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Disaster Nursing golden lecture


DISASTER NURSING GOLDEN LECTURE Kawkab Shishani, RN, PhD Community Health Nursing Kawkab.shishani_at_gmail.com Jordan Richard Garfield, RN, DrPH Director WHO/PAHO ... – PowerPoint PPT presentation

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Title: Disaster Nursing golden lecture

Disaster Nursing golden lecture
  • Kawkab Shishani, RN, PhD Community Health Nursing
  • Kawkab.shishani_at_gmail.com Jordan
  • Richard Garfield, RN, DrPH
  • Director WHO/PAHO Collaborating Center School of
    Nursing, Columbia University in the City of New
  • Nicolas Padilla, MD Universidad de
    Guanajuato Mexico
  • Ronald LaPorte, PhD Director Telecommunications
    and Disease Monitoring WHO Collaborating
    Center University of Pittsburgh June 8, 2009

  • 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.

  • Define a disaster
  • Discuss patterns of mortality and injury
  • Understand impact of disasters on health
  • Describe the factors that contribute to disasters
  • Discuss role of nursing in disasters
  • Apply principles of triage in disaster
  • Analyze the WHO components of effective disaster

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.

  • Natural
  • Pandemics
  • Transportation
  • Technological
  • Terrorism

  • 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.

  • 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

  • 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.

  • 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

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  • 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
  • Respiratory illnesses from the inhalation of ash
  • For individuals close to the volcano, some danger
    exists from lava flows, or more likely mud flows

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Vulnerabilities, Needs, and Abilities Vary
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Man-made Threat
  • Unpredictable Challenges
  • Disruptive
  • Unexpected
  • Targeting weaknesses
  • Very rare, impossible to conceive before event
  • Threats to Civilians, Information

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
  • 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 publics 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

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
  • 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
  • Malnutrition after the event (feeding the
    population affected)
  • Excess NCD mortality following a disaster
  • Mental health (disaster

Mental wellness
  • Little attention is paid to the children
  • Listen attentively to children without denying
    their feelings
  • Give easy-to-understand answers to their
  • 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
  • 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 most vulnerable
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
  • Recovery
  • Getting a community back to its pre-disaster

  • Activities that reduce or eliminate a hazard
  • Prevention
  • Risk reduction
  • Examples
  • Immunization programs
  • Public education

  • 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

  • Activities a hospital, healthcare system, or
    public health agency take immediately before,
    during, and after a disaster or emergency occurs

  • 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 dont 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.

Are nurses prepared??
Health Worker Density by Region
Killed By Disasters
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
  • 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
  • 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
  • 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,

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
  • (WHO, 2008)

Topics that must be covered by disaster nursing
  • Basic life support
  • System and planning for settings where nurses
  • 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 members
    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 DisasterNursing
    Supercourse to emphasize the contribution of
    nursing to global health

Building disaster nursing Supercourse
  • Reasons
  • Nurses form the largest health care professional
  • 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
  • Promote partnerships among instructors at schools
    of nursing in the world in the area of disaster
  • Offer up to date evidence based scientific
    knowledge to enhance faculty training

  • Most of all, if gains in health and nutrition
    during emergencies are to be sustained, graduates
    need to understand the importance of capacity
    building of national staff and institutions.
  • Salama et al, Lessons Learned from Complex

Disaster Nursing Supercourse
  • To join the Nursing Supercourse, please visit
  • www.pitt.edu/super1
  • or e-mail
  • super2_at_pitt.edu.
  • Membership in the Global Health Network
    Supercourse will allow you to receive
    free Supercourse CDs, just in time lecture, and
    annual prevention lectures
  • Note send this lecture to a friend button
    works from PowerPoint slide show mode

More information
  • This lecture is available at
  • http//www.pitt.edu/super1/lecture/lec35051/index
  • Please fee free to e-mail at
  • kawkab.shishani_at_gmail.com
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