment

of damage 2) Triage & first

aid 3) minimize

panic & chaos

4) provide shelter/food

5) morgue facilities

established

6) Search & Rescue activities

PHASES OF A DISASTER

3. PostImpact a. Emergency

1) rescue 2) first aidb. Recovery 1) Prevent debilitating effects 2) Restore personal, economic environmental health 3) Post-traumatic stress management 4) Evaluative feedback

SCOPE & SEVERITY

• Vulnerability of population/individual– Age, physical/mental

status/mobility

• Environmental Factors/Type of Impact– Length time loss of utilities– Chemical leaks– Bacterial contamination

• Warning Time/Proximity to Disaster– Increased response if no

warning and close proximity

• Individual Perceptions– Coping skills– Personal losses– Previous disaster

experiences– Role overload

CORE COMPETENCIES

• Critical Thinking

• Communication Skills

• Assessment Skills

• Technical Skills

CRITICAL THINKING

• Ethical framework to support decision-making

• Assessing potential for appropriate and timely response

• Modify approaches to triage

COMMUNICATION SKILLS

• Understand chain of command

• Locate emergency response plan

• Responsible party within the agency

• Accurately document

• Key referral sources

ASSESSMENT

• Safety issues for self and team

• Sign/symptoms of common diseases

• Conduct health assessment—physical status

• Mass Casualty Event (MCE) scene

HEALTH ASSESSMENT

• Respiratory, airway

• Cardiovascular, signs of shock

• Integumentary

• Pain

• Head to toe trauma assessment

• Basic neurological exam

• Mental status assessment

TECHNICAL SKILLS

• Med administration

• Tube insertions

• Eye lavage

• Isolation procedure

• Fluid/nutrition support

• Prepare injured for transport

CORE KNOWLEDGE

• Health promotion, risk reduction, disease prevention– Identify potential threats/impact on public– Protect self– Consider community health issues– Describe epidemiological and surveillance principles

CORE KNOWLEDGE

• Health care systems and policy– Emergency response system– Describe the phases of a disaster– Aware of impact of MCIs on access to

resources– Maintain the site as crime scene (forensics)– Legal authority of public health agencies to

take action to protect the public

CORE KNOWLEDGE

• Illness and disease management

CORE KNOWLEDGE

• Information and health care technologies

• Ethics

• Human Diversity

PROFESSIONAL ROLE DEVELOPMENT

• Describe nursing roles

• Choose your role

• Know limits of one’s knowledge/skills

• Continuing education in this area

• Participate in regular drills

MENTAL HEALTH ASPECTS OF TERRORISM

• Fears, anxiety

• Insomnia, nightmares

• Sensitivity to loud noises

• Irritability, confusion

• Disobedience

• Depression

• Alcohol/drug use

NURSES RESPONSIBILITIESNurses’ Characteristics

• Learn early signs and symptoms– First to notice increase in symptoms– Rapid recognition and diagnosis

• Learn modes of transmission

• Protect Self– Nurse on front lines at risk

• Know emergency plans

• Participate in preparedness programs

DISCUSSION QUESTION

• Mrs. Fraker was angry and resentful. She was told that everyone would be getting 1% loans to rebuild their houses and businesses. Many of her neighbors had been seen and were starting to rebuild. Prices were going up and no one from the government had even come to look at damages to her house. Discuss her reaction to the disaster.

DISCUSSION QUESTION

• Consider your response in an emergency situation. If you witnessed a car or bus wreck what would you do? Would you stop? If no, why not? If you were home and heard about the wreck would you report to work? If you did not work would you call the ARC and volunteer?

WebLinks/References

www.astho.org/programs/preparedness (pandemic planning & response) Association of State and Territorial Health Officials

Ahrq.gov (how to set up mass immunization screening) Health Care Services

http://www.panurses.org/ PSNA RN Emergency Preparedness Taskforce

Beachley, M. L. (2005). Nursing in a disaster, in Maurer, F. A., & Smith, C. M., Eds.). Community/public health nursing practice: Health for families and populations, pp. 496-516.

http://www.aacn.nche.edu/Education/pdf/INCMCECompetensies International Nursing Coalition for Mass Casualty Education