1. D ISASTER N URSING GOLDEN LECTURE Kawkab Shishani, RN, PhD Community Health Nursing Kawkab.shishani@gmail.com Jordan Richard Garfield, RN, DrPH Director WHO/PAHO Collaborating Center School of Nursing, Columbia University in the City of New York Nicolas Padilla, MD Universidad de Guanajuato Mexico Ronald LaPorte, PhD Director Telecommunications and Disease Monitoring; WHO Collaborating Center University of PittsburghJune 8, 2009

2. M ISSION 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.

3. O BJECTIVES 1. Define a disaster 2. Discuss patterns of mortality and injury 3. Understand impact of disasters on health 4. Describe the factors that contribute to disasters severity 5. Discuss role of nursing in disasters 6. Apply principles of triage in disaster 7. Analyze the WHO components of effective disaster nursing

4. T YPES Natural Pandemics Transportation Technological Terrorism

7. M YTHS 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

8. P ATTERNS 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.

9. D ISASTER 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)

10. M ENTAL 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)

11. M ENTAL 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

12. T HE P HASES OF D ISASTER 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

13. W HAT IS T RIAGE ? French verb “trier” means to sort Assigns priorities when resources limited Do the best for the greatest number of patients

14. R OLE 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)

15. T HE N EED FOR DISASTER N URSING 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)

16. S UPERCOURSE 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

17. B UILDING DISASTER NURSING S UPERCOURSE 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

18. B UILDING DISASTER NURSING S UPERCOURSE 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

19. B UILDING DISASTER NURSING S UPERCOURSE How: 1. Provide training for future generations of nurses who might be engaged in a disaster 2. Collaborate with WHO 3. Build disaster nursing lectures to train nurses worldwide 4. Promote partnerships among instructors at schools of nursing in the world in the area of disaster nursing 5. Offer up to date evidence based scientific knowledge to enhance faculty training

20. More information This lecture is available at: http://www.pitt.edu/~super1/lecture/lec35051/index.htm Please fee free to e-mail at: kawkab.shishani@gmail.com