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Disaster Nursing golden lecture. Kawkab Shishani, RN, PhD Community Health Nursing Kawkab.firstname.lastname@example.org Jordan Richard Garfield, RN, DrPH Director WHO/PAHO Collaborating Center School of Nursing, Columbia University in the City of New York
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Disaster Nursing golden lecture Kawkab Shishani, RN, PhDCommunity Health Nursing Kawkab.email@example.comJordan Richard Garfield, RN, DrPH Director WHO/PAHO Collaborating Center School of Nursing, Columbia University in the City of New York Nicolas Padilla, MDUniversidad de GuanajuatoMexico Ronald LaPorte, PhDDirector Telecommunications and Disease Monitoring; WHO Collaborating CenterUniversity 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 • 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
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 • The community is too shocked and helpless • Cross-cultural dedication to common good is most common response to natural disasters
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 Phases of Disaster • Mitigation: • Lessen the impact of a disaster before it strikes • Preparedness: • Activities undertaken to handle a disaster when it strikes • Response: • Search and rescue, clearing debris, and feeding and sheltering victims (and responders if necessary). • Recovery: • Getting a community back to its pre-disaster status
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 long-term 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.
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 DisasterNursingSupercourseto 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: • 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