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. NURSES AND EDUCATION Education is the most powerful weapon which you can use to change the world. Nelson Mandela

3. 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.

4. 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

5. W HAT 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.

6. T YPES Natural Pandemics Transportation Technological Terrorism

7. H URRICANES 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.

8. T ORNADOES 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.

9. F LOODS 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.

10. E ARTHQUAKES 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

12. V OLCANOES 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

15. V ULNERABILITIES, N EEDS, AND A BILITIES V ARY

18. M AN - MADE T HREAT Unpredictable Challenges Disruptive Unexpected Targeting weaknesses Very rare, impossible to conceive before event Threats to Civilians, Information Infrastructure

19. C OMPONENTS OF DISASTER DEBRIS Building Debris Household Debris Vegetative Debris Problem Waste Streams

20. 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

21. 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.

22. D ISPLACEMENT 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)

23. D ISASTER 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

24. 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)

25. 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)

26. 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

27. T HE MOST VULNERABLE

28. 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

29. M ITIGATION Activities that reduce or eliminate a hazard Prevention Risk reduction Examples Immunization programs Public education

30. P REPAREDNESS 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

31. R ESPONSE Activities a hospital, healthcare system, or public health agency take immediately before, during, and after a disaster or emergency occurs

32. R ECOVERY 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

33. 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

34. W HY IS D ISASTER T RIAGE NEEDED Inadequate resource to meet immediate needs Infrastructure limitations Inadequate hazard preparation Limited transport capabilities Multiple agencies responding Hospital Resources Overwhelmed

35. ADVANTAGES OF T RIAGE 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

36. W HO 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.

37. A RE NURSES PREPARED ??

38. H EALTH W ORKER D ENSITY BY R EGION

39. N URSES

40. K ILLED B Y D ISASTERS

41. 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)

42. N URSES ’ 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

43. C OMMUNICATION 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

44. 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)

45. C ORE 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)

46. T OPICS 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)

47. 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

48. 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

49. 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

50. 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

51. “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 Emergencies

52. D ISASTER N URSING S UPERCOURSE o To join the Nursing Supercourse, please visit www.pitt.edu/~super1 or e-mail super2@pitt.edu. o Membership in the Global Health Network Supercourse will allow you to receive free Supercourse CDs, just in time lecture, and annual prevention lectures o Note: “send this lecture to a friend” button works from PowerPoint slide show mode

53. 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