1. Communities in Crisis: Disasters, Group Violence, and Terrorism

2. What would you do if your local news station broadcast an announcement that your community was directly in the path of a hurricane that earlier in the day had caused extensive damage and loss of life in a neighboring state?
What would you do if you were shopping at a local mall, suddenly heard an explosive noise followed by shouts and cries for help, then noticed that a pungent odor was filling the air?

3. Disasters, group violence, and terrorism are ever-present possibilities
Nurses and other health care professionals have an obligation to respond appropriately

4. DISASTERS
A disaster is any natural or manmade event that causes a level of destruction or emotional trauma exceeding the abilities of those affected to respond without community assistance.
The geographic distribution of disasters varies because certain types of disasters are more common in some parts of the world.
When certain types of disasters are anticipated, communities are usually better prepared for them.

5. Characteristics of Disasters
Cause:
Disasters are often characterized by their cause.
Natural disasters are caused by natural events, such as the floods and earthquakes
Manmade disasters are caused by human activity, Other manmade disasters include nuclear reactor meltdowns, industrial accidents, oil spills, construction accidents, and air, train, bus, and subway crashes…

6. Characteristics of Disasters cont..
2. Casualty: is a human being who is injured or killed by or as a direct result of an incident.
Although major disasters sometimes occur without any injury or loss of life, disasters are commonly characterized by the number of casualties involved.
If casualties number more than 2 people but fewer than 100, the disaster is characterized as a multiple-casualty incident.
Mass-casualty incidents—those involving 100 or more casualties—often completely overwhelm the resources of even large cities.
Preparedness for mass-casualty incidents is essential for all communities

7. Characteristics of Disasters cont..
3. Scope:
The scope of a disaster is the range of its effect, either geographically or in terms of the number of victims.
The collapse of a 500-unit high-rise apartment building has a greater scope than does the collapse of a bridge that occurs while only two cars are crossing.

8. Characteristics of Disasters cont..
4. Intensity:
The intensity of a disaster is the level of destruction and devastation it causes. For instance, an earthquake centered in a large metropolitan area and one centered in a desert may have the same numeric rating on the Richter scale, yet have very different intensities in terms of the destruction they cause.

9. Victims of Disasters
Victims may be characterized by their level of involvement. Direct or indirect victims.
Direct victims are the people who experience the event, whether fire, volcanic eruption, war, or bomb.
They are the dead and the survivors, and even if they are without physical injuries, they are likely to have health effects from their experience.
Some may be without shelter or food, and many experience serious psychological stress long after the event is over

10. cont..
Depending on the cause and characteristics of the disaster, some direct victims may become displaced persons or refugees.
Displaced persons are forced to leave their homes to escape the effects of a disaster.
Usually, displacement is a temporary condition and involves movement within the person’s own country.
A common example is relocation of residents of flooded areas to schools, churches, mosques and other shelters on higher ground.
Typically, the term refugee is reserved for people who are forced to leave their homeland because of war or persecution.

11. Cont..
Indirect victims are the relatives and friends of direct victims.
Although these people do not experience the stress of the event itself, they often undergo extreme distress from trying to locate loved ones or accommodate their emergency needs.
If bodies cannot be found or are unidentifiable, indirect victims experience even greater distress and may not be able to accept that their loved one has died.

12. Factors Contributing to Disasters
Host Factors: The host is the human being who experiences the disaster.
Host factors that contribute to the likelihood of experiencing a disaster include age, general health, mobility, psychological factors, and even socioeconomic factors

13. Cont..
Agent Factors: The agent is the natural or technologic element that causes the disaster.
Environmental Factors: are those that could potentially contribute to or mitigate a disaster.
community’s level of preparedness
the presence of industries that produce harmful chemicals or radiation
the presence of flood-prone rivers lakes, or streams
average amount of rainfall or snowfall
average high and low temperatures
proximity to fault lines, coastal waters, or volcanoes
level of compliance with local building codes
and presence or absence of political unrest.

14. Phases of Disaster Management
Prevention Phase: During the prevention phase, no disaster is expected or anticipated.
The task during this phase is to:
Identify community risk factors
Develop and implement programs to prevent disasters from occurring.
Task forces typically include representatives from the community’s local government, health care providers, social services providers, police and fire departments, major industries, local media, and citizens’ groups.
Programs developed during the prevention phase may also focus on strategies to mitigate the effects of disasters that cannot be prevented, such as earthquakes, hurricanes, and tornadoes.

15. Cont..
Preparedness Phase: it involves improving community and individual reaction and responses so that the effects of a disaster are minimized.
Disaster preparedness saves lives and minimizes injury and property damage. It includes plans for communication, evacuation, rescue, and victim care.

16. Cont..
Response Phase: The response phase begins immediately after the onset of the disastrous event.

17. Cont..
Recovery Phase: the community takes actions to repair, rebuild, or relocate damaged homes and businesses and restore health and economic vitality to the community.
Psychological recovery must also be addressed.

18. Role of the Community Health Nurse
The community health nurse has a pivotal role in preventing, preparing for, responding to, and supporting recovery from a disaster.
After a thorough community assessment for risk factors, the community health nurse may initiate the formation of a multidisciplinary task force to address disaster prevention and preparedness in the community

19. First role: Preventing Disasters
Primary Prevention. Primary prevention of a disaster means keeping the disaster from ever happening by taking actions that completely eliminate its occurrence.
Secondary Prevention. Secondary disaster prevention focuses on the earliest possible detection and treatment.
Tertiary Prevention. Tertiary disaster prevention involves reducing the amount and degree of disability or damage resulting from the disaster

20. Second role: Preparing for Disasters
Disaster planning is essential for a community, business, or hospital.
It involves thinking about details of preparation and management by all involved, including community leaders, health and safety professionals, and lay people.

21. Cont..
Personal Preparation. we should consider the need for all nurses to address their own personal preparedness to respond in a disaster
Assessment for Risk Factors and Disaster History
Establishing Authority, Communication, and Transportation.
Mobilizing, Warning, and Evacuating

22. Third role: Responding to Disasters
Rescue. One of the first obligations of relief workers is to remove victims from danger.
Triage: is the process of sorting multiple casualties in the event of a war or major disaster.
Immediate Treatment and Support. Disaster nurses provide treatment on-site at emergency treatment stations, in shelters, or at local hospitals and clinics
Care of Bodies and Notification of Families. Identification and transport of the dead to a morgue or holding facility are crucial, especially if contagion is feared.

23. Fourth role: Supporting Recovery From Disasters
Long-term treatment may be required for many victims of disasters, straining the local rehabilitative-care facilities and resources
Long-Term Support. Victims of disasters may need funding to repair or rebuild their homes or to reopen businesses, such as stores, restaurants, and other services needed by the community
Psychological support

24. Cont.. Need for Self-Care. Self-care, including:
stress education for all relief workers after a disaster
helps to lower anxiety and put the situation into proper perspective.

25. Cont..
Critical incident stress debriefing (CISD) provides victims with professional debriefing in small groups or individually and becomes a mechanism for emotional reconciliation.
The ideal time for CISD is between 24 and 72 hours after the disaster event.
Positive effects of CISD include:
• Accelerating the healing process
• Equipping participants with positive coping mechanisms
• Clearing up misconceptions and misunderstandings
• Restoring or reinforcing group cohesiveness
• Promoting a healthy, supportive work atmosphere
• Identifying individuals who require more extensive psychological assistance

26. GROUP VIOLENCE Gang Violence
Riots: is a violent disturbance created by a large number of people assembled for a common purpose.
It may or may not involve criminal activities, such as willful destruction of cars, stores, and other property; looting (stealing goods); arson (the deliberate burning of buildings); lynching (execution by hanging without due process of law); or physical attacks on a perceived enemy or on law enforcement officers

27. Cont Violent Crimes by Specific Groups of Perpetrators
Violent crimes are those involving physical or psychological injury or death, or the threat of injury or death.
These crimes are often accompanied by destruction to or loss of property.
Assault and Battery, Rape, Homicide, Genocide (the killing of a group of people because of their racial, political, or cultural differences).

28. Factors Contributing to Group Violence
Environmental factors include
• Parental conflict, lack of supervision, child abuse, or inconsistent parenting
• Negative school experiences, including early academic failure and lack of commitment to school • Negative peer influence, including peers who engage in criminal activity
• Socioeconomic factors, such as high rates of substance abuse in the community, living in a high-crime neighborhood, and economic deprivation

29. Cont.. Environmental factors lack of social opportunities
social disorganization
institutional racism
cultural maladaptation
deficiencies in social policy
and availability of criminal opportunities.

30. Role of the Community Health Nurse
Preventing Group Violence
Assessing the problem
Developing
Policy based on established objectives
Conducting research
Procuring funding
Promoting offender accountability

31. Cont.. Assessing a Community’s Level or Potential for Violence
Responding to Group Violence
Supporting Recovery From Group Violence
Counseling is the primary rehabilitative intervention for victims of rape. It may be necessary not only immediately after the attack but months or even years later, as new responses and reactions arise.

32. TERRORISM
“the unlawful use of force and violence against persons or property to intimidate or coerce a government, the civilian population, or any segment thereof, in furtherance of political or social objectives” (Evans et al, 2002).

33. Cont..
Terrorists typically use nuclear, biologic, or chemical (NBC) agents and explosives or incendiary devices to deliver the agents to their targets

34. Cont..
Nuclear warfare involves the use of nuclear devices as weapons and can take several forms.
Chemical warfare involves the use of chemicals such as explosives, nerve agents, blister agents, choking agents, and incapacitating or riot-control agents to cause confusion, debilitation, death, and destruction
Biologic warfare involves using biologic agents to cause multiple illnesses and deaths. Typical biologic agents are anthrax, botulinum, bubonic plague, Ebola, and smallpox.

35. Factors Contributing to Terrorism
Political factors are the most common contributors to terrorism

36. Role of the Community Health Nurse
Primary Prevention Community health nurses are in ideal situations within communities to participate in surveillance.
They must look and listen within their communities for anti- group sentiments, which might reflect anti-religion, anti-gay, or antiethnic feelings. The nurse should report any untoward activities accordingly. Nurses should be alert to signs of possible terrorist activity.

37. Cont.. Secondary and Tertiary Prevention:
The community health nurse may be called on to provide direct care to victims, to volunteer as a hospital-community liaison, to set up and administer mass immunizations, to make home visits to affected families, or to serve on committees responding to terrorist acts. formulating, updating, and following a disaster plan is one of the most effective community-based strategies to minimize injury and mortality from terrorism