Blizzard/extreme cold
Cyclone, hurricane, typhoon
Drought
Earthquake
Extreme heat/heat wave
Flooding
TornadoTsunami
Volcanic eruption
Wildfires
Terrorism
• Chemical
• Biological
• Radiological
• Nuclear
• Explosive
Transportation accident
Industrial accident
Chemical spill
Water/power/HVAC failure
Fire/explosion
Flood
Loss of medical gases
Chemical/radiation release
Violence/hostage-taking
Elevator emergencies
Building collapse
Inability of staff to reach work
DISASTER CHARACTERISTICS
Disasters are typically classified into two main groups: natural disasters and human-caused disasters. Understanding the differences between these two groups and their unique characteristics can help define planning and response efforts.
NATURAL DISASTERS
The World Health Organization defines a natural disaster as the “result of an ecological disruption or threat that exceeds the adjustment capacity of the affected community” (Lechat, 1979). Natural disasters are of many types and have diverse characteristics that will be addressed in this chapter.
HUMAN-CAUSED DISASTERS
Human-caused disasters are those events for which the principle, direct causes are identifiable human actions, deliberate or otherwise. Human-caused disasters can be divided further into three categories:
1. Complex emergencies
2. Technological disasters
3. NA-TECHS (pronounced “Nay-Teks”), or combination, disasters
Complex Emergencies
Complex emergencies involve situations where populations suffer significant casualties because of war, civil strife, or other political conflict. Some disasters are the result of a combination of forces such as drought, famine, disease, and political unrest, resulting in the displacement of millions of people from their homes.
Technological Disasters
Technological disasters are those in which large numbers of people, property, community infrastructure, and economic welfare are affected directly and adversely by any of the following:
• Major industrial accidents
• Unplanned release of nuclear energy
• Fires or explosions from hazardous substances such as fuel, chemicals, or nuclear materials
NA-TECHS
NA-TECHS occur when a natural disaster results in a secondary disaster that is the result of weaknesses in the human environment. An example of this is an earthquake triggering a chemical explosion.
While most disasters can be categorized as either natural or human-caused, every disaster has a unique set of characteristics that prevents a community from developing a one-size-fits-all approach to disaster planning. “All-hazards” planning is the key to community and organizational preparedness. Understanding the impact that these disaster characteristics have on individuals and communities will be important to responding in a safe, timely, and appropriate manner.
DISASTER MANAGEMENT CONTINUUM
Each disaster is a unique event. It is important both to appreciate the characteristics of a disaster and to understand how these characteristics can vary from disaster to disaster.
Disasters are defined by the following four key characteristics:
• Onset
• Duration
• Scope
• Impact
ONSET OF A DISASTER
The onset of a disaster can be sudden, without warning. However, in some cases there may be minimal advance notice. Consider the timing of the following disasters and their effects:
• An earthquake that occurs late at night when everyone is asleep
• A tornado that strikes in the middle of the day when people are at work
• The detonation of a bomb during a crowded public event
DURATION OF A DISASTER
The duration of a disaster is measured from the time it starts (for example, when the tremors from an earthquake begin) to the time the immediate crisis has passed (when the tremors from an earthquake cease). Some disasters begin and end quite quickly, and the time from beginning to end may be seconds or minutes. Other disasters are much more prolonged (occurring over hours, days, or months), such as hurricanes, slow-rising floods, wildfires, and, in extreme cases, droughts or famine.
SCOPE OF A DISASTER
The scope or magnitude of a disaster involves the geographic area or region that is affected by the disaster. A disaster can be limited to a concentrated area, such as a small neighborhood or town. Alternatively, it can cover a large geographic region (e.g., the coastline communities of five states).
IMPACT OF A DISASTER
The fourth characteristic, the impact of the disaster, addresses more specifically the extent to which the population or community infrastructure has been affected. Disasters can strike rural areas in which very few people or community resources are impacted, or they can strike areas that are heavily populated and where the majority of a community’s infrastructure may be damaged or destroyed.
All disaster response begins at the local level, and as such, communities must be prepared for whatever happens, no matter how big or small. Successful disaster response requires a community to address the following:
• Identify and anticipate disaster risks and hazards (“all-hazards”).
• Prepare the material resources and skilled personnel to respond to these risks and hazards.
• Develop comprehensive plans to deploy these resources to assist the community and its recovery.
• Learn from disasters and translate the lessons learned into invaluable future preparedness.
Effective planning is the most important element of disaster management, and strong leadership is required to mobilize and focus the organization’s energy. Disaster management refers to the cycle of preparing for, responding to, and recovering from a disaster. This cycle consists of the following five phases (Figure 1-1, Table 1-2 and Box 1-1):
• Preparedness
• Mitigation
• Response
• Recovery
• Evaluation
 |
| Figure 1-1 Disaster management continuum. |
| ™Tener Goodwin Veenema. | |||
| PREIMPACT | IMPACT | POSTIMPACT | |
|---|---|---|---|
| Time | 0-24 hours | 24-72 hours | >72 hours |
| Disaster continuum | Preparedness | Response, mitigation | Recovery, evaluation |
| Nursing actions | Participate in development of community disaster plans Participate in community risk assessment Elements of hazard analysis for “all-hazards” approach Hazard mapping Vulnerability analysis Initiate disaster prevention measures Prevention or removal of hazard Movement/relocation of at-risk populations Public awareness campaigns Establish early warning systems Perform disaster drills and table-top exercises Identify educational and training needs for all nurses Develop disaster nursing databases for notification, mobilization, and triage of emergency nurse staffing resources Develop evaluation plans for all components of disaster nursing response | Activate local disaster response plan Notification and initial response Leadership assumes control of event Command post is established Establish communications Conduct damage and needs’ assessment at scene Search, rescue, and extricate Establish field hospital and shelters Triage and transport of patients Mitigate all ongoing hazards Activate individual agency disaster plans Establish need for mutual aid relationships Integrate state and federal resources Ongoing triage and provision of nursing care Evaluate public health needs of affected population Establish safe shelter and delivery of adequate food and water supplies Provide for sanitation needs and waste removal Establish disease surveillance and vector control Evaluate need for/activate additional nursing staff (disaster nursing response plans) | Continue provision of nursing and medical care Continue disease surveillance Monitor safety of food and water supply Withdraw from disaster scene Restore public health infrastructure Retriage and transport patients to appropriate level of care facilities Reunite family members Monitor long-term physical health outcomes of survivors Monitor mental health status of survivors Provide counseling and debriefing for staff Provide staff with adequate time off for rest Evaluate disaster nursing response actions Revise original disaster preparedness plan |
BOX 1-1
The Five Phases of the Disaster Management Continuum∗
1. Preparedness refers to the proactive planning efforts designed to structure the disaster response before its occurrence. Disaster planning assesses the risk for a given disaster to occur and evaluates its potential damage.
2. Mitigation attempts to limit a disaster’s impact on human health and community function by taking measures to limit the amount of damage, disability, or loss of life that may occur.
3. Response phase is the actual implementation of the disaster plan focusing on saving lives, providing first aid, minimizing and restoring damaged systems such as communications and transportation, and providing care and basic life requirements to victims.
4. Recovery actions focus on stabilizing and returning the community to its preimpact status. This can range from rebuilding damaged buildings and repairing infrastructure to relocating populations and instituting mental health interventions.
5. Evaluation involves evaluating the response efforts to the disaster in order to better plan and prepare for future disasters.
∗The Federal Emergency Management Agency (FEMA) officially recognizes only the first four phases of the disaster management continuum; however, evaluation is an important, yet frequently overlooked, phase of disaster management.
ROLE OF NURSES
Nurses play a critical role in effectively coordinating and implementing any disaster response plan. They directly participate in disaster triage, transportation, and treatment of a potentially large number of victims.
Nurses may or may not have received any disaster response training before the event’s occurrence. Access to disaster nursing resources and just-in-time (JIT) training programs is strongly encouraged. Nurses will also be expected to supervise unlicensed healthcare providers.
Ongoing changes in disaster healthcare policy will target new emphasis on the nation’s public health infrastructure, information technology and communications’ systems, immunization and antibiotic therapy guidelines, educational preparation, and numerous other aspects of daily healthcare practice. Nurses need to understand and participate in the healthcare policy development process with respect to disaster preparedness and response as planners, policy makers, educators, individuals, members of a community, and members of professional organizations. This requires knowledge of the process at the levels in which it occurs: local, state, national, and political representation at the individual as well as the organizational level.
Globalization is frequently discussed in all areas of healthcare today, including disaster relief. Nurses have been involved in international policy development through the International Council of Nurses and the World Health Organization. The direct involvement of nurses in planning for and responding to international disasters will become more important as boundaries that separate one country from another become less rigid, accessibility is improved, and the number and scope of disasters continue to increase.
LEVELS OF RESPONSE
In a disaster emergency the following three levels of response exist:
• Local
• State and regional
• Federal
LOCAL RESPONSE
All disaster responses begin at the local level. No matter the size or scale of the event, local communities are expected to provide the immediate disaster response. Local disaster response organizations include police departments, fire departments, public health departments, emergency services, and the American Red Cross (ARC). These groups protect our communities on a daily basis and may be “first to the scene” (first responders). Local hospitals (first receivers) also need to develop an emergency operations plan (EOP) for the activation of resources in the event of an internal or external disaster. The responsibilities of the hospital disaster committee include the following:
• Define what would be a disaster for the hospital.
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