Disaster Nursing

NORMAN G. CALDERON
DISASTER NURSING

TERRORISM and MASS CASUALTY

 Biologic warfare
 Weapons of mass destruction WMD
 TRIAGE implementation
Role of Nurse

 May perform beyond his expertise

 Insertion of ET and CT
 Debridement and suturing
 TRIAGE officer
 Nonmedical personnel may be utilized
 EMERGENCY RESCUE AND
TRANSPORT
transport

 One man carry

 Assist to walk
 Lovers carry
 Firemans carry
 Firemans drag
 Blanket drag
 Shirt drag
transport

 2 man carry
 2 man on side
 Arms as a litter
 Chair as a litter
transport

 3 man carry
 Man on both sides
 Man along sides
Triage

 START- SIMPLE TRIAGE AND RAPID

TREATMENT
- quick assessment of respiration,
perfusion, mental status
 SAVE- SECONDARY ASSESSMENT
OF VICTIM ENDPOINT
-used to identify who may benefit fr care
available
 START

Respiration

Yes
No
>30 <30
Position airway
Immediate radial pulse
No yes
No yes
Control breathing mental status
Unsalvagable immmediate
Immediate follows commands
No Yes

Immediate delayed
 Triage categories
Red Yellow Green Black

Most urgent 2nd urgent Non-urgent death

Life- Injuries w/ Localized No distinction

threatening systemic injuries w/o bet. Clinical
shock,hypoxia effects but not immediate and biological
yet life systemic death
threatening implications
Tornado
Flood
Flood
Forest Fire
Tornado
Tornado
Storm
Volcano Eruption
Tornado
Tsunami
Flash Flood
Earthquake
 Tornado
Prepare a Home Tornado Plan
 Pick a place where family members could gather if
a tornado is headed your way. It could be your
basement or, if there is no basement, a center
hallway, bathroom, or closet on the lowest floor.
Keep this place uncluttered.
 If you are in a high-rise building, you may not have
enough time to go to the lowest floor. Pick a place
in a hallway in the center of the building.
Tornado
 Stay Tuned for Storm Warnings
- Tornado watch
- Tornado warning
When a Tornado WATCH Is Issued...
 Listen to local radio and TV stations for further
updates.
 Be alert to changing weather conditions.
Blowing debris or the sound of an approaching
tornado may alert you. Many people say it
sounds like a freight train.
Tornado
 When a Tornado WARNING Is Issued...
 If you are inside, go to the safe place you
picked to protect yourself from glass and other
flying objects. The tornado may be approaching
your area.
 If you are outside, hurry to the basement of a
nearby sturdy building or lie flat in a ditch or
low-lying area.
 If you are in a car or mobile home, get out
immediately and head for safety (as above).
Tornado

 After the Tornado Passes...

 Watch out for fallen power lines and stay
out of the damaged area.
 Listen to the radio for information and
instructions.
 Use a flashlight to inspect your home for
damage.
 Do not use candles at any time.
SEVERE THUNDERSTORM

Before Lightning Strikes...

 Keep an eye on the sky. Look for darkening
skies, flashes of light, or increasing wind. Listen
for the sound of thunder.
 If you can hear thunder, you are close enough
to the storm to be struck by lightning. Go to safe
shelter immediately.
 Listen to Weather Radio, commercial radio, or
television for the latest weather forecasts.
 When a Storm Approaches...
 Find shelter in a building or car. Keep car
windows closed and avoid convertibles.
 Telephone lines and metal pipes can
conduct electricity. Unplug appliances.
Avoid using the telephone or any electrical
appliances. (Leaving electric lights on,
however, does not increase the chances of
your home being struck by lightning.)
 Avoid taking a bath or shower, or running water
for any other purpose.
 Turn off the air conditioner. Power surges from
lightning can overload the compressor, resulting
in a costly repair job!
 Draw blinds and shades over windows. If
windows break due to objects blown by the
wind, the shades will prevent glass from
shattering into your home
If Caught Outside...

 If you are in the woods, take shelter

under the shorter trees.
 If you are boating or swimming, get to
land and find shelter immediately!
Protecting Yourself
Outside...
 Go to a low-lying, open place away from trees,
poles, or metal objects. Make sure the place
you pick is not subject to flooding.
 Be a very small target! Squat low to the ground.
Place your hands on your knees with your head
between them. Make yourself the smallest
target possible.
 Do not lie flat on the ground--this will make you
a larger target!
After the Storm Passes...

 Stay away from storm-damaged areas.

 Listen to the radio for information and
instructions
 If Someone is Struck by
Lightning...
 People struck by lightning carry no electrical charge and can
be handled safely.
 Call for help. Get someone to dial 9-1-1 or your local
Emergency Medical Services (EMS) number.
 The injured person has received an electrical shock and may
be burned, both where they were struck and where the
electricity left their body. Check for burns in both places.
Being struck by lightning can also cause nervous system
damage, broken bones, and loss of hearing or eyesight.
 Give first aid. If breathing has stopped, begin rescue
breathing. If the heart has stopped beating, a trained person
should give CPR. If the person has a pulse and is breathing,
look and care for other possible injuries.
Flash floods

Know What to Expect

 Know your area's flood risk--if unsure, call your
local red cross, emergency management office,
or planning and zoning department.
 If it has been raining hard for several hours, or
steadily raining for several days, be alert to the
possibility of a flood.
 Listen to local radio or TV stations for flood
information.
Flashflood

Reduce Potential Flood Damage By--

 Raising your furnace, water heater, and
electric panel if they are in areas of your
home that may be flooded.
 Consult with a professional for further
information if this and other damage
reduction measures can be taken.
Flashflood

 Prepare a family disaster plan

 Check to see if you have insurance that
covers flooding. If not, find out how to
get flood insurance.
 Keep insurance policies, documents,
and other valuables in a safe-deposit
box.
 Assemble a disaster supply kit
 Flashflood
When a Flood WATCH Is Issued . . .
 Move your furniture and valuables to higher
floors of your home.
 Fill your car's gas tank, in case an
evacuation notice is issued.
When a Flood WARNING Is Issued . . .
 Listen to local radio and TV stations for
information and advice. If told to evacuate,
do so as soon as possible.
 Flashflood
 When a Flash Flood WATCH Is Issued . . .
 Be alert to signs of flash flooding and be ready to evacuate on
a moment's notice.
 When a Flash Flood WARNING Is Issued . . .
 Or if you think it has already started, evacuate immediately.
 Move to higher ground away from rivers, streams, creeks, and
storm drains. Do not drive around barricades . . . they are
there for your safety.
 If your car stalls in rapidly rising waters, abandon it
immediately and climb to higher ground.
 blackout
Top Safety Tips for a Blackout
 Only use a flashlight for emergency lighting. Never use
candles!
 Turn off electrical equipment you were using when the power
went out.
 Avoid opening the refrigerator and freezer.
 Do not run a generator inside a home or garage.
 If you use a generator, connect the equipment you want to
power directly to the outlets on the generator. Do not connect
a generator to a home's electrical system.
 Listen to local radio and television for updated information.
How Can I Prepare Before a
Blackout Happens?
 Assemble essential supplies, including:
 Flashlight
 Batteries
 Portable radio
 at least one gallon of water
 a small supply of food.
 Due to the extreme risk of fire, do not use
candles during a power outage.
What to do during blackout?

 Turn off all elctrical appliances and switches

 Leave 1 bulb on
 Avoid opening the refrigerator
 Use the phone if necessary
 Limit travel esp by car
 Keep cool if it is hot and warm yourself if it is
cold
Volcano
Before:
 Learn about your community warning systems
and emergency plans.
 Be prepared for the hazards that can
accompany volcanoes:
- Mudflows and flash floods
- Landslides and rockfalls
- Earthquakes
- Ashfall and acid rain
- Tsunamis
 Make evacuation plans
 Develop an emergency communication plan
 Have disaster supplies on hand:
Flashlight and extra batteries
First aid kit and manual
Emergency food and water
Non-electric can opener
Essential medicines
Dust mask
Sturdy shoes
 During:
Follow the evacuation order issued by
authorities.
 Avoid areas downwind and river valleys
downstream of the volcano.
If caught indoors:
 Close all windows, doors, and dampers.
 Put all machinery inside a garage or
barn.
 Bring animals and livestock into closed
shelters.
If trapped outdoors:
 Seek shelter indoors.
 If caught in a rockfall, roll into a ball to
protect your head.
 If caught near a stream, be aware of
mudflows. Move up slope, especially if
you hear the roar of a mudflow.
Protect yourself during ashfall:
 Wear long-sleeved shirts and long pants.
 Use goggles to protect your eyes.
 Use a dust mask or hold a damp cloth
over your face to help breathing.
 Keep car or truck engines off.
After: If possible, stay away from volcanic
ashfall areas.
When outside:
 Cover your mouth and nose. Volcanic ash
can irritate your respiratory system.
 Wear goggles to protect your eyes.
 Keep skin covered to avoid irritation from
contact with ash.
 Clear roofs of ashfall
 Avoid driving in heavy ashfall
 If you have a respiratory ailment, avoid
contact with any amount of ash
Fire/ Carbon monoxide
disaster
 Make your home fire safe
 Plan the escape route
 Escape Safely
 Once you are out, stay out! Call the fire
department from a neighbor's home.
 If you see smoke or fire in your first
escape route, use your second way out.
If you must exit through smoke, crawl
low under the smoke to your exit.
 If you are escaping through a closed door,
feel the door before opening it. If it is warm,
use your second way out.
 If smoke, heat, or flames block your exit
routes, stay in the room with the door
closed. Signal for help using a bright-
colored cloth at the window. If there is a
telephone in the room, call the fire
department and tell them where you are.
drought

 Water conservation
 Risk for water borne diseases
 Risk for heatstroke and dehydration
 terrorism
 Create an emergency communications plan.
Choose an out-of-town contact your family or household
will call or e-mail to check on each other should a
disaster occur. Your selected contact should live far
enough away that they would be unlikely to be directly
affected by the same event, and they should know they
are the chosen contact. Make sure every household
member has that contact's, and each other's, e-mail
addresses and telephone numbers (home, work, pager
and cell). Leave these contact numbers at your
children's schools, if you have children, and at your
workplace.
 Establish a meeting place.
Having a predetermined meeting place away
from your home will save time and minimize
confusion should your home be affected or the
area evacuated. You may even want to make
arrangements to stay with a family member or
friend in case of an emergency. Be sure to
include any pets in these plans, since pets are
not permitted in shelters and some hotels will
not accept them.
 Assemble a disaster supplies kit.
Prepare a disaster supplies kit in an easy-to-carry
container such as a duffel bag or small plastic trash can.
Include "special needs" items for any member of your
household (infant formula or items for people with
disabilities or older people), first aid supplies (including
prescription medications), a change of clothing for each
household member, a sleeping bag or bedroll for each, a
battery powered radio or television and extra batteries,
food, bottled water and tools. It is also a good idea to
include some cash and copies of important family
documents (birth certificates, passports and licenses) in
your kit.
 Check on the school emergency plan of any
school-age children you may have.
You need to know if they will they keep children
at school until a parent or designated adult can
pick them up or send them home on their own.
Be sure that the school has updated information
about how to reach parents and responsible
caregivers to arrange for pickup. And, ask what
type of authorization the school may require to
release a child to someone you designate, if
you are not able to pick up your child.
If Disaster Strikes
 Remain calm and be patient.
 Follow the advice of local emergency officials.
 Listen to your radio or television for news and
instructions.
 If the disaster occurs near you, check for
injuries. Give first aid and get help for seriously
injured people.
 Call your family contact—do not use the
telephone again unless it is a life-threatening
emergency.
 If the disaster occurs near your home while you are
there, check for damage using a flashlight. Do not
light matches or candles or turn on electrical
switches. Check for fires, fire hazards and other
household hazards. Sniff for gas leaks, starting at
the water heater. If you smell gas or suspect a leak,
turn off the main gas valve, open windows, and get
everyone outside quickly.
 Shut off any other damaged utilities.
 Confine or secure your pets.
 Check on your neighbors, especially those who are
elderly or disabled.
 A Word on What Could Happen
As we learned from the events of September 11, 2001, the
following things can happen after a terrorist attack:
 There can be significant numbers of casualties and/or damage to
buildings and the infrastructure. So employers need up-to-date
information about any medical needs you may have and on how
to contact your designated beneficiaries.
 Heavy law enforcement involvement at local, state and federal
levels follows a terrorist attack due to the event's criminal nature.
 Health and mental health resources in the affected communities
can be strained to their limits, maybe even overwhelmed.
 Extensive media coverage, strong public fear and international
implications and consequences can continue for a prolonged
period.
 Workplaces and schools may be closed, and there may be
restrictions on domestic and international travel.
 You and your family or household may have to evacuate an area,
avoiding roads blocked for your safety.
 Clean-up may take many months.
 Evacuation
If local authorities ask you to leave your home, they
have a good reason to make this request, and you
should heed the advice immediately. Listen to your
radio or television and follow the instructions of
local emergency officials and keep these simple tips
in mind-
 Wear long-sleeved shirts, long pants and sturdy
shoes so you can be protected as much as
possible.
 Take your disaster supplies kit.
 Take your pets with you; do not leave them behind.
Because pets are not permitted in public shelters,
follow your plan to go to a relative's or friend's
home, or find a "pet-friendly" hotel.
 Lock your home.
 Use travel routes specified by local authorities—
don't use shortcuts because certain areas may be
impassable or dangerous.
 Stay away from downed power lines.
 First Aid Primer
If you encounter someone who is
injured, apply the emergency action
steps: Check-Call-Care. Check the
scene to make sure it is safe for you to
approach. Then check the victim for
unconsciousness and life-threatening
conditions.. Call out for help. Care for
non life threatening injuries.
Control Bleeding
 Cover the wound with a dressing, and press firmly
against the wound (direct pressure).
 Elevate the injured area above the level of the heart
if you do not suspect that the victim has a broken
bone.
 Cover the dressing with a roller bandage.
 If the bleeding does not stop:
 Apply additional dressings and bandages.
 Use a pressure point to squeeze the artery
against the bone.
 Provide care for shock.
Care for Shock
 Keep the victim from getting chilled or
overheated.
 Elevate the legs about 12 inches (if
broken bones are not suspected).
 Do not give food or drink to the victim.
Tend Burns
 Stop the burning by cooling the burn with
large amounts of water.
 Cover the burn with dry, clean dressings
or cloth.
Care for Injuries to Muscles, Bones and Joints
 Rest the injured part.
 Apply ice or a cold pack to control swelling and
reduce pain.
 Avoid any movement or activity that causes
pain.
 If you must move the victim because the scene
is becoming unsafe, try to immobilize the
injured part to keep it from moving.
Be Aware of Biological/Radiological
Exposure
 Listen to local radio and television
reports for the most accurate information
from responsible governmental and
medical authorities on what's happening
and what actions you will need to take.
Reduce Any Care Risks
The risk of getting a disease while giving first
aid is extremely rare. However, to reduce the
risk even further:
 Avoid direct contact with blood and other body
fluids.
 Use protective equipment, such as disposable
gloves and breathing barriers.
 Thoroughly wash your hands with soap and
water immediately after giving care.
Landslide/mudslide
 Factors that allow the force of gravity to
overcome the resistance of earth material to
landslide movement include: saturation by
water, steepening of slopes by erosion or
construction, alternate freezing or thawing,
earthquake shaking, and volcanic eruptions.
 Landslides are typically associated with periods
of heavy rainfall or rapid snow melt and tend to
worsen the effects of flooding that often
accompanies these events. In areas burned by
forest and brush fires, a lower threshold of
precipitation may initiate landslides.
 Debris flows, sometimes referred to as
mudslides, mudflows, lahars, or debris
avalanches, are common types of fast-
moving landslides. These flows generally
occur during periods of intense rainfall or
rapid snow melt. They usually start on steep
hillsides as shallow landslides that liquefy
and accelerate to speeds that are typically
about 10 miles per hour, but can exceed 35
miles per hour.The consistency of debris
flows ranges from watery mud to thick,
rocky mud that can carry large items such
as boulders, trees, and cars.
Awareness Information
 Areas that are generally prone to landslide hazards include
existing old landslides; the bases of steep slopes; the bases of
drainage channels; and developed hillsides where leach-field septic
systems are used.
 Areas that are typically considered safe from landslides include
areas that have not moved in the past; relatively flat-lying areas away
from sudden changes in slope; and areas at the top or along ridges,
set back from the tops of slopes.
 Learn what to watch for prior to major landsliding. Look for
patterns of storm-water drainage on slopes near your home, noting
especially the places where runoff water converges, increasing flow
over soil-covered slopes. Check hillsides around your home for any
signs of land movement, such as small landslides or debris flows or
progressively tilting trees.
 Make a disaster plan
 If you are at risk from landslides:
- Talk to your insurance agent.
- Develop an evacuation plan..
- Discuss landslides and debris flow with your
family.
 Prepare a diasaster kit
- Disaster Suplies Kit basics
- Evacuation Supplies Kit
What to Do Before Intense Storms
 Become familiar with the land around you. Learn whether
landslides and debris flows have occurred in your area by
contacting local officials, state geological surveys or
departments of natural resources, and university departments
of geology. Knowing the land can help you assess your risk
for danger.
 Watch the patterns of storm-water drainage on slopes
near your home, and especially the places where runoff
water converges, increasing flow over soil-covered
slopes. Watch the hillsides around your home for any signs of
land movement, such as small landslides or debris flows, or
progressively tilting trees. Watching small changes could alert
you to the potential of a greater landslide threat.
What to Do During Intense Storms
 Stay alert and awake. Many debris-flow fatalities occur when
people are sleeping. Listen to a NOAA Weather Radio or
portable, battery-powered radio or television for warnings of
intense rainfall. Be aware that intense, short bursts of rain
may be particularly dangerous, especially after longer periods
of heavy rainfall and damp weather.
 If you are in areas susceptible to landslides and debris
flows, consider leaving if it is safe to do so. Remember
that driving during an intense storm can be hazardous. If you
remain at home, move to a second story if possible. Staying
out of the path of a landslide or debris flow saves lives.
 Listen for any unusual sounds that might indicate moving
debris, such as trees cracking or boulders knocking
together. A trickle of flowing or falling mud or debris may
precede larger landslides. Moving debris can flow quickly and
sometimes without warning.
 If you are near a stream or channel, be alert for any
sudden increase or decrease in water flow and for a
change from clear to muddy water. Such changes may
indicate landslide activity upstream, so be prepared to move
quickly. Don't delay! Save yourself, not your belongings.
 Be especially alert when driving. Embankments along
roadsides are particularly susceptible to landslides. Watch the
road for collapsed pavement, mud, fallen rocks, and other
indications of possible debris flows.
What to Do if You Suspect Imminent Landslide
Danger
 Contact your local fire, police, or public works
department. Local officials are the best persons
able to assess potential danger.
 Inform affected neighbors. Your neighbors may
not be aware of potential hazards. Advising them of
a potential threat may help save lives. Help
neighbors who may need assistance to evacuate.
 Evacuate. Getting out of the path of a landslide or
debris flow is your best protection.
What to Do During a Landslide
 Quickly move out of the path of the
landslide or debris flow. Moving away
from the path of the flow to a stable area
will reduce your risk.
 If escape is not possible, curl into a
tight ball and protect your head. A
tight ball will provide the best protection
for your body.
What to Do After a Landslide
 Stay away from the slide area. There may be danger of
additional slides.
 Check for injured and trapped persons near the slide,
without entering the direct slide area. Direct rescuers to
their locations.
 Help a neighbor who may require special assistance--
infants, elderly people, and people with disabilities.
Elderly people and people with disabilities may require
additional assistance. People who care for them or who have
large families may need additional assistance in emergency
situations.
 Listen to local radio or television stations for the latest
emergency information.
 Watch for flooding, which may occur after a landslide
or debris flow. Floods sometimes follow landslides and
debris flows because they may both be started by the
same event.
 Look for and report broken utility lines to appropriate
authorities. Reporting potential hazards will get the
utilities turned off as quickly as possible, preventing
further hazard and injury.
 Check the building foundation, chimney, and
surrounding land for damage. Damage to foundations,
chimneys, or surrounding land may help you assess the
safety of the area.
 Replant damaged ground as soon as possible
since erosion caused by loss of ground cover
can lead to flash flooding.
 Seek the advice of a geotechnical expert for
evaluating landslide hazards or designing
corrective techniques to reduce landslide risk. A
professional will be able to advise you of the best
ways to prevent or reduce landslide risk, without
creating further hazard.