NCM 121 DISASTER AND EMERGENCY NURSING

1. The Philippine Disaster Risk Profile

✓ Due to the geographical context of the Philippines, the country is vulnerable to numerous natural
disasters ranging from earthquakes, tropical cyclones, and flooding.

Disaster hazards
Besides earthquakes, volcanic eruptions within the “Ring of Fire” coupled with coastal hazards such as typhoons,
flooding, and rising sea levels pose a constant threat to the population with over 100 million inhabitants.

Fatalities
The fatalities caused by natural disasters in the Philippines, however, has been on the decline since having
peaked in 2013 due to typhoon Haiyan.

✓ Definition of Common Terms

Disaster
A disaster is an occurrence disrupting the normal conditions of existence and causing a level of suffering
that exceeds the capacity of adjustment of the affected community. (WHO, 2018)
Hazard
A natural or human-made event that threatens to adversely affects human life, property or activity to
the extent of causing a disaster. (WHO, 2018)
Disaster
A disaster is defined as: “a serious disruption of the functioning of a community or a society at any scale
due to hazardous events interacting with conditions of exposure, vulnerability and capacity, leading to
one or more of the following: human, material, economic and environmental losses and impacts”
(United Nations International Strategy for Disaster Reduction [UNISDR], 2017).
A “health disaster” is a catastrophic event that results in casualties that overwhelm the healthcare
resources in that community (Al-Madhari & Keller, 1997)

✓ Concept and Types of Disaster

1) Natural VS Technological Disaster
Natural disasters are catastrophic events with atmospheric, geological, and hydrological origins.
(e.g. hurricanes, earthquakes, tornadoes, wildfires, tsunamis, and floods, as well as extreme weather
events such as blizzards, droughts, extreme heat, and wind storms).

Technological disasters are a catastrophic event that is caused by either human error in controlling
technology or a malfunction of a technology system. Technology-based disasters are as serious as
natural disasters. Sometimes, the disaster symptoms may gradually appear over a few years, but
other impacts may immediately disrupt society and business. (e.g. oil spills, industrial fires, nuclear
and hazardous materials accidents).

2) Internal VS External Disaster

An internal disaster is an event that happens within the facility that poses a threat to interrupt the
environment of care. (e.g. Bomb threats, Utility failures, Workplace violence, Emergency
evacuations).
An external disaster is an event that impacts a facility when demand for services goes beyond
available resources. (e.g. Mass casualty events, Tornado warning, Biohazard events, Pandemic
events).
 ✓ Classifications and Characteristics of Disasters
Classification by Cause:
-Natural Disasters
Geophysical, Meteorological, Hydrological, Climatological, Biological
-Man-Made Disasters
Terrorism, Technological, Transitional human shelters

Classification by Scale:

GEOGRAPHY
• Urban/Local
• Wide area/Localized type

LENGTH
• Short/Long

✓ Trends and Patterns of Disasters

Phases of a Disasters
-preparation
-warning
-impact
-emergency response
-recovery
-rehabilitation

2. ICN Framework of Disaster Nursing Competencies

A. Prevention / Mitigation Competencies

1. Risk reduction, Disease Prevention and Health Promotion

Disaster risk reduction is the concept and practice of reducing disaster risks through systematic efforts
to analyze and reduce the causal factors of disasters

Disease prevention is a procedure through which individuals, particularly those with risk factors for a
disease, are treated in order to prevent a disease from occurring

Health promotion is the process of enabling people to increase control over, and to improve, their
health.

2. Policy development and planning

To increase opportunities and better elucidate nursing perspectives about health care and health care
professionals, we need to recognize the importance of perusing the possible policy issues including
recommended solutions.

Guide to Policy Making

Step 1: Define the issues or problems
Step 2: Make a research
Step 3: Discuss and Debate among Board Level
Step 4: Draft the Policy
Step 5: Read and Revise
Step 6: Adopt the Policy
Step 7: Implementation
 B. Preparedness competencies
1. Ethical Practice, Legal Practice, and Accountability
2. Communication and Information Sharing
3. Education and Preparedness

C. Response Competencies
1. Care of the community
2. Care of Individuals and Families
3. Psychological Care
4. Care of vulnerable Populations

D. Recovery and rehabilitation competencies

1. Long-Term Individual, Family, and Community Recovery

3. Disaster Management Continuum

The life cycle of a disaster is generally referred to as the “disaster continuum,” or “emergency management
cycle.” This life cycle is characterized by three major phases—preimpact (before), impact (during), and
postimpact (after)—and provides the foundation for the disaster time line.
Preparedness refers to the proactive planning efforts designed to structure the disaster response prior to its
occurrence.

“Warning” (also known as “forecasting”) refers to monitoring events to look for indicators that predict the
location, timing, and magnitude of future disasters.

Mitigation includes measures taken to reduce the harmful effects of a disaster by attempting to limit its impact
on human health, community function, and economic infrastructure.

Prevention refers to a broad range of activities, such as attempts to prevent a disaster from occurring, and any
actions taken to prevent further disease, disability, or loss of life.

Mitigation usually requires a significant amount of forethought, planning, and implementation of measures
before the incident occurs.

Response phase is the actual implementation of the disaster plan. It focuses primarily on emergency relief.

Recovery actions focus on stabilizing and returning the community (or an organization) to normal (its preimpact
or improved status).

Evaluation is the phase of disaster planning and response that often receives the least attention. FEMA
recognizes the previously mentioned phases of the disaster life cycle; however, the importance of response and
recovery evaluation cannot be underestimated.

DISASTER MANAGEMENT CONTINUUM

A. Pre-Impact
1. Prevention / Mitigation
The UN system provides operational inputs and services and tools to support Governments and the
humanitarian community to respond effectively and in a coordinated manner to disasters in order to minimize
the impact of such events on the most vulnerable.

The International Strategy for Disaster Reduction (ISDR) aims at increasing public awareness to understand risk,
vulnerability and disaster reduction globally.

The Hyogo Framework for Action (HFA) offers guiding principles, priorities for action, and practical means for
achieving disaster resilience for vulnerable communities.

HYOGO FRAMEWORK FOR ACTION PRIORITIES FOR ACTION

1. Make disaster risk reduction a priority
2. Know the risks and take action
3. Build understanding and awareness
4. Reduce risk
5. Be prepared and ready to act

A Hazard, Risk and Vulnerability Analysis (HRVA) is an assessment of:

Hazards: These are sources of potential harm, or situations with a potential for causing harm, in terms of human
injury; damage to health, property, the environment, and other things of value; or some combination of these.
Risk: This refers to the likelihood that a hazard will occur, as well as the severity of possible impacts to health,
property, the environment, or other things of value.
Vulnerability: This refers to the people, property, infrastructure, industry, resources, or environments that are
particularly exposed to adverse impact from a hazardous event.
 2. Preparedness

General Preparedness

✓ Fire
Key elements for fire preparedness are:
• regular assessments & records
• early warning, i.e. fire warning or voice communication systems such as megaphones
• adequate means of escape, i.e. minimum 2 clearly signposted safe escape routes, evacuation kits
• familiarity with the emergency plan through knowledge and practice

✓ Earthquake
Step 1:
Secure your space by identifying hazards and securing moveable items.
Step 2:
Plan to be safe by creating a disaster plan and deciding how you will communicate in an emergency.
Step 3:
Organize disaster supplies in convenient locations.
Step 4:
Minimize financial hardship by organizing important documents, strengthening your property, and considering insurance.
-SAFETY PRINCIPLE: DROP/DUCK, COVER AND HOLD ON

✓ Volcanic eruptions
Develop an evacuation plan and a sheltering plan for yourself, your family, and others in your household. Supplies should
include the following:
• Photo of emergency supplies.
• Flashlight and extra batteries
• First aid kit and manual
• Emergency food and water
• Manual (nonelectric) can opener
• Essential medicines
• Sturdy shoes
• Respiratory (breathing) protection
• Eye protection (goggles)
• Battery-powered radio

✓ Floods, Tornadoes, Typhoons, Cyclones, and Tsunami

Floods:
Excessive rain, damage to nearby dams, and tsunamis are some of its causes. When faced with flooding,
these tips are to be followed:
• Do not attempt to walk, swim, or drive through the floods. Floodwater contains debris and
contamination and can also be deadly due to fallen electrical lines in the water.
• Stay clear of bridges over fast-moving water.
• Keep an eye out for evacuation alerts.
• Move to higher ground.
• If your vehicle is trapped in flood and water starts filling inside the car, seek refuge on the roof.

Tornadoes
Tornadoes continue to impact locations across the country every year, bringing massive winds and
destruction in their paths.
 To stay safe during a tornado, prepare a plan and an emergency kit, stay aware of weather conditions
during thunderstorms, know the best places to shelter both indoors and outdoors, and always protect
your head.

Typhoons
To prepare for a Typhoon, you should take the following measures:
• To begin preparing, you should build an emergency kit and make a family communications plan.
• Know your surroundings.
• Learn the elevation level of your property and whether the land is flood-prone. This will help you know
how your property will be affected when storm surge or tidal flooding are forecast.
• Identify levees and dams in your area and determine whether they pose a hazard to you.
• Learn community Typhoon evacuation routes and how to find higher ground. Determine where you
would go and how you would get there if you needed to evacuate.
• Make plans to secure your property

Cyclones
Cyclones are tropical storms, caused by atmospheric disturbances around a low-pressure area. Cyclones
are accompanied by strong winds, moving at a speed of sixty-two kmph or more. When faced with a
hurricane, keep these tips in mind:
• Be alert to changing weather conditions.
• Listen to radio/TV for the latest information.
• Look for approaching storms.
• Look for the following warning signs: – Dark, often greenish sky – Large hailstones, a large, dark, low-
lying cloud (particularly if rotating), roars, similar to a freight train.
• If you see approaching storms or any of the danger signs, be prepared to take shelter immediately.
• If you are under a tornado warning, seek shelter immediately. NOTE: In places where you have
designated cyclone shelters, take refuge there.

Tsunami
Tsunamis are a series of enormous ocean waves caused by earthquakes, underwater landslides, or
volcanic eruptions. Tsunami waves range from tens to hundreds of feet tall and can travel twenty to
thirty miles per hour. When faced with this phenomenon, these tips are to be followed:
• Turn on your radio/TV to learn and follow the precautionary instructions during a tsunami warning,
primarily when you reside near a coastal area.
• Move inland to higher ground immediately and stay there.
• Check for a noticeable recession in water away from the shoreline as this is nature’s tsunami warning
and should be heeded. It would help if you moved away immediately.
• Please stay away from flooded and damaged areas until officials say it is safe to return.
• Please keep yourself away from debris in the water; it may pose a safety hazard to boats and people.

✓ Communication plan
Universal Emergency Code System
EMERGENCY CODES ARE COLOR-CODED INDICATORS used in health care facilities to alert all staff
members of potential issues arising in a facility.
CODE BLUE: MEDICAL EMERGENCY
CODE RED: FIRE
CODE PINK: CHILD ABDUCTION (PATIENT)
CODE AMBER: CHILD ABDUCTION (VISITOR)
CODE WHITE: URGENT SECURITY REQUEST/HOSPITAL EVACUATION
CODE ORANGE: HAZARDOUS MATERIALS
CODE GREEN: EMERGENCY OPERATION PLAN ACTIVATION
CODE SILVER: ACTIVE SHOOTER
 CODE BROWN: SEVERE WEATHER
CODE BLACK: BOMB THREAT
ALL CLEAR: CANCELLATION NOTICE
OVERHEAD: SECURITY ALERT
OVERHEAD: WEATHER EMERGENCY

✓ Preparing Family Communication Plan

According to FEMA, your Family Emergency Communication Plan starts with one simple question:
“What if?”
“What if something happens and I’m not with my family?”
“Will I be able to reach them?”
“How will I know they are safe?”
“How can I let them know I’m OK?”
Simply put, a Family Emergency Communication Plan tells your family what to do, how to find each
other, and how to communicate in case of an emergency. Your plan should include strategy for both
communication and meeting up.
✓ Preparedness planning: Personal and Home Disaster Survival
a. Assembling Emergency Kit
b. Learning Preparedness Skills
Six components of knowledge and skills for emergency care in natural disaster for CHVs are required
including
1) early warning,
2) disaster triage,
3) first aid,
4) search and rescue,
5) logistic and communication, and
6) team organizations.

✓ Patterns of Survival (Staying Alive)

a.Finding Fast Solutions Naturally
b.Food and Water Procurement
c.Signals
d.Navigation
e.Special Needs

✓ Health Needs arising at Natural Disasters

1. Immediately after the disaster, health needs emerge with medical needs.
2. Health needs are diverse
3. Health needs may persist for a mid to long period of time, depending on the prolonged evacuation
and the time required until the reconstruction of livelihood.

✓ Communication planning: PACE Planning

Primary-Alternate-Contingency-Emergency

• Primary: The main form of communication. For most business travelers, this in the form of digital cellular
communications. Depending on Wi-Fi is not advised.
• Alternate: If the primary fails, this is your secondary form of communication. Most common is voice calls
when the data network is down.
• Contingency: Tertiary method of communication. A satellite phone is a great example as it is not reliant
on any cellular network.
• Emergency: If all else fails, this is the worst-case option. It is usually ugly but will get a message across.
Examples go from sending shortcodes or texts from GPS tracking devices to using landlines if available.
High Frequency (HF) radios have also been used but extremely rarely.

Shelter in Place or Bugging Out

Bug In – Shelter-in-Place – Hunker Down – Stay Home
Bugging in is a term commonly used by preppers to refer to a time when you choose to face impending
dangers from your well-stocked, secured home. The benefits of facing danger from your prepper home far
outweigh the benefits of bugging out unless the situation demands it.
Bug Out – Evacuate – Escape – Vacate – Leave Home
Bug out is a military term that is commonly used by preppers to refer to a time when you may need to leave
your home quickly due to a dangerous situation.
 B. Impact Response

✓ Disaster Triage Categories

o Simple Triage and Rapid Treatment (START)
o Immediate/Emergent (Class I) Tagged as RED
o Delayed/Urgent (Class II) Tagged as YELLOW
o Minimal/Non-Urgent (Class III) Tagged as GREEN
o Expectant (Class IV) Tagged as BLACK
o JumpSTART (Children)

✓ Simple Triage and Rapid Treatment (START)

The START triage tool is a commonly used adult MCI primary triage tool developed by the Newport
Beach Fire and Marine Department and Hoag Hospital in California, first published in 1983 and revised in
1994
The five basic parameters assessed with START are:
(a) the ability to walk,
(b) the presence or absence of spontaneous respirations,
(c) the respiratory rate,
(d) an assessment of perfusion, and
(e) the ability to obey commands. These parameters are often referred to as respirations, perfusion, and
mental status (RPM).
Triage Category : RED
• Places to be given the highest priority in all responses
• Prevent "preventable death" through appropriate initial response in order to improve the quantity and
quality of responses in the Red Zone.
✓ Emergency medical care for traumatized patients
Ÿ Multiple trauma
Ÿ Head trauma
Ÿ Chest/abdominal trauma
Ÿ Pelvic fracture/Open fracture
Ÿ Crash syndrome
Ÿ Extensive burn

✓ Nursing intervention in Red Area

ŸAssist medical consultation: Stabilization of ABC
ŸMental Care
ŸSupport for families
ŸSharing of information
ŸConsideration of safety
ŸPrivacy protection
ŸConsideration to hygiene
ŸSecuring of manpower
ŸPreparation for wide-area transportation
ŸResponses for crash syndrome

Triage Category : YELLOW

• Continue to perform re-triage till treatment starts
• Assumed patients: those with injuries such as spinal cord damage and fracture

Ÿ Stable respiration/circulation dynamics

Ÿ Clear consciousness
First-aid & Follow-up
Ÿ Physical assessment
- see, listen & touch
Ÿ Keeping of a peripheral intravenous access
Ÿ Arrest of bleeding/fixation (stabilization)
Ÿ Oxygen administration (priority to red area)
Ÿ Monitoring by ME device (minimum)

✓ Nursing intervention in Yellow Area

ŸIncreased number of patients: To secure the area and manpower

ŸSharing of information
ŸResponses to the complaints by patients and their families
ŸRe-triage: To secure ABC and find crash and spinal cord damage
ŸSelection and distribution of equipment & material: Monitoring
ŸConsideration of privacy protection
ŸManagement of infusion, confirmation of treatment
ŸHeating
ŸGiving of words; response to anxiety
ŸSecuring of means of transport to the Red Area and of communication
ŸDivision of the area into sub-areas
Triage Category : GREEN
• Therapy-waiting group
• Re-triage should not be missed

ŸRe-triage
ŸTo perform medical examination, treatment and care after completing all and majority of responses to the emergency
treatment group
ŸCases without indication for hospitalization
ŸChecking of the conditions of their house
ŸTaking to an evacuation shelter
✓ Nursing intervention in Green Area
ŸTo control a crowd of people. Posting of instructions on a whiteboard
ŸTo develop a collaborative network with a local community
ŸRe-triage
ŸFirst-aid treatment
ŸTo let patients go home if they can do
ŸResponses to complaints: Patients & their families
ŸPreparation and distribution of the area according to season and weather
ŸSelection of equipment & material
ŸTo understand medical records and injured persons
ŸGuiding to and introduction of an evacuation shelter
ŸLifestyle guidance at home, requiring medical examination if any change is felt or seen.

Triage Category : BLACK

• Response to patient's families by regarding the patients as "Treatment-waiting group" until death is
confirmed.
• ŸInstruction on basic life support
• ŸRisk intervention
• ŸPreparation of the place for the patient families to stay at the patient's deathbed
• ŸDeath certification, examination and morgue procedures after the completion of all and majority of responses
to emergency treatment group

JumpSTART (Children)
• The JumpSTART Pediatric MCI Triage Tool was the first objective tool developed specifically for the
primary triage of children in the multi-casualty/disaster setting.
• JumpSTART was developed in 1995 and modified in 2001 by Dr. Lou Romig, a pediatric emergency
medicine physician with a background in both EMS and pediatric disaster preparedness and response.
2.Mass Casualty Incident (MCI)
A mass casualty incident (MCI) is defined as “an event that overwhelms the local healthcare system, where the number
of casualties vastly exceeds the local resources and capabilities in a short period of time.”
ŸPatient Assessment and Identification
ŸScene Size-up
ŸObtaining Patient History
ŸPhysical Examination
ŸMedical History
ŸRapid Trauma Assessment
ŸOn-going Assessment
3.Patient Handling / Rapid Extrication Technique
Ÿ Rescuer staging
Ÿ Body Substance Isolation (BSI) Universal Precaution including Personal Protective Equipment (PPE)
Ÿ Safe patient Lifting and Moving
Ÿ Extrication
Ÿ Use of Kendric Extrication Device (KED)
Ÿ Dressing and Bandaging
Ÿ Stabilization
Ÿ Restraints
Ÿ Rescuer staging
Ÿ Body Substance Isolation (BSI) Universal Precaution including Personal Protective Equipment (PPE)
C. Post-Impact Recovery, Reconstruction, Rehabilitation
1. Critical incident Stress Debriefing
• Supportive
• Communication Skills
• Assisted Coping Techniques
• Common Emergency Stress Reactions
2.Psychological First Aid (PFA)
• Role of Psychological First Aider in a Class Extracted from the lecture prepared by
• Fear Management Strategies
Asso. Prof. Paksah Manga
3.Public Health Intervention