Rama Bhandari
Staff Nursing, Grande International Hospital, Dhapasi, Kathmandu, Nepal

The majority of death immediately after a natural disaster like earthquake are directly associated with blunt trauma, crush-related injuries and burn injuries. The 25th April 2015 Nepal earthquake killed nearly 9,000 people and injured approximately 22,000.
The initial evaluation of a patient who is injured critically from multiple trauma (physically and psychologically) is a challenging task and every minute can make the difference between life and death. Grande international hospital started medically treating the patient by applying TRIAGE SYSTEM during the post disaster period i.e after earthquake. This protocol ensures that the most immediately life threatening conditions are quickly identified and addressed in the order of their risk potential.
Regardless of the clinical setting, the care team was organized before the patients arrival. Was done by Nurses , Nursing supervisors, Medical officers ,Senior doctors and other health team members. A physician from either service who was experienced in the case of trauma patients served as the team leader and the directed evaluation and resuscitation. During that  mass casualty we nurses and doctors implemented advance triage system. This involves the colour- coding scheme using red, yellow, green , white and black tags.
Red tags: (immediate) – were used to label those who cannot survive without immediate treatment but who had a chance of survival.
Yellow tags : (observation) –labeled for those who requires observation. Their condition was stable for the moment and was not in immediate danger of death. But still needs hospital care and would be treated immediately under normal circumstances.
Green tags : (wait) – were reserved for the “ walking wounded” who may need medical care at some point after more critical injuries were treated.
White tags : (dismiss) – were given to those having minor injuries for whom a doctors care wasnot required.
Black tag : (expectant) – were used for deceased and for those whose injuries were so extensive that there were not able to survive given the care that is available.

The post disaster scenario at GIH was of this kind; Right after the entry point the victims were received at the registration counter. After an abrupt registration the nurses on duty took vital signs of victims and medical officers diagnosed the related triage. The triage were separated within the different tent on the same huge ground.
GIH also managed to carry on its social responsibility by educating the patient and their visitors regarding infectious disease that generally follows the disaster. Major awareness concerns were related to easily communicable/spreadable diseases like
 Water- borne diseases which may cause diarrhea cholera , dysentery, hepatitis
Air-borne or droplet disease which may cause acute respiratory infection (Pneumonia) , influenza ,measles.
Vector-borne diseases which may cause malaria, dengue.
Contamination from wound injuries may cause tetanus.
Moreover the hospital also distributed Oral-Rehydration solution and some common medications like paracetamol, metron the visitors of the patients. Also as a part of moral obligations the hospital managed to distribute hygienic foods, snacks, juice, and fruits to the patient ,their visitors and the staffs too. In addition the hospital also made available free health service during earthquake period to most of the victims.
The psychological effects  after the devastating earthquake are inevitable and normal part of human psychology. Most of the human straight away experiencing a major natural disaster like earthquake experience psychological effects – both individual psychological effects impacting on how they relate to each other. Talking about a high risk group women(ESPECIALLY MOTHERS OF YOUNG CHILDREN) , children and people with a prior history with mental illness or poor social adjustment appear to be moreover the recovery period and this needs monitoring from those working in the field.. WE RECEIVED ONE OF THE CASES SUFFERING FROM BOTH PHYSICAL AND PSYCHOLOGICAL TRAUMA. A woman named Manisha Shrestha of 37 years diagnosed as right tibia and clavicle fracture with depression. She was in misery as she lost her husband and a son in GIH was not only concerned to treat her physical injuries but also paid  equal attention to recover her psychological trauma.
The risk factors for increased infectious disease transmission and outbreaks are mainly associated with the after effect of disaster rather than the primary disaster itself. So in order to minimize the post effects of disaster we organized various health camp on various places nearby our area like Tokha, Kavresthali etc. The findings of many after effects of earthquake includes displacement of population (internally displaced person), unplanned and overcrowded shelters, poor water and sanitation conditions, poor nutritional status and insufficient personal hygiene. 
Consequently, resulting low level of immunity to vaccine preventable disease or insufficient vaccination coverage and limited access to health care services and the interruption of on-going treatments and use of unprescribed medication. Conduction of our free health camp included ophthalmology, nephrology, orthopedics, endocrinology, and internal medicine department. Most of the people participating the camp were at mid 40s, 50s and 60s and the other were the youths. We served some octogenarians too who were having ophthalmological issues like cataract, glaucoma. Some were hypertensive, some were hyperglycemic/diabetes mellitus about which they were not much aware. Many complained of back pain and legs pain. At last, we conducted health education program on the same camp regarding above mentioned disease, conditions, risk factors, preventive measures and further treatment which can be done.
The 2015 Nepal earth quake marked a milestone in history where humanitarian disaster relief agencies have finally understood how useful big data and online mapping approaches can be. The crisis and post disaster relief co ordination involved a massive combination of methods such as crisis mapping (gathering, display and analysis of data by a large number of people including the public during a crisis, usually a natural disaster) and “crowd sourced” data collection to help plant the emergency work. In addition to these more institution focused methods, similar technologies at the individual level(such as mobile and web based applications) started appearing where people could ‘check-in’ as safe or locate missing persons online. Examples are the Facebook Saftey Check or Google Person Finder. We too need to focus on addressing basic human needs, changing and relative nature of need, time-related changes in well being and the must is the leadership behavior of the supervisor.

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