Question

I'm choosing Earthquakes. What are some of the nursing implications of this disaster? What diseases do you need be concerned about and how would you protect yourself and others?

Answer 1

Presently at the global level, there has been considerable concern over natural disasters. Even as substantial scientific and material progress is made, the loss of lives and property due to disasters has not decreased. In fact, the human toll and economic losses have mounted. There has been an increase in the number of natural disasters over the past years and with it, increasing losses on account of urbanization and population growth, as a result of which the impact of natural disasters is now felt to a larger extent.

DISASTER

Disaster means that any occurrence that causes damage, ecological disruption, loss of human life or deterioration of health and health services on a scale sufficient to warrant and extraordinary response from outside the affected community or area (WHO, 1995).

TYPES

Disaster is an occurrence, either natural or man-made that causes human suffering and creates human needs that victims cannot alleviate without assistance.

Disasters can be natural & man-made.

· Natural disasters include droughts, earthquakes, tsunamis, forest fires, landslides and mudslides, blizzards, hurricanes, tornadoes, floods and volcanic disruptions.

· Man-made disasters includes hazardous substance accidents (e.g., chemicals, toxic gases), radiologic accidents, dam failures, resource shortage (e.g., food, electricity and water), structural fire and explosions and domestic disturbances (e.g., terrorism, bombing and riots), Bioterrorism.

DISASTER AGENT

· Agent

· It is the physical item that actually causes the injury or destruction. Earthquakes is a kind of faulty shifting of the earths layers leading to the movement of its crusts thus causing tremors.. Secondary agents include bacteria and viruses that produce contamination or infection after the primary agent has caused injury or destruction. These areas genarally face problems in controlling epidemics, cleaning debris & determining the soundness of the remaining structures.

· Host:

· The host is human kind. Host factors are those characteristics of humans that influence the severity of the disaster's effect. Host factors include age, immuni­zation status, pre-existing health status, degree of mobility and emotional stability.

· Environment:

· Environmental factors that affect the outcome of a disaster include physical, chemical, biological and social factors.

· Physical factors include the time when the earhquakes occurs, weather conditions, the availability of food and water and the functioning of utilities such as electricity and telephone service.

· Chemical factors influencing disaster outcome include leakage of stored chemicals into the air, soil, ground water or food supplies.

· Biological factors are those that occur or increase as a result of contaminated water, improper waste disposal, insect or rodent proliferation, improper food storage, or lack of refrigeration owing to interrupted electrical services.

· Social factors are those that contribute to the individual's social support systems. Loss of family members, changes in roles, and the questioning of religious beliefs are social factors to be examined after a disaster.

PHASES OF A DISASTER ( EARTHQUAKE )

· Pre-Impact Phase:

The pre-impact phase is the initial phase of the disaster, prior to the actual occurrence. A warning is given at the sign of the first possible danger to a community. Many times there is no warning, but with the aid of weather networks and satellites, many metrological disasters can be predicted. The earliest possible warning is crucial in preventing loss of life and minimizing damage. This is the period when the emergency preparedness plan is put into effect.

Emergency centers are opened by the local Civil Defense Authority. Communication is a very important factor during this phase; disaster personnel will call on amateur radio operators, radio and television stations and any available method to alert the community and keep it informed. The community must be educated to recognize

the threat as serious. When communities experience false alarms several times, members may not take future warnings very seriously. The role of the nurse during this warning phase is to assist in preparing shelters and emergency aid stations and establishing contact with other emergency service groups.

· Impact Phase:

The impact phase occurs when the disaster actually happens. It is a time of enduring hardship or injury and of trying to survive. This is a time when individuals help neighbors and families at the scene, a time of "holding on" until outside help arrives. The impact phase may last for several minutes or for days or weeks (e.g., in a flood, famine or
epidemic).

This phase must provide for preliminary assessment of the nature, extend and geographical area of the disaster. The number of persons requiring shelter, the type and number of needed disaster health services anticipated and the general health status and needs of the community must be evaluated. The impact phase continues until the threat of further destructions has passed and the emergency plan is in effect. If there has been no warning, this is the time when the Emergency Operation Center (EOC) is established and put in operation. The EOC is the operating center for the local chapter of the American Red Cross. It serves as the center for communication with other government agencies, the center for recruitment of health care providers to staff shelters

· Post impact Phase:

Recovery beings during the emergency phase and end with the return of normal community order and functioning. For persons in the impact area this phase may last a lifetime (e.g., victims of the atomic bombing of Hiroshima).

The victims of a disaster go through four stages of emotional response:

1. Denial: During the first stage, the victim may deny the magnitude of the problem or, more likely, will understand the problem but may seem unaffected emotionally. The problems created by the disaster are being denied or have not fully "registered." The victim may appear unusually unconcerned.

2. Strong emotional response: In the second stage, the person is aware of the problem but regards it as overwhelming and unbearable. Common reactions during this stage are trembling, tightening of the muscles, sweating, speaking with difficulty, weeping, heightened sensitivity, restlessness, sadness, anger, and passivity. The victim may want to retell or relive the disaster experience over and over.

3. Acceptance: During the third stage, the victim begins to accept the problems caused by the disaster and makes a concentrated effort to solve them. He or she feels more hopeful and confident. It is especially important for victims to take specific actions to help themselves and their families.

4. Recover: The fourth stage represents a recovery from the crisis reaction. Victims feels that they are back to normal. Routines become important again. A sense of well-being is restored. The ability to make decisions and carry out plans returns. Victims develop a realistic memory of the experience.

THE NURSING ROLE IN DISASTERS

• Disaster nurses play key leadership and service provision roles in planning and implementing disaster relief efforts, preventing technologic disasters, and addressing problems that occur during a disaster, such as the physical and emotional stress of disaster victims.
• During a disaster many environmental health problems emerge. The scope and magnitude of these problems determines the nursing role. Nurses collaborate with community agencies and officials to recognize and reduce disaster risks and maximize the health and safety of individuals involved in disaster crises.
• Following a disaster, nurses make numerous referrals to community agencies for a variety of needs including psychologic care, emotional support services, and treatment for victims and their families. Recovery encompassed dealing with many disaster effects such as loss of life, income, and home. The communicable disease implications of disasters are also immense:

STAGES OF DISASTER AND THE ROLE OF NURSES

1. Preparedness

Personal Preparedness

Great stress is placed on the nurse with client responsi­bilities who also becomes a disaster victim. Conflicts arise between family and work-related responsibilities. In addition, the community health nurse who will be assisting in disaster relief efforts must be as healthy as possible, both physically and mentally. A disaster worker who is not well is of little service to his or her family, clients, and other disaster victims. Personal preparedness can help case some of the conflicts that will arise and allows nurses to attend to client needs sooner that one may anticipate.

Professional Preparedness

· Professional preparedness requires that nurses become aware of and understand the disaster plans at their workplace and community. Nurses who take disaster preparation seriously will take the time to read and understand workplace and community disaster plans and will participate in disaster drills and community mock disasters. The more adequately prepared nurses are, the more they will be able to function in a leadership capacity and assist others toward a smoother recovery phase. Personal items that are recommended for any nurse preparing to help in a disaster include the following

· A copy of their professional license

· Personal equipment, such as a stethoscope

· A flashlight and extra batteries

· Cash

· Warm clothing and a heavy jacket (or weather-appropriate clothing)

· Record-keeping materials

· Pocket-sized reference books

Community Preparedness

The level of community preparedness for a disaster is only as good as the people and organisations in the community make it. Some communities remain vigilant as to the possibility of a disaster hitting their community and stay prepared by having a solid disaster plan on paper and by participating in yearly mock disaster drills

ROLE OF THE COMMUNITY HEALTH NURSE IN DISASTER RESPONSE

· The role of the community health nurse during disaster depends greatly on the nurse's past experience, role in the institutions and community's preparedness, specialized training, and special interest. The most important attribute for anyone working in a disaster, however, is flexibility. One certain factor about disaster is that change is a constant.

· Although valued for their expertise in community assessment, case finding and referring, prevention, health education, surveillance, and working with aggregates, at times the community health nurse is the first to arrive on the scene and must respond accordingly.

· Community health nurses working as members of an assessment team have the responsibility of feeding back accurate information to relief managers to facilitate rapid rescue and recovery. Many times nurses are required to make home visits to gather needed information, a task that comes quite naturally to the community health nurse. Types of information included in initial assessment reports include the following:

· Geographical extent of disaster's impact

· Population at risk or affected

· Presence of continuing hazards

· Injuries and deaths

· Availability of shelter

· Current level of sanitation

· Status of health care infrastructure..

ROLE OF THE COMMUNITY HEALTH NURSE IN DISASTER RECOVERY

· The role of the community health nurse in the recovery phase is as varied as in the preparedness and response phases of a disaster. Flexibility remains an important component of a successful recovery operation. Commu­nity cleanup efforts can incur a host of physical and psychological problems. For example, the physical stress of moving heavy objects can cause back injury, severe fatigue, and even death from heart attacks. In addition, the continuing threat of communicable disease will continue as long as the water supply remains threatened and the living conditions remain crowded. Community health nurses must remain vigilant in teaching proper hygiene and making sure immunization records are up to date.

· Acute and chronic illnesses can be exacerbated by the prolonged effects of disaster. The psychological stress of cleanup and moving can bring about feelings of severe hopelessness, depression, and grief. Recovery can be impeded by short-term psychological effects eventually merging with the long-term results of living in adverse circumstances. In some cases, stress can lead to suicide and domestic abuse. In addition, although most people eventually recover from disasters, mental distress may persist in these valuable populations who continue to live in chronic adversity. Referrals to mental health professional should continue as long as the need exists.

· The community health nurse must also remain alert for environmental health hazards during the recovery phase of a disaster. Home visits may lead the nurse to uncover situations such as a faulty housing structure. Lack of water supply, or lack of electricity.