8/3/18

Disaster
The world has experienced such a complex emergency

Earthquake
High tide Tsunami

Disaster Nursing as Sciences Flood Volcano eruption

Other natural
Heavy snowfall phenomenon
For International Emergency Nursing Camp (IENC) Program
At Universitas Muhammadiyah Yogyakarta Heavy rain Disasters Fire/Wildfire

Mass refugee
Storm
movement
Associate Professor Yupin Aungsuroch PhD, RN Landslide Explosion
Faculty of Nursing Chulalongkorn University
3 August 2018 Armed conflicts Others
(Train, plane, ship)
Release of
radiation

Types of Disaster Health Needs at Natural Disaster

Classification by cause Health problem at disaster caused by:
Environmental factors
´ Natural disaster: Typhoon, tornadoes, torrential rain, flooding,
Compromised vital functions Main needs are livelihood supported in:
droughts, earthquake, tsunami, landslide, Diet
Self-control of health
snow damage, volcanic eruption, emerging Physical activities/Exercise
infectious diseases etc. Sanitary/Hygiene
Temperature/Noice
´ Man-made disaster: Large traffic accident, train crach,
Rehabilitation
airplane crach, collapsing (building, bridge), Health care & Education
explosion, fire, structural collapse,
Immediately after the disaster, health needs emerge with medical needs.
´ Special disaster: Terrorism, Bioterrorisam, war,
Health needs are diverse.
combined natural & man-made disaster
Health needs may persist for a mid to long period of time, depend on
the prolonged evacuation and the time required until the reconstruction
of livelihood.

Psychological Consequences of Disaster Psychological Consequences of Disaster

Psychological recovery process

Extremely anxiety Heroic phase: Immediately after disaster Heroic phase

Honeymoon phase: 1 wk – 6 m

Mental paralysis Disillusionment phase: 2 m – 1-2 yr

Reconstruction phase: Several years
Disaster-affected people behave
Psychological recovery process courageously without regard for their own
Heroic phase: Immediately after disaster safety, in order to protect lives and properties
Honeymoon phase: 1 week – 6 months of themselves, their family and neighbors.
Disillusionment phase: 2 months – 1-2 years
Reconstruction phase: Several years

Assoc.Prof. Yupin Aungsuroch Ph.D., R.N. 1


Psychological Consequences of Disaster
Psychological recovery process
Heroic phase: Immediately after disaster Honeymoon phase
Honeymoon phase: 1 wk – 6 m
The affected people, who share the
Disillusionment phase: 2 m – 1-2 yr
Reconstruction phase: Several years
catastrophic experience and have survived
the disaster together, are tied with a strong
sense of unity. Encouraged by the support
they receive. The community of affected area
are filled with warm and hopeful atmosphere.
Recover as a Community
Not only the affected people, but also the whole
community are damaged by the shock of disaster.
Consequently, people and community must
recover jointly from the damage of disasters.
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Disaster Relief Nurses’ role
Since the time of Florence Nightingale, nurses have
contributed at the International level to the care of
nations, communities, families, and individuals who
have fallen victim to disasters.
While local nurses normally provide most of the care,
it is common practice for some nurses to travel abroad
in order to provide assistance in disaster situations.
To provide appropriate medical and nursing care
to help the victims maintain their health
To strive to reduce the mental and physical burden
of the affected nurses.
Assoc.Prof. Yupin Aungsuroch Ph.D., R.N.
8/3/18
Psychological Consequences of Disaster
Psychological recovery process
Heroic phase: Immediately after disaster Disillutionment phase
Honeymoon phase: 1 wk – 6 m
The affected people reach the end of their
Disillusionment phase: 2 m – 1-2 yr
Reconstruction phase: Several years
patience, their dissatisfaction with delayed
disaster relief grows. They feel unfocused anger
and cause troubles. Alcohol problems may
occur.
As the affected people are busy struggling to
reconstruct their own livelihood and to solve
personal problems, the community bonding and
mutual sympathy are lost.
Psychological Consequences of Disaster
Psychological recovery process
Heroic phase: Immediately after disaster Reconstruction phase
Honeymoon phase: 1 wk – 6 m
Disillusionment phase: 2 m – 1-2 yr
Usual life is returning, where the affected
Reconstruction phase: Several years
people courage to reconstruct their livelihood.
The people gradually recover self-confidence
by participating in the reconstruction efforts of
)
ck
However, those who are behind the
reconstruction or have lost their spiritual
support, continue to suffer stressful life.
Disaster Relief Nurses’ role
Nursing has a long association with the care of
individuals, groups, and communities that experience
disasters.
Involved at local, national, and international levels,
nurses have, with other health care professionals,
played a key roles in disaster prevention and in the
delivery and management of care in disaster situations.
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Disaster Relief Nurses’ role Activities of Disaster Relief Nurses

Principle of activities
The contribution of nursing to disaster response and
To stay in the evacuation center for 24 hrs and provide
preparedness is viewed as being immense because
evacuees with direct support. To reduce the mental and
nurses are one of the largest groups of frontline
workers within the humanitarian community. physical burden of the affected nurses.

Nurses with their technical skills and knowledge of
epidemiology, physiology, pharmacology, cultural
familial structures, and psychosocial issues can assist
in disaster preparedness programs as well as during
disasters.
In order to assess the needs for support, to send
coordinators at on-site disaster response headquarters,
where they coordinate the allocation of support.
To transfer of severe patients to medical institution.

Impact of Disaster Relief Nurse Activities
➤ Able to transfer the patients with urgent needs to a
medical team promptly.
➤ Able to prevent the spread of infectious diseases
➤ Presence of disaster nurses for 24 hrs are
encouraging, the number of ambulance calls was
reduced significantly.
Impact of Disaster Relief Nurse Activities
➤To respond effectively to such incidents, it is
necessary to know the concept of disaster nursing.
➤Introduction to disaster nursing can lead to positive
outcomes such as reduction of mortality and cost of
healthcare organizations, and increase health
promotion in the community (Wynd, 2006; Jennings-

➤ Flexibility to deal with health care system Sanders, 2004; Gebbie and Qureshi, 2002).

➤ To provide the evacuees with the sense of security

Disaster Nursing as a Science

The collaborative application of various health
disciplines, i.e., medical science, sociology,
psychology, epidemiology, public health, emergency,
and international health becomes a comprehensive
interdisciplinary branch of nursing and focuses on the
holistic and continuous adjustment of nursing care to
the prevention, immediate response, and rehabilitation
of the health problems arising from disaster.

Assoc.Prof. Yupin Aungsuroch Ph.D., R.N. 3

 8/3/18

Two types of views related to the definition

Disaster Nursing as a Science of disaster nursing structure
Japan’s Disaster Nursing Association defined disaster nursing: One approach is divided
into disaster preparedness,
Disaster nursing involves a series of activities that are Assessment & disaster emergency
Preparation stage
performed to mitigate the hazards posed by disasters on response, and long-term
recovery involving
human life and health that apply unique knowledge and reconstruction.
Outbreak Recovery stage
skills systematically and flexibly and allow for cooperation Another approach is
with other professional fields. divided into four categories
as follows: disaster
Response stage reduction and prevention,
disaster preparedness,
response, recovery and
Disaster Cycle/Structure reconstruction.

Preconditions for Disaster Nursing Mission of Disaster Nursing

❊ Best possible care for the greatest number of people ❊ To rescue victims, which can promote the healing of disease

❊ Limited nursing resources ❊ To provide for a proper disaster rescue environment

➤ The number of nurses ❊ To guide affected individuals towards a restoration of health

➤ Knowledge, technique, skill of nurses ❊ To provide life support for the victims
➤ Limited medical resources and equipment
❊ To alleviate the pain caused by health disorders
❊ Limited length of time
❊ To support recovery and reconstruction activities
➤ Nursing care to the greatest number of people
➤ Urgent medical relief activities in limited period of time ❊ To provide support for the preparedness for disaster prevention

Role of Disaster Nursing Core Knowledge of Disaster Nursing

To investigate and analyze the knowledge of disaster rescue
❊ To assist life-saving and quicker cure from diseases of
and training strategies of nurses, nurses should know:
disaster victims who suffer from various health problems.
Ø Cardiopulmonary resuscitation (CPR)
❊ To improve disaster-caused problems in the living Ø Wound hemostasis techniques
environment and help victims maintain good health Ø Site immobilization and splinting of fractures
Ø Methods for removing a foreign body in the airway
condition. Ø Treatment measures for unexplained syncope
❊ To support the restoration from disaster to enable the Ø Evaluation methods of trauma sites
Ø Classification of trauma triage
victims to return to a normal life.
Ø The use of an automatic external defibrillator
❊ To support people and communities to improve Ø Evacuation of fire and earthquake sites, and other skills
preparedness for disaster during non-disaster time. (for 15 types of disaster rescue skills) and strategies.

Assoc.Prof. Yupin Aungsuroch Ph.D., R.N. 4


According to Li et al., disaster rescue knowledge of nursing
personnel should include 4 dimensions:
v First aid
v Transportation
v Hospital emergency care
v Sanitation and epidemic prevention
These dimensions are subdivided into
site evaluation, field rescue techniques, transit and monitoring,
common emergency and critical care, cardiopulmonary
resuscitation, emergency response measures, psychological
counseling, disinfection and isolation technology, epidemic
prevention of infectious diseases and 20 other relevant disaster
rescue knowledge topics
Disaster Nursing Competency
2) Emergency rescue competency
´ Emergency response competency is one of the important indicators in
measuring the quality of nursing care.
´ Early first aid for the wounded is very important at the disaster scene. As
medical admiral injury will happen within 1 h, it is a very high requirement that
they must save the prime rescue time, which in the first 10 min as platinum
rescue time.
´ The nurse should maintain emergency awareness and alertness of the overall
situation and observe the environment for subtle changes in conditions.
´ When a disaster occurs suddenly, nurses need to quickly react and assess the
scene, promptly take appropriate treatment measures, and treat the
wounded.
´ The nurse should focus on adequate preparation, on-site first aid, transit safety
and treatment coordination, attend to special populations, and offer effective
psychological intervention and other aspects of the emergency protocol.
Disaster Nursing Competency
4) Psychological support and health education
´ The destruction of homes and separation of individuals from their
relatives and friends cause individuals to experience a lack of
security and belonging and often creates extreme panic and
anxiety. If we do not intervene in time, it will lead to emotional,
cognitive, behavioral and other issues related to the mental health
of individuals; ultimately, individuals may experience posttraumatic
stress disorder.
´ The nurse should give psychological counseling and humanitarian
care to affected individuals in a timely manner and encourage
them to be positive about overcoming the situation and rebuilding
their homes.
´ Psychological stress management is an important resource for
professional nurses in disaster management.
Assoc.Prof. Yupin Aungsuroch Ph.D., R.N.
8/3/18
Disaster Nursing Competency
1) Competency in preparedness for the prevention of disasters
´ Pre-disaster preparedness involves meeting the health
needs of the affected individuals in the early and middle
periods, which has a certain effect on the sustainable
development of the economy.
´ Personnel not only need to be competent in clinical skills
but also should possess skilled application related to
supervision, management and coordination of the
community, risk handling, risk information transfer, health
protection and other fields.
Disaster Nursing Competency
3) The competence of rational allocation and management of
resources
´ The nurse should examine prioritize and manage patients
according to the classification of injuries and coordinate their
transport.
´ The nurses should be familiar with the use and storage of all
types of supplies, carefully check the material type, quantity,
and specification, and ensuring accurate delivery and
minimization of waste. The management and coordination of
nursing resources are an indispensable part of disaster
nursing. The nurse should be flexible in the selection of the
existing effective resources for temporary treatment and
application.
Disaster Nursing Competency
5) Ethical and legal practice
Awareness of the ethical underpinnings of aid relief is critical if
nurses wish to participate in such work and be effective in the
long term either as practitioners in disaster relief health care of
advocates for individuals and communities who experience
disaster. Nurses need to follow and understand:
´ The code of conduct and reinforce laws on disaster
prevention
´ Legal liability and government overall disaster planning
´ Compliance with privacy ordinance
´ No discrimination based on gender, religion, nationality,
social status
5

Disaster Nursing Competency
6) Cultural competence
´ Natural disasters are colorblind in terms of whom and how
they strike. “When a disaster hits, it doesn’t hit by race, color
or creed. It hits people who are humans and bleed,”
´ Cultural competence is an integral part of any disaster
behavioral health intervention. In order to be effective,
[health workers responding to disasters] must be aware of
cultural differences among survivors and patients.
´ Nurses responding to natural disasters have precious little
control over how government resources are apportioned,
but they do have control over how they treat patients.
Disaster nursing in Thailand
❊ Thailand is less vulnerable to natural hazards than
many countries in the Asia-Pacific region
❊ Flooding is the most severe hazard in the country
and is frequent and destructive. Impacts from
flooding vary throughout the country, but the entire
country experiences flood damage each year.
Barriers and Challenges in Disaster
Preparedness in Thailand
Five prominent problems:
1) No good system of patient registration and record
2) Wound infection
3) Lack of communication skill with foreign clients
4) Lack of coordination among GO/NGO and lack of
unification of database/ information in the same
province, referral, survivor/dead identification
5) No systematic management of donated supply and
equipment
(Nanthaphan Chinlumprasert, 2016)
Assoc.Prof. Yupin Aungsuroch Ph.D., R.N.
8/3/18
Disaster Nursing Competency
7) Communication and transport
´ Disasters that involve multiple nations create additional obstacles
that must be effectively addressed in order for humanitarian efforts
to be successful
´ The success of failure of the communication and transport systems
in any disaster response will influence the overall outcome of the
relief effort
´ In the developed world high-tech communications systems are
often ineffective in disaster situations
´ English is also a barrier if disaster happens in developing country,
such as in Thailand
´ medical device technology, interpersonal skills, critical thinking
skills, and good physical qualities successfully complete the key
elements in the rescue mission
Barriers and Challenges in Disaster
Preparedness in Thailand
❊ Many hospitals were not up to standard in terms of
disaster preparedness. Hospitals should prioritize
disaster preparedness to fulfill their responsibility
during crisis situations and improve their flood
disaster preparedness (Rattanakanlaya, 2016)
Current disaster in Thailand
(Click to play)
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Risk management system

Group management
Nursing intervention in individual areas

Reconstruction system
(Risk management system)
To understand how to treat victims in the acute stage
at the hospitals in disaster area
Command

Risk management system

Group management Operations Planning Logistics Finance
Nursing intervention in individual areas

(Need appropriate leadership and independent activities)

Risk management system Risk management system

Group management Group management
Nursing intervention in individual areas Nursing intervention in individual areas

Organization for initial responses at disasters

(Risk management system)
Methodology for Medical Institutions
Leader
in the Disaster Area
Do Plan Coordinate Finance
Pre-hospital triage Information collection Resource, equipment Reception for medical
Green zone Analysis, Assessment Drugs, medicines care
In-hospital triage policy decision, Manpower Accounting Group Management
Yellow zone Evaluation, Lifeline management of
Red zone modification Damage, destruction medical records (Entrance control/Zoning/Flow control/Triage)
(For those requiring Transportation means,
greatest medical care destination
namely by doctor) Mass media
Black zone
Transportation

Leader – Understanding of the whole organization

– Ability to control organization

Risk management system Risk management system

Group management Group management
Nursing intervention in individual areas Nursing intervention in individual areas

Inhibitors that Hamper Disaster Medical Care Features of Time of Disaster

and their Characteristics
Many casualty and sick people
Many victims with experience of
loss (families, properties, etc.)
Many victims with experience with
danger and crisis
Those with experience of threat,
stress, and anxiety
Medical needs
Many Casualties but Few Medical Staff
Insufficient, disrupted information
Destruction of medical facilities ❊ Control of entrance/exit
Disruption of lifeline
Lack of medical staff
❊ One-way flow of patients
Lack of medical & sanitary products ❊ Zoning of emergency outpatient unit
Lack of means of transportation
Ø Urgent treatment group
Available medical Ø Semi-urgent treatment group
services
Ø Non-urgent group (waiting for treatment)
Ø Unsavable group

Assoc.Prof. Yupin Aungsuroch Ph.D., R.N. 7

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Risk management system Risk management system

Group management Group management
Nursing intervention in individual areas Nursing intervention in individual areas

Triage Category: Red

❊ Place to be given the highest priority in all responses
❊ Prevent “Preventable death” through appropriate
initial response in order to improve the quantity and
Nursing Intervention in Each Area quality of responses in the red zone.

Emergency medical care for traumatized patients

Ø Multiple trauma
Ø Head trauma
Ø Chest/abdominal trauma
Ø Pelvic fracture/Open Fracture
Ø Crash syndrome
Ø Extensive burn

Risk management system Risk management system

Group management Group management
Nursing intervention in individual areas Nursing intervention in individual areas

Triage Category: Yellow

Nursing Intervention in Red Area Continue to perform re-triage till treatment starts
v Assist medical consultation: Stabilization of ABC Assumed patients: Those with injuries, i.e., spinal cord
v Mental care
damage and fracture
❊ Stable respiration/circulation dynamics
v Support for families
❊ Clear consciousness
v Sharing of information
v Consideration of safety First aid & Follow-up
v Privacy protection Ø Physical assessment
v Consideration to hygiene (See, listen, touch)
Ø Keeping of a peripheral intravenous access
v Security of manpower
Ø Arrest of bleeding/fixation (stabilization)
v Preparation for wide-area transportation Ø Oxygen administration (priority to red area)
v Responses for crash syndrome Ø Monitoring by ME device (minimum)

Risk management system Risk management system

Group management Group management
Nursing intervention in individual areas Nursing intervention in individual areas

Nursing Intervention in Yellow Area

Triage Category: Green
v Increase number of patients: To secure the area and manpower
v Sharing of information Therapy-waiting group
v Responses to complaint by patient and families Re-triage should not be missed.
v Re-triage: To secure ABC and find crash and spinal cord damage
v Selection and distribution of equipment & material Ø Re-triage
v Consideration of privacy protection Ø To perform medical examination, treatment and care
v Management of infusion, confirmation of treatment after completing all majority of responses to the
emergency treatment group.
v Heating
Ø Case without indication for hospitalization
v Giving words: response to anxiety ü Checking of the conditioned of their house
v Security of means of transport to red area and of communication ü Taking to and evacuation shelter
v Division of the area into sub-area

Assoc.Prof. Yupin Aungsuroch Ph.D., R.N. 8

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Risk management system Risk management system

Group management Group management
Nursing intervention in individual areas Nursing intervention in individual areas

Nursing Intervention in Green Area

v To control a crowd of people. Posting of instruction on white board
Triage Category: Black
v To develop collaborative network with local community Response to patient’s families by regarding the
v Re-triage patients as “treatment-waiting group” until
v First-aid treatment death is confirmed.
v To let patients go home if they can do so
v Responses to complaint from patient and family Ø Instruction on basic life support?
Ø Risk intervention
v Preparation and distribution of area according to season and whether
Ø Preparation of the place for families to stay at the
v Selection of equipment & material patient’s deathbed
v To understand medical records and injured persons Ø Death certification, examination and morgue procedure
v Guiding to and introduction of an evacuation shelter after the completion of all and majority of responses to
emergency treatment group.
v Lifestyle guidance at home, requiring medical examination if any
change is felt of seen.

Risk management system

Group management
Nursing intervention in individual areas

Nursing Intervention in Black Area

v To secure a place in an invisible area, and cover the place with
blanket and curtain
v To respond and explain to the patient’s families, followed by
subsequent response and the description of the conditions on a tag.
v To confirm and manage patients identity and describe a clue on tag
v Management of belongings
v Management of the corpse (to prevent family to take it away)
v To share and manage patients/ information (with headquarter)
v To divide those with vital sign from those without it into different areas.
v To clean the patients as much as possible.

Assoc.Prof. Yupin Aungsuroch Ph.D., R.N. 9