Many natural and human-made disasters occur across the surface of the planet every day. Forest fires, tsunamis, earthquakes, oil spills, hurricanes, and other kinds of cataclysms pose a significant danger to human and animal lives (“Disaster nursing,” 2011). In a case of an emergency, medical institutions are expected to provide all possible assistance to the population through the practice of triage medicine. As nurses make up the majority of the medical contingent, upon them falls the difficult and noble role of providing direct medical assistance to those in need. The purpose of this paper is to describe the role of the nurse in an emergency situation (an earthquake) by listing out priorities, resources, providing a description of the nursing process, and identifying the epidemiological profile of possible diseases that may develop within the suffering population.
Earthquake – a Destructive Force of Nature
According to statistics, over 500,000 earthquakes occur every year (Parihar, 2011). The majority of them remain unseen, too weak to be perceived by humans. Out of that number, only 7 to 10 can actually lead to a loss of life (Parihar, 2011). Earthquakes are some of the deadliest naturally occurring disasters. They have the power to annihilate entire cities, destroy infrastructure, and cause countless human casualties. In most scenarios, it is not the shaking that does the damage, but the collapse of the buildings, destroyed pipelines and communications, conflagrations that result because of the numerous gas leaks, and diseases brought upon by the destruction of the main water supplies. Famine, lack of medical equipment, general chaos, and the abundance of casualties are common in powerful earthquakes.
Case Scenario
A 7.1-magnitude earthquake has struck in South Asia, flattening many villages and leaving hundreds of thousands homeless. With limited building infrastructure, government agencies have set up temporary housing and public health centers to treat the affected. Limited running water and unsanitary, cramped conditions have allowed cholera to spread. Several temples were destroyed during the disaster, and there is an additional sense of loss among the survivors.
Asia is a continent most prone to earthquakes. Historically, massive earthquakes occur over the territories of Japan, India, China, Pakistan, and various island nations in the Pacific Ocean (Parihar, 2011). More often than not, these earthquakes are followed by large tsunami waves, which cause additional damage to anything in the vicinity of the coastline. In developing nations, such as China and India, earthquakes are particularly devastating, as many people there live in one or two-story houses made of brick and clay, which is a poor material against earthquakes. The scenario, thus, is very plausible, especially in the scope of an international healthcare organization such as the Red Cross.
Community and Population Profile
South Asia is a rural, yet rapidly industrializing region, where large cities grow next to rural communities. Agrarian economies and rural villages are common. Due to the fact that Asian culture values collectivity, their families are large, and often live together under the same roof. Depending on the level of development in a community, the level of medical care varies. Large cities provide quality healthcare via a westernized hospital system, whereas more rural communities often have to rely on traditional medicine. In India such as Ayurveda are very popular (Parihar, 2011).
The Role of a Nurse during a Disaster
During a disaster, the nurse has to take upon numerous roles – from that of a primary healthcare provider to that of a community leader. A nurse should be able to organize the survivor population in her immediate vicinity, provide means of sustenance and adequate training to perform basic medical duties. Other duties would involve cooperation with other nursing and local emergency response teams. Providing physical and psychological comfort is also a very important aspect of nursing during a disaster situation, like feelings of panic, fear, and depression is very likely to take hold.
Epidemiology of Earthquakes
The aftermath of a devastating earthquake is usually ghastly. Hundreds of people become trapped underneath the collapsed buildings, leaking gas and torn electrical wires cause massive fires to erupt. Smoke and dust pose a great danger to anyone with a lung disease, such as asthma. In the first hours after the event, the majority of the population would arrive in need of medical assistance associated with physical traumas (Noji, n.d.). However, much more people become sick in the aftermath, even if they came out relatively unscathed. Large earthquakes destroy homes and infrastructure, forcing people to live on the streets among ruins, with no food or water. If the water is present, it is usually not processed, and the lack of sanitation causes diseases such as cholera and dysentery to spread among the survivors (Noji, n.d.).
Cholera and Dysentery
Cholera and Dysentery are the most common diseases during a massive emergency, such as flood or an earthquake. They develop due to a lack of clear water, food, or proper hygiene, which is always an issue in temporary refugee camps. These diseases can be transmitted from one person to another very quickly. One can contract them by drinking contaminated water or food (“Water-borne diseases,” n.d.). Prevention of these diseases is a primary concern for a nurse following an aftermath of an earthquake is to establish hygiene procedures and routine rationing to prevent the use of unsafe water.
Nursing Processes During an Earthquake
The first thing a nurse should do after an earthquake is to immediately assess the situation and make an approximation of possible casualties, required and available supplies, and possible help to deal with the aftermath. Unfortunately, earthquakes tend to destroy or damage any medical infrastructure, so the approximate assessments of the population need to be done in advance. After that, search and rescue operations are to take place. The nurse would need to involve anyone capable of doing so. Research shows that many people rescued during the first hours after the earthquake. Once rescue operations are over, the nurse should move on to triage and medical treatment of the survivors. According to statistics, from 25 to 50% of casualties during earthquakes could have survived if they were administered appropriate first aid and medical treatment (Noji, n.d.).
Resources and Agencies
Since earthquakes in Asia are a common occurrence, there are many organizations offering help during times of need. International organizations that offer humanitarian aid include the Red Cross, WHO, Americare, Mercy Corps, and many other organizations (Gulzar et al., 2012). They usually operate in clusters and provide medication, resources, food, and specialists to work on the ground. However, the international response may be slow and take several days or even weeks to mobilize. The immediate resources available to a nurse would be those within the immediate vicinity. Local hospitals and other healthcare institutions should have emergency supplies for these situations. The police, the emergency services, and the army may also serve as additional specialists and workforce during the rescue.
Triage Practices
In an earthquake, particularly in the south-Asian region, the number of casualties is so great that nurses are too few to administer help to everyone in a timely manner. START allows managing the patients depending on their traumas. This allows rescuing more people while avoiding wasting time on patients that could not be saved. The nurse should assess all the patients and distribute colored badges according to the degree of complexity and need of a patient. Red requires immediate treatment. Yellow stands for treatment that could be delayed. Green stands for minor injuries that are not threatening. Black – for dead or close to dying.
Cultural and Religious Needs of the Patients
The south-Asian part of the continent includes such countries as India, Pakistan, Nepal, Singapore, Vietnam, and parts of Korea and China (“Respecting the religious and cultural needs,” n.d.). These countries vary in in their national representation and in religion. The predominant religions in the region are Buddhism, Islam, Hinduism, Sikhism, and Christianity. While respecting the patients’ cultural heritage by addressing them in their language, providing them with means of exercising their faith and other commodities is important, during a disaster many of these factors are considered secondary. Some of the more important factors include the willingness to accept transfusion and organ replacement as means of survival. As a rule, all representatives of these confessions are likely to accept blood transfusions, but they should be asked beforehand. Some Buddhists may be against organ transplantation as they consider it unnatural (“Respecting the religious and cultural needs,” n.d.).
Communication Techniques and Ethical Considerations
Since south-Asian countries tend to be a blend of numerous nationalities and cultures, it is best to use a culture-neutral tone during work, in order to avoid possible confusions and misunderstandings (“Respecting the religious and cultural needs,” n.d.). It would also save the nurse time and effort to memorize each and every patient’s cultural background during the emergency triage situations. Once the situation stabilizes and triage procedures become less hectic, it is recommended to address the feelings of loss and confusions in regards to the destruction of spiritual temples and places of worship. The concept of the “Temple within Oneself” is a valuable one to teach patients, as they would not be having any dedicated places of worship anytime soon (“Respecting the religious and cultural needs,” n.d.).
References
Disaster nursing. (2011). Web.
Gulzar, S.A., Faheem, Z.A., & Somani, R.K. (2012). Role of community health nurse in earthquake-affected areas. Journal of Pakistan Medical Association, 62(10), 1083-1086.
Noji, E.K. (n.d.). The epidemiology of earthquakes: Implications for vulnerability reduction, mitigation, and relief. Web.
Parihar, R. (2011). Disaster nursing. Web.
Respecting the religious and cultural needs of patients. (n.d.). Web.
Water-borne diseases: Cholera and dysentery: Epidemic dysentery. (n.d.). Web.