DISASTER NURSING Introduction: In the past two decades, there have been many natural and manmade disasters

in India. Natural disasters like floods, earthquakes, cyclones, droughts and human made such as terrorist acts, Nuclear or chemical war, fires and industrial accidents. Disasters can significantly lead to a degradation of social and economic progress achieved over decades of initiatives by the people. 80% of countries geographical area is disaster prone and the majority of people live at or below the poverty line. India has been devastated by three major disasters in last five years- Super Cyclone in Orissa, earthquake in Gujarat and now the latest one the tsunami in the Andaman and Nicober Islands,. Tamil nadu, Andhra Pradesh and Kerala. Each disaster brought a great deal of miscarry to the affective population. Definitions of Disaster: A disaster can be defined as any occurrence that cause damage, ecological disruption, loss of human life, deterioration of health and health services, Vs a scale sufficient to warrant as extraordinary response from outside the affected community or area. -(W.H.O.) An occurrence of a severity and magnitude that normally results in death, injuries and property damage that cannot be managed through the routine procedure and resources of government. - FEMA (Federal Emergency Management Agency) A disaster can be defined as an occurrence either nature or manmade that causes human suffering and creates human needs that victims cannot alleviate without assistance. - American Red Cross (ARC) United Nations defines disaster is the occurrence of a sudden or major misfortune which disrupts the basic fabric and normal functioning of a society or community. Definitions of Disaster Nursing: Disaster Nursing can be defined as the adaptation of professional nursing skills in recognizing and meeting the nursing physical and emotional needs resulting from a

disaster. The overall goal of disaster nursing is to achieve the best possible level of health for the people and the community involved in the disaster. Disaster Nursing is nursing practiced in a situation where professional supplies, equipment, physical facilities and utilities are limited or not available. DISASTER alphabetically means: D - Destructions I - Incidents S - Sufferings A - Administrative, Financial Failures. S - Sentiments T - Tragedies E - Eruption of Communicable diseases. R - Research programme and its implementation The global scenario: Impact of natural disaster in the last 30 years. Death of 3 million people Economic loss increased due to disaster like flood In Indian scenario, 34jmijlion people affected per year and 5116 death per year. In US, economic loss is 400 million dollar and 3 million people died. Emergency:According to WHO, an emergency is a situation where a sudden incident or event has occurred and normally used, local responses will suffice to care for the situation without calling in outside help. E.g.: car accident or a water main breaking. Vulnerability:Vulnerability in this context can be defined as the diminished capacity of an individual or group to anticipate, cope with, resist and recover from the impact of a natural or man-made hazard. The concept is relative and dynamic. Vulnerability is most often associated with poverty, but it can also arise when people are isolated, insecure and defenseless in the face of risk, shock or stress.

Hazard:Hazards are defined as phenomena that pose a threat to people, structures, or economic assets and which may cause a disaster. They could either be manmade or naturally occurring in our environment. Epidemiology of Disaster:1.Agent 2.Environment 3.Host Agents Primary Agents: It includes falling of buildings, heat wind rising waters and smoke. Secondary Agents: It includes bacteria and viruses that produce contamination or infection after the primary agent has caused injury or destruction. Primary or secondary agent will vary according to the type of disaster. For example: - A hurricane with rising water can cause flooding and high winds, these are primary agents. The secondary agents would include damaged buildings and bacteria or viruses that thrive as a result of the disaster. In an epidemic the bacteria or virus causing a disease is the primary agent rather than the secondary agent. Host factorsIn the epidemiological frame work as applied to disaster the host is human-kind. Host factors are those characteristics of humans that influence the severity of the disaster effect. Host factors include Age Immunization status Degree of mobility Emotional stability

Environmental factorsThis includes, 1. Physical Factors Weather conditions, the availability of food, time when the disaster occurs, the availability of water and the functioning of utilities such as electricity and telephone service. 2. Chemical Factors Influencing disaster outcome include leakage of stored chemicals into the air, soil, ground water or food supplies. Eg: - Bhopal Gas Tragedy. 3. Biological Factors: Are those that occur or increase as result of contaminated water, improper waste disposal, insect or rodent proliferations improper food storage or lack of refrigeration due to interrupted electrical services. Bioterrorism: Release of viruses, bacteria or other agents caused illness or death. 4. Social Factors: Are those that contribute to the individual social support systems. Loss of family members, changes in roles and the questioning of religious beliefs are social factors to be examined after a disaster. 5. Psychological Factors: Psychological factors are closely related to agents, host and environmental conditions. The nature and severity of the disaster affect the psychological distress experienced by the victims. Types of disasters:A. B. C.

Natural disasters Manmade disasters Biological disasters

Natural disasters--Natural hazards are naturally occurring physical phenomena caused either by rapid or slow onset events which can be geophysical (earthquakes, landslides, tsunamis and volcanic activity), hydrological (avalanches and floods), climatologically (extreme

temperatures, drought and wildfires), meteorological (cyclones and storms/wave surges. FloodsDuring a flood - Turn off the electricity to reduce the risk of electrocution. - Protect people and property: - as soon as the flood begins, take any vulnerable people (children, the old, the sick, and the disabled) to an upper floor; - whenever possible, move personal belonging upstairs or go to raised shelters provided for use in floods. - Beware of water contamination - if the taste, colour, or smell of the water is suspicious, it is vital to use some means of purification. - Evacuate danger zones as ordered by the local authorities it is essential to comply strictly with the evacuation advice given. Authorities will recommend that families take with them the emergency supplies they have prepared. After a flood When a flood is over, it is important that people do not return home until told to do so by the local authorities, who will have ensured that buildings have not been undermined by water. From then on it is essential to: - wait until the water is declared safe before drinking any that is untreated; - clean and disinfect any room that has been flooded; - sterilize or wash with boiling water all dishes and kitchen utensils; - get rid of any food that has been in or near the water, including canned foods and any food kept in refrigerators and freezers; - get rid of all consumables (drinks, medicines, cosmetics, etc.). EarthquakesEarthquakes are the result of forces deep within the earth's interior. Sudden break within the upper layers of the earth, sometimes breaking the surface, resulting in the vibration of the ground, which were strong enough will cause the collapse of buildings and destruction of life and property. Earthquakes are measured according to the Richter scale - the most devastating effects are seen on level 6 and above, and if the epicenter of the earthquake is

located in highly populated areas. Earthquakes can cause high numbers of deaths and injuries as well as serious destruction of buildings and infrastructure. What to do beforehand The movement of the, ground in an earthquake is rarely the direct cause of injuries; most are caused by falling objects or collapsing buildings. Many earthquakes are followed (several hours or even days later) by further tremors, usually of progressively decreasing intensity. To reduce the destructive effects of earthquakes a number of precautions are essential for people living in risk areas: - Build in accordance with urban planning regulations for risk areas. - Ensure that all electrical and gas appliances in houses, together with all pipes connected to them, are firmly fixed. - Avoid storing heavy objects and materials in high positions. - Hold family evacuation drills and ensure that the whole family knows what to do in case of an earthquake. - Prepare a family emergency kit. During an earthquake - Keep calm, do no panic. - People who are indoors should stay there but move to the central part of the building. - Keep away from the stairs, which might collapse suddenly. - People who are outside should stay there, keeping away from buildings to avoid collapsing walls and away from electric cables. - Anyone in a vehicle should park it, keeping away from bridges and buildings. After an earthquake - Obey the authorities instructions. - Do not go back into damaged buildings since tremors may start again at any moment. - Give first aid to the injured and alen the emergency services in case of fire, burst pipes, etc. - Do not go simply to look at the stricken areas: this will hamper rescue work. - Keep emergency packages and a radio near at hand. - Make sure that water is safe to drink and food stored at home is fit to eat (in case of electricity cuts affecting refrigerators and freezers).

You cannot prevent earthquakes but you can reduce the potential damages:
y y y y y

Development of possible warning indicators. Land-use regulations. Building regulations. Relocation of communities. Public awareness and education programs.

TsunamiA tsunami is a series of water waves (called a tsunami wave train [1]) caused by the displacement of a large volume of a body of water, such as an ocean. The original Japanese term literally translates as "harbor wave." Droughts- Drought is an insidious phenomenon. Unlike rapid onset disasters, it tightens its grip over time, gradually destroying an area. In severe cases, drought can last for many years and have a devastating effect on agriculture and water supplies. Drought is defined as a deficiency of rainfall over an extended period a season, a year or several years relative to the statistical multi-year average for the region. Lack of rainfall leads to inadequate water supply for plants, animals and human beings. A drought may result in other disasters: food insecurity, famine, malnutrition, epidemics and displacement of populations. Rural communities can sometimes cope with one or two successive rain failures and crop or livestock losses: the situation becomes an emergency when people have exhausted all their purchasing resources, food stocks, assets and normal coping mechanisms. In general, the Red Cross Red Crescent response to drought and food insecurity prioritizes the provision of food, safe water and basic sanitation, basic health services, along with food-security surveillance and nutritional monitoring. In parallel, programmes are implemented to preserve and restore livelihoods. Such assistance may take the following forms:
y y y

distribution of seeds, tools and fertilizer; destocking or restocking of livestock; distribution of livestock fodder;

y y y y y

support to pastoralists in transporting livestock to alternative grazing areas during severe dry spells; income-generating schemes that enable people to diversify their sources of income on a small scale; training and education in relevant skills, for example in carpentry or bicycle repair, to enable people to earn an income; vegetable-gardening, poultry and fish-pond projects; Small-scale irrigation schemes.

It is also important to ensure that populations have access to safe water and basic sanitation in times of drought, as wells and other groundwater supplies dry up or become polluted. The International Federation is committed to reducing vulnerability to drought by enhancing the availability of and access to food and by increasing communities resilience so that they are better able to deal with food insecurity. Volcanic eruptionVolcanic eruptions happen when lava and gas are discharged from a volcanic vent. A volcano is an opening, or rupture, in a planet's surface or crust a crust is the outermost solid shell of a rocky planet or moon, which allows hot magma (paste), ash and gases to escape from below the surface. The word volcano is derived from the name of Volcano island off Sicily which in turn, was named after Vulcan, the Roman god of fire.[1]

Manmade Technological disasters:Danger originating from technological or industrial accidents, dangerous procedures, infrastructure failures or certain human activities, which may cause the loss of life or injury, property damage, social and economic disruption or environmental degradation. Technological disasters are non-natural disastrous occurrences that include:
y

Accident release Occurring during the production, transportation or handling of hazardous

chemical substances
y

Explosions Disasters will only be classified as explosions when the explosions is the actual disaster. If the explosion is the cause of another disaster, the event will be classified as the resulting disaster. Chemical explosion Violent destruction caused by explosion of combustible material, nearly always of chemical origin. Nuclear explosion/Radiation Accidental release of radiation occurring in civil facilities, exceeding the internationally established safety levels. Mine explosion Accidents which occur when natural gas or coal dust reacts with the air. Pollution Degradation of one or more aspects in the environment by noxious industrial, chemical or biological wastes, from debris or man-made products and from mismanagement of natural and environmental resources.

Chemical pollution A sudden pollution of water or air near industrial areas, leading to internal body disorders with permanent damage of the skin. Atmosphere pollution Contamination of the atmosphere by large quantities of gases, solids and radiation produced by the burning of natural and artificial fuels, chemicals and other industrial processes and nuclear explosions
y

Acid rain A washout of an excessive concentration of acidic compounds in the atmosphere, resulting from chemical pollutants such as sulphur and nitrogen compounds. When deposited these increase the acidity of the soil and water causing agricultural and ecological damage.

The Federation has more of an advocacy/information sharing role and does not involve itself with the technical aspects, e.g. cleaning up, irradiation sickness or

(advanced) treatment of people who have been exposed. However, the Federation offers care to people that are displaced or flee from the disasters, providing shelter, foods, basic health, water and sanitation. Psychological support is also often vital. For more than twenty years on, the Federation is still running a programme to assist victims of the Chernobyl nuclear reactor explosion of 1986, providing medical assistance and check-ups, and psycho-social support. Equally, in situations of chemical and biological warfare, the Federation provides basic information about symptoms and effects of agents, antidotes and protection. Again, National Societies and the Federation take care of people displaced or fleeing from chemical or biological attacks, providing shelter, food, basic medical care, water and sanitation. Biological hazards:An epidemic is then unusual increase in the number of cases of an infectious disease which already exists in a certain region or population. It can also refer to the appearance of a significant number of cases of an infectious disease in a region or population that is usually free from that disease. Epidemics may be the consequence of disasters of another kind, such as floods, earthquakes, droughts, etc Cholera Cholera is mainly spread by drinking water contaminated by faeces. The fatality rate for severe, untreated cases is 50 per cent; when treated this drops to one per cent. The incubation period is 1-12 days and severe cases need hospitalisation. Less severe cases can be treated with rehydration therapy on an outpatient basis. Only 10 per cent of those infected present symptoms. Key control factors are: ensuring a safe water supply and rigorous hygiene (hand washing and disposal of soiled items). Crowded wards are not a hazard to staff or visitors, if good hygiene is observed. Quarantine is unnecessary. Vaccine is inappropriate in an emergency.

Swine flu The WHO has raised the Influenza Pandemic Alert to the highest level which is 6. Already India has seen over 60 confirmed cases of Swine Flu and the threat of a full blown epidemic in India is very real. Some Vital Stats Total Confirmed Cases in India Total Deaths in India Total Confirmed Cases Worldwide Total Deaths Worldwide 29904** 1404** Over 622482* At least 16455*

In order to prevent epidemics, the community in general and families in particular must take simple measures. Leaders can collaborate with health centers and other relevant institutions present in the area. Community activities Inspect and repair water supply network Ensure proper hygiene of people who handle food Maintain and clean public latrines Manage solid waste in public areas (vector control) Control vectors (eliminate refuse in public areas) Coordinate with local health center Family activities Ensure hygienic water management in the home Ensure proper food hygiene in the home Maintain and clean family latrines Handle domestic solid waste (vector control) Control vectors (eliminate refuse) Practice personal hygiene

Responding to disasters The elements of disaster response: emergency needs assessment The first step in any emergency response is to assess the extent and impact of the damage caused by the disaster (the needs) and the capacity of the affected population to meet its immediate survival needs (degree of vulnerability). Although the impact may vary considerably from one disaster to another, typical needs that arise include:
y y y y y y y

food; shelter; essential items, such as blankets, heaters, water containers; medical care; safe drinking water; sanitation and waste disposal; psychosocial support.

Such an assessment will identify the needs that require external intervention and the gaps to be filled. It is a vital component of the programme-planning process. It provides the information on which key decisions affecting the lives of the disaster victims will be made. Assessments can take the following forms:
y

Rapid assessment: Undertaken immediately after a disaster, rapid assessment provides information on needs, possible courses of action and resource requirements. It normally takes up to a week. Detailed assessment: A more detailed assessment is carried out after a rapid assessment, if the situation is changing and more information is needed. It takes about one month, depending on the size of the area and the complexity of the situation. Continual assessment: Disaster situations can evolve rapidly and include unexpected knock-on effects, such as population movements.

Assessment should therefore be an ongoing process throughout the emergency phase Experience shows that a poorly conducted assessment is likely to lead to poor planning decisions and an inadequate response. Phases of Disaster:1) Preimpact: a. Occurs prior to the onset of the disaster. b. Includes the period of threat and warning. c. May not occur in all disaster. 2) Impact Phase: a. Period of time when disaster occurs, continuing to immediately following disaster. b. Inventory and rescues period. Assessment of extent of losses. Identification of remaining sources. Planning for Use of resources Rescue of victims Minimizing further injuries and property damage. May be brief when disasters strike suddenly and is over in minutes (air plane clash, building collapse) or lengthy as incident continues (earthquake, flood, tsunami etc.) 3) Post impact phase a. Occurs when majority of rescue operations are completed. b. Remedy and recovery period. c. Lengthy phase that may last for years. Honeymoon phase - feeling of euphoria, appearances of little effect by disaster. Disillusionment phase - feeling of anger, disappointment and resentment. Reconstruction phase - acceptance of loss, copping with stereo, rebuilding. 4) Rehabilitation The final phase in a disaster should lead to restoration of the pre-disaster conditions. The pattern of healthy needs with change rapidly, moving from casualty treatment to more primary health care.

The Disaster Management Cycle:The fundamental aspects of Disaster Management Program Disaster Prevention Disaster preparedness Disaster response Disaster mitigation Rehabilitation Reconstruction

4 Fundamental Aspects of Disaster Management1. 2. 3 4. Disaster mitigation Disaster Preparedness Disaster response Disaster Recovery

Goals of Disaster ManagementReduce, or avoid, losses from hazards; Assure prompt assistance to victims; Achieve rapid and effective recovery. The Disaster management cycle illustrates the ongoing process by which governments, businesses, and civil society plan for and reduce the impact of disasters, react during and immediately following a disaster, and take steps to recover after a disaster has occurred. The four disaster management phases illustrated here do not always, or even generally, occur in isolation or in this precise order. Often phases of the cycle overlap and the length of each phase greatly depends on the severity of the disaster.

Mitigation - Minimizing the effects of disaster. Lessen the impact of a disaster before it strikes. Activities that reduce or eliminate a hazard it includes prevention, risk reduction. Examples: building codes and zoning; vulnerability analyses; public education It is virtually impossible to prevent occurrence of most Natural Disasters, but it is possible to minimize or mitigate their damage effects. Mitigation measures aim to reduce the Vulnerability of the System [ e.g. By improving & enforcing building codes etc] Disaster prevention implies complete elimination of damages from a hazard, but it is not realistic in most hazards. [e.g. Relocating a population from a flood plain or from beach front] Medical Casualty could be drastically reduced by improving the Structural Quality of Houses, Schools, and Public or Private buildings. Also ensuring the Safety of Health facilities, Public Health Services, Water Supply, Sewerage System etc. Mitigation complements the Disaster Preparedness and Disaster Response activities. A Specialized Unit within the National Health Disaster Management Program should coordinate the works of experts in the field of Health, Public Policy & Public Health Hospital Administration Water Systems Engineering & Architecture Planning, Education etc

The Mitigation Program will direct the following activities-

1. Identify areas exposed to Natural Hazards and determine the vulnerability of key health facilities and water systems 2. Coordinate the work of Multi Disciplinary teams in designing and developing building codes and protect the water distribution from damages 3. Hospitals must remain operational to attend to disaster victims 4. Include Disaster Mitigation Measures in the planning and development of New facilities 5. Identify priority hospitals and critical health facilities that complies with current building codes and standards 6. Ensure that mitigation measures are taken into account in a facilitys maintenance plans 7. Inform, sensitize and train those personnels who are involved in planning, administration, operation, maintenance and use of facilities about disaster mitigation 8. Promote the inclusion of Disaster Mitigation in the curricula of Professional training institutes

Preparedness - Planning how to respond. Disaster preparedness refers to measures taken to prepare for and reduce the effects of disasters. That is, to predict and, where possible, prevent disasters, mitigate their impact on vulnerable populations, and respond to and effectively cope with their consequences. Disaster preparedness provides a platform to design effective, realistic and coordinated planning, reduces duplication of efforts and increase the overall effectiveness of National Societies, household and community members disaster preparedness and response efforts. Disaster preparedness is a continuous and integrated process resulting from a wide range of risk reduction activities and resources rather than from a distinct sectoral activity by itself. It requires the contributions of many different areasranging from training and logistics, to health care, recovery, livelihood to institutional development. Activities that are taken to build capacity and identify resources that may be used. Emergency communication plan. Preventive measures to prevent spread of disease. Public education. Activities undertaken to handle a disaster when it strikes.

The objectives of the disaster preparedness is to ensure that appropriate systems, procedures and resources are in place to provide prompt, effective assistance to disaster victims, thus facilitating relief measures and rehabilitation services. Disaster preparedness is an ongoing, multi-sectoral activity to carry out the following activities: Evaluate the risk of the country or particular region to disasters. Adopt standards and regulations Organize communication, information and warning systems Ensure coordination and response mechanisms Adopt measures to ensure that financial and other resources are available for increased readiness and can be mobilized in disaster situations. Develop public education programs Coordinate information sessions with news media Organize disaster simulation exercises that test response mechanisms

Response - Efforts to minimize the hazards created by a disaster. Examples: search and rescue; emergency relief . Search and rescue, clearing debris and feeding and sheltering victims. OBJECTIVES Appropriate application of current technology can prevent much of the death, injury, and economic disruption resulting from disasters Morbidity and mortality resulting from disasters differ according to the type and location of the event. In any disaster, prevention should be directed towards reducing (1) Losses due to the disaster event itself (2) Losses resulting from the Mismanagement of disaster relief.

Recovery - Returning the community to normal. Getting a community back to its pre-disaster status. Examples: temporary housing; grants; medical care. As the emergency is brought under control, the affected population is

capable of undertaking a growing number of activities aimed at restoring their lives and the infrastructure that supports them. There is no distinct point at which immediate relief changes into recovery and then into longterm sustainable development. There will be many opportunities during the recovery period to enhance prevention and increase preparedness, thus reducing vulnerability. Ideally, there should be a smooth transition from recovery to on-going development. Recovery activities continue until all systems return to normal or better. Recovery measures, both short and long term, include returning vital lifesupport systems to minimum operating standards; temporary housing; public information; health and safety education; reconstruction; counseling programs; and economic impact studies. Information resources and services include data collection related to rebuilding, and documentation of lessons learned. Triage system:French verb Trier means to sort. Assigns priorities when resources limited. Do the best for the greatest number of patients. Advantages of triage1. 2. 3. 4. 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.

When the quantity and severity of injuries overwhelm the operative capacity of health facilities, a different approach to medical treatment must be adopted. The principle of "first come, first treated", is not followed in mass emergencies. Triage consists of rapidly classifying the injured on the basis of the severity of their injuries and the likelihood of their survival with prompt medical intervention. It must be adopted to locally available skills. Higher priority is granted to victims whose immediate or long-term prognosis can be dramatically affected by simple intensive care. Moribund patients who require a great deal of attention, with questionable benefit, have the lowest priority. Triage is the only approach that can provide maximum benefit to the greatest number of injured in a major disaster situation.

Although different triage systems have been adopted and. are still in use in some countries, the most common classification uses the internationally accepted four colour code system. Red indicates high priority treatment or transfer, yellow signals medium priority; green indicates ambulatory patients and black for dead or moribund patients.

Triage system

START SYSTEM
Created in the 1980s by Hoag Hospital and the Newport Beach CA Fire Dept Allows rapid assessment of victims It should not take more than 15 sec/ Pt Once victim is in treatment area more detailed assessment should be made

START SYSTEM
Clasification is based on three items Respiratory Perfusion Mental status evaluation

START First Step

Can the Patient Walk?
YES NO Evaluate Ventilation (Step-2)

Green (Minor)

START Step-2
Ventilation Present? NO
Open Airway

YES

Ventilation Present? NO Black YES

> 30/Min

< 30/min

Red/ Immediate
Evaluate Circulation (Step-3)

Red/ Immediate

START Step-3
Circulation
Absent Radial Pulse Control Hemorrhage Red/ Immediate Present Radial Pulse Evaluate Level of Consciousness

START Step-4
Level of Consciousness Cant Follow Simple Commands Can Follow Simple Commands

Red/ Immediate

Yellow/ Delayed

Contaminated Patients
Patients with exposure (potential or real) to contaminants should be tagged as BLUE This category will continue to stay until patient is adequately decontaminated then follow START as usual Some recommend a double tagging with blue and the standard START color

In the federal structure of India, the state governments are responsible for the execution of relief work in wake of natural disasters. Government of India plays a supportive role, in terms of supplementation of final resources to the states. An administrative system has been developed to combat and minimize the adverse impact of the natural disasters. At the centre, the Ministry of Agriculture is the nodal ministry for coordination of all activities during a natural disaster. Since health is an important part of disaster management, in the DGHS under the ministry of Health and Family Welfare there is a special wing called the Emergency Medical Relief Wing which coordinates all activities related to health? In a vast country like India, it is not practicable for the government machinery alone, to undertake disaster reduction programmes without involvement of NGOs. Public education and community involvement plays a vital role here. As part of the International Decade for Natural Disaster Reduction activities, every year, the second Wednesday of October has been designated as World Disaster Reduction Day. Indian Meteorological Department (IMD) plays a key role in forewarning the disaster. It has five centers in Kolkata, Bhubaneswar, Vishakhapatnam, Chennai and Mumbai for detection and tracing of cyclone storms. Satellite imagery facilities and cyclone warning radars are provided to various Cyclone Warning Centers. In addition, it has 31 special observation posts set up along east coast of India. For all ships out at sea, warnings are issued six times a day. Inset Disaster Warning System (DWS) receivers have been installed primarily in the coastal areas of Tamil Nadu and Andhra Pradesh. This has proved very reliable form of communication system. The Snow and Avalanche Study Establishment (SASE) in Manali has been issuing warning to people about avalanches 24 to 48 hours in advance. MAN MADE DISASTERS INTERNATIONAL AGENCIES PROVIDING HEALTH HUMANITARIAN ASSISTANCE every country is a potential source of health humanitarian assistance for some other disaster-stricken nation. Bilateral assistance, whether personnel, supplies or cash is probably the most important source of external aid. Several international or r regional agencies have established special funds, procedures and offices to provide humanitarian assistance. United Nation's Agencies are United Nations Office for the Coordination of Humanitarian Affairs (OCHA), World Health Organization (WHO), UNICEF, World Food Programme (WFP), Food and Agriculture Organization (FAO). Inter-governmental organizations are European Community Humanitarian Office (ECHO), Organization of American States (OAS), Centre of

Coordination for Prevention of Natural Disasters in Central America, Caribbean Disaster Emergency Response Agency. Some Non-Governmental Organizations are CARE, International Committee of Red Cross, International Council of Voluntary Agencies (1CVA), International Federation of Red Cross and Red Crescent 2 Societies (IFRC) etc.

Disaster Nursing:Disaster nursing refers to nursing services offered to the victims of disaster who experiences trauma caused by disaster produce several kinds of trauma. a. Physical - Fractures, burns, injuries and infections. b. Physiological - Shock and electrolyte imbalance c. Psychological- Anxiety, depression, substance abuse, stress reaction. d. Socio-economic- Unemployment, Homelessness, Environmental destruction, disorganization. The Symptoms related to Trauma Produced by disaster usually occurs in Five Phases. a. Impact Phase: It includes event itself and is characterized by shock, extreme b. Heroic Phase: Characterized by co-operative spirit exist between friends, neighbor and emergency teams. Constructive activity at this time can help to overcome feelings of anxiety and depression. c. The honeymoon phase: It begins to appear one week to several months after the disaster, the need to help others is sustained, and the money, resources and support received from varying agencies allow life to begin again in the community. d. Disillusionment phase: It last from two months to one year._ A time of disappointment, resentment, frustration and anger. Victims often begin to compare their neighbors with their own and may start to resent or show hostility towards others. e. Reconstruction and reorganization phase: In this individual recognize that they must adjust with their own problems. They begin to rebuild their homes, business and lives in constructive fashion. This ... period may last for year after the disaster. Nurse along with the health team needs to utilize primary health care intervention in acute emergencies as follows: Immunization and preventive health Management of diarrheas and dehydration. Management of acute respiratory infections. Setting up a health information system.

 Safe drinking water supply. Sanitation. Training and support for health workers. Other basic services. In addition to above the following psychosocial intervention are provided by the nurses: Crises intervention / counseling Group work Telephone contact services. Disaster response managements Health education Community services like facilitation of self help groups etc. Community measures in Disaster Pre disaster phase, appropriate management of disaster requires advance planning. A nurse should be the part of the team for disaster planning. a. Community Participation: It is the process by which individuals, families and communities assume the responsibility of promoting their own health and welfare. The community health nurse maintains the link between professional group of experts in disaster management and community. b. Mock trails/training: The training of various inter-disciplinary forces like school children, voluntary organizations can be imparted by community health nurse and her team, c. Mass awareness: The community should have the knowledge of all the Channel communication system, stand by equipment supplies and other resources; otherwise disaster preparedness will be failure. d. Education: Mass awareness through media, booklets, panel discussion, films and televisions information is very essential. Basic community Education should incorporate the following essentials: a. Setting up the first aid post b. Causality evaluation c. Basic hygiene and sanitation d. Safety measures e. Maintenance of food and water supply f. Maintenance of law and order. g. Provision of shelters h. Rescue streaming i. Significance of traffic control and communication j. Use of fire services

k. Hazards of radiation and preventive measures l. Prevention of future disasters. m. Grant in aid n. Rehabilitation CONCLUSION Disasters are of different types which can happen any time, any where, in the world causing tremendous after effects such as loss of human life ,economical imbalances, food scarcity epidemics , forced relocation of population etc. Disasters usually affect the developing countries comparing with the developed countries. While deserting the matter we could come to the conclusion that the adverse effects of natural disasters can be minimized by proper preventive measures alert technologies at high risk areas, proper mobilization of resources, and decreased corruption in the field and also the mock training programmes in the community.