Communities in Crisis:
Disasters, Group Violence, and Terrorism
Upon mastery of this chapter, you should be able to:
● Describe
a variety of characteristics of disasters, including causation, number of
casualties, scope, and intensity.
● Discuss
a variety of factors contributing to a community’s potential for experiencing a
disaster.
● Identify
the four phases of disaster management.
● Describe
factors involved in disaster planning.
● Describe
the role of the community health nurse in preventing, preparing for, responding
to, and supporting recovery from disasters.
● Compare
and contrast the most common types of group violence.
● Discuss
a variety of factors contributing to a community’s potential for experiencing
group violence.
● Describe
the role of the community health nurse in preventing and responding to group
violence.
●
Distinguish terrorism from other types of group violence.
● Use
the levels of prevention to describe the role of the community health nurse in
relation to acts of chemical, biologic, or nuclear terrorism.
What would you do if your local news station broadcast an
announcement that your community was directly in the path of a hurricane that
earlier in the day had caused extensive damage and loss of life in a
neighboring state? What would you do if you were shopping at a local mall,
suddenly heard an explosive noise followed by shouts and cries for help, then
noticed that a pungent odor was filling the air? What DID you do on the morning
of September 11, 2001, when the world of each American, especially those in
DISASTERS
A disaster is any natural or manmade event that
causes a level of destruction or emotional trauma exceeding the abilities of those
affected to respond without community assistance. The crash of a private plane
over the
The geographic distribution of disasters varies because certain
types of disasters are more common in some parts of the world. For example,
Here
is a brief sampling of major disasters that occurred in 2002-2003:
•
January 2002, Ipiales,
•
January 2002, Democratic
•
February 2002,
•
March 2002,
• May
2002,
• May
2002,
•
June 2002, Western United States—several major wildfires, including the worst
fire in
•
June 2002,
• June
2002,
•
July 2002,
•
September 2002,
•
October 2002,
•
December 2002,
•
February 2003,
•
February 2003,
• May
2003,
•
August 2003,
•
September 2003,
•
December 2003,
Characteristics of Disasters
Disasters are often characterized by their cause. Natural
disasters are caused by natural events, such as the floods in western Europe or the earthquakes in
A casualty is a human being who is injured or
killed by or as a direct result of an incident. Although major disasters sometimes
occur without any injury or loss of life, disasters are commonly characterized
by the number of casualties involved. If casualties number more than 2 people
but fewer than 100, the disaster is characterized as a multiple-casualty incident.
Although multiple-casualty incidents may strain the health care systems of
small or mid-sized communities, mass-casualty incidents—those involving
100 or more casualties— often completely overwhelm the resources of even large
cities. Preparedness for mass-casualty incidents is essential for all
communities.
The possibility of being prepared is another
characteristic that varies with different types of disasters. For instance, the
path and time of landfall of a hurricane can be tracked so that residents in
the storm’s path can be evacuated and families and businesses can be protected.
Communities can also minimize devastation from flooding by building reservoirs
or refusing to grant building permits in flood-prone areas, and sandbagging can
be used during rainy weather. In fire-prone areas, communities can post notices
to heighten awareness of fire danger and enforce regulations to cut back
vegetation near structures in forested areas. On the other hand, some disasters
strike without warning. For example, the terrorist attacks in
The scope of a disaster is the range of its
effect, either geographically or in terms of the number of victims. The
collapse of a 500-unit high-rise apartment building has a greater scope than
does the collapse of a bridge that occurs while only two cars are crossing.
The intensity of a disaster is the level of
destruction and devastation it causes. For instance, an earthquake centered in a
large metropolitan area and one centered in a desert may have the same numeric
rating on the Richter scale, yet have very different intensities in terms of
the destruction they cause.
Victims of Disasters
Because disasters are so variable, there is no typical
victim in a disaster. Nor can anyone predict whether he or she will ever become
a victim of a disaster. However, once disaster strikes, victims may be
characterized by their level of involvement.
Direct victims are the people
who experience the event, whether fire, volcanic eruption, war, or bomb. They are
the dead and the survivors, and even if they are without physical injuries,
they are likely to have health effects from their experience. Some may be
without shelter or food, and many experience serious psychological stress long
after the event is over (Display 20-1).
Depending on the cause and characteristics of the
disaster, some direct victims may become displaced persons or refugees. Displaced
persons are forced to leave their homes to escape the effects of a
disaster. Usually, displacement is a temporary condition and involves movement
within the person’s own country. A common example is relocation of residents of
flooded areas to schools, churches, and other shelters on higher ground.
Typically, the term refugee is reserved for people who are forced to
leave their homeland because of war or persecution. For example, in early 2000,
thousands of refugees fled
Often, the
displacement of refugees is permanent. For example, many young people who fled
Indirect victims are the
relatives and friends of direct victims. Although these people do not
experience the stress of the event itself, they often undergo extreme anguish
from trying to locate loved ones or accommodate their emergency needs. If
bodies cannot be found or are unidentifiable, indirect victims experience even
greater anguish and may not be able to accept that their loved one has died.
For example, many of the mothers of young Argentineans who disappeared in the
1970s still march daily in downtown Buenos Aires, demanding public
acknowledgment of the murders of their daughters and sons. Family members of
victims from 9/11 in
Factors Contributing to Disasters
It is useful to apply the host, agent, and environment
model to understand the factors contributing to disasters, because manipulation
of these factors can be instrumental in planning strategies to prevent or
prepare for disasters.
Host Factors
The host is the human being who experiences the
disaster. Host factors that contribute to the likelihood of experiencing a
disaster include age, general health, mobility, psychological factors, and even
socioeconomic factors. For instance, elderly residents of a mobile home
community may be unable to evacuate independently in response to a tornado
warning if they no longer can drive. Impoverished residents of a lowincome apartment complex in a large city may notice that
their building is not compliant with city fire codes but may avoid alerting
authorities for fear of being forced to move to more expensive housing.
Agent Factors
The agent is the natural or technologic element
that causes the disaster. For example, the high winds of a hurricane and the
lava of an erupting volcano are agents, as are radiation, industrial chemicals,
biologic agents, and bombs. The Station Nightclub fire and the apartment deck
collapse in
Environmental Factors
Environmental factors are those that
could potentially contribute to or mitigate a disaster. Some of the most common
environmental factors are a community’s level of preparedness; the presence of
industries that produce harmful chemicals or radiation; the presence of
flood-prone rivers, lakes, or streams; average amount of rainfall or snowfall;
average high and low temperatures; proximity to fault lines, coastal waters, or
volcanoes; level of compliance with local building codes; and presence or
absence of political unrest.
Agencies
and Organizations for Disaster Management
Among
disaster-relief organizations, perhaps none is as famous as the Red Cross, the
name commonly used when referring to the American Red Cross, the Federation of
Red Cross and Red Crescent Societies, and the International Committee of the
Red Cross. The American Red Cross was founded in 1881 by Clara Barton and was
chartered by the U. S. Congress in 1905. It is authorized to provide disaster assistance
free of charge across the country through its more than 1 million volunteers.
The Federal Emergency Management Agency (FEMA), established
in 1979, is the federal agency responsible for assessment of and response to
disaster events in the
As a relatively
new department, it is undergoing many changes related to its scope of service.
In June 2002, the American Public Health Association became concerned because some
of the responsibilities of the Centers for Disease Control and Prevention and
the Health Resources and Services Administration (such as the cache drugs,
medical supplies, and equipment for emergencies through the National
Pharmaceutical Stockpile) were being usurped by the Department of Homeland
Security. Some experts see this department as fragmenting the nation’s
broad-based public health system, which may hinder overall responsiveness and
compromise the public health system (Late, 2002). It is hoped that such serious
concerns will be addressed as this department evolves.
Governments often send their military personnel and equipment
in response to international disasters. For example, in March 2000, the
governments of
Phases
of Disaster Management
In developing strategies to address the problem of
disasters, it is helpful for the community health nurse to consider each of the
four phases of disaster management: prevention, preparedness, response, and
recovery.
Prevention
Phase
During the prevention phase, no disaster is
expected or anticipated. The task during this phase is to identify community
risk factors and to develop and implement programs to prevent disasters from occurring.
Task forces typically include representatives from the community’s local
government, health care providers, social services providers, police and fire
departments, major industries, local media, and citizens’ groups. Programs
developed during the prevention phase may also focus on strategies to mitigate
the effects of disasters that cannot be prevented, such as earthquakes,
hurricanes, and tornadoes.
The
Preparedness Phase
Disaster preparedness involves improving community
and individual reaction and responses so that the effects of a disaster are
minimized. Disaster preparedness saves lives and minimizes injury and property
damage. It includes plans for communication, evacuation, rescue, and victim
care. Any plan must also address acquisition of equipment, supplies, medicine,
and even food, clean water, blankets, and shelter. Semiannual disaster drills
and tests of the Emergency Broadcast System are examples of appropriate
activities during the preparedness phase. Disaster preparedness activities
occur locally, regionally, and nationally. A town keeps its warning system
working and tests it each month. Sections of the country coordinate larger
warning systems to notify communities in the path of a tornado or hurricane,
and the country has a plan to stockpile smallpox vaccine for mass immunization.
The National Institute of Allergy and Infectious Diseases has
tried diluting a few of the existing 86 million doses of vaccine and has tested
the diluted dosage on 100 volunteers to see whether it still works. The results
showed that this cache alone contained enough to vaccinate everyone in an
emergency. Laboratories have been contracted to make more than 200 million
doses in the event that biologic warfare becomes a threat. The last case of
smallpox in the
Response Phase
The response phase begins immediately after the
onset of the disastrous event. Preparedness plans take effect immediately, with
the goals of saving lives and preventing further injury or damage. Activities
during the response phase include rescue, triage, on-site stabilization,
transportation of victims, and treatment at local hospitals. Response also
requires recovery, identification, and refrigeration of bodies so that
notification of family members is possible and correct, even weeks after disaster. This care of the dead is demanding
and time-consuming work that is often overlooked by people unfamiliar with
disaster response. Supportive care, including food, water, and shelter for
victims and relief workers is also an essential element of the total disaster
response.
Recovery Phase
During the recovery phase, the community takes
actions to repair, rebuild, or relocate damaged homes and businesses and
restore health and economic vitality to the community. Psychological recovery
must also be addressed. The emotional scars from witnessing a traumatic event
may last a lifetime. Both victims and relief workers should be offered mental
health services to support their recovery (see Voices from the Community).
Role of the Community Health Nurse
The community health nurse has a pivotal role in
preventing, preparing for, responding to, and supporting recovery from a disaster.
After a thorough community assessment for risk factors, the community health
nurse may initiate the formation of a multidisciplinary task force to address
disaster prevention and preparedness in the community.
Preventing
Disasters
Disaster prevention may be considered on three levels:
primary, secondary, and tertiary. These are applied to a natural disaster in
the Levels of Prevention Matrix.
Primary Prevention. Primary
prevention of a disaster means keeping the disaster from ever happening by
taking actions that completely eliminate its occurrence. This is the first
aspect of primary disaster prevention. Although it is obviously the most
effective level of intervention, both in terms of promoting clients’ health and
containing costs, it is not always possible. Tornadoes, earthquakes, and other
disasters often strike without warning, despite the use of every available technologic
device for prediction and tracking.
If
possible, primary prevention of disasters can be practiced in all settings: in
the workplace and home with programs to reduce safety hazards, and in the
community with programs to monitor risk factors, reduce pollution, and
encourage nonviolent conflict resolution. Primary disaster prevention efforts
should take into account a community’s physical, psychosocial, cultural,
economic, and spiritual needs. The community health nurse has a role in each of
these areas. As a teacher, the community health nurse educates people at home,
at work, at school, or in a faith community about safety and security focused
on preventing a disaster. The community health nurse can teach community
members how to protect themselves from the effects of a natural disaster. The nurse can be a part of a safety team, if
working as a school nurse or occupational health nurse. If working for a health
department, the nurse can determine during home visits whether a family has a
personal disaster plan and help them develop one if none exists. There are many
actions the nurse can initiate.
The second aspect of primary disaster prevention is
anticipatory guidance. Disaster drills and other anticipatory exercises help
relief workers experience some of the feelings of chaos and stress associated
with a disaster before one occurs. It is much easier to do this when energy and
intellectual processes are at a high level of functioning. Anticipatory work
can dissipate the impact of a disastrous event. The community health nurse has
a role in these disaster drills through committee membership, organization of
drills at the place of employment, or activism at the grassroots level to
assist in holding community-wide disaster drills on a regular basis.
Secondary Prevention. Secondary
disaster prevention focuses on the earliest possible detection and treatment.
For example, a mobile home community is devastated by a tornado, and the local
health department’s community health nurses work with the American Red Cross to
provide emergency assistance. Secondary prevention corresponds to immediate and
effective response.
Nurses
at St. Vincent’s Hospital, the closest Level I Trauma Center to the
On a
typical day, that number would have been 40 to 45 during the same time period.
In the days after the disaster, some rescuers found body parts and had to
transport them to the morgue. Rescuers came to the emergency department
suffering from symptoms related to fatigue and emotional distress (Ostrowski, 2001).
Nurses
from other hospitals offered to help, and volunteers brought food; the owners
of a restaurant and coffee shop near the hospital closed their doors to the public and provided free food and beverages for hospital
staff. Massage therapists came to the hospital and volunteered to give
massages. The nurses received tremendous support from strangers and peers
across the country. This helped them keep up their spirits as they dealt with
the direct victims, while being indirect victims themselves (Ostrowski, 2001).
Tertiary Prevention. Tertiary
disaster prevention involves reducing the amount and degree of disability or
damage resulting from the disaster. Although it involves rehabilitative work,
it can help a community recover and reduce the risk of further disasters. In
this sense, it becomes a preventive measure.
Another
example from September 11, 2001, comes from a nurse living in the
The most important interventions the nurses provided were
a listening ear and validation that what the employees were feeling and
experiencing was normal, and often essential, for healthy grieving. Some employees
needed to talk about good times, others were quiet and sad, and others
expressed a fear of flying again but did so with the support of family and
friends. All demonstrated courage and an ability to continue their lives with a
sense of strength and hope. Working with these employees enabled the nurse to
recapture the essence and true meaning of her life (DiVitto,
2002).
Preparing for
Disasters
Disaster planning is essential for
a community, business, or hospital. It involves thinking about details of preparation
and management by all involved, including community leaders, health and safety
professionals, and lay people. A disaster plan need not be lengthy. Two weeks
after the April 1995
Personal Preparation. Before
we discuss the preparation of a disaster plan for a community, we should
consider the need for all nurses to address their own personal preparedness to
respond in a disaster. Personal preparedness means that the nurse has read and
understood workplace and community disaster plans and has developed a disaster
plan for her or his own family. The prepared nurse also has participated in
disaster drills and knows cardiopulmonary resuscitation and first aid. Finally,
nurses preparing to work in disaster areas should bring copies of their nursing
license and driver’s license, durable clothing, and basic equipment such as
stethoscopes, flashlights, and cellular phones.
Assessment for Risk
Factors and Disaster History.
As noted earlier in the chapter, the community health
nurse is uniquely qualified to perform a community assessment for risk factors
that may contribute to disasters. In addition, the nurse should review the disaster
history of the community. Have earthquakes, tornadoes, hurricanes, floods,
blizzards, riots, or other disasters occurred in the past? If so, what (if any)
were the warning signs? Were they heeded? Were people warned in time? Did
evacuation efforts remove all people in danger? What were the community’s
on-site responses, and how effective were they? What programs were put in place
to rehabilitate the community?
Establishing
Authority, Communication, and Transportation.
In addition to assessing for preparedness, the effective
disaster plan establishes a clear chain of authority, develops lines of
communication, and delineates routes of transport. Establishing a clear and
flexible chain of authority is critical for successful implementation of a
disaster plan. Usually, the chain is hierarchical, with, for example, the
community’s governmental head (eg, mayor) initiating
the plan, alerting the media to broadcast warnings, authorizing the police to
begin evacuations, and so on. Within each level of the organization, the
hierarchy continues. For example, at the local hospital, the hospital
administrator may be responsible for alerting nurse managers to call in
additional personnel. Flexibility is essential, because key authority figures
may themselves be victims of the disaster. If the home of the chief of police
is destroyed in an earthquake, his or her second-incommand
must have equal knowledge of the community’s disaster plan and be able to step
in without delay.
Mobilizing, Warning, and Evacuating. In
many natural disasters, local weather service personnel, public works officials,
police officers, or firefighters have the earliest information indicating an
increasing potential for a disaster. These officials typically have a plan in
place for providing community authorities with specific data indicating
increased risk.
They may also advise the mayor’s office or other
community leaders of their recommendations for warning or evacuating the
public. Additionally, they may recommend actions the community can take to
mitigate damage, such as spraying rooftops in the path of fires, sandbagging
the banks of rising rivers, or imposing a curfew in times of civil unrest. Disaster
plans must specify the means of communicating warnings to the public, as well
as the precise information that should be included in warnings. Planners should
never assume that all citizens can be reached by radio or television or that
broadcast systems will be unaffected by the disaster. Broadcast media may
indeed be a primary means of communicating warnings, but alternative
strategies, such as police or volunteers canvassing neighborhoods with
loudspeakers, should also be in place. In multilingual communities, messages should
be broadcast in multiple languages. Not only homes but also businesses must be
informed. Information that should be communicated includes the nature of the
disaster; the exact geographic region affected, including street names if
appropriate, and the actions citizens should take to protect themselves and
their property.
An evacuation plan is an essential component of the total
disaster plan. The plan should cover notification of the police, local military
personnel, or voluntary citizens’ groups of the need to evacuate people, as
well as methods of notifying and transporting the evacuees. A plan should also
be made for responding to citizens who refuse to evacuate. For example, will
police authorities forcibly remove an elderly citizen from his home to a
shelter? Will evacuation plans include household pets? If farms or ranches are
in the path of fires or floods, will animals be evacuated?
Responding to
Disasters
At the disaster site, police, firefighters, nurses, and
other relief workers develop a coordinated response to rescue, triage, and
treat disaster victims.
Rescue. One
of the first obligations of relief workers is to remove victims from danger.
This job typically falls to firefighters and personnel with special training in
search and rescue. Depending on the disaster agent, protective gear, heavy
equipment, and special vehicles may be needed, and dogs trained to locate dead
bodies may be brought in. Usually, the immediate disaster site is not the best place
for the disaster nurse, who can be far more effective in triage and treatment
of victims. One of the lessons of the
Rescue workers face the logistically and psychologically difficult
task of determining when to cease rescue efforts. Some factors to consider
include increasing danger to rescue workers, diminishing numbers of survivors,
and diminishing possibilities for survival. For example, after a plane crash on
a snowy mountain, rescue efforts may cease if it is deemed that anyone who
might have survived the crash would subsequently have died from exposure.
Triage. Whereas
emergency nurses daily determine which clients require priority care, the
community health nurse may be at a loss as to where to start when faced with multiple
victims of a disaster. Knowing the principles and practice of triage allows the
nurse to offer her or his nursing skills most effectively.
Triage is the process of sorting
multiple casualties in the event of a war or major disaster. It is required
when the number of casualties exceeds immediate treatment resources. The goal of
triage is to effect the greatest amount of good for
the greatest number of people. Figure 20–2 shows the four basic categories of
the international triage system, as well as a triage tag.
Prioritization of treatment may be very different in a mass-casualty
event as opposed to an average day in a hospital emergency department. Under
normal circumstances, a person presenting to a hospital emergency department
with a myocardial infarction and showing no pulse or respirations would receive
immediate treatment and have a chance of recovery. At a disaster site, a victim
without a pulse or respi rations would most likely be placed in
the nonsalvageable category.
Victim triage tag. There are four basic
categories that are all applied when a medical system is overwhelmed with
victims.
1. Red: Urgent/Critical
Victims in this category have
injuries or medical problems that will likely lead to death if not treated
immediately (e.g., an unconscious
victim with
signs of internal bleeding).
2. Yellow: Delayed
Victims in this category have
injuries that will require medical attention; however, time to medical
treatment is not yet critical
(e.g.,
a conscious victim with a fractured femur).
3. Green: Minor/Walking
Wounded
Victims in this category have
sustained minor injury or are presenting with minimal signs of illness.
Prolonged delay in care
most
likely will not adversely effect their long-term outcome (e.g., a conscious
victim with superficial cuts, scrapes, and
bruises).
4. Black: Dead/Non-salvageable
Victims in this category are
obviously dead or have suffered mortal wounds because of which death is
imminent (e.g., an
unconscious
victim with an open skull fracture with brain matter showing). Life-saving
heroics on this group of victims will
only
delay medical care on more viable victims.
Mass casualties refers to a
number of victims that is greater than that which can be managed safely with
the resources the community has to offer, such as rescue vehicles and emergency
facilities available to serve disaster victims while also meeting the needs of
the rest of the community. Frequently in mass casualty occurrences, the broader
community needs to become involved, which necessitates calling in rescue
vehicles, firefighters, and police officers from neighboring towns, or the use
of neighboring hospitals. This adds another layer of disaster management
coordination that must be considered.
Immediate Treatment and Support. Disaster
nurses provide treatment on-site at emergency treatment stations, in shelters,
or at local hospitals and clinics. In addition to direct nursing care, on-site
interventions might include arranging for transport once victims are stabilized
and managing the procurement, distribution, and replenishment of all supplies.
Disposable items might be in short supply, requiring resterilization procedures that may be unfamiliar to a
nurse not accustomed to field work. These procedures may pose a challenge even
to an experienced nurse because of the field environment. The nurse may also
manage provision or distribution of food and beverages, including infant
formulas and rehydration fluids, and arrange for adequate, accessible, and safe
sanitation facilities, either on-site or in a shelter. Finally, the nurse often
must also arrange for psychological and spiritual care of victims of disasters.
Some victims who seem physically uninjured may, in fact,
be suffering from major injuries but be unable to relate their symptoms to a
relief worker because of shock or anxiety about injured, dead, or missing loved
ones. For instance, a father pulling debris away from his collapsed house after
a tornado may be so worried about a missing child that he does not realize that
he has a broken arm.
Other victims may be so emotionally traumatized by a disaster
that they act out, disrupting efforts to assist them and other victims and even
engaging in dangerous activities. This may cause relief workers to focus on
emotional care; however, such victims must be assessed for head trauma and
internal injuries, because their behavior may have a physical cause. If they
are physically able, such victims may be given a simple, repetitive task to
perform, which serves as both a distraction and a means to restore, to a small
extent, their sense of control over their environment.
Care of Bodies and Notification
of Families. Identification and
transport of the dead to a morgue or holding facility are crucial, especially
if contagion is feared. Toe tags make documentation visible and accessible.
Records of deaths must be made and maintained, and family members should be
notified of their loved ones’ deaths as quickly and compassionately as
possible. If feasible, a representative from each of the area’s faith
communities should be available to assist families awaiting news of missing
loved ones. As stated earlier, a family’s recovery from their loss is often delayed
when notification of relatives (indirect victims) is not possible because the
victims’ bodies are badly damaged or not found. This was a major problem of the
GROUP VIOLENCE
The rates of group violence and violent crime decreased
in many
Types of Group Violence
The problem of family violence is discussed in more
detail in Chapter 25, school and adolescent violence in Chapter 28, and workplace
violence in Chapter 29. This chapter presents an overview of group violence and
how it affects communities.
Gang Violence
The California Attorney General defines a gang as
a looseknit organization of individuals between the
ages of 14 and 24 years that has a name, is usually territorial or claims a
certain territory as being under its exclusive influence, and is involved in
criminal acts. Its members associate together and commit crimes against other
gangs or against the general population. Gangs are most commonly involved in
drug distribution, aggravated assault, robbery, burglary, and motor vehicle
theft (Huff, 2002). Some gangs focus on stealing, whereas others focus on
fighting. Large cities are the most likely to have gang problems, and rural
counties are the least likely.
There
are theories on how gangs form. Hirschi’s (2004) social
bond theory proposed that criminal behavior results from the weakening (in
youth) of the ties that bind the individual to society. He believed that the
strong subcultural bonds insulate the individual from
conventional behavior. Gangs often require members to display symbols of their allegiance
to one another. These symbols also serve to identify them to other gangs. They
may include certain colors, special caps or coats, tattoos, handshakes or other
signs, and terminology unique to the gang. Gangs may also require members to
participate in rites of passage or “hazing” to test their loyalty, events that
often involve committing a crime. Gang members usually share the same ethnicity
or at least the same belief system. Many gangs today have sophisticated Web
sites and are capable of equally sophisticated crimes (Huff, 2002; Miller, Maxson, & Klein, 2001).
Gang
members consider themselves family and turn to each other for support. Often,
members are searching for emotional intimacy in the gang as a substitute for a
dysfunctional family that is unwilling or unable to provide that intimacy. Gangs
also provide discipline and a structured environment to young people who,
because of absent or unresponsive parents, may have a
strong desire for an external locus of authority and a set of predictable rules
and regulations.
Riots
A riot is a violent disturbance created by a large
number of people assembled for a common purpose. It may or may not involve
criminal activities, such as willful destruction of cars, stores, and other
property; looting (stealing goods); arson (the deliberate burning
of buildings); lynching (execution by hanging without due process of
law); or physical attacks on a perceived enemy or on law enforcement officers. Riots
often erupt during times of war, political instability, racial inequity, and
economic injustice.
For
example, in the
Violent Crimes by Specific Groups of Perpetrators
Violent crimes are those
involving physical or psychological injury or death, or the threat of injury or
death. These crimes are often accompanied by destruction to or loss of
property. For example, armed robbery is
considered a violent crime, regardless of whether anyone is injured during the
crime.
Assault and Battery. Legally,
assault and battery refers to the threat to use force against another
person, and the accomplishment of that threat. More loosely, assault can
be used to refer to any violent attack such as assault with a deadly weapon or
sexual assault. Domestic assault is discussed in Chapter 25.
One type of group assault that is becoming more prevalent
is assault on the homeless. These assaults are usually perpetrated on
individual homeless men, often by groups of three or more young men who beat
the victim severely and sometimes fatally, sometimes for no other reason than
that he asked them for money. Alcohol and drugs are often factors. In addition,
abuse of the homeless is considered to be a new and underestimated hate crime (Bacque, 2000).
Rape. Legal
definitions of rape vary, but the key elements include some form of
sexual contact and a lack of consent. Consent is considered lacking under
conditions of force, deception, or coercion, or when the victim is a minor or
is drugged, unconscious, mentally retarded, or physically restrained.
Different categories of rape are commonly described. One
of the most common is date rape, in which the assailant and victim meet
by mutual consent but the assailant forces the victim to engage in a sexual act
against the victim’s will. Stranger rape is sudden and usually violent,
involving the use of a knife, gun, or violent physical force. Statutory rape
refers to sexual intercourse with a female who has not reached the
statutory age of consent; in many states, this age is 14 years. Rape may also
be perpetrated by a group, as when a group of college men drug and then rape a
female student or when a youth gang assaults and rapes a woman jogging on its
“turf” after dark. Both agent and environmental factors can contribute to rape.
Some of the more common factors are an increased history of childhood sexual
abuse among rapists, a patriarchal value system in which men are expected to
prove their masculinity by dominating or “conquering” women, and an environment
in which violence is explicitly or implicitly accepted or encouraged.
Homicide. Homicide
is the killing of one person by another. Like the rates for group violence
overall, the homicide rate is declining. In 1980, there were 10.2 homicides for
every 100,000 people in the
the rate among
males aged 15 to 24 years in the
In addition, the 21st century has already been marred by numerous
instances of multiple homicides in schools, universities, restaurants, and
workplaces. For example, on March 1,
In
the summer of
Genocide. The most
notorious historical example of genocide, the killing of a group of
people because of their racial, political, or cultural differences, was the
murder of millions of Jews, Catholics, gypsies, homosexuals, intellectuals, and
other “undesirables” by the Nazis before and during World War II. Tragically,
genocide continues today. Recent examples include the mass “ethnic cleansings”
in
Factors Contributing to Group Violence
Violence among specific groups of perpetrators and
violence directed toward selected groups of people often has its roots in the
childhood or youth of the perpetrators. These forms of violence can be traced
to many causes. The
• Parental conflict, lack of supervision, child abuse, or
inconsistent parenting
• Negative school experiences, including early academic failure
and lack of commitment to school
• Negative peer influence, including peers who engage in criminal
activity
• Socioeconomic factors, such as high rates of substance abuse
in the community, living in a high-crime neighborhood, and economic deprivation
The roots of youth gang problems are multifactorial.
They may be related to lack of social opportunities, social disorganization,
institutional racism, cultural maladaptation, deficiencies
in social policy, and availability of criminal opportunities.
Additionally,
frequent exposure to violence in the news, at sporting events, on television
programs, in movies, on the Internet, in video games, and in violent
pornography has been linked to an increase in aggression. Children seem to be
especially vulnerable, and the link seems to be particularly strong if the
subject matter glorifies violence as the ideal and appropriate solution to
personal problems (Goode, 2000). For example, Dr. James Garbarino,
author of Lost Boys: Why Our Sons Turn Violent and How We Can Save Them (1999),
observes that children “have ample opportunities to see on television and in
the movies how you threaten people, what it means to shoot someone, and ample
opportunities to learn about revenge and how desirable it is in this society.
For the nation to be shocked and appalled . . . is either a kind of denial or
hypocrisy.” Simple access to weapons cannot be discounted as a factor in
criminal activity. The
Role of the Community Health Nurse
Community health nurses can play a key role in reducing group
violence by interacting with students, parents, churches, law enforcement
officials, local politicians, and community organizers.
Preventing Group Violence
The typical model for preventing or reducing group
violence includes activities such as assessing the problem, developing policy
based on established objectives, conducting research, procuring funding, and
promoting offender accountability. For example, an increase in rapes on one
university campus might prompt the nursing department to facilitate a
university-wide open forum to discuss the issue, identify possible factors,
initiate research, and develop solutions. Programs might include outreach to
all students currently enrolled at the university through dormitory teaching
sessions, church-group activities, involvement of team coaches for university
sports, and even participation by teachers and student advisors. Violence can
be reduced in elementary and secondary schools by increasing supervision and
surveillance.
Community health nurses can influence the reduction of school
violence by establishing strong cooperative relationships between adults and
students, recognizing (and helping others, such as parents and teachers, to
recognize) behaviors that could signal a problem, and identifying situations
that may predispose teens to violence. The “Six Vs” can be used to help
identify teens who may need evaluation, especially if the
frequency or intensity of these behaviors increases (Steger, 2000):
• Venting—angry outbursts inappropriate for the child’s age,
frequent mood swings, and other behaviors indicating poor control of emotions
• Vocalizing—threats by a teen to harm self or others, or
use of inappropriate language or profanity
• Vandalizing—intentional damage of property or a history
of vandalism, even targeting his or her own property
• Victimizing—teens who see
themselves as victims, whether true or not, become just as prone to violence as
those who have actually been abused; they blame others for their problems and
do not take responsibility for their actions
• Vying (for attention)—being involved in gangs or fringe
groups, acting out in class, bringing weapons or other contraband to school to
show others, wearing outlandish or banned clothing, or purposefully getting
suspended or expelled.
• Viewing—like actual victims of abuse, young people who witness
the abuse of others are likely to display violent tendencies themselves.
TERRORISM
At the start of the 21st century, the world is a global
community. This is particularly evident in the increased incidence and
sophistication of terrorist threats and acts around the world. Incidents
occurring on
The U. S. Federal Bureau of Investigation defines terrorism
as “the unlawful use of force and violence against persons or property to
intimidate or coerce a government, the civilian population, or any segment
thereof, in furtherance of political or social objectives” (Evans et al, 2002).
A terrorist is overzealous and obsessed with an idea.
Terrorism and terrorist acts are not new; although the term terrorism can
be traced back to 1798, the use of terrorist tactics precedes this date. A
highly organized religious sect called the sicarii
attacked crowds of people with knives during holiday celebrations in
Three major countries operated offensive bioweapons programs in recent years: the
Nuclear warfare involves the use
of nuclear devices as weapons and can take several forms. Terrorists who gain
access to nuclear power plants could cause a chain of events that lead to a
meltdown of the nuclear core, thereby releasing radioactive particles for
hundreds of miles around the site. Nuclear accidents have occurred, but no
known terrorist attacks have yet involved the use of nuclear power plants as weapons.
A terrorist attack using nuclear weapons or destruction of a nuclear plant
would cause multiple and prolonged deaths with extensive damage and negative
effects for decades.
Chemical warfare involves the use
of chemicals such as explosives, nerve agents, blister agents, choking agents, and
incapacitating or riot-control agents to cause confusion, debilitation, death,
and destruction (Yergler, 2002). Terrorists in the
The aircraft used on September 11, 2001, were huge chemical
weapons because they were carrying thousands of tons of jet fuel. The success
of the mission depended on the surprise of the attack, severe damage to
recognizable buildings, and the deaths of many people. The collapse of the buildings
was unplanned. If the planes had been low on fuel, the damage would not have
been as severe. The liquid fuel burned at such a high temperature that the
internal structure of the buildings was weakened.
Biologic warfare involves using
biologic agents to cause multiple illnesses and deaths. Typical biologic agents
are anthrax, botulinum, bubonic plague, Ebola, and
smallpox. These agents could be used to contaminate food, water, or air. Deliberate
food and water contamination remains the easiest way to distribute biologic
agents for the purpose of terrorism (Khan, Swerdlow,
& Juranek, 2001). In addition, the U. S. Office of
Technology Assessment has speculated that the release of
The
anthrax infections and deaths that occurred after September 11, 2001, have
added to these concerns. However, it has not been confirmed that these
incidents were committed by an organized foreign or domestic terrorist group.
They could have been carried out by a single disturbed citizen, who would be a
terrorist nevertheless, because the outcomes would be the same: fear, death,
and destruction. Factors Contributing to Terrorism Political factors are the
most common contributors to terrorism. Anti-American sentiment runs high in
many foreign countries, especially those that perceive the
Within
the
Role of the Community Health Nurse
Community health nurses need to be prepared for the
possibility of terrorist activity. They have a role in primary, secondary, and
tertiary prevention.
SUMMARY
A disaster is any event that causes a level of
destruction that exceeds the abilities of the affected community to respond without
assistance. Disasters may be caused by natural or manmade/technologic events
and may be classified as multiple- casualty incidents or mass-casualty
incidents.
The scope of a disaster is its range of effect, and the
intensity is the level of destruction it causes. Victims of disasters include
direct victims, those injured or killed, and indirect victims, the loved ones
of direct victims. Displaced persons are those who are forced to flee their
homes because of the disaster, and refugees are those who are forced to leave
their homelands, usually in response to war or political persecution.
Host factors that contribute to the likelihood of
experiencing a disaster include age, general health, mobility, psychological factors,
and socioeconomic factors. The disaster agent is the fire, flood, bomb, or
other cause. Environmental factors are those that could potentially contribute
to or mitigate a disaster. In developing strategies to address the problem of
disasters, it is helpful for the community health nurse to consider each of the
four phases of disaster management: prevention, preparedness, response, and
recovery.
Primary prevention of disasters means keeping the
disaster from ever happening by taking actions to eliminate the possibility of
its occurrence. Secondary prevention focuses on earliest possible detection and
treatment. Tertiary prevention involves reducing the amount and degree of
disability or damage resulting from the disaster.
In addition to assessing for preparedness, an effective disaster
plan establishes a clear chain of authority, develops lines of communication,
and delineates routes and modes of transport. Plans for mobilizing, warning,
and evacuating people are also critical elements of the disaster plan. At the disaster
site, police, firefighters, nurses, and other relief workers develop a
coordinated response to rescue victims from further injury, triage victims by
seriousness of injury, and treat victims on-site and in local hospitals. Care
and transport of dead bodies must also be managed, as well as support for the
loved ones of the injured, dead, or missing.
Long-term support includes both financial assistance and physical
and emotional rehabilitation.
Self-care, including stress education for all relief
workers after a disaster, helps to lower anxiety and put the situation into
proper perspective. CISD provides victims with a mechanism for emotional
reconciliation and healing.
Problems of group violence include school violence, gangs,
riots, and violent crimes. A gang is an organization of youths that has a name,
is usually territorial or claims a certain territory as being under its
exclusive influence, and is involved in criminal acts.
The roots of group violence are multifactorial
and include inadequate parenting; socioeconomic and racial injustices; exposure
to violence in media, cartoons, and pornography; and easy access to weapons.
The goals of Healthy People 2010 for reducing
violence include reductions in physical assaults and weapon carrying by
schoolchildren and reduction of work-related assaults and homicides.
The role of the community health nurse in preventing and
reducing group violence includes effective community organization and program
development, as well as policy making to address the family and environmental
factors that contribute to increased risk of group violence.
Terrorism is the unlawful use of force or violence against
persons or property to intimidate or coerce a government or civilian population
in the furtherance of political or social objectives. Terrorism may be nuclear,
biologic, or chemical, including nerve agents and explosive devices. The community
health nurse should be alert to signs of possible terrorist activity and
prepared to address the secondary or tertiary effects of such attacks.
Preparation includes knowledge of the effects of specific biologic or chemical
agents and how to help people cope with the terror they personally feel.
Internet
Resources
Action
Committee Against Violence: http://www.acav.org
Almanac
of Disasters: http://www.disasterium.com
Bioterrorism:
http://bioterrorism.straws.com
Bioterrorism
Resources: www.acponlone.org/bioterro/index.html
Center
for the Study and Prevention of Violence: http://www.colorado.edu/cspv/
Citizen
Corps: www.citizencorps.gov
Men Against Domestic Violence (MADV)—Domestic Violence Resources:
http://www.silicom.com/~paladin/madv/
National
Coalition Against Domestic Violence (NCADVE): http://www.healthtouch.com