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The initial response to any disaster is always local, which is why cities and rural places need to be prepared for disasters. An alert system must be in place, while the magnitude of the disaster is assessed. Disaster services include search and rescue, performing triage and initial stabilization, provision of definitive medical care, and evacuation. Search and rescue teams, the police and other units access to the disaster scene may be restricted as well as communication because of destroyed buildings, which houses emergency response offices. With basic trauma nursing skills, disaster preparedness, and proper planning, the responding nurse generally can expect to improve the disaster victims’ outcome. The needs and conditions of disaster victims vary, and the resources available are unpredictable. The ability to adapt and improvise at the disaster scene is essential. Whoever arrives first should begin triage until additional qualified rescuers arrive.
STAGES OF DISASTERS. Grant, et al. (Grant, Murray, & Bergeron, 1990) describe seven stages of disaster, that can provide tips to victims’ potential behavior. The seven-stage standard disaster model is showing the sequence of events (warning, threat, impact, inventory, rescue, remedy, and restoration stages) and a general indication of their relative duration.
Warning: During this stage, people are apprehensive about the possibility of a disaster or emergency. Not all disasters give a warning period; sometimes people ignore or do not receive the warning. Other disasters such as an airliner crash into a building are sudden or unpredictable.
Threat: By the threat stage, there are unequivocal signs of the approaching disaster. When a threat is perceived, those affected must effectively take action to avoid harm.
Impact: The impact stage is when the disaster actually strikes, and damage property and harm people. After this intense stage, there may be considerable pain and grief, but the destruction is over.
Inventory: During the inventory stage, most survivors begin to piece together what has happened, inventory their losses, take stock of damage, and activate coping skills, while others will continue to be immobilized by injury and fear.
Rescue: During the rescue stage, intervention begins as the survivors set priorities, begin to help victims, and meet immediate concerns. Survivor group spontaneously emerge and begin the rescue process (treating the injured, freeing trapped victims, and extinguishing fires).
Remedy: The remedy period is often the longest stage after a disaster, where teamwork drives survivors to reconstruct the disaster area and help the victims. Relief agencies take control of the disaster scene and impose a formal structure on people’s inventory and rescue stages.
Restoration: During the restoration stage, the disaster area is replaced by reestablishing the old structure or beginning a new pattern of life. The type of disaster and the resources available influence the level of restoration, rebuilding, and its predisaster level of functioning. This stage may last months to years.
CLASSIFICATION OF DISASTERS. A localized disaster that occurs in a well-defined geographic area, for example a terrorist bombing of a restaurant, makes the access to the victims less restricted, and community resources can be mobilized for assistance. When the event is widespread, a so called compartmentalized disaster, for example a serious earthquake the care can be fragmented, because nurses and other rescuers may be trapped somewhere, and the hospital may be destroyed. Victims are isolated from one another, transportation routes and communication may also be impaired (Chitwood, 1995). For example, after the hurricane in New Orleans 2005, hospitals and health systems were experiencing extreme staffing shortages because of the loss of many health care professionals.
Small-scale emergencies involve few individuals or small groups of people, and emergency response operations are relatively short, lasting minutes or hours to completion of response actions. There are usually limited numbers of risks, and smaller emergencies can generally be handled by a local response organization. Major disasters severely affect large numbers of people, and often extend over very large areas. Response activities in major disasters can stretch in days, weeks, or even months. Major disasters involve multiple risks that can vary widely in nature, for example, active fires, collapsing buildings and hazardous materials. Few responders will have experience with everything they might encounter in the aftermath of a major disaster, and supplementary capabilities are not routinely maintained by local response organizations. Major disasters can also damage or destroy infrastructures, such as communications, transportation, water supplies and power outages. International aid can help national and local authorities, and establish temporary medical facilities and may support later specialist elective services.
An adequate response requires planning and coordination. There is no substitute for a carefully developed disaster plan and periodic field exercises in preparing the team to perform optimally in situations of mass casualty or disasters. To meet the needs for multiple trauma patients, personnel as well as material resources must be provided by mobilization (call for assistance, open up the supply depot), and by reallocation (professionals and supplies are moved from areas with less need of specialized emergency care). Hospitals have to stop diverting patients to the emergency room, get patients out of the ER and into the hospital rooms so they do not clog up the system. Access to personal protective equipment, the ability to casualty surge, and supplies of critical hospital equipment, such as decontamination showers, ventilators, dialysis, and intensive care beds, will most certainly have an impact on the delivery of trauma care, survival rates and patient’s outcomes. It is also very important that hospitals and emergency medical services can communicate effectively with police, fire departments and other emergency responders. Communications should be clear, concise, and understandable.
Some disaster plans identify three levels of disaster. One version is described in The Student Manual for Disaster Management and Planning for Emergency Physician's Course (ACEP:1-2): Level I is a localized multiple casualty emergency wherein local medical resources are available and adequate to provide for field medical treatment and stabilization, including triage. The patients will be transported to the appropriate local medical facility for further diagnosis and treatment. Level II is a multiple casualty emergency where the large number of casualties and/or lack of local medical care facilities are such as to require multi-jurisdiction (regional) medical mutual aid. Level III is a mass casualty emergency wherein local and regional medical resource's capabilities are exceeded and/or over-whelmed. Deficiencies in medical supplies and personnel are such as to require assistance from state or federal agencies.
Nearly every rescue team is likely to be faced with a multivehicle accident at some time. The principles of dealing with the situation are the same for any mass casualty event on receiving a call for emergency assistance involving multiple casualties the dispatcher must gather (at least) the following information:
On the basis of this initial information, the dispatcher must determine how many ambulances should be sent and what ancillary services, such as police, fire department, and utility company technicians such as utility workers to deal with downed wires, should also be requested to respond. A special, reprinted dispatch record, is helpful in providing guidance in obtaining all the necessary information, and it also provides a lasting record of the call. The caller is likely to be in an excited state, so instructions must be clear and simple. The dispatcher should also inform the caller of the rescuers’ estimated time of arrival at the scene, and explain any anticipated delays.
For practice guidance, Web sites, components of a first-aid kit, an emergency preparedness program, incident commanders’ checklists, and many more contain useful information. Plans for resource management (i.e., the mobilization of more personnel, equipment, supplies, facilities), and directing incoming responders and volunteers to designated check-in or staging areas and determining what resources are available should be established in advance. Disaster response may depend on locating resources that are not commonly used in routine emergency responses or are in short supply. A comprehensive plan should establish procedures for locating various specialty professionals, teams, and resources. Hospitals and other facilities must have the capacity to meet patient needs and to ensure continuity of power, communications, water, sewer, and waste disposal in large-scale emergencies and disaster situations. Exchange of patient information will be particularly important in the post-impact and recovery phases. The needs and opportunities for creative assistance worldwide are endless.