LECTURE 8: ENVIRONMENTAL DISASTERS AND EMERGENCIES
MA. CONCEPCION B. SEKITO, MPH, RN
OUTLINE
A. Environmental Disasters and Emergencies
B. Community Assessment for
Public Health Emergency Response (CASPER)
Toolkit
C. Restoring Public Health under Disaster
Conditions: Basic Sanitation, Water and Food
Supply, and Shelter
D. Climate Change and Health: The Nurse’s Role in
Policy and Practice
ENVIRONMENTAL DISASTERS AND
EMERGENCIES
• Environmental challenges loom as the world
population surpasses 7 billion.
• Global climate change combined with a rapidly
growing world population have advanced the
probability of occurrence of environmental
disasters. Take note of the combination of the
climate change that takes place throughout the
world as well as the rapidly growing world
population. All of these are instrumental in terms
of the occurrence of environmental disasters.
• An environmental emergency is a sudden
threat to the public health or to the well-being of
the environment arising from the release or
potential release of oil, radioactive materials, or
hazardous chemicals into the air, land, or water.
• An environmental disaster is an environmental
emergency whose scope and duration exceeds the
local resources available to respond. Take note of
the occurrence of the situation, how long do the
emergency situation takes place, what is the scope
or the coverage, what regions or localities that are
affected, then if the resources sufficient to the
needs of those that are affected. If the need is
beyond what is available, it is covered here in the
concept of environmental disaster.
• Health impact of an environmental disaster on a
community may be:
➢ Immediate
➢ Ongoing
➢ Delayed
• Collaboration with many types of governmental
officials and community responders is critical to
mitigate the damage that may occur from an
environmental hazard.
• Examples of government agencies that can
provide assistance in terms of environmental
disasters:
➢ Department of Social Welfare and
Development (DSWD) - has streamlined the
process of providing relief assistance and basic
services to calamity-striken areas.
➢ Department of Health (DOH) - regularly
monitors the occurrence of health emergencies
and disasters, including events that may lead to
health emergencies.
➢ Department of Environmental and
Natural Resources (DENR) - tasked to
formulate and implement policies, guidelines,
rules, and regulations to environmental
management.
➢ Bureau of Fire Protection (BFP) - conduct
rigid fire safety inspection to structures,
buildings, and the like to reduce fire incidents/
occurrences.
➢ Philippine Institute of Volcanology and
Seismology (PHIVOLCS) - monitors volcano,
earthquake, and tsunami activity, and issue
warnings as necessary.
➢ Department of Interior and Local
Government (DILG) - equip LGUs with the
necessary skills needed to proactively establish
disaster preparedness and resiliency measures
in their localities.
➢ National Disaster Risk Reduction and
Management Council (NDRRMC) - plans and
leads the guiding activities in the field of
communication, warning signals, emergency,
transportation, evacuation, and rescue.
➢ Philippine Atmospheric, Geophysical, and
Astronomical Services Administration
(PAGASA) - provide flood and typhoon
warnings, public weather forecasts and
advisories, meteorological, astronomical,
climatological, and other specialized
information and services.
• Take note that different agencies and community
leaders assume responsibilities in terms of the
occurrence of environmental disasters and they
are important in terms of mitigating the damage
that can occur associated with environmental
hazards.
• Successful planning for potential environmental
disasters/ emergencies demands that nurses be
knowledgeable of the environmental hazards
endemic to the area including the movement of
hazardous substances through the area. For
example, in Legaspi City, what environmental
emergencies can take place in the area associated
with the presence of Mayon Volcano. Same
manner with that of Taal.
• Working in conjunction with their public health
colleagues and as members of an interdisciplinary
disaster response team, nurses must be able to
detect environmental changes that will create the
potential for both immediate and long-term
negative health outcomes. These nurses are not
only supposed to determine and identify the
hazards that are existing within a particular
locality, additional competency that are expected
from these nurses is for them to detect
environmental changes. With the detection of
these changes, these nurses are supposed to
determine also the immediate as well as the long-
term negative health outcomes.
ENVIRONMENTAL EMERGENCIES
• In 2017, the world population surpassed 7.4
billion people (U.S. Census Bureau, International
program, 2017), creating a taxing burden on our
global environment whose impact will undoubtedly
reveal itself in the decade ahead.
• Increases in world population translate into
increased consumption of natural resources,
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a growing demand for the production of
energy, the manufacture of large amounts
of waste, and an ongoing strain on the
sustainability of our environment.
• Coupled with an awareness of the ongoing and
anticipated future impact of global climate change,
it seems reasonable to state that our environment
is changing dramatically—and not for the better.
• The combination of these factors will result in
more frequent occurrences of disasters and
environmental emergencies that threaten human
health.
• An environmental emergency is a sudden
threat to the public health or to the well-being of
the environment arising from the release or
potential release of oil, radioactive materials, or
hazardous chemicals into the air, land, or water.
• These emergencies may occur from:
➢ Transportation accidents
➢ Events at chemical facilities
➢ Other facilities using or manufacturing
chemicals
➢ A result of natural or man-made disasters
(Environmental Protection Agency [EPA], 2017).
• Although there are multiple serious environmental
problems with which public health and
environmental safety officials are concerned,
environmental emergencies and the activities that
surround them are focused generally on sudden,
immediate threats.
ENVIRONMENTAL DISASTERS
• An environmental disaster is defined as an
environmental emergency or ecologic
disruption of a severity and magnitude resulting
in deaths, injuries, illness, and/or property damage
that cannot be effectively managed by the
application of routine procedures or resources and
results in a need for additional assistance. With the
occurrence of the environmental disaster, making
use of routine procedures or resources could not
really help in terms of the situation. There is a
need for additional assistance to what is available
within the locality. With the occurrence of ecologic
disruption, what results are death, injuries, illness,
and property damage. It is severe and there is
increased magnitude.
• In terms of magnitude, if we go back into the
factors affecting priority-setting for community
health problems, what is this magnitude of the
problem? At a community level, Maglaya utilized
five criteria for the determination of community
health problems:
➢ Nature of the Problem - the problems are
classified by the nurse as health status, health
resources, or health-related problems.
- Health status = 3
- Health resources = 2
- Health-related = 1
➢ Magnitude of the Problem - refers to the
severity of the problem which can be measured
in terms of the proportion of the population
affected by the problem.
- 75%-100% affected = 4
- 50%-74% affected = 3
- 25%-49% affected = 2
- <25% affected = 1
➢ Modifiability of the Problem - refers to the
probability of reducing, controlling, or
eradicating the problems.
- High = 3
- Moderate = 2
- Low = 1
- Not modifiable = 0
➢ Preventive Potential - refers to the
probability of controlling or reducing the effects
posed by the problem.
- High = 3
- Moderate = 2
- Low = 1
➢ Social Concern - refers to the perception of
the population or community as they are
affected by the problem and their readiness to
act on the problem.
- Urgent community concern, expressed
readiness = 2
- Recognized as a problem but not needing
urgent attention = 1
- Not a community concern = 0
• In terms of the occurrence of the environmental
emergency, if we make use of the concept of
priority-setting according to Maglaya, if more than
75% are affected, if there are deaths, illness,
injuries, as well as damage to properties, these
concepts are related to that of environmental
emergencies. Example: The Super Typhoon
Yolanda and the sinking of Doña Paz with its
collision with an oil tanker.
• The consequences of the damage to the
environment will vary based on the:
➢ Type of hazard,
➢ Mechanism of its release into the environment,
➢ Geographical location of the event,
➢ Determinants of human exposure (e.g., the
weather conditions at the time of the event),
and
➢ Length of time before the response.
• Whether the event is an acute one-time
occurrence or a chronic, ongoing mechanism of
disruption will also be a major determinant of the
health consequences for the affected population.
• As with natural disasters, health promotion and
disease prevention activities must focus on the
following:
➢ The immediate removal of the hazard from the
environment (or if this is not possible, the
movement of the population away from the
hazard)
➢ Decontamination of exposed individuals
➢ The restoration of services to meet the
immediate physiological needs of the affected
people
➢ The prevention of further illness or injury as a
result of exposure to the hazard
• Disasters of a chronic or long-term nature (e.g.,
industrial contamination of soil and water supply)
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are more insidious and may be more difficult to
address.
• The health outcomes of these types of
environmental disasters may take years to
manifest (e.g., certain cancers, endocrine
disruption), and the scientific evidence that they
will occur has been mounting for some time
(Colburn, Dumanoski, & Myers, 1997; Schug,
Janesick, Blumberg, & Heindel, 2011). If it took
place 1940s, years will take prior to the
manifestation of the health outcomes.
ENVIRONMENTAL PUBLIC HEALTH
TRACKING: PROTECTING COMMUNITIES
THROUGH INTEGRATED ENVIRONMENTAL
PUBLIC HEALTH SURVEILLANCE
• Environmental public health tracking is the
ongoing collection, integration, analysis, and
interpretation of data about the following factors:
➢ Environmental hazards
➢ Exposure to environmental hazards
➢ Health effects potentially related to exposure to
environmental hazards
• The goal of environmental public health tracking is
to protect communities by providing information to
federal, state, and local agencies.
• These agencies, in turn, will use this information
to plan, apply, and evaluate public health actions
to prevent and control environmentally related
diseases (Centers for Disease Control and
Prevention [CDC], 2017).
• Public health tracking monitors known
environmental hazards along with the mechanism
of action that may create the potential for disaster.
• Some environmental hazards create the potential
for a public health emergency because of regular
exposure—they are already present in the
environment in which the individual is living and
working (e.g., lead, radon, asbestos). Example,
the materials that is being utilized for the roof of
the buildings so as to prevent the occurrence of
fire, they use asbestos. Only to find out that after
several years, individuals who were working in that
particular area developed cancers. Another one is
lead, which is found in paint. If a paint that
contains lead is being utilized for painting the crib
of a baby, that baby is exposed to lead from hours,
to months, and years.
• Other environmental hazards create the potential
for a disaster or emergency by being transferred
from one location to another. For example, it is the
movement or transportation of hazardous
chemicals, nuclear products, and petroleum
products that creates the potential for exposure
(e.g., oil spills, chemical spills, or radiation
events).
ENVIRONMENTAL PROTECTION AGENCY
• The U.S. Environmental Protection Agency
(EPA) is the lead governmental agency
responsible for monitoring the environment in the
United States.
• The EPA’s mission is to “protect human health and
to safeguard the natural environment—air, water,
and land—upon which life depends” (EPA, 2017).
• Protecting human health is an integral part of the
EPA’s mission.
• In the Philippines, which agency assume the
responsibilities for protecting human health as well
as safeguard the natural environment?
➢ Department of Health (DOH) - the principal
health agency in the Philippines. It is
responsible for ensuring access to basic public
health services to all Filipinos through the
provision of quality health care and regulation
of providers of health goods and services.
➢ Department of Environmental and
Natural Resources (DENR) - the primary
agency responsible for the conservation,
management, development, and proper use of
the country’s environment and natural
resources, specifically forest and grazing lands,
mineral resources, including those in
reservation and watershed areas, and lands of
the public domain, as well as the licensing and
regulation of all natural resources as may be
provided for by law in order to ensure equitable
sharing of the benefits derived therefrom for
the welfare of the present and future
generations of Filipinos.
• The EPA conducts numerous research programs
worldwide that study the effects of pollution on the
human body.
• Research efforts include studies on how
pollution affects children and people with
asthma and other illnesses, and how water
contaminants may affect swimmers and
beachgoers.
• Monitoring environmental quality also plays an
important role in protecting human health.
• The EPA works with state and local agencies, as
well as with volunteer and other citizen groups, to
monitor air and water quality and to reduce human
exposure to contaminants in the air, land, and
water.
• The EPA provides leadership in the nation’s
environmental science, education, and assessment
efforts, and works closely with other federal
agencies, state and local governments, and Native
American communities to develop and enforce
regulations under existing environmental laws.
• The EPA is responsible for researching and setting
national standards for a variety of environmental
programs and delegates to states and tribes
responsibility for issuing permits and monitoring
and enforcing compliance.
• Where national standards are not met, the EPA can
issue sanctions and take other steps to assist the
states and tribes in reaching the desired levels of
environmental quality.
• The EPA also works with industries and all levels
of government in a wide variety of voluntary
pollution prevention programs and energy
conservation efforts. The Department of Labor
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and Employment (DOLE) have standards being
set in terms of establishments. EPA mentions that
sanctions are being done, same manner with DOLE.
MANDATE OF THE DEPARTMENT OF HEALTH
(DOH)
• Source: EO. No. 292 series of 1987 Instituting
the Administrative Code of 1987 Signed on
July 25, 1987.
CHAPTER 1: GENERAL PROVISIONS
Section 1: Declaration of Policy
• The State shall protect and promote the right to
health of the people and instill health
consciousness among them; adopt an integrated
and comprehensive approach to health
development, with priority for the underprivileged
sick, elderly, disabled, women, and children;
endeavor to make essential goods, health and
other social services available to all the people at
affordable cost; establish and maintain an
effective food and drug regulatory system; and
undertake appropriate health manpower
development and research, responsive to the
country’s health needs and problems.
Section 2: Mandate
• The Department shall be primarily responsible for
the formulation, planning, implementation, and
coordination of policies and programs in the field
of health.
• The primary function of the Department is the
promotion, protection, preservation or restoration
of the health of the people through the provision
and delivery of health services and through the
regulation and encouragement of providers of
health goods and services.
Section 3: Power and Functions
• The Department shall:
1. Define the national health policy and formulate
and implement a national health plan within the
framework of the government’s general policies
and plans, and present proposals to appropriate
authorities on national issues which have health
implications;
2. Provide for health programs, services, facilities
and other requirements as may be needed,
subject to availability of funds and
administrative rules and regulations;
3. Coordinate or collaborate with, and assist local
communities, agencies and interested groups
including international organizations in activities
related to health;
4. Administer all laws, rules and regulations in the
field of health, including quarantine laws and
food and drug safety laws;
5. Collect, analyze and disseminate statistical and
other relevant information on the country’s
health situation, and require the reporting of
such information from appropriate sources;
6. Propagate health information and educate the
population on important health, medical and
environmental matters which have health
implications;
7. Undertake health and medical research and
conduct training in support of its priorities,
programs and activities;
8. Regulate the operation of and issue licenses and
permits to government and private hospitals,
clinics and dispensaries, laboratories, blood
banks, drugstores and such other
establishments which by the nature of their
functions are required to be regulated by the
Department;
9. Issue orders and regulations concerning the
implementation of established health policies;
and
10. Perform such other functions as may be
provided by law.
Section 4: Organized Structure
• The Department shall consist of the Department
Proper, National Health Facilities, Regional Offices,
Provincial Health Offices, District Health Offices
and Local Health Agencies.
CDC NATIONAL ENVIRONMENTAL PUBLIC
HEALTH TRACKING NETWORK
• Environmental public health tracking is a
type of surveillance that is of great value to
disaster planners as well as responders. The
environmental public health tracking is assisting
disaster planners as well as responders and
surveillance is being utilized so that they can use
these data in terms of planning.
• Surveillance is a method to monitor trends by
collecting, interpreting, and reporting data.
• The CDC’s National Environmental Public
Health Tracking Network brings together
health and environmental data into one place,
making it easier to compare hazards and
environmental exposures with health outcomes at
a local and national level.
• The Tracking Network collects health data and
environmental data from national, state, and city
sources, and provides supporting information to
make the data available to planners.
• The Tracking Network has data and information on
environments and hazards, health effects,
and population health.
• The Tracking Network can be accessed at
www.ephtracking.cdc.gov/showHome in order to:
➢ Use the query tool to view interactive maps,
tables, and charts
➢ View info by location for county-level data
snapshots
➢ Visit state and local tracking websites
EXAMPLES OF ENVIRONMENTAL HAZARDS
AND THEIR IMPACT
AIR POLLUTANTS
Description
• Toxic air pollutants (also known as hazardous
air pollutants) are those pollutants that cause or
may cause serious health effects, such as cancer,
severe respiratory disease, reproductive
effects or birth defects, or adverse
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environmental and ecological effects (CDC,
2018).
• Examples of toxic air pollutants include:
➢ Benzene, which is found in gasoline.
➢ Perchlorethlyene, which is emitted from
some dry cleaning facilities.
➢ Methylene chloride, which is used as a
solvent and paint stripper by a number of
industries.
• Examples of other air toxics include dioxin,
asbestos, toluene, and metals such as
cadmium, mercury, chromium, and lead
compounds.
• Most air toxics originate from human-made
sources including those that are:
➢ Mobile (e.g., cars, trucks, buses)
➢ Sationary (e.g., factories, refineries, power
plants)
➢ Indoor sources (e.g., building materials,
cleaning chemicals, carbon monoxide, and mold)
• Some air toxics are also released from natural
sources such as volcanic eruptions and forest
fires (EPA, 2017).
• The World Trade Center disaster resulted in
the release of multiple air pollutants causing
significant disease (Reibman et al., 2016).
• People exposed to toxic air pollutants at sufficient
concentrations and durations may have an
increased chance of getting cancer, pulmonary
disease, or other serious health effects.
• These health effects can include damage to the
immune system, as well as neurological,
reproductive, developmental, respiratory,
and other health problems. Cancer and
pulmonary diseases are included in the top ten
leading causes of morbidity and mortality, not only
in the U.S. but in the Philippines as well.
• Acute and chronic exposure to some air pollutants
can lead to immediate or prolonged death. In
addition to exposure from breathing air toxics,
risks are also associated with the deposition of
toxic pollutants onto soils or surface waters
where they are taken up by plants, ingested by
animals, and eventually magnified up through the
food chain.
• Humans and animals alike may experience health
problems if exposed to sufficient quantities of air
toxics over time (EPA, 2017). For example,
increases in ambient air ozone and air pollution
can be linked to increased occurrences of asthma
exacerbations because the exposure has been
found to induce an increase in airway inflammation
(Peden, 2002).
• Urbanization and the ever-growing world
population have introduced several challenges in
air pollution.
• Emissions from electric utilities, vehicular
exhaust, gasoline vapors, and chemical
solvents are some of the largest contributors to
production of low-level ozone (EPA, 2017i).
• Ozone is formed when these toxic substances
react in sunlight close to the earth’s surface and,
unlike the ozone layer that protects from harmful
ultraviolet (UV) radiation from the sun, exposure
can lead to severe permanent respiratory disease
(EPA, 2017).
• Particle pollution, the suspension of particles of
solids or liquids in the air from industrial or
chemical products, has become exceptionally
problematic (CDC, 2017b); in some cities, it can
become severe enough to see, smell, and taste.
• Research suggests that exposure to air pollutants
affects the respiratory system to a greater extent
and may introduce chronic systemic health
problems (Kahle et al., 2015).
• Children, the elderly, those with existing
pulmonary diseases, and those with chronic
health conditions are particularly susceptible to
adverse health outcomes from living in areas
where particle pollution is more prominent.
• Living in urban areas and areas that receive more
sunlight may correlate with increased exposure to
air pollutants due to increases in exposure to
industrial products and increased ozone
productions.
• The EPA maintains an Air Quality Index (AQI) as
a tool for the general public to monitor and avoid
particle pollution, ozone, and smoke at
www.airnow.gov.
• The EPA regulates air pollution under the Clean
Air Act.
• The EPA is required to monitor and set strict limits
for six criteria air pollutants in the United States
(carbon monoxide, ground level ozone, lead,
nitrogen oxides, particulate matter, and
sulfur dioxide).
• The EPA helps states that are not meeting the
requirements implement remediation plans
containing measures needed to meet federal
standards.
• The agency also conducts periodic reviews of the
scientific literature on the health effects of criteria
air pollutants.
• The reports are used to determine national
standards.
• One weakness in the legislation is that the EPA
does not regulate indoor air pollution levels
(www.epa.gov/clean-air-act-overview/ air-
pollution-current-and-future-challenges).
REPUBLIC ACT NO. 8749: THE PHILIPPINE
CLEAN AIR ACT
Description
• Republic Act No. 8749, otherwise known as the
Philippine Clean Air Act, is a comprehensive air
quality management policy and program which
aims to achieve and maintain healthy air for all
Filipinos.
• Based on the data that we have, millions of people
died each year because of smokey homes due to
cooking, or heating with inefficient fuel or
technology combinations.
• Data showed that pneumonia deaths are caused
by household use of solid fuels and kerosene
paired with polluting cook stove.
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• Moreover, millions of death take place due to heart
disease, stroke, pulmonary diseases, pneumonia,
as well as lung cancer (WHO, 2019).
• In the Philippines, you have vehicle exhaust,
industrial emission and power production, smoke
from cooking and heating with uncleaned
technologies and fuel, agricultural practices, waste
burning, and wild fire.
• According to the Philippine Health Statistics
(PHS), the leading cause of morbidity includes
acute respiratory infection, lower respiratory
infection, pneumonia, bronchitis, heart diseases --
all of these are related to pollution. Those that I
mentioned are chronic conditions.
• 4.2 million deaths occur each year as a
consequence of air pollution.
• All potential sources of air pollution (mobile, point
and area sources) must comply with the provisions
of the law. All emissions must be within the air
quality standards.
➢ Mobile sources refer to vehicles like cars,
trucks, buses, jeepneys, tricycles, motorcycles,
and vans.
➢ Point sources refer to stationary sources such
as industrial firms and the smokestacks of
power plants, hotels, and other establishments.
➢ Area sources refer to sources of emissions
other than the above. These include smoking,
burning of garbage, and dust from construction,
unpaved grounds, etc.
• The objectives of the Clean Air Act are to:
➢ Achieve and maintain healthy air for all Filipinos.
➢ Lay down policies to control the spread of air
pollution.
➢ Set standards for vehicle owners as well as
manufacturing plants to follow and impose the
appropriate punishments for violations of the
law.
➢ Outline the different programs to be
implemented by the government in order to
manage and maintain air quality.
• You will notice in the rural areas; they utilize
plastics for cooking. They use it for lighting the
firewood. The community people are supposed to
be instructed to avoid burning plastics. If there are
bottles that are being utilized, they’re not
supposed to be burned.
• Another point for keeping the air clean is to report
smoke belching vehicles. Conducting smoke test
for the vehicles as a requirement for issuance of
license.
• Also, instead of burning garbage, recycling and
segregating has to be practiced.
COMMUNITY ASSESSMENT FOR PUBLIC
HEALTH EMERGENCY RESPONSE (CASPER)
TOOLKIT
DISASTER
Description
• A serious disruption of the functioning of society,
causing widespread human, material or
environmental losses, that exceeds the local
capacity to respond and calls for external
assistance.
• 3 main types: Natural, Human-Induced, and
Complex Emergencies.
COMMUNITY ASSESSMENT FOR PUBLIC
HEALTH EMERGENCY RESPONSE (CASPER)
Description
• CASPER is an epidemiologic technique designed
to provide quickly and at low cost, household-
based information about a community’s needs
in a simple format to decision-makers.
• It is one type of Rapid Needs Assessment (RNA)
• Provides household-based information about a
community, quickly and at low-cost
• Quick, reliable public health and basic needs data
to inform decision-makers
• Used in both disaster and non-disaster settings
• Is generalizable, flexible, and uses simple
reporting format
• Cluster sample methodology – two stage (30x7)
design
• Results are descriptive of the entire sampling area
Goals of CASPER
• Rapidly obtain information about the needs of an
affected community
• Produce population-based estimates for decision
makers
• Assess new or changing needs
What CASPER is NOT
• NOT intended to deliver food, medicine, medical
services, or other resources to the affected area
• NOT intended to provide direct services to
residents such as cleanup or home repair
• NOT able to determine why people are not
returning to the community, nor to establish
current population estimates
CASPER Phases
• PREPARE for the CASPER
➢ Objectives
➢ Assessment area
➢ Forums (survey, etc)
➢ 1st stage sampling (30 clusters)
• CONDUCT the CASPER
➢ Just-in-time traiing
➢ Interview teams
➢ 2nd stage sampling (7 households)
• ANALYZE the data
➢ Weighted data
➢ Tracking form
• Write the REPORT
➢ Interpret data
➢ Write report
➢ Share results
CASPER Methodology Overview
• Two-stage probability sampling (30 clusters & 7
households)
• Household interview
• Data weighting to obtain population estimates
• Report generated within 36 hours of data
collection and shared with key stakeholders and
decision-makers
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CASPER Team Composition
• “Diverse” teams of two:
➢ Locals with non-locals
➢ Avoid male-male teams
➢ Experience with less experience
➢ At least one person must have a car
• Remember, be flexible!
• Please check-in your team and receive your
assigned cluster packet. Please be patient and take
a break while the sign-in process is being
completed.
Introduction to CASPER Packet
• In your CASPER Packet you should find:
➢ Maps of your cluster(s)
- The map number(s) should correspond with
the number(s) written on the outside of your
folder
➢ 1 consent form in a plastic cover
- Numerous additional consent forms
➢ At least 7 questionnaires per cluster
➢ At least 2 tracking forms per cluster
➢ Handful of referral forms (approximately 3)
SYSTEMATIC SAMPLING OF HOUSEHOLDS
• Randomly choose a starting point (e.g.,
intersection) prior to heading into the field
• Select the nearest house, then every nth house
after
• Choose in based on the size of the cluster:
➢ Look at the approximate number of households
found on the map. Example, if there are 23
households divided by 7 you have 3. So there
will be an interval of 3 houses then you do the
data gathering. If houses are 10, go to every
house.
- If 23 households, 23/7=3 … select every 3rd
household
- If 10 or less households, go to every one
- Apartment complexes: each unit is a separate
household
➢ Once you pick a number, stick to that number!
• The goal is to be sure interviews are spread out
across the cluster.
• Example of selecting households to interview: We
have chocolates in a box. You want to randomly
eat 7. So if each chocolates resembles the number,
the interval here would every 3rd chocolate.
24 chocolates in the box
You want to randomly eat 7
24/7 = 3.3
N=3
• Example of selecting households to interview:
Look at the violet color.
Tips for Selecting a Household to Interview
• Apartment complexes
➢ Approximate number of households by counting
on one floor and multiplying by the number of
floors
➢ High rises: randomly select 7 floors then get an
interview on each floor
➢ Mixed clusters: attempt houses first then move
to apartment complex
- Goal is to have interviews spread out in the
cluster
• Replacing households only if vacant, refused, or
after third attempt with no answer
• Always call headquarters if there are any questions
• REMEMBER TO TRACK ALL HOUSEHOLDS
Tips for Replacing Households
• ONLY replace households if:
➢ VACANT,
➢ REFUSES, or
➢ no answer after THREE attempts
• Take note, this only applies to the utilization of
CASPER. We don’t do replacement for the
community diagnosis in our target barangays. It is
expected that each household should be
interviewed because it’s a baseline information. In
the case of CASPER, households are randomly
selected.
Things to Avoid
• Convenience sampling. Example in the
television, random interviews are being done.
• Target sampling.
• Sequential sampling
• Poor record keeping
• Remember: an individual can choose the clusters,
but random selection of households is the
responsibility of the whole team.
TRACKING FORM
• Used for tracking every household sampled
• Each cluster is collected on a separate form
• Allows for calculation of response rates
• Example of the codes being utilized in the
tracking form: Each household included in
the sampling, the information has to be
recorded.
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MA. CONCEPCION B. SEKITO, MPH, RN

• Provide household with copy

• Consent script contains
o Who you are
o Why you are there
o How long it will take
o Explicit request for consent
o Phone number for verification or
questions

• Make sure to track EVERY visit

CONFIDENTIAL REFERRAL FORM

• Write information to identify households to

return to or any notes that you may need to
take (e.g., why the household is
inaccessible) on the back of the form

CONSENT SCRIPT

• Report urgent household need(s)

• May need to pass personal identifying
information to health department or other
agency
• Will illicit immediate follow up

QUESTIONNAIRE
• Review questionnaire
• Clarification of specific questions
o Intent of question
o Explanation of skip patterns
• Tips for completion
• Interviewing
o Empathy and Respect are key
o Remind the participant that all answers
are confidential
o Be confident
o STANDARDIZE
• Consent script = intro to the CASPER
• Verbal consent is sufficient
o No personal identifiers collected STANDARDIZATION
Why Standardize Procedures
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MA. CONCEPCION B. SEKITO, MPH, RN
• Increases reliability of data
• Allows others to replicate findings
• Easier to explain findings
• Helpful to identify sources of bias/error
Why Standardization is Difficult
• Situation is artificial
• Using a script can be awkward
• Tempting to change content
• On the part with the information being
gathered for the community diagnosis, we
utilize interview schedule so that that
questions that being asked are uniform for
all households, not an interview guide
because only key points being utilize for the
interview.
Tips for Standardization
• Ask the question in the same order with the
exact wording
• Don’t prefill questions or finish respondents
sentences
• Read the entire question
• Record answers verbatim
Departures for Standardization
• Changing wording = asking different
questions
• If respondents have difficulty…pause
• Document any departures
• Standardization increases reliability of data
ENDING CASPER INTERVIEW
• Thank for participation
• Offer how and when results will be available
• Check the entire questionnaire before
leaving
• Re-check the questionnaire and tracking
form once you leave the household. Those in
the community were able to experience this.
With the inaccurate information or data that
were lacking, you were instructed to go back
and ask again in terms of the missing
information. That’s why it is important to
check the entire questionnaire before
leaving.
Safety First
• Watch out for domestic/ wild animals
• No trespassing vs no solicitation
• Personal safety
o Only enter a household if both you and
your partner feel comfortable to do so
▪ Decide this now
▪ If you enter a household, stay in the
entryway closest to door
o Know you limitations
o Drink plenty of water
• Do not insist if you are not allowed to enter
because safety has to be considered.
When you Return
Team Member Responsibilities
• Remain flexible – 2 person team
• Think safety
• Understand the objectives
• Adhere to the methodology
o Map –sample validity
o Interview – data quality
o Tracking form – representativeness
o Data entry – timeliness
• Be respectful
• Understand personal limitations
Logistics
• Please CALL/ TEXT HEADQUARTERS (NAME
- NUMBER)
o When arrive in cluster
o After your second interview
o If you have ANY questions
o If you have any media encounters
(please do not talk to the media)
• Please leave your cluster at sundown (TIME
pm)
• We will meet tomorrow at headquarters at
TIME pm
SUMMARY
• Community Assessment for Public Health
Emergency Response (CASPER) can be
utilized in terms of important health disasters
covering air pollutants; chemical spills;
land, waste, and brownfields; mold; oil
spills; unconventional gas and oil
production; pesticides; radiation
release and contamination; water; and
pharmaceuticals. It is being utilized to
assess for the hazards as well as the
potential health risks associated with the
exposure to the toxic chemicals.
• Nurses are supposed to determine the
important hazards in the environment and
nurses are supposed to work to create an
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MA. CONCEPCION B. SEKITO, MPH, RN
environment that promotes and sustains
health for all its citizens.
• Increases in the scientific knowledge
regarding development of toxic chemicals
and advances in technology must be
balanced by the wisdom respecting their
transport and use.
• The impact on a community resulting from
an environmental emergency may be
immediate, on going, or delayed for decades.
• Depending on the type of toxic agent and the
duration of the exposure, populations may
need to be closely monitored for years in
order to evaluate the health impact of the
event.
• Nurses must become educated regarding
tracking environmental hazards in their
communities, must become advocates for
public policy limiting toxic agent use, and
must become proponents of research into
the health effects of those environmental
agents.
CHAPTER 19
RESTORING PUBLIC HEALTH UNDER
DISASTER CONDITIONS: BASIC
SANITATION, WATER AND FOOD SUPPLY,
AND SHELTER
OBJECTIVES
After the lecture-discussion, the students will
be able:
1. Describe the 10 essential functions of public
health as they relate to a disaster
2. describe the importance of a clean
environment as a foundation for good health
3. appraise both risks and resources in the
environment to meet the basic needs (food,
water, shelter, and safety) for survival
4. discuss the major health risks in a population
affected by a disaster and identify and
prioritize according to prevention/control of
disease, epidemics, and other hazards
5. describe rapid environmental assessment
(REA) as a methodology for data collection in
a disaster-affected community
6. discuss the Sphere Project humanitarian
standards for disaster response
7. identity restoration of electricity a critical to
protecting human health.
Take note:
✓ Populations affected by a disaster experience
diminished environmental conditions that put
them at risk of negative health outcomes.
✓ Basic physiological needs must be met in a
timely manor to ensure survival.
CHAPTER 21
✓ Sanitation is a cornerstone of the public
health response.
✓ Establishing, Implementing, and
continuously no minimum standard a for
waler and food safety, sanitation, shelter,
personal hygiene, and vector control –
provides a firm foundation for health
promotion. Infectious disease outbreaks
often occur in the postimpact and recovery
phases of a disaster (not during the cute
phase); nurses should be
knowledgeable about diseases
endemic to the affected area.
✓ Food safety is a particular concern, and not
only during the disaster condition.
➢ The risk of epidemics increases if drought,
famine, and/or large displacements of people
are involved.
➢ The length of lime that people spend in
temporary shelters is an important
determinant of the risk of disease
transmission that might lead to major
epidemics.
➢ Working in conjunction with public health
colleagues, and as members of an
interdisciplinary disaster response team,
nurses must be able to detect
environmental changes that can
increase the potential for the spread of
infectious disease.
➢ Populations affected by a disaster may
experience severely diminished
environmental conditions that put them at
risk of negative health outcomes.
➢ Health promotion and disease prevention
initiatives must be implemented immediately
to protect the heath of all affected
individuals, including meeting basic
physiological needs in a timely manner to
ensure survival.
➢ Take note that the priority concern of public
health is health promotion and disease
prevention. Curative aspect is not the main
focus. So this has to be implemented so as
to protect the health of the people within the
particular community.
➢ Infectious disease outbreaks will
usually occur in the postimpact and
recovery phases of a disaster (not
during the acute phase), and the risks
of epidemics increase if drought,
famine, and/or large all is
displacement of people are involved.
➢ Awareness of the emergence of foodborne
illnesses is of importance to the health and
well-being of the entire population.
➢ Restoration off electrical power as soon as
possible following a disaster should be a
priority.
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 LECTURE 8: ENVIRONMENTAL DISASTERS AND EMERGENCIES
MA. CONCEPCION B. SEKITO, MPH, RN
CLIMATE CHANGE AND HEALTH:
THE ROLE OF NURSES IN
POLICY AND PRACTICE
OBJECTIVES
After the lecture-discussion, the students will
be able:
1. Describe the real and potential impacts of
climate change on human health.
2. Appreciate the physical drivers of climate
change.
3. Describe the nurse's role in mitigation and
adaptation efforts to reduce climate change
impacts on human health.
4. List vulnerable population at most risk for
poor health outcomes related to climate
change.
5. Identify new studies that confirm observed
climate changes and validate climate models.
6. Describe areas in practice and advocacy
where nurses can contribute to addressing
climate change and health risks, including
hoe Green Teams can benefit an
organization.
✓ Widespread scientific consensus exists that
the world’s climate is changing.
✓ Some of these changes will likely include
more variable weather, heat waves, heavy
precipitation events, flooding, droughts,
more intense storms, sea level rises, and air
pollution.
✓ Each of these impacts could negatively affect
population health.
And you will see that all of these are existing
throughout the world.
✓ While climate change is a global issue, the
effects of climate change will vary across
geographical regions and populations, with
vulnerable populations at higher risk for
adverse health consequences.
✓ Healthcare professionals recognize that
there is a direct and indirect connection
between climate change and human health.
✓ Knowledge of climate change drivers and
their effects must be part of the nurse’s
assessment and decision making in the
development of patient and community care
plans.
✓ Did you recognize risk aspects in terms of
your problem identification in the
community?
✓ The health of the public must be protected –
nurses can play a vital role in the reduction
of climate change related impacts on human
health.
✓ Researches were conducted and increasing
frequency of extreme weather events and
changes in geographical areas of climate-
sensitive infectious disease transmitters have
served to revives considerably our
understanding of climate change impact on
environments and human health.
Take note:
➢ An important consequence of this
understanding is the awareness that climate
change’s negative health effects are most
severe for those who are most at risk and
that these challenges to population health
clearly demonstrate the imperative role on
nurses. (Goodman, 2016)
✓ The skills set those nurses bring to mitigate
against and adapt to climate change’s
influence on health is essential.
✓ Effective solutions for protecting community
health will depend on knowledgeable and
competent nurses who can identify existing
and anticipated emerging health threats in
their region.
You will notice in the curriculum, BSN
curriculum, since the 5-year curriculum was
revised into the 4-year BSN curriculum, a
community-based curriculum was then
identified, up to the start of K12, the revision
of the curriculum by which disaster nursing
was included in the curriculum and this can
be a vehicle for nurses to assume roles in
terms of protecting the health of the people
in the community. So that nurses will be
competent and knowledgeable in terms of
delivering services.
✓ More schools are including climate change
and health curricula in the coursework, yet
this integration must increase to meet the
challenges and the pledge by the Health
Educators Commitment.
✓ Educators must also share their experience
in teaching climate change to identify best
practices.
✓ There are many resources and successful
advocacy examples and tool kits for nurses
to effusively adapt and mitigate the negative
consequences.
✓ Furthermore, collaboration between nurses
and their professional; organizations can
raise the volume of the professional
collective voice in local, national, and
international conversations.
✓ So, the recognize professional group for
nurses is the Philippine Nurses Association.
So next year you will be part of PNS, so you
can now raise your voices in terms of climate
change and disaster.
✓ Through active roles as educators, research
consumers, health messengers, client
advocated, leaders, and change agents,
nurses are vital partners in developing and
implementing national and community
strategies for protecting individual and
overall community health.
✓ Nurses’ advocacy extends to promoting
public and policymaker awareness and
preparedness for the fight against the
negative health effects of climate change –
bring their knowledge, skills and critical
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MA. CONCEPCION B. SEKITO, MPH, RN

thinking to “the greatest global health AIR POLLUTION

opportunity of the 21st century”. Direct effects:
• Initiate or worsen respiratory, cardiovascular
IMPACT OF CLIMATE CHANGE and other diseases
ON HUMAN HEALTH Indirect effects:
• Reduced visibility
• Reduced productivity at work or school
• Degradation of crops and water bodies

EXTREME HEAT
Direct effects:
• Heat stress and illness
• Worsening of preexisting conditions
• Heat-related mortality
Indirect effects:
• Infrastructure failures
• Strain on essential srvices
• Disruption to key social networks

FLOODS & DROUGHT

Direct effects:
• Mental stress
• Waterborne disease
You will see here the impact of climate change in
• Drowning and injuries
human health.
Indirect effects:
So, what you see at the center:
• Respiratory ailments
✓ Rising temperatures
• Disruption to economic and sociak networks
✓ More extreme weather
• Strain on essential servies
✓ Rising Sea levels
• Wildfires
✓ Increasing CO2 levels
Because of these, you have:
ECOSYSTEM THREATS
✓ Change in vector etiology
Direct effects:
✓ Increasing allergens
• West Nile virus
✓ Water quality impacts
• Lyme disease
✓ Water and food supply impacts
• Liver, respiratory, nervous, skin disorders
✓ Environmental degradation
(from harmful algal blooms)
✓ Extreme heat
Indirect effects:
✓ Severe weather
• Threats to livelihood
✓ Air pollution
• Financial strains
And outside of the second circle are the conditions.
Conditions that are the results of the effect of
THE ROLE OF NURSES IN CLIMATE CHANGE
climate change.
• National studies show that nurses recognize
the numerous ways that climate change
DIRECT AND INDIRECT HEALTH
affects health, yet many feel they are not
EFFECTS OF CLIMATE CHANGE
well enough prepared to meet those
challenges.
• In one study, nurses agreed that public
health nursing had the responsibility to
address health-related impacts of
climate change yet some doubted that
actions could decrease health-related
impacts.
• Furthermore, most melt they were not
prepared and that within their departments
they did not have the ability to address
health-related impacts on climate change
due to limited resources and personnel
allocated to endeavor. (Polivka, Chaudry,
& Mac Crawford, 2012)
• A study among hospital, primary care, and
emergency room nurses in Sweden found
that public health work was regarded as a
health co-benefit of climate change
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MA. CONCEPCION B. SEKITO, MPH, RN
mitigation and that nurses perceived a
responsibility for individual and professional
commitment to opportunities to positively
influence the environment. (Anakaer,
Nilsson, Holmner, & Elf, 2015)
• A similar study in Canadian nurses concurred
with these studies in that nurses were only
moderately knowledgeable about climate
change and its specific health threats and
gelt this was an area for further development
and training.
• They expressed interest in climate change as
an important determinant of health and the
need for integrating it into practice, in
agreement with the Canadian Nurses
Association’s list od nurse actions to address
climate change (Angelini 2017; Laan, 2014)
• Nursing is a clinical profession grounded in
evidence. A nurse is a researcher and
consumer of research, identifying and
translating new and emerging information to
the practice setting.
• Integration of new findings often requires
new ways of thinking and acting, engaging,
and incorporating a system-wide approach to
meet healthcare needs both now and in the
future.
• Nurses can apply mitigation and adaptation
measure, personally and professionally, to
address know and emerging health impacts
in our changing climate. (Angelini, 2017)
• Some existing health threats will intensify
and new health threats will emerge and not
everyone is equally at risk. Important
considerations of risk for climate change-
related health impact include age, economic
resources, and location (CDC, 2017a)
• In the United States, public health can be
affected by disruptions of physical,
biological, and ecological systems including
disturbances originating domestically and
elsewhere.
• Emphasizing this point the 2015 Lancet
Commission on Health and Climate Change
argues that the response to climate change
could be “the greatest global health
opportunity of the 21st century” (Watts et
al., 2017)
• The perspective then shifts to the effects of
climate change on human health
consequences, what has been done, and
what future work needs to be done.
• Since the days of Florence Nightingale, the
practice of nursing has been rooted in
"person, environment, and health" as the
interrelated determinants of health
(McDonald, 2001)
PHYSICAL DRIVERS OF CLIMATE CHANGE
• Despite often contentious public and political
debate, the physical drivers or climate
change are quite clear.
• Greenhouse gases such as carbon dioxide
absorb heat (infrared radiation) emitted from
the earth’s surface.
• Since the mid-1800s when humans began to
burn coal, gas, and oil, scientists have known
that CO2 is one of the main greenhouse
gases of importance to Earth's energy
balance.
• Other greenhouse gases (notably methane
and nitrous oxide) are also increasing as a
consequence of human activities.
• The observed global surface temperature
rises since 1900 is consistent with detailed
calculations of the impacts of the observed
increase in atmospheric CO2 (and other
human-induced changes) on Earth's energy
balance.
• Increases In the atmospheric concentrations
of these gases cause the earth to warm by
trapping more of this heat.
• Human (anthropogenic) activities especially
the burning of fossil fuels since the start of
the Industrial Revolution. -have
unquestionably increased atmospheric CO2
concentrations by about 40%, with more
than half the increase occurring since 1970
(National Academy of Science and
Royal Society, 2015; USGCRP, 2017).
• Since 1900, the global average surface
temperature has increased by about 0.8°C
(1.4°F)
• This has been accompanied by warming of
the Ocean, a rise in sea level, a strong
decline in Arctic Sea ice, and many other
associated climate effects.
• Much of this decades aha arming has
occurred in the last four analyses have
shown that the warming during this the
warming during this period is mainly a result
of the increased concentrations of CO2 and
other greenhouse gases.
• Continued emissions of these gases will
cause further climate change, including
substantial increases in global average
surface temperature and important changes
in regional climate.
• The magnitude and timing of these changes
will depend on many factors, and slowdowns
and accelerations in warming lasting a
decade or more will continue to occur.
• However, long-term climate change over
many decades will depend mainly on the
total amount of CO2 and other greenhouse
gases emitted as a result of human activities
(National' Academy of Science and
Building Royal Society 2015).
There is overwhelming evidence that climate change
has contributed to:
➢ Higher average global temperatures and sea
levels.
➢ Decreased sea and land use levels
➢ Changes in precipitation patterns
NCM 120 ┃ DISASTER NURSING
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MA. CONCEPCION B. SEKITO, MPH, RN

➢ Increased frequency of extreme weather

events: heat waves, droughts, hurricanes,
and wildfires
➢ Heavy pollution
➢ Shifts in animal and plant habitable ranges
(Intergovernmental Panel on Climate
Change [IPCC], 2014; National
Academy of Science and Royal Society.
2015)

There are suggestions for research areas. These are

the suggested areas for research: (Portier et al.,
2010)
• Asthma, Respiratory Allergies, and Airway
Diseases
• Cancer
• Cardiovascular Disease and stroke
• Foodborne Disease and Nutrition
• Heat-related Morbidity and Mortality
• Human Developmental Effects
• Mental health and stress-Related Disorders
• Neurological Diseases and Disorders
• Vectorborne and Zoonotic Diseases
• Waterborne Diseases
• Weather-created Morbidity and Mortality

The dynamics of climate change’s regional weather

changes and human exposures, direct or indirect,
will be related most directly to extreme weather,
flooding, and heat wave events as well as changes
in geographical habitats of vectorborne diseases
(Barna, Goodman, & Mortimer 2021)

✓ Climate change-related water disasters have

been associated with major environmental
disruption resulting in exposures to toxins,
molds, and infectious agents with resultant
significant morbidity and mortality (Veenema
et al., 2017)
✓ These health concerns represent cross-
cutting issues for vulnerable and susceptible
populations.

NCM 120 ┃ DISASTER NURSING