Chapter 27 Disasteran occurrence, either natural or man-made, that causes human suffering and creates human needs that

hat victims cannot alleviate without assistance Emergency a serious threatening event that falls within the coping abilities of the individual family, or community o Increasing severity of disaster effects is due to human populations more densely concentrated in areas with high disaster potential Human caused disasters o TOXIC LEAKS o TRANSPORTATION DISASTERS o ELECTRICAL OUTAGES Pandemics epidemics that affect major segments of the world Terrorism the inducements of fear, use or threat of extraordinary violence, premeditation in the use of violence, and a political or (religious) motivation o Argoterrorism directed at plants and animals intended for food o Biological agents agents used or threatened use against a person, group, or larger population to create fear or illness for the purpose of intimidation, interruption of normal activities, or idiological activities Human-caused or technological disasters o Complex emergencies, technological disasters, material sources, and other disasters not caused by natural hazards and can be either accidental or intentional Unintentional human-caused disasters hazardous materials releases and other industrial accidents, transportation disasters, technological disasters, civil conflict, and terrorism CDC categorized Biological agents by their potential for destruction o Category A: high priority because of ease of dissemination or high interpersonal communicability, high rates of mortality, high potential for panic and social disruption Anthrax, botulism, plague, smallpox, Ebola o Category B: 2nd priority because of moderate ease of dissemination, moderate morbidity and low mortality Brucellosis Food safety threatsSalmonellosis, shigellosis Thyphus fever, Viral encephalitis, Water safety threats o Category C: priority for preparation of emerging pathogens that could be readily available, easily produced and disseminated. Most significant type of threat because small quantities needed to create extensive morbidity, low cost, and insidious nature Hanta Virus Chemical Terrorism: employs poisonous aerosols, vapors, liquids o Nerve agents o Vesicants: cause chemical burns o Pulmonary agents o Blood agents and cyanides o Releases can be overt or covert Covertcan go unrecognized until many people affected Explosive devices conventional bombs, nuclear weapons Characteristics of a Disaster o Frequency Determines amount of knowledge and experience that a community may have to react and respond Affects preparedness o Predictability River flooding, Snow blizzards, Situations that are not predictable, Explosions, Chemical spills Situations that are preventable o Preventability o Imminence

Speed of occurrence Advanced warning can minimize the impact of the event o Duration o Extent of effects Disaster Impact o Destructive potential o Geographical scope Affecting multiple areas, continents, etc. Elements of a Disaster o Temporal o Spatial o Role o Effects Temporal Elements: Stages of Disaster Response o Nondisaster Stage/Inter-disaster stage Disaster risk identification and vulnerability analysis Capability inventory and stockpiling: adaptive capacity Prevention and mitigation Response planning and plan dissemination Public and professional education Vulnerability assessment predisaster identification of groups within the population who would be particularly vulnerable to the adverse effects of a disaster Mitigation action take to prevent or reduce the harmful effects of a disaster on human health or property Hard mitigationconstruction of the built environment to withstand the force of natural hazards (i.e. retrofitting o reinforcing major highway overpasses) Soft mitigation minimize adverse effects of disasters that cannot be prevented (i.e. developing communication strategies that enhance the capability of multiunit response to major brush fires) o Predisaster Stage Warning Overwarning may affect response Pre-impact mobilization Mobilization to shelter Evacuation Preimpact mobilization action aimed at averting the disaster or minimizing its effects o Impact Stage Damage inventory Injury assessment Inventory of immediate needs of a community o Emergency Stage Search and rescue First aid Relief assistance Restoration of communication and transportation Public health surveillance Break out if disease o Recovery Stage Restoration of functional capabilities Reestablishment of a basic way of life and occurs within the first 6 months of a disaster Reconstruction of physical and social environments Rebuilding and reordering of the physical and social environments

Reunification of families Reconstitution when the life of the community has returned, as far as possible, to normal Mitigation of future disaster events Spatial Element o Area of total impact: most serious effects o Area of partial impact o Outside areas: may be a source of assistance o Community risk maps pinpoint the locations of disaster risks within the community o Community resource maps locations of resources likely to be needed in the event of each of the types of disasters for which the community is at risk Role Element o Victim Primary victims those who experience maximum exposure to the disaster event Refugees and internally displaced persons Secondary victims indirectly affected as friends and family Third-level victims responders and health care personal Fourth-level other community membres who offer help or share the grief and loss experienced by the primary victims Fifth-level not directly affected by the disaster but suffer psychological upset as a result Sixth-level indirectly or vicariously affected by the disaster o Helper o Internally displaced persons (IDPs) those who are forced by the disaster to leave their homes but relocate in another part of their own country Effects Element o Primary/direct effectsimmediate effects of the disaster event itself such as death, injury, and destruction of property o Secondary/indirect effects occur indirectly as a result of the disaster Psychological problems Post traumatic stress Depression Distrust o Tangible effects those that can be measure in economic costs o Intangible effects those that cannot be measured in terms of monetary losses (i.e. death and suffering) Disaster-relate Assessment o Pre-disaster risk and capacity assessment o Post-disaster rapid assessment Assessment of Response Capability o Attitudes of community members o Extent of preparations o Emergency routes o Community resources Role of Community Health Nurses o Key responders Assess the extent of health-related disaster effects Death, Injuries, Potential illnesses Biophysical Considerations o Vulnerable populations Very young Elderly Groups with disabilities or illnesses o Proximity to potential situations

Psychological Considerations o Response to warning Perceived evacuation capability Prior experience with disasters Concern about actual evacuation Information dissemination o Response to actual disaster Extent of property damage Realization of economic impact Extent of deaths and traumatic injuries Perceptions of human carelessness or intent to cause event Physical Environment Considerations o Features in physical environment o Adequacy of communitys response o Conditions that imperil health during disaster Sociocultural Considerations o Presence of tensions in community o Terrorism susceptibility o Social responses o Social effects Behavioral Considerations o Consumption patterns Malnourished Post-disaster consumption patterns o Leisure activities Inability to perform strenuous labor Special skills of certain groups Health System Considerations o Adequacy of health system response o Available facilities o Damage to existing facilities o State and local health department preparedness Educating providers to recognize unusual disease pattern Primary Prevention Mitigation o Preventing disasters Security Reporting behaviors Rerouting hazardous materials Education Immunizations o Minimizing disaster effects Individual training Neighborhood training Advanced level training Secondary Prevention Response Planning o Disaster Preparedness set of measures that ensure the organized mobilization of personnel, funds, equipment, and supplies within a safe environment for effective relief o Purpose Limit morbidity and mortality Ensure availability of resources o Principles of Disaster Preparedness Flexible response plans

Base plans on everyday methods and procedures Provide for extended authority Use existing knowledge of human response to disasters Use plans with local focus Enlist support and coordinate efforts of entire community Specify personnel roles by titles Ensure that plans are acceptable to all Provide for resource acquisition and management Include provisions for mental as well as physical health Disseminate plan to public Implement plans into disaster drills o Elements of an Effective Disaster Response Plan Notification Warning Control Coordination Logistical coordination coordination of attempts to procure, maintain, and transport needed materials Evacuation Rescue Rescue chains logistical component of emergency health services and reflect plans for moving injured persons to appropriate health care facilities Additional Elements o Immediate care care required on the spot to ensure a disaster victims survival or a disaster workers continued ability to function Triage process of sorting casualties on the basis of urgency and their potential for survival to determine priorities for treatment, evacuation, and transportation o Supportive care providing food, water, and shelter for victims and disaster relief workers and also sanitation and waste disposal, providing medications and routine health care, and reuniting families separated by the disaster Early warning systems planned surveillance systems designed to alert health care personnel of potential large-scale health problems resulting from a disaster Syndromic surveillance special form of earl warning system in which data are collected regarding specific clusters of symptoms or syndromes from a variety of sources o Recovery o Evaluation Primary Prevention Activities o Disaster prevention Identification of contributing factors Political activism to eliminate or modify risk factors Advocacy regarding identification of potential terrorist targets Immunization Public education for preparedness o Minimizing disaster effects Assist in communicating community disaster response plans to the public Educate the public Advocate for availability and use disaster responders Educate responders Initiate post-disaster immunization campaigns Secondary Prevention Activities o Immediate care Triage

Treatment of injuries o Supportive care Shelter supervision Surveillance and screening Treatment of disease and injury or referral for care Tertiary Prevention Activities o Follow-up care for injuries o Follow-up care for psychological problems o Recovery assistance o Prevention of future disasters and their consequences