ENVIRONMENTAL HEALTH
OBJECTIVES:
1. Define environmental health
2. Explain the need for public health nurses to study the different
elements of the human environment
3. Discuss the environmental health indicators maintained by the public
health nurses in the Philippines
4. Differentiate the pollutants from each of the elements of the
environment (land, water, or air)
5. Synthesize the provisions of Philippine laws and implementing rules
and regulations related to environmental health
6. Identify the types of disasters and discuss characteristics of disasters.
7. Describe the stages of a disaster
8. Identify potential bioterrorist chemical and biological agents
9. Describe the role of government agencies and volunteer agencies like
the Philippine Red Cross, involved in disaster management.
10. Elucidate on the National Disaster Risk Reduction and Management
Plan.
11. Explain the Incident Command System.
12. Describe the role and responsibilities of nurses in relation to
disasters.
DEFINITION
• Is the component of the individual’s well-being that is
determined by interactions with the physical, chemical,
biological an psychosocial factors external to him or her
• According to Sister Callista Roy: No amount of medical
knowledge will lessen the accountability for nurses to do what
nurses to do: manage the environment to promote positive life
processes
• To enable the public health nurse to use the environment to
assist the community in improving the state of wellness, it is
necessary to study components of environment and human
health
• Provide emphasis that the individual is the client of the public
health nurse instead of the environment
Executive Order no. 489: Institutionalizing the Inter-Agency
Committee on Environmental Health (IACEH)
• Represented by the various secretaries and directors of the
Executive branch of the government
• Headed by the secretary of DOH as chairperson, and the
secretary of DENR as vice chairperson
• Task: Coordinating, monitoring, and evaluating environmental
health programs initiated by the government and private
agencies to achieve environmental protection for health
promotion
• National Environmental Health Action Plan (NEHAP) had been
developed to perform these roles
o 7 components of environmental health:
1) Solid waste,
2) water,
3) air,
4) toxic and hazardous waste,
5) occupational health,
6) food safety
7) and sanitation (SWATOFS)
o These are assigned to the leaders of the IACEH
o July 2010 – expanded to include climate change
Environmental Health Records Management
• In the PH, the maintenance of the environmental health
records is one of the responsibilities given to city, municipal,
and provincial nurses
• Care of the city, municipal and provincial health nurses
• Field Health Service Information System (FHSIS); current data
management used by DOH
• Data collections starts with the midwife and BHWs
• In 2008 version of FHSIS: monthly record of environmental
health program accomplishments in the “summary table” form
by midwife
8 ENVIRONMENTAL HEALTH INDICATORS:
1. Household with access to improved or safe water- stratified to
levels I, II, and III
2. Households with sanitary toilets
3. Household with satisfactory disposal of solid waste
4. Household with complete basic sanitation facilities
5. Food establishments
6. Food establishments with sanitary permits
7. Food handlers
8. Food handlers with health certificates
• At the end of each year: midwife would have completed 12-
month columns of the summary table
• At the 2nd week of January of the following year: annual
barangay health station report: “A-BHS” form to city /
municipal health nurse
• 3rd week of January: municipal or city nurse consolidates A-
BHS forms into an annual report of the city/municipality using
the A1 form
• 4th week of January: provincial health nurse performs the
same task and submits consolidated A1 report of all cities and
municipalities of the province to DOH regional FHSIS
coordinator
• 2nd week of March: consolidated regional annual reports are
submitted to the DOH national office.
• Public Health Nurse needs to be abreast with the gathering of
these records which have to be maintained
2008 version of the FHSIS presents the following definitions:
1. Households with access to improved or safe water supply:
• Covered by or have access to any 3 levels of safe water sources
that conforms to the national standards for drinking water.
Level I (point source):
• Shallow or deep well, developed spring, or rainwater cistern
with an outlet but without a distribution system; rural areas;
• Serves 15-25 households, not more than 250 meters from the
farthest user.
• Yield or discharge is generally from 40-140 liters/min
• Adaptable for rural areas where houses are thinly scattered
• Point of consumption of Level 1 systems is at the source itself,
so placing the water reservoir is at higher risk of contamination
• Considered Level III: if level 1 reservoir (e.g protected
rainwater cistern) is piped into the tap of households; risk of
reservoir contamination is minimized
Level II (communal faucet system or standpost):
• Composed of source, reservoir, piped distribution network, and
a communal faucet; located not more than 25 meters from the
farthest house.
• Includes communal faucet where group of households get their
water supply even if said faucet is connected to a level III source
• Suited for rural or urban areas where houses are clustered
densely enough to justify a simple piped water system
• Delivers 40-80 liters per capital per day to an average of 100
household, with one faucet per 4-6 households.
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 • Piped distribution takes the point of consumption AWAY from • Hazardous materials: cadmium, lead and mercury from
the reservoir – reducing risk of contamination/pollution from disposed batteries which can accumulate in land and be
consumers present in harvested products
o Contamination from level II sources would more likely take 3. Habit of member of food chain:
place during transport or storage in individual households • Bioaccumulation-accumulated hazardous materials in soil
Level III (Waterworks system): affects lower life forms; biomagnification – as these creatures
• Source, transmission pipes, reservoir, and a piped distribution in the bottom of the food chain are consumed by more superior
network for household taps; suited for densely populated areas creatures.
• Requires minimum treatment for disinfection • Hazardous chemicals increase in concentrations in the food
• E.g water districts with individual household connections, may chain in the process of biomagnification
include level I system with piped distribution for household • Since humans are the top of the food chain, they are at risk of
taps, serving a group of house dwellings such as apartments consuming hazardous materials
and condominiums. 4. Filter for surface water:
2. Household with sanitary toilets: • Natural bodies of water and storm water permeate through the
• Households with own flush toilets connected to septic tanks layers of the soil until it finds its way to the ground water
and/or sewerage system or any other approved treatment • Soil saturated with pollution not only acts as poor filter but may
system, sanitary pit latrine or ventilated improved pit latrine also contaminate the seeping water.
• National target is 96% for urban and 86% for rural – 91% overall • Nurse should scrutinize those communities that rely on ground
3. Household with complete basic sanitation facilities: water should be interested in routine testing of these sources
• Satisfy the presence of the ff basic sanitation elements: ECOLOGICAL WASTE CLASSIFICATION
o Access to safe water Through the definitions used by RA 9003 or Ecological Solid Waste
o Availability of sanitary toilet, Management Act of 2000 and the DOH Manual On Healthcare Waste
o And satisfactory system of garbage disposal. Management of 2011, a way by which solid waste may be classified
4. Food establishments: as follows:
• Where food or drinks are manufactured, processed stored, MUNICIPAL WASTE
sold, or served, including those that are located in vessels. • All discarded nonhazardous household commercial and
5. Sanitary permit: institutional waste, street sweepings, and construction debris.
• Written certification of the city or municipal health officer or HEALTH CARE WASTE
sanitary engineer that the establishment complies with existing • Health care waste (biomedical waste): refuse that is generated
minimum sanitation requirements upon inspection conducted in the diagnosis, treatment, or immunization of human being or
in accordance with Presidential Decree Nos. 522 and 856 and animals together with those related to the production or
local ordinances. research of the same.
• Very important that every establishment has this • Classified as follows:
6. Food handlers: Bacterial, viral, parasitic, or
• Persons who handle, store, prepare or serve any food item, fungal pathogens in sufficient
drink, or ice; in contact with any eating or cooking utensil or concentration so as to cause a
food vending machine disease in susceptible host
• As food handlers are taken as any human source of food Example: Laboratory cultures,
contamination aside from the consumer, the interest of PHN as Infectious waste contaminated waste from
to consumers and handlers is to look at the FHSIS and to client’s infectious disease and
compare the number of food handlers with the number of have any other dressing, swabs,
active health certificates instruments or materials in
Health Certificate contact with infected persons
• A written certification, using prescribed form and issued by the (HIV, meningitis, Hep B) or
municipal or city health officer to a person after passing the animals
required and medical examination and immunizations. Tissues, organs, body parts,
SOLID WASTE MANAGEMENT human fetuses, animal
• Refers to activities that reduce and possibly eliminate the carcasses and blood and body
potentially recyclable materials in the waste stream before Pathological waste fluids.
they end up as added undesirable matter on the land known as Anatomical waste - healthy
land pollution. body parts of humans and
• Reduce the contamination and supports the work of PHN in animals – subcategory of
enabling the community to increase community’s level of waste
wellness Drugs, vaccines, and sera,
• Protects supporting functions of land, such as: bottles or boxes with residues,
1. Platform for human activities: Pharmaceutical waste gloves, masks, connecting
• Disease causing parasites and microbes tubing and drug vials which are
2. Agricultural production: no longer required and need to
• There is alteration of soil composition making the land be disposed of appropriately
unsuitable for growing crops and threaten food security. for any reason

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 Varied states of chemical
matter from clinical or
laboratory activities,
environmental work,
Chemical waste housekeeping, and disinfecting
procedures;
This category has any of the 5
properties of hazardous waste
and is therefore termed as
hazardous chemical waste
Biochemical waste that causes
Sharps cuts or puncture wounds
Examples: Needles, broken
glass, and scalpel blades
Sealed radiation sources in
cancer treatments, liquid and
gaseous materials
contaminated with
radioactivity and excreta of
Radioactive wastes patients who underwent
radionuclide diagnostic and
therapeutic applications
together with paraphernalia
tap water washing or those
who underwent
chemotherapy
• Yellow with biohazard symbol: pathological / anatomical
waste
• Yellow bag that can be autoclaved: infectious waste
• Yellow with black band: pharmaceutical, cytotoxic or chemical
wastes (labeled separately)
• Orange with radioactive symbol: radioactive
waste.
The segregated waste is transported and disposed accordingly:
• Materials recovery facility: recyclable waste (metals, plastic,
paper and glass) to generate recycled raw materials for
producers
• Compositing unit: for processing and subsequent agricultural
use (biodegradable and organic waste)
• Sanitary landfill: only residual waste
There are various waste processes that will be utilized by institutions,
organizations, or LGU s like shredders, biological reactors and thermal
processors
Individuals should be responsible for community services and should
know that law excludes incineration of these wastes since it can
produce toxic fumes

INDUSTRIAL WASTE RA 9003 has declared the ff as some prohibited acts

• Arise from production and agricultural and mining industries.
• Aside from rubbish, industrial waste can be mixed with
contaminated soil, ashes, and hazardous waste
HAZARDOUS WASTE
• Substances that pose either immediate or long-term substantial
danger to human because of possessing any of the following
properties.
1. Toxic
2. Corrosives such as acid of pH < 2 and bases of pH > 12
3. Flammable
4. Reactive such as those that can cause explosions
5. Genotoxic: such as cytostatic drugs
SOLID WASTE MANAGEMENT (RA 9003)
• Defines sold waste management as: Discipline associated with
the control of generation, storage, transfer and transport,
processing and disposal of solid waste in a manner that is in
accordance with the best principles of public health, economics
engineering, conservation, aesthetics, and other
environmental considerations, and that is also responsive top
public attitudes.
• Governs the solid waste stream
o Solid waste stream begins with solid waste generation
wherein waste reduction can be done through the reuse
of materials
Manual On Healthcare Waste Management (3rd ed. By DOH in Dec
2011)
• The following color coding of hospital waste bins were
prescribed.
o Materials that cannot be reused should be segregated into
color-coded labels so that waste management can be
followed accordingly
• Black or colorless: nonhazardous and nonbiodegradable
• Green: nonhazardous biodegradable waste
• Open burning of solid wastes
• Open dumping
• Burying in flood-prone areas
• Squatting in landfills
• Operation of landfills on any aquifer, groundwater, reservoir, or
water shed
• Construction of any establishment within 200 meters from a
dump or landfill
WATER SANITATION
• Increase in access to safe water supply is one of the crucial
steps to achieve the MDG
• DOH Administrative Order 2007-0012 aka Philippine National
Standards of Drinking Water of 2007
o Supervises all drinking water from large water systems to
water refilling stations to create a water safety plan
• General requirements of safe drinking water cover the
following
1. Microbial quality tested though the parameters of total
coliform, fecal coliform, fecal coliform, and heterotrophic plate
count
2. Chemical and physical quality tested through the parameters of
pH, chemical-specific levels, color, odor, turbidity, hardness, and
total dissolved solids
3. Radiological quality tested through the parameters of gross
alpha activity, gross beta, and radon
3 Key Components of Water Safety Plans:
1. System assessment: delivers water of quality that meets health-
based targets
• Determines if the drinking water supply chain as a whole
cand deliver water quality meeting standards
2. Operational monitoring: Identify control measures in the
drinking water system and collectively control identified risk; and
ensure health-based targets are met; rapid detection of any
deviation from required performance.
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3. Management plans: describes actions taken during normal
operations or incident conditions.
National Law on Water Quality Management is the RA 9275 aka
Philippine Clean Water Act of 2004
• DENR is the lead agency in implementation and
enforcement of this law
• DOH will be responsible for promulgation of standard
drinking standards
• Other than standards of drinking water, DOH also approved
PD 856
Implementing Rules and Regulation of The Code of Sanitation of the
Philippines (PD 856): Water Supply
1. Washing and bathing within a radius of 25 meters from any well
or source of drinking water is prohibited
2. No artesian, deep, or shallow well shall be constructed within 25
meters from any source of pollution. (including septic tanks and
sewerage systems). Drilling wells within a 50-meter distance
from a cemetery is also prohibited
3. No radioactive source or material shall be stored within a radius
of 25 meters from any well or source of drinking water unless
the radioactive source is adequately and safely enclosed by
proper shielding.
4. No dwellings shall be constructed within the catchment area of
a protected spring water source and shall be off limits to people
and animals.
EMERGENCY WATER TREATMENT
• The water that needs treatment during emergencies is the one
that is used in drinking and providing pools. Estimated to about
5 meters per person per day
• In 2011, the WHO published the Ethical Modes on Drinking
Water, Sanitation, and Hygiene in emergencies created by Water
Engineering And Development Center wherein it provides the
following prescriptions for emergency treatment of drinking
water:
Pretreatment processes:
• Aeration: remove volatile substances, reduce CO2 content, and
oxidize dissolved minerals in preparation for sedimentation and
filtration.
o Method: rapidly shaking a container that is partially full of
water for about 5min
• Settlement: allowing water to stand undistributed in the dark
for a day.
o >50% death to most harmful bacteria and settling of
suspended solids
o Repetition of settlement in another container or tub
increases effectiveness of the process since water is made
to settle for longer periods
• Filtration: utilizing filters to block particles, while allowing
water to pass through:
o Filters include: clean cloth, sand, and ceramics
Disinfection Process:
• Boling: very effective method for water disinfection
o Despite being energy consuming it is an effective method
o Water should be boiled to a rolling boil (vigorous state of
maintained boiling in which large bubbles erupt
continuously on the surface of the liquid and cannot be
disrupted by stirring or adding ingredients) and kept at
that state for one minute at sea level and for 3 minutes in
higher altitudes
o Allows water to change the base which can be improved
by performing a ration when water has been cooled
• Chemical disinfection: using various chemicals;
o Widely used is chlorine which kills viruses and bacteria
o However, some of the species of protozoa and helminths
have been seen to be resistant to chlorination
o Chlorine is available in various size and strength so it is
important to follow manufacturer’s instruction for use
• Solar Disinfection (SODIS): UV rays from the sun destroy
harmful organisms in water.
o Method: filling transparent plastic containers 1 to 2 liters
in size with clear water, then exposing them to direct
sunlight for about 5hrs, and expose the bottles for 2
consecutive days if skies are cloudy.
• Water storage and consumption:
o Wide-neck containers with tight fitting lids: best for water
storage
▪ Easy to clean between use
o Proper washing technique: high importance for hands and
utensils.
▪ Educate people about proper washing
technique
AIR PURITY
• PHN must be sensitive to various sources of air pollution in the
community
• DENR Administrative Order 2000-81 defines Air pollutant: any
matter in the atmosphere other than the natural
concentrations of oxygen, nitrogen, water vapor, carbon
monoxide, and inert gases that may be detrimental to health or
the environment
• The first 11 km of the atmosphere from the earth: troposphere
(where we live in)
o The temperature profile is warmest at sea level and
coolest at higher altitudes
o PHN serving in mountainous communities should keep in
mind that they are generally more exposed to cooler
weather.
o As air gets cooler = less water vapor is carried = PHN
should be sensitive to rise in respiratory infections in the
community as the mucous ciliary blanket protection of the
airways could be interrupted by the dry air
o The clinical composition of air can be disturbed by
pollutants. These pollutants can be suspended in
particulate matter or in gases themselves. Particulate
matter that is of public health concern is 10 microns in size
or particulate matter 10 since they can be suspended in
air. Gases that exceed their normal concentrations are
considered as pollutants to healthy air
o Troposphere has a composition of gases that support
healthy human life: 78% nitrogen and 21% oxygen and 1%
other gases (carbon dioxide, argon, and water vapors)
▪ As altitude increases, oxygen percentage
decreases
• Stratosphere – where the ozone layer is found
o Has an inverted vertical temperature profile that gets
warmer as you increase the altitude
o PHN with airports know that this is the layer where most
airplanes fly, and most problems of fuel combustion
happen
DENR Administrative Order 2000-81: Implementing Rules and
Regulation For RA 8746 Identified Some Of The Pollutants That
Should Concern Communities;
• Clinical composition of air can be disturbed by pollutants so
pollutants can be suspended in particulate matter or gases
themselves
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 • These are the pollutants that should concern the communities:
• Chlorofluorocarbons (ozone depleting substances) and fuel
components like aromatics, benzene and sulfur. (10 microns
thick)
o A particulate matter that could be a public health concern
since they can be suspended in air
o Particulate matter that exists in a tiny form as a liquid or
solid other than water
• Greenhouse gases: carbon dioxide, methane, and oxides of
nitrogen
o Gases that exceed their normal concentration are
considered as pollutants
o Include global warming
• They defined emission as: any measurable pollutant gas or
unwanted sound from any known source which is passed into
the atmosphere
o PHN should identify possible sources of air pollution and
be aware of the 2 major sources of air pollution
2 major sources of air pollution (According to Clean Air Act)
MOBILE SOURCE
• Any vehicle/machine propelled by or though oxidation or
reduction reactions including combustion of carbon-based or
other fuel, constructed, and operated principally for the
conveyance of persons of property or goods, that emit air
pollutants as a reaction product
STATIONARY SOURCE
• Any building or fixed structure, facility, or installation that emits
or may emit any air pollutant
Principles of particulate matter
• Other than air pollution, contamination with microorganism is
a public health concern in terms of clean air
• Infections with microbes can generally follow the principles of
particulate matter invasion of the respiratory tract
• The smaller the particle is, the more efficient it becomes in
reaching the lower airways.
• The American Conference of Governmental Industrial Hygienist
has defined a criteria on the efficiency of various particles sizes
in entering the respiratory tract:
1. Inhalable particulate matter: starts at 100-µm in diameter
2. Thoracic particulate matter starting at 10-µm diameter
3. Respirable particulate matter starting at 4-µm diameter
• The Pollution Prevention Statement Handbook by World Bank
says that particles most likely to cause adverse effects are the
fine particulate
o Fine particulates PM10 (particulate matter) and PM 2.5-
particles smaller than 10 and 2.5-µm are particles that
most likely to cause adverse health effects.
o Use of branded N-95 mask: high efficiency particulate
filters (HEPA) for prevention of exposure.
DENR Environmental Management Bureau (DENR-EMB)
• Monitors air quality;
• DENR - EMB Acts as chairperson of the air management,
whereas Dept of Transportation and Communication (DOTC)
acts as vice chairperson
• Maintains 42 air quality- monitoring stations nationwide, which
measures total suspended particulates (TSP).
• Healthy air has a TSP that does not exceed 90-µg/m3
• Direction of air quality monitoring is toward building technical
capacity to monitor PM10 and PM2.5
Several programs have been initiated to address air pollution:
• BANTAY TSIMINEYA PROGRAM – monitors point source air
pollution from industries
• BANTAY TAMBUTSO PROGRAM AND STANDARD SETTING
(euro 2) – adopted Euro 2 emission standards for moto5rized
vehicles
o Penalizes vehicle owners that fail to meet the set
standards
• IMPROVED FUEL QUALITY PROGRAM – phased out weathered
gasoline and regulated the sulfur benzene and aromatic
content of fuels
• NATIONAL RESEARCH AND DEVELOPMENT PROGRAM FOR
THE PREVENTION AND CONTROL OF AIR POLLUTION – most
developments directed by AO 2000-81 to the DENR-EMB in
coordination with the DOST
• PHN serve as an expert resource not only for mayors or
governors of localities but also as an air shed for the city and
municipalities it dwells
• An air shed means an area with a common mother or natural
biological condition and a common source of air pollution
o DENR secretary on developmental management bureau
has legal mandate to provide geopolitical regions of the
country into air sheds for more effective air quality
management
o PHN is both nurse who advocates for client and as a
government officer who assures the rights of the people
are protected
Philippine Clean Air Act of 1999 (RA 8749)
• Defines people’s rights to clean air
• The following rights of the citizens are sought to be recognized
1. The right to breathe clean air
2. The right to utilize and enjoy all natural resources according to
the principle of sustainable development
3. The right to participate in the formulation, planning,
implementation and monitoring of environmental policies and
programs and in the decision-making processes
4. The right to participate in the decision-making processes
concerning development policies, plans and programs projects
or activities that may have adverse impact on the environment
and public health.
5. The right to be informed of the nature and extent of the
potential hazard of any activity, undertaking or project and to be
served timely notice of any significant rise in the level of
pollution and the accidental or deliberate release into the
atmosphere pf harmful or hazardous substances
6. The right to access to public records which a citizen may need to
exercise his or her rights effectively under this act
7. The right to bring action in court or quasi-judicial bodies to enjoin
all activities in violation of environmental laws and regulations,
to compel the rehabilitation and cleanup of affected area, and to
seek the imposition of penal sanctions against violators of
environmental laws
8. The right to bring action in court for compensation of personal
damages resulting from the adverse environmental and public
health impact of a project or activity
TOXIC AND HAZARDOUS WASTE CONTROL
• The government accounts the chemicals that it monitors in
Philippine Inventory of Chemicals And Chemical Substances
• Has several poison control measures nationwide headed by
National Poison Management and Control Center (NPMCC) in
the Philippine General Hospital
• In 2009, centers reported 1,286 poisoning cases
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• Top causes of poisons are the following:
1. Jewelry cleaners (high in cyanide)
2. Pesticides
3. Button batteries
4. Watusi firecracker
5. Jatropha seeds
6. Multivitamins
7. Malathion and xylenes
8. Camphor with methyl ASA (acetylsalicylate acid)
9. Turpentine
• Primary healthcare facilities could be capable of following WHO
recommendations by essential symptomatic treatment of
acute poisoning.
• Healthcare workers and volunteers should wear PPE in
evacuation of victims who are contaminated
In the event of skin contamination
• Clothing is removed and skin is washed with the appropriate
fluid
Interventions that may be considered thereafter include:
• Gastric aspiration and lavage of adults and induced emesis of
children
• Administration of high dose activated charcoal into the
stomach
• Administration of protective agents such as
o Atropine: carbamate and organophosphate pesticides
o Methylene blue: for chlorates and nitrites
o N-Acetylcysteine or methionine: for paracetamol
overdose
o Hydroxocobalamin or sodium thiosulfate for cyanide in
silver cleaners
• Referral to higher institutions for save toxicological analysis and
subsequent administration of specific antidotes:
anticonvulsants, antiarrhythmics, and analgesics.
• Toxic And Environmental Health Working Group is headed by
DENR (chairperson) and Department of Agriculture (vice
chairperson)
FOOD SAFETY
• The NEHAP (National Environment Health Action Plan) defines
food safety as the assurance that food will not cause any harm
to the consumer when its prepared and eaten according to its
intended use
• To gear towards food safety, DOH formed the interagency
committee that is head by FDA (Food and Drug Administration)
• Food and Drug Administration Act strengthens FDA in
safeguarding the safety and quality of processed foods, drugs,
diagnostic reagents, medical devices, cosmetics, and household
substances.
Sanitation Requirements for Operation of Food Establishment
(As defined by DOH through Implementing Rules and Regulations of
Chapter III of P.D. 856)
• Sanitary Permit: Must be posted in a conspicuous place in the
establishment, available for inspections by health and other
regulatory personnel
o The food establishment must have a sanitary permit from
the city or municipality that has jurisdiction over the
business.
• In the case of food-establishments on-board sea-crafts, the
application must be filed in the vessel's port of origin.
• Employed personnel must have health certificates issued by
city/municipal health officer (not allowed to work in food
handling if with communicable diseases, including boils,
infective wounds, respiratory infections, diarrhea, and GI
upset)
o Clipped on the upper left portion of the employee while
working
• Particular guidelines on sources, transportation, preparation,
storage, and serving have been set by the implementing rules
and regulations. All of which are geared toward the
preservation of the quality and cleanliness of food, as well as
the safety of the service and consumption of the same.
• Food preparations and storage rooms are never be used or
directly connected to a sleeping apartment or toilet
• No animals in food area and display of live animal in the food
area is strictly prohibited.
• Floors, walls, and ceilings must be made of materials that can
be cleansed
• Adequate lighting, sufficient ventilation, and minimum space
requirements
• Must have handwashing basins, appropriate toilet facilities,
water supply and refuse management systems.
• Utensils must be scrapped from all food particles and be
washed in warm water (49°C) with soap. If running water is not
available, the wash water shall be changed frequently.
• Utensils are subjected to one of the ff bactericidal treatments:
1. Immersion for at least 30 seconds in clean hot water (77°C)
2. Immersion for at least 1min in lukewarm water containing
55-100ppm (parts per million) of chlorine solution
3. Exposure to stream for at least 15min to 77°C or for 5min
to at least 200°C
• Duty of sanitation inspector of city, municipality, or province to
perform inspection and evaluation for compliance of food
establishments
• Ambulant food vendors should sell only bottled drinks,
prohibited from selling food that require utensils
• As monitored by the FHSIS, all food handlers must maintain an
updated health certificate. The public health nurses are at an
advantageous position to participate in the monitoring and
implementation of the ordinance on food handlers as they are
given the task to collate and report data in the FHSIS system.
SANITATION
• Philippine Sanitation Sourcebook and Decision Aide developed
by DENR and DOH and Local Water Utilities Administration in
2005 defined sanitation as:
• Hygienic and proper management, collection, disposal, or reuse
of human excreta (feces and urine) and community liquid waste
to safeguard the health of individual and communities.
• This is proof of the development of the arts and sciences
involved in the various fields of sanitation, that is, a singular
code on sanitation such as the Presidential Decree 856 : the
Cade on Sanitation of the Philippines of 1976
Sanitation and hygiene promotion programming guidelines
• PD 856 needs to be revisited to provide more comprehensive
coverage
• In 2005, the guidelines developed these:
• 6F’s that form part of means to transmit microorganisms in
fecal materials to new host
o Feces
o Fingers
o Fluids
o Flies
o Fields / floors
o Food
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 • It featured the primary and secondary barriers that public Pit latrine (Pit Privy): Fecal
health practice could implement to prevent the transmission of matter is eliminated into a
the pathogens. hole in the ground that
• Primary barriers: structures and facilities that prevent leads to a dug pit
contamination from the 6Fs Latrine – toilet facilities
• Secondary barriers: practices that prevent contamination of without bowl (equipped
6Fs from coming in contact with food or the new host; with either a squatting plate
o example: handwashing practices, insect and vermin or a riser with a seat)
control, water treatment and proper food handling Pit reduces the volume of
4 components of sanitation facilities: the contents as liquid
• The following text focuses on the primary barriers. Sanitation infiltrates the surrounding
facilities generally. have four components, source
• Toilet: receptacle (bowl) where user sits down or a squatting Common in provincial areas
plate Antipolo toilet: Made up of
• Collection systems or sewerage systems: transport an elevated pit privy that
wastewater for treatment or disposal has a covered latrine.
• Treatment: processes of reducing liquid and solid waste to The elevation ensured that
nonpolluting matter the bottom is at least
• Disposal or reuse: releases treated waste to the environment. 1.5meters above the water
• The disposal can mean discharge to water bodies such as table.
rivers, application to soils, or release to the atmosphere in the
Septic privy: fecal matter is
form of gas. Ecological ‘sanitation moves for the reuse instead
collected in a built septic
of the disposal of treated wastewater as they can be safely used
tank that is not connected
for irrigation of agricultural and landscaped plants and fire
to a sewerage system
fighting.
Septic tank contains water
General classification of sanitation systems according to water
but there is no drop pipe
reliance:
from latrine that is dipped
• A general classification of sanitation systems could be done into water
according to water reliance.
Aqua Privy: fecal matter is
• Water-reliant systems: uses water to flush and transport waste eliminated into a water-
material to the collection system thus requiring continuous sealed drop pipe that leads
supply of water from the latrine to a small
o Communities that do not have access to continuous water water-filled septic tank
supply may have problems with this facility located directly below the
• Nonwatery-reliant systems: make use of dry storage for urine squatting line/plate
and feces. Drop pipe extends below
o E.G vacuum-flush toilets of busses and airplanes the septic tank water level
o Small amount of water may be used to cleanse dry system to form a simple water seal
• Privy: a toilet system not connected to a sewerage system An effluent pipe is also
3 components of a sanitary privy: installed in septic tank to
• The Implementing Rules and ‘Regulations of the Sanitation prevent overflow of water
Code of the Philippines developed. by the DOH describes three. to squatting plate
components of a sanitary privy: Water loss is then replaced
• Earthen pit, by adding water with each
• A floor covering the pit toilet use.
• And a water-sealed bowl Ventilation pipe with screen
on top is added to this
Sanitation facilities that may encounter in the community: design
Box-and-can privy (or Overhung latrine: fecal
bucket latrine): fecal matter matter is directly eliminated
is collected in a can or into a body of water such as
bucket which is removed a flowing river that is
periodically for emptying underneath a facility
and cleaning. WHO recognizes
acceptability in disastrous
conditions like heavy floods
when water is deemed
polluted
Chosen body of water
should be large and freely
flowing
7
PHN should coordinate on
downstream communities
on releasing advisory if the
body of water is polluted
Common in Pasig River and
Manila Bay
Ventilated-improved pit
(VIP) latrine: is a pit latrine
with a screened air vent
installed directly over the
pit
The ambient air that enters
the pit hole pushes the foul
air onto the vent
Screen on top of vent
prevents entry of insects
attracted by the smell
Filled pits are then covered
with soil for composting,
and the facility is redirected
or relocated to another pit.
Concrete vault privy: fecal
matter is collected in a pit
privy lined with concrete in
such a manner so as to
make it watertight
Common in provinces in
America
Chemical privy: fecal matter
is collected into a tank that
contains a caustic chemical
solution, which in turn
controls and facilitates the
waste decomposition
Compost privy: fecal matter
is collected into a pit with
urine and anal cleansing
materials with the addition
of organic garbage such as
leaves and grass to allow
biological decomposition
and production of
agricultural or fishpond
compost (or nightsoil)
Pour-flush latrine: has a
bowl with a water-seal trap
similar to the conventional
tank-flush toilet except that
it requires only a small
volume of water for flushing
Feces at water-sealed trap
are washed off by small
quantities of water hand
poured from container
Tank-flush toilet: feces are
excreted into a bowl with a
water-sealed trap. Water
tank receives a limited
amount of water empties
into the bowl for flushing of
fecal materials through the
water-sealed trap and into
the sewerage system. The
trap retains an amount of
the flush to maintain the
water seal
Urine Diversion
Dehydration Toilet (UDDT):
a waterless toilet system
that allows separate
collection and on-site
storage or treatment of
urine and feces.
Site can be made of urine
separation toilet with urine
side to collecting container
for agriculture use while
fecal side is for ventilated
vault
The fecal vault is kept dry
and feces is dried for
agriculture use
In 2010, 3 sanitation facilities that are considered sanitary under the
DOH and National Statistics Office (NSO)
• In 2010, the DOH published the Philippine Sustainable Sanitation
Roadmap. and defined the three sanitation facilities that are
considered sanitary under the DOH and. the National Statistics
Office {NSO) definitions:
1. Water-sealed toilet connected to a sewer or septic tank, used
exclusively by the household
2. Water-sealed toilet connected to another depository type, used
exclusively by the household
3. Closed pit used exclusively by the household.
The same considers the following as unsanitary facilities:
1. Water-sealed toilet connected to a sewer or septic tank, shared
with other households
2. Water-sealed toilet connected to another depository type,
shared by other households
3. Closed pit used shared by other households
4. Open pit
5. Hanging toilet
6. Open unsanitary types of practice
7. Open defecation
VERMIN AND VECTOR CONTROL (PD 856)
• The DOH had also prepared the Implementing Rules and
Regulations of Chapter XVI Vermin Control of the Code of
Sanitation of the Philippines (P.D. 856). This document defined
the following terms:
1. Vermin: group of insects or small animals such as flies,
mosquitos, cockroaches, fleas, lice, bedbugs, mice, and rats,
which are vectors of diseases.
2. Insects: flies, mosquitos, cockroaches, bedbugs, fleas, lice, ticks,
ants, and other arthropods
8
3. Pests: destructive or unwanted insects or other small animals o Rooms provided with artificial ventilation shall have ceiling
like rats, mice, etc. that cause annoyance, discomfort, nuisance, not less than 2.40, (8ft): measured from floor to ceiling
or transmission of disease to humans and damage to structures o Rooms with natural ventilation shall have ceiling heights
4. Rodent: small mammals such as rats and mice, characterized by of not less than 2.70m (9ft)
constantly growing incisor teeth used for gnawing or nibbling. o Mezzanine floors shall not be less than 1.80m above and
5. Vector: any organism that transmits infection by inoculation into below it
the skin or mucous membrane by biting or by deposit of infective • Minimum window sizes
materials on skin, food, or other objects or by biological o Rooms shall be provided for any uses and not provided
reproduction within the organism. with artificial ventilation system
Strategies of Vermin Abatement Program by DOH o Rooms shall be provided with a window or windows with
1. Community-wide and community-participated a total free area of opening equal to at least 10% of the
2. Technically coordinated floor area of the room, provided that such opening shall
3. Must be continuing be not less than 1.00 square meters
4. Basically, a partnership between private and government sectors o Toilet and bathrooms, laundry rooms, and similar rooms
5. Utilize indigenous technology and resources to attain self- shall be provided with window or windows with an area
reliance. not less than 1/20th of the floor area of such rooms,
Various Vermin Controls And Disinfestation Methods outlined by provided that such opening shall not be less than 240
DOH mm2.
• Environmental sanitation control: cleanliness of premises and o Such window or windows shall open directly to a court,
proper building construction and maintenance to prevent yard, public street or alley, or open water course.
access of pest into human dwellings. Summary:
o Clean-up drives are aimed at altering or eliminating the • Public health nurses in the Philippines maintain a record of
breeding sites of the vectors. indicators of environmental health in the country, particularly
• Naturalistic control: A pest control method that utilizes nature that of sanitation, safe water access, solid waste management,
and nature’s systems without distributing the balance of nature and food safety. It is necessary that the nurse becomes aware of
• Biological and genetic control: A method that utilizes living the various effects of solid waste. water, air, toxic and hazardous
predators, parasites, and other natural enemies of the pest wastes, food safety, sanitation, and vermin control on human
species to reduce or eliminate the pest populations, It is aimed health. In the management of these, the nurse must be guided
at killing the larvae without polluting the environment. by the various laws, standards, and implementing rules and
• Mechanical and physical control: uses mechanical devices such regulations that govern each.
as rodent traps, fly traps mosquito traps, air curtains, and UV
light
• Chemical control: uses rodenticides, insecticides, larvicides,
and pesticides
o Example: Baygon
• Integrated control: use of different methods and procedures to
complement each other, such as use for pesticides,
environmental sanitation measures and natural, as well as
mechanical and biological control methods.
BUILT ENVIRONMENTS
• Refers to man-made structures that provide a setting for
human activities.
• PD 1096: National Building Code of The Philippines, governs the
design of built environments
• In 2004, DPWH revised implementing rules and regulation of
National Building Code Of The Philippines-
Provisions enacted to protect public health are as ollows
• Minimum air space shall be provided as follows:
o School rooms: 3.00m3 with 1.00m2 of floor area per
person
o Workshops, factories, and offices: 12.00m3 of air space
per person.
o Habitable rooms: 14.00m3 of air space per person
• Minimum sizes of rooms and their least horizontal dimensions
shall be as follows.
o Rooms for human habitations: 6.00m2 with at least
horizonal dimension of 2.00m
o Kitchen: 3.00m2 with at least horizontal of 1.50m
o Bath and toilet: 1.20m2 with at least horizontal dimension
of 900mm
• Celling height of habitable rooms:

9
DISASTER MANAGEMENT • Refugees: a group of people who have fled their home or even
• Because of its geographical location, the Philippines frequent their country as a result of famine, drought, natural disaster,
experiences natural disasters such as typhoons, floods, and 227 war or civil unrest.
earthquakes. Types of Disaster
• Industrial accidents may also lead to disasters, such as mining ➢ Natural hazard.
disasters. Further, in recent years, terrorist attacks have o Physical force such as
become more common. o Typhoon
• Terrorist attacks occur all over the world on an almost daily o Flood landslide
basis, and concerns about potential terrorist attacks have o Earthquake
increased the focus on what needs to be done in terms of o Volcanic activity
prevention, preparedness, response, and recovery—not only in ➢ Biological hazard
the event of terrorist attacks but also in the event of disasters o Process or Phenomenon of organic origin including
of all kinds. exposure to pathogenic microorganisms, toxins, and
• Nurses are uniquely positioned to provide valuable bioactive substances
information for the development of plans for disaster o Conveyed by biological vectors such as exposure to
prevention, preparedness, response, and recovery for pathogenic microorganisms
communities. Nurses, as team members, can cooperate with o E.g disease outbreak (COVID,H1N1,Ebola, Malaria), red tide
health and social representatives, government bodies, poisoning.
community groups, and volunteer agencies in disaster planning ➢ Technological hazard
and preparedness programs (i.e., drills). o Technological or industrial conditions including accidents,
• Nurses can utilize their knowledge of nursing, public health, and dangerous procedures, and infrastructure failures
cultural-familial structures, as well as clinical skills and abilities, o Societal hazard: results from interaction of varying political,
in order to actively assist or participate in all aspects and stages societal or economic factors which may have a negative
of an emergency or disaster, regardless of the setting in which impact on the community.
the event may occur. o Eg stampedes, armed conflict, terrorist activities, and riots
• Nurses have a significant role in meeting the health care needs ➢ Na-tech (natural-technological) disaster
of the community, not only on a day-to-day basis but also in o A natural disaster that creates or results in a widespread
relation to disasters. technological problem
• Emergency: any event endangering the life and health of a o Earthquake that causes structural collapse of roadways or
significant number of people and demanding immediate action. bridges that brought down electrical wires and subsequent
o An emergency situation that may result from a fires
natural, man-made, technological, or societal hazard o Another example is a chemical spill resulting from a flood.
(DOH, 2012). Types of Disasters in The Philippines
• Disaster: any event that causes a level of destruction, death or Natural disasters Man-Made disasters
injury that affects the abilities of the community to respond to • Communicable diseases • Civil unrest
the incident using available resources. • Droughts • Riots
o Emergencies differ from disaster in that the agency or • Earthquakes • Explosions or bombings
individual can manage an emergency using his or her • Floods • Fires
own resources. But a disaster event, depending on • Heat waves • Mass transit accidents
the characteristics of the disaster, may be beyond the • Landslides • Mining
ability of the community to respond and recover from
• Mudflow/debris flow • Pollution
the incident using their own resources. Disasters
(lahar) • Structural failures (bridges_
frequently require assistance from outside the
• Red tide phenomena • Terrorist events
immediate community, both to manage resulting
• Tsunamis • Toxic or hazardous spills
issues and to recover completely.
• Volcanic activities • Wars/opened armed
• Some disasters (e.g., a house fire) may affect only a few
• Weather disturbance conflicts
persons, whereas others (e.g., a hurricane) can impact
(tornadoes or typhoons)
thousands.
Top 5 Disasters in the Philippines
• Mass casualty: one in which 100 or more individuals are
• Injury or death from a disaster may be direct or indirect. For
involved
example, injuries from typhoons occur because people fail to
• Multiple casualty: more than 2 but fewer than 100 are
evacuate or take shelter, do not take Precautions in securing
involved.
their property, and do not follow guidelines on food and water
Classification of Casualties:
safety or injury prevention during recovery
• Direct victim: individual who is immediately affected by the
1. Flood
event
2. Fire
o Displaced persons and refugees are special
3. Earthquake
categories of direct victims.
4. Landslide
• Indirect victim: may be a family member, or friend of the victim
5. Tornado
or 1st responder
Terrorism
• Displaced persons: those who have to evacuate their home,
school or business as a result of a disaster

10
• Acts of terrorism have become a frequent occurrence in
different countries, which have resulted in considerable loss of
lives and destruction of property.
• United Nations defined: “Criminal acts, including against
civilians, committed with the intent to cause death or serious
bodily injury, or taking of hostages, with the purpose to provoke
a state of terror in the general public or in a group of persons or
particular persons, intimidate a population or compel a
government or an international organization to do or to abstain
from doing any act" (UN SECURITY COUNCIL, 2004)
• Threats of terrorism, assassinations, kidnappings, hijackings,
bomb scares and bombings, computer-based attacks, and use of
chemical, biological, nuclear, and radiological weapons are
considered acts of terrorism
Weapons of Mass Destruction
• Concerns now are increasingly focused on weapons of mass
destruction.
• refer to any weapon that is designed or intended to cause death
or serious bodily injury through the release, dissemination, or
impact of toxic or poisonous chemicals, or its precursors; any
weapon involving a disease organism; or any weapon that is
designed to release radiation or radioactivity at a level
dangerous to human life

11
 BIOLOGICAL WEAPONS OF MASS DESTRUCTION

Biological Lethality Prevention Treatment Potential

organism for use

Smallpox High Vaccine Symptomatic; One person

(Incubation secondary could
1-5 days) infections possibly
cause a
national
epidemic
Anthrax Very high Vaccine Antibiotics Likely agent;
(incubation early; if late, resistant to
2-60 days) nothing weather;
can be
stored
Plague Very high; No vaccine Antibiotics Not
(Yersinia 100% if considered
pestis) untreated a likely
(Incubation agent;
1-3 days) difficult to
turn into a
weapon
Botulism High Vaccine Antitoxin; Not
tested requires considered
intensive a likely
supportive weapon
care
Tularemia Moderate Vaccine being Antibiotics Difficult to
studied stabilize for
use of
weapon
Ebola Very high No vaccine Minimal Not
considered
a likely
weapon;
difficult to
acquire;
poorly
understood
Brucellosis Low No vaccine Antibiotics; Not
(incubation begin upon considered
period 5-21 suspicion of a likely
days) disease weapon;
low lethality
Q fever Low Vaccine Antibiotics; Not
(Coxiella begin in considered
burnetiid) incubation a likely
incubation period weapon;
period 14- low lethality
26 days
CHEMICAL AGENTS OF MASS DESTRUCTION
Chemical Lethality Treatment Impact
agent
Sarin (nerve High Move to fresh Likely nerve agent; chemicals
agent) air; wash skin; needed to produce are banned
drugs limited by International Chemical
effectiveness Weapons Convention
Vx (nerve Very high Move to fresh Not likely weapon; difficult to
agent) air; drugs manufacture
limited
effectiveness
Tabun High Move to fresh Easy to manufacture nerve
(nerve air; wash skin; agent’; likely agent used
agent) drugs limited
effectiveness
Chlorine Low Move to fresh Readily available; likely agent
(pulmonary air; wash skin; because of availability; breaks
agent) no antidote down with water 12
Hydrogen Low to Move to fresh Industrial product; some
cyanide moderate air; wash skin; chemicals used to produce are
(blood some drugs banned; likely agent because
agent) mitigate of availability
effects
The chemical warfare agents are classified as nerve agents,
pulmonary agents, or cyanide (blood agents)
CHARACTERISTICS OF DISASTERS
• Frequency
• Predictability
• Preventability
• Imminence
• Scope and number of casualties
• Intensity
FREQUENCY
• Refers to how often a disaster occurs
• Tropical cyclones with variable frequency between the months
of June and November but due to climate change, occurrence
of typhoons have become more variable than in previous years
• Terrorist activities are occurring at an almost daily basis in Iraq
or Pakistan
PREDICTABILITY
• The ability to tell when and if a disaster event will occur
• Some disasters like floods may be predicted on expected
volume of rain fall
• Weather forecasters can predict when conditions are right for
the development of typhoons and with the monsoon rains.
These generally occur between June and November, but
climate change has made their occurrence more variable.
Because of advances in technology, weather forecasters can
predict hurricanes with increasing accuracy. Other disasters
(e.g., fires and industrial explosions) may not be predictable at
all.
PREVENTABILITY
• Preventability is a characteristic indicating that actions can be
taken to avoid a disaster. Some disasters (e.g., typhoons and
earthquakes) are not preventable, whereas others can be easily
controlled if not prevented entirely.
• Flooding can be prevented through proper refuse disposal,
maintenance of waterways, control of indiscriminate logging
and construction of infrastructure for flood control
➢ PRIMARY PREVENTION
o Preventing the occurrence of a disaster or limiting
consequences when the event cannot be prevented
o Occurs in non-disaster and pre-disaster stage which refers
to period when disaster is pending or period immediately
before the disaster
▪ Actions: assessing communities to determine
potential hazards
▪ Preventive actions during the nondisaster stage
include assessing communities to determine potential
disaster hazards, developing disaster plans at local and
national levels, conducting drills to test the plan,
training volunteers and health care providers, and
providing educational programs of all kinds. The
disaster plan is initiated predisaster or when a disaster
is imminent. Primary prevention actions during this
stage include notifying the appropriate officials,
warning the population, and advising what response to
take (e.g., shelter in place or evacuate).
➢ SECONDARY PREVENTION
o Strategies are implemented once the disaster occurs.
Secondary prevention actions include search, rescue, and
triage of victims and assessment of the destruction and
devastation of the area involved.
➢ TERTIARY PREVENTION
o Focuses on recovery of the community, that is, restoring the
community to its previous level of functioning and its
residents to their maximum functioning.
o Tertiary prevention is aimed at preventing a recurrence or
minimizing the effects of future disasters.
NURSES NEED TO KNOW
1. Kind of disasters that threaten the communities
2. Injuries to expect from different disaster scenarios
3. Evacuation routes
4. Location of shelters or evacuation centers
5. Warning systems
• Nurses must also be able to educate others about disasters and
how to prepare for and respond to them.
• Be updated with latest recommendations and advances in life
saving measures like first aid and CPR and automated external
defibrillators
IMMINENCE
• Speed of onset of an impending disaster and relates to the
extent of forewarning possible, and the anticipated duration of
the incident
• Weather forecasters can tell when a weather disturbance may
be developing days ahead of its expected arrival and can give
the approximate time of arrival, the general direction it will
take, and the location for its landing and forward movement.
Weather disturbances like typhoons, however, are subject to
other weather variables and can change direction and intensity
several times before actual landfall.
• Announcement to the public in terms of Public Storm Warning
Signals
• Typhoons however are subject to weather variables on the
direction and intensity
SCOPE AND NUMBER OF CASUALTIES
• The scope of a disaster indicates the range of its effect.
• Geographic area involved and in terms of the number of
individuals affected, injured, or killed
• Location, type, and findings of a disaster event are predictors
for the type of injury that will occur
• For example, several factors brought about contrasting effects
of TS Ondoy in 2009 and TS Sendong (international code name
Washi) in 2011.
INTENSITY
• Characteristic describing the level of destruction and
devastation of the disaster event
• Tropical cyclones that affect the country are categorized
according to intensity in terms of wind speed near the center
of the cyclone
CLASSIFICATION OF TROPICAL CYCLONES ACCORDING TO
STRENGTH (windspeed near the center of cyclone)
• Tropical disturbance: a weak tropical cyclone with wind speed
between 35-64 kph near the center
• Tropical storm: a moderate tropical cyclone with maximum
wind speed between 65 and 118 kph near the center.
• Typhoon: an intense tropical cyclone with wind speed between
119-200 kph near the center
• Super typhoon: most intense category of tropical cyclones with
wind speed greater than 200 kph
• Factors contributing to the amount of damage from a disaster
event such as a typhoon are the distance from the zone of
maximum winds, degree of exposure of the location to the
13
 disaster, building standards, vegetation type, and resultant
flooding.
DISASTER MANAGEMENT
• When one is aware of the types and characteristics of disasters,
the question then becomes: What can be done to prevent,
prepare for, respond to, and recover from disasters?
• Requires an interdisciplinary, collaborative team effort and
involves a network of agencies and individuals to develop a
disaster plan that covers the multiple elements necessary for
an effective plan
• Communities can respond more quickly, more effectively, and
with less confusion if the efforts needed in the event of a
disaster have been anticipated and plans for meeting them
have been identified. The result of planning is that more lives
are saved and less property is damaged. Planning ensures that
resources are available and that roles and responsibilities of all
personnel and agencies, both official and unofficial, are
delineated. Nurses need to know their personal, professional,
and community responsibilities. They should realize that
conflicts may arise between their personal and professional
responsibilities if these have not been considered and planned
for in advance. In addition, nurses may be direct or indirect
victims and may even be displaced persons themselves as a
result of a disaster event.
• For example, a nurse who is a single parent with young children
and has a limited support system may be forced to decide
between his or her responsibility to care for his or her children
or a mandate to report to work to care for patients. Choosing
may result in loss of employment or danger to the children.
Potential conflicts such as this should be considered, discussed,
and decisions be made in conjunction with the employer before
a disaster event.
STAGES OF DISASTER MANAGEMENT
I. Prevention stage
II. Preparedness and planning stage
III. Response stage
IV. Recovery stage
I. PREVENTION STAGE
• Occurs before a disaster is imminent; also known as non-
disaster stage
• Potential disaster risks should be identified, and risk maps
created
• Example: geohazard maps to identify areas prone to natural
dangers like landslides, flooding, and ground subsidence or
sinking
• Maps are used in preparing government authorities and the
people for possible disasters
• DENR spearheaded the creation of geohazard maps through its
Mines and Geosciences Bureau wherein it contains the
agencies and their websites from which the geohazard maps
may be accessed and downloaded.
• The population demographics and vulnerabilities, as well as the
community's capabilities, should be analyzed. Primary
prevention measures include educating the public regarding
what actions to take to prepare for disasters at the individual,
family, and community levels. Further, based on the
assessment of potential risks, the community must develop a
plan for meeting the potential disasters identified.
• With regard to bioterrorist attacks, prevention means that
health care providers need to be knowledgeable about the
biological and chemical agents that might be used. In addition,
health care providers need to know the signs and symptoms of
the various biological and chemical agents that have been
recognized as potential threats.
• As mentioned, unlike other disasters, biochemical terrorist
threats may be identified only when events raise the suspicions
of health care providers, rather than first responders at a
particular site.
• Primary prevention measures: educating public regarding
what actions to take, develop a plan for meeting potential
disasters, healthcare providers need to be knowledgeable
about biological and chemical agents that might be used (for
bioterrorist attacks) and its signs and symptom
GUIDELINES FOR EARLY DETECTION OF BIOCHEMICAL
TERRORIST INCIDENTS
• Rapidly increasing disease incidence (within hours or days) in a
normally healthy population
• Unusual increase in the no. of people seeking care esp. with
fever, respiratory or GI complaints
• Endemic disease rapidly emerging at an uncharacteristic time
or in an unusual pattern
• Cluster of patients arriving from a single locale
• Large number of rapidly fatal cases – patients who die within
72 hours after admission to the hospital
• Any patient presenting with a disease that is relatively
uncommon and has bioterrorism potential (e.g. pulmonary
anthrax, smallpox, or plague)
II. PREPAREDNESS AND PLANNING STAGE
• Individual and family preparedness includes training in first aid,
assembling a disaster emergency kit, establishing a
predetermined meeting place away from home, and making a
family communication plan
Emergency supplies
Food
• Store at least a 3-day supply of nonperishable food
• Have a manual can opener
• Keep disposable plates/cups and utensils
Clean air
• Store snugly fitting face masks
• Store plastic sheeting, duct tape, and scissors to seal off a room
First aid kit
• First aid supplies include sterile gloves, dressings, soap,
antibiotic ointment, bandages, eye wash, and nonprescription
medications (e.g. aspirin) – in case one of the family members
get sick
Make a plan
• Create a family plan
o Plan on how to contact one another if the family is
separated
o Review plan for different situations
At school and work
• Schools, day care providers, workplaces, apartment buildings,
and neighborhoods should all have site-specific emergency
plans
In high-rise building
• Plan for the possibility – You may be in a high-rise building at the
time of an attack.
• Note where the closest emergency exit is
• Be sure you know another way out in case your 1 st choice is
blocked
• Take cover against a desk or table if things are falling.
• Face away from windows and glass.
• Move away from exterior walls.
14
 • Do not use elevators
• Stay to the right
Water
• Store at least a 3-day supply; 1 gallon per day per person
• Store water in clean plastic bottles
Supply checklist
• Basic supplies include flashlight, batteries, radio, garbage bags,
map, moist towelettes, whistle, clothing, bedding and tools
Special needs items
• Prescription medications; special items for infants (diapers,
formula), elders, or persons with disabilities
In a moving vehicle
• If the vehicle becomes difficult to control, pull over (avoid
accidents)
• Avoid road hazards
• Obey barriers and signs
Deciding to stay or go
• Depending on nature of attack and situation
• 1st decision is whether you stay put or get away
• You should understand and plan for both possibilities
Elements of Community Disaster Plan
• Although there will be some variation according to the individual
community's needs, all community disaster plans should address
the following elements: authority, communication, control,
logistical coordination of personnel, supplies and equipment,
evacuation, rescue, and care of the dead.
• The plan should indicate who has the power to declare that there
is a disaster and who has the power to initiate the disaster plan.
1. Authority – A clear chain of authority carrying out the plan is critical
for successful implementation of the plan
• should be designated by the title of the person; it should
not specify a person by name. There should also be backup
positions identified in the event the first individual is not
available. Every individual should be equally informed
about the role and responsibilities that go with this
authority. A clear chain of authority for carrying out the
plan is critical for successful implementation of the plan.
Authority may change, depending on whether the disaster
is natural or man-made as a result of some criminal action,
and the change of authority should be addressed in the
plan.
2. Communication – should address how the authority figure will be
notified of the disaster, how emergency management team
members will be notified, how community residents will be warned
about the incident and what actions will be required
• Misinformation and misinterpretation can occur when
communication is ineffective.
• Reliance on telephone systems or cell phones should not
be the sole planned means of communicating because
these may not work or the systems might be overloaded.
• The communication section of the disaster plan should
address how the authority figure will be notified of the
disaster, how the emergency management team members
will be notified, how the community residents will be
warned about the incident, and what actions will be
required.
• This section needs to address how communication
between relief workers and authorities will be maintained.
Also, it should include information on the role of the media
in keeping people informed and in letting people know
what assistance and supplies are needed. In case of
electric power interruptions, the use of battery-operated
portable radios is advised so residents may listen for
instructions and updates about the disaster.
• One of the most important elements to consider in
communication is the early warning stage.
• This generally impacts on how the community will respond
to warnings of possible disaster, which eventually will be
very crucial in preventing the loss of lives
• The analysis of the population during the non disaster
stage should identify groups that need special attention as
to the process of notification.
• These people include those who speak different
languages, are homeless or poor, are without television or
other means of communication, and are in institutions
such as prisons, custodial care facilities, day care settings,
or schools.
• Effective communication during a disaster must be
credible, current, and authoritative and must give some
indication of future events.
3. Logistical section – should specify where supplies and equipment
are located or where additional supplies and equipment can be
obtained from, where these will be stored or found, and how these
will be transported to the disaster site.
4. Essential Human Resources – (e.g., emergency and disaster
specialists, officials of governmental and voluntary agencies,
engineers, weather specialists, and community leaders) should be
identified and tracked where they will be located.
5. Evaluation and Rescue - The plan should include information about
transportation for evacuation and rescue (particularly taking into
account vulnerable groups), documentation and record keeping,
and plans for evaluation of the success or failure of the plan.
• For a plan to be effective, it must be tested by having different
disaster scenario drills.
• The more times realistic scenarios are created to test the plan
in actual practice sessions, the more problems with the plan will
be identified, and solutions for those problems can be found.
Without practice drills, plans may have many unrecognized
faults and, as a result, many more individuals may be harmed
and communities damaged when an actual disaster occurs.
III. RESPONSE STAGE
• Begins immediately after the disaster incident occurs
• Community preparedness plans developed are initiated
• If a disaster occurs, people should remain calm and exert
patience, follow the advice of local emergency officials, and
listen to the radio or television for news and instructions. If
people nearby are injured, one should give first aid, seek help,
and check the area for dangerous hazards. Those at home should
shut off any damaged utilities, confine or secure pets, call family
contact(s), and check on neighbors, especially the elderly or
disabled.
• The plan may call for people to shelter in place or to evacuate,
or for search and rescue to begin. If the only response needed is
shelter in place, then people need to know what to do if they are
at home, at work, at school, or in their vehicle
➢ Evacuation:
o Each community should have established evacuation routes
for the residents to use if evacuation from the area is
necessary. In some instances, mandatory evacuation may
be implemented.
o However, there are always some individuals who will not
leave their home for any numbers of reasons (e.g., fear of
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 vandalism, denial of the potential extent of the disaster,
pride in their home and belongings).
o Education of residents as to the potential damage, deaths,
and injuries that will be incurred from the potential
disasters that may affect their community needs to be done
in the preparedness stage and not when evacuation is
ordered. In some extreme cases, it may be necessary for
hospitals and other facilities, such as nursing homes, to
evacuate patients.
o This requires significant advance planning, as health
practitioners must determine how to move seriously, and
even critically ill people and coordinate transportation and
placement for their disposition to safe facilities.
➢ Search and rescue
o Before search and rescue should begin, safety must be
considered.
o In some instances, if a criminal action is suspected, law
officials will be among the first to respond in order to secure
the area and possibly gather evidence.
o While the area is being checked and then cleared of
potential threats, a staging area can be set up at or near the
site of the incident to direct on-site activities.
o Search and rescue of victims can begin once clearance is
given, a disaster triage area is established, and an
emergency treatment area is set up to provide first aid until
transportation for victims to hospitals or health care
facilities for treatment can be coordinated
➢ Staging area
o The staging area is the on-site incident command station.
Disaster responders should report to this area to “check in”
so that everyone is accounted for and can be given an
assignment.
o This will allow for the most effective use of the skills and
abilities of those responding. No one should go to the
disaster site unless directed to do so by the staging area
commander.
o The staging area is also where the authority rests for
decisions as to additional resources to be called to the area
to manage the disaster incident.
o Resources may include construction equipment to move
building materials, rescue dogs to locate humans who are
buried in the debris, or more fire, police, or medical
personnel.
➢ Disaster triage
o Triage at the site and again at the treatment area is very
different from triage that is routinely conducted in the
emergency department.
o The focus of disaster triage is to do as little as possible, for
the greatest number, in the shortest period of time.
DISASTER TRIAGE
• One triage system used is used by first responders: START
• START “simple triage and rapid treatment”
• This system describes what to do when first arriving at a
multicasualty or mass casualty incident.
• Disaster triage of an injured person should occur in less than 1
minute
• Disaster triage of an injured person should occur in less than 1
minute. This system also describes how to enlist people with
minor injuries to assist. As a decision is made regarding the
status of an individual, the person is tagged with a colored triage
tag. Depending on what type of tag is available, the tags may
simply be pieces of colored paper.
• Green – walking wounded, minor injuries (cuts and abrasions);
can wait several hours before receiving treatment
• Yellow – systemic but not yet life-threatening complications; can
wait 45-60 minutes (e.g. simple fractures)
• Red – top priority or immediate and is for those with life-
threatening conditions but who can be stabilized; high
probability or survival (e.g. amputations)
• Black – deceased; extensive injuries that nothing can be done to
save them (e.g. multiple severe injuries)
• New classification of victim: contaminated, requires a hazmat
tag (hazardous materials)
o Assessing within 1-minute guideline:
▪ First step: RR is checked, if >30 cpm (tachypneic).,
individual is tagged red or immediate, if < 30 cpm;
moves to the second step – perfusion
▪ Second step: CRT (capillary refill time) or pinching the
nail bed wherein color should return within 2 seconds
▪ Third step: checking mental status (e.g. who are you?)
▪ By doing these steps, the individual responsible for
triage can very quickly assess an individual and decide
which color tag fits his or her condition.
o Remember: “30-2-can do”
▪ 30 – number of respirations
▪ 2 – seconds for blood to return (perfusion)
▪ Can do – mental status
• Following triage, victims are then moved to the treatment area
where their condition is checked again. First aid may be provided
there, until transportation is available. Ambulances, helicopters,
buses, or all three may be used to transport the victims to
various hospitals or health care facilities. Some victims, such as
those in the surrounding area that may have been affected by
the incident, may even go by private vehicle to a hospital or
medical facility.
• Although triage of individuals exposed to chemical warfare
agents is basically the same as for any multiple or mass casualty
incident, it poses special challenges. For these events, the triage
area is set up in the “hot zone” to assist in determining priorities
for resuscitation, decontamination, pharmacological therapy,
and site evacuation.
• Only specially trained emergency personnel who are familiar
with chemical agents and the use of personal protection
equipment should triage chemical agent victims. The same triage
categories can be assigned to these victims.
PSYCHOLOGICAL TRIAGE
• Presents the challenge of determining who most needs help and
deciding what interventions will help
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• Mental health disorders r/t disasters: anxiety disorders,
exacerbation of substance abuse problems, somatic complaints,
depression, and PTSD (Post Traumatic Stress Disorder)
• Research has identified four keys to gauging the mental health
impact of such events, any two of which may result in severe,
lasting, and pervasive psychological effects. T
• Key factors to gauging mental health impact of such events, any
2 of which may result to severe lasting psychological effects
1. Extreme and widespread property damage
2. Serious and ongoing financial problems
3. High prevalence of trauma in the form of injuries, threat to
life and loss of life
4. When human intent caused the disaster
• In addition, panic during the disaster, horror, separation from
family, and relocation or displacement are factors that may play
a part in psychological impairment.
• Nurses need to evaluate an_ individual's danger to self or others.
Nurses need to know the symptoms to look for and know what
resources are available for people who need help (Patterson,
2005).
IV. RECOVERY STAGE
• Begins when danger from the disaster has passed and concerned
local and national agencies are present in the area to help victims
rebuild their lives and help community restore public services
• Cleanup of the damage and repair of homes and businesses
begin.
• Evaluation and revision of the disaster plans based on lessons
learned from the experience are made.
• Understanding the financial impact on the community and
agencies involved is essential in developing future public health
policy.
• Research is needed on all aspects of prevention, preparedness,
response, and recovery stages of disasters. Research is also
needed on the education and training needs of first responders,
health care providers, and community populations.
• Nurse researchers, in partnership with researchers from other
disciplines, can play a significant role in these research
endeavors.
GOVERNMENT RESPONSIBILITIES
• Responsible for safety and welfare of its citizens
• Emergencies and disaster incidents are handled at the lowest
possible organizational and jurisdictional level.
• First responders: responsible for incident management at the
local level (police, fire, public health, public works, medical
emergency services)
• Local officials and agencies are responsible for preparing their
citizens for all kinds of emergencies and disasters and, where and
when possible, for testing disaster plans with mock drills.
• For a biological or chemical terrorist incident, the process is very
different. First responders generally are not involved. Rather,
nurses and doctors in health care facilities may be the first to
suspect that a biological or chemical agent has been released
into the community.
• In an incident other than a biological, chemical, radiation, or
nuclear event, in most cases, it is the fire or police department
that gets the initial message.
o The emergency telephone number for the Philippines is 117,
also called Patrol 117, which is under the management of the
Department of Interior and Local Government (DILG). Executive
Order No. 226, s. 2003 institutionalized Patrol 117 as the
nationwide emergency hotline number for police assistance,
fire protection, Philippine Red Cross (PRC), among others.
PUBLIC HEALTH SYSTEM
• The public health system’s mission is the promotion of health,
prevention of disease, and protection from threats to health.
• The public health system is a broad term used to describe all of
the governmental and nongovernmental organizations and
agencies that contribute to the improvement of the health of
populations.
• Public health agencies are the primary agencies for the health
and medical response to disaster incidents and therefore are a
part of the initial response activities,
• Public health officials provide advice and assistance to other
public officials related ‘0 environmental and health matters.
• Preparedness includes vigilance and reporting of suspicious
illnesses (e.g., signs and symptoms of biological agents, food-
borne diseases, and communicable diseases) in the community
by physicians and nurses in local health care facilities or private
offices and clinics.
• Public health officials then have the responsibility of detecting
outbreaks, determining the cause of illness, identifying the risk
factors for the population, implementing interventions to
control the outbreak, and informing the public of the health risks
and preventive measures that need to be taken.
• These relate both directly and indirectly to the essential public
health services.
THE PHILIPPINE RED CROSS (est. 1947)
• When it was officially founded in 1947, the PRC carried out two
main functions: blood provision and disaster-related services.
Embodying the fundamental principles of the International Red
Cross and Red Crescent Movement (i.e, humanity, impartiality,
neutrality, independence, voluntary service, unity and
universality), the present-day Red Cross offers six major services
(PRC, 2013):
• 2 MAIN FUNCTIONS: blood provision and disaster-related
services
• Offers 6 major services:
1. National Blood Services – provision of safe blood for medical
purposes.
2. Safety services – first aid, BLS (basic life support), water safety,
accident prevention, and other basic rescue courses.
3. Social services – among its wide range of services, social services
relevant to disaster and post disaster situations include
o Guidance and counseling.
o Psychosocial support program or critical incident
stress management - helps in stress during disasters.
o Tracing service - assists in locating displaced or missing
person(s) during a disaster that occurred either in the
Philippines or in a foreign country where normal
channels of communication have become difficult for
the families concerned.
o Referral service.
o Early livelihood recovery program - supports
restoration of livelihood after a disaster.
o Hot meals - facilitates a feeding program to prevent
malnutrition among calamity victims, especially
children.
4. Volunteer services – provides training courses for volunteers.
5. Community health and nursing services – offers training
programs in Basic Health Education Program and Primary Health
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 Care (Community-Based Health Program) for professional nurses
and student nurses.
6. Disaster management services – involves disaster relief
operations and services of identifying hazard-prone areas and
making vulnerability assessment of these areas. The PRC offers
several courses on Disaster Management, including Community-
Based Disaster Management Training. Specific disaster
management services offered include:
o Relief operations
o Deployment of disaster teams
o Organization of barangay disaster action team
o Preposition of relief supplies
• The PRC is one of the major nongovernmental agencies that
work hand-in-hand with government agencies in disaster risk
reduction. This purpose of the PRC is specifically stated in R.A.
10072 or the Philippine Red Cross Act (Congress of the
Philippines, 2009).
THE NATIONAL DISASTER RISK REDUCTION AND MANAGEMENT
PLAN (NDRRMP)
• Signed into law in 2010, R.A. 10121, also known as the Philippine
Disaster Risk Reduction and Management Act, brought about a
paradigm shift from disaster preparedness and response to
disaster risk reduction and management (DRRM). It also
mentioned disasters brought about by climate change. The law
specified the policy of developing and implementing a National
Disaster Risk Reduction and Management Plan (NDRRMP)
(Congress of the Philippines, 2010).
• Framework: “safer, adaptive, and disaster-resilient Filipino
communities toward sustainable development”.
• The goal is to shift from being reactive to proactive in DRRM. This
means the focus is on (1) building individual, collective, and
institutional capacities to adjust to situations (increased
resilience) and (2) decreasing vulnerabilities. Filipinos will
continue to be subjected to risk factors (hazards), but in due
time, resources will be invested more on disaster prevention,
mitigation, preparedness, and climate change adaptation, rather
than on response and rehabilitation and recovery.
• Aims to:
o Strengthen the capacity of the government-national and local
together with partner stakeholders;
o Build disaster resilience of communities;
o And institutionalize arrangements and measures for reducing
disaster risks
4 PRIORITY AREAS
1. Disaster prevention and mitigation – reducing vulnerabilities
and exposure and enhancing capabilities of communities
• Examples of activities that prevent and mitigate disasters
are hazard and risk mapping (geohazard mapping),
construction of dams or embankments that eliminate flood
risks, regulations that do not permit any settlement in high-
risk zones, improved environmental policies, and increased
public awareness.
2. Disaster preparedness – anticipate, respond to and recover from
the impacts of hazardous events or conditions
• This includes such activities as contingency planning,
stockpiling of equipment and supplies, development of
arrangements for coordination, evacuation drills, and
associated training.
3. Disaster response – the provision of emergency services and
public assistance during or immediately after a disaster in order
to save lives, reduce health impacts, ensure public safety, and
meet the basic subsistence needs of the people affected. It is
sometimes called “disaster relief.”
4. Rehabilitation and Recovery – measures that ensure the ability
of affected communities to restore their normal level of
functioning by rebuilding livelihood and damaged infrastructure
and increasing the communities’ organizational capacity
(NDRRMP, 2011)
INCIDENT COMMAND SYSTEM
• Is a standardized, on-scene, all-hazard incident management
concept.
• It allows its users to adopt an integrated organizational structure
to match the complexities and demands of single or multiple
incidents without being hindered by jurisdictional boundaries.
• A nonpermanent organization and is activated only in response
to disasters or emergencies
• The establishment of an ICS was also provided for by the
Implementing Rules and Regulations of R.A. 10121 (NDRRMC,
2012b),
• Headed by Incident Commander and made up of the Command
Staff and General Staff.
o The command function may be done either as a Single Incident
Command or as a Unified Command.
• Single Incident Command – applied when incident occurs within
a single jurisdiction; no functional agency overlaps.
• Unified Command – applied when a disaster or emergency
affects several areas or jurisdictions; requires multiagency
engagement.
o Here, agencies work together through the designated members
of the Unified Command to establish a common set of
objectives and strategies and a single Incident Action Plan
• Command Staff – people who directly report to the Incident
Commander including
o The Public Information Officer who is responsible for providing
the public, media, and/or other agencies with required
information related to the incident. Even a Unified Command
has a single Public Information Officer.
o The Safety Officer who monitors operations related to the
incident and advises the Incident Command on matters of
operational safety, including the health and safety of
responding personnel. The Safety Officer is responsible for the
safe conduct of the incident management and has the authority
to stop any unsafe act.
o The Liaison Officer who takes charge of coordinating with
representatives from cooperating and assisting agencies or
organizations
• General Staff – responsible for functional aspects of incident
command structure.
o Consists of operations, planning, logistics and
finance/administration
RESPONSES TO A DISASTER
• Classic four phases of a community’s reaction to a disaster
o Heroic phase
o Honeymoon phase
o Disillusionment phase
o Reconstruction phase
1. Heroic Phase
o During the heroic phase, nearly everyone feels the need to rush
to help people survive the disaster.
o In this phase, medical personnel may work hours without sleep
under very dangerous and life-threatening conditions, in order
to take care of their patients
o
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 o Medical personnel may help out in areas in which they are not • Volatile
familiar and have no experience. emotion
o Disaster medical assistance teams, consisting of professionals s
and paraprofessional medical personnel provide emergency
relief during a disaster and may travel long distances to help
out in a disaster
o This was illustrated by the people who volunteered to help in
the immediate aftermaths of the Luzon earthquake of 1990 and
TS Ondoy.
2. Honeymoon Phase
o Individuals who have survived the disaster gather together with
others who have simultaneously experienced the same event;
o People begin to tell their stories and review over and over again
what has occurred. Bonds are formed among victims and health
care workers.
o Gratitude is expressed for being alive.
3. Disillusionment Phase
o When time has elapsed and a delay in receiving help or failure
to receive the promised aid has not occurred, feelings of
despair arise. • The reactions by individuals to a disaster vary. Table 14.4 lists
o Medical personnel and other first responders may begin to some of the more commonly encountered emotional, cognitive,
experience depression due to exhaustion from many long days physical, and interpersonal reactions to a disaster that may be
of long hours. experienced.
o Depression may set in as a result of knowledge of what has • It should be noted that both victims and helpers are under stress
happened to the community, friends, and family. as a result of a disaster, thus disaster planning becomes futile if
o People realize the way things were before the disaster is not it fails to account for possible intra- and intergroup conflicts.
the way things are now and may never be the same again. POSTTRAUMATIC STRESS DISORDER
o They recognize that many things are different and much needs • The reactions mentioned usually resolve in 1 to 3 months after
to be done to adjust to the current situation. the disaster event but, in some cases, may lead to PTSD.
4. Reconstruction Phase • PTSD is a psychiatric disorder that can occur following an
o Once the community has restored some of the buildings, individual’s experiencing or witnessing a life-threatening event,
businesses, homes, and services, and some sense of normalcy such as a disaster.
is returning, feelings of despair will subside. • Men and women, adults and children, and all socioeconomic
o Counseling support for victims and helpers may need to be groups can experience PTSD. People who have PTSD often relive
initiated to help people to recover more fully. the experience through nightmares and flashbacks.
o During this phase, people begin to look to the future. • 6 most common causes of PTSD
COMMON INDIVIDUAL REACTIONS TO A DISASTER Table 14.4 1. Physical abuse
BIOLOGICAL EMOTIONAL PHYSICAL BEHAVIORAL 2. Sexual abuse
• Poor • Shock • Nausea • Suspicion 3. Witnessing or experiencing serious accidents
concentr • Numbne • Lighthead • Irritability 4. Witnessing or experiencing a mass disaster
ation ss ed • Arguments 5. War
• Confusio • Feeling • Dizziness with friends 6. Emotional abuse
n overwh • Gastroint and loved
• Disorien elmed estinal ones • The social and psychological symptoms mentioned in Table
tation • Depressi problems • Withdrawal 14.4 can be severe enough, and last long enough, to
• Indecisiv on • Rapid • Excessive significantly impair a person’s daily life.
eness • Feeling heart rate silence
•
• If PTSD occurs in conjunction with related disorders (eg.
Shorten lost • Tremors • Inappropriate
ed • Feeling • Headache humor depression, substance abuse, and other problems of physical
attentio harm to s • Increased/de and mental health), the situation becomes more complicated.
ns pan self • Grinding creased Individuals experiencing PTSD require medical attention
• Memory and/or of teeth eating (National Center for Post-traumatic Stress Disorder, 2005).
loss loved • Fatigue • Change in • Research is needed on all aspects of prevention, preparedness,
• Unwant ones • Poor sexual desire response, and recovery stages of disasters. Research is also
ed • Feeling sleep or function needed on the education and training needs of first responders,
memori nothing • Pain • Increased
health care providers, and community populations.
es • Feeling • Hyperaro smoking
• Difficulty abando • Increased
• Nurse researchers, in partnership with researchers from other
usal
making ned • Jumpines substance disciplines, can play a significant role in conducting research on
decision • Uncertai s use or abuse disaster management.
s nty of
feelings Summary
• Now more than ever, communities need to be aware of
potential disasters that may affect them. Comprehensive
19
 disaster plans at all levels of government and by all
communities, families, and individuals 352 need to be
developed. Having disaster plans in place increases the
likelihood of an effective response, resulting in saved lives and
minimized destruction to the community.
• Nurses have a role and contribution to make at every stage of
disaster management.
• Nurses need to have personal and professional plans in place
for any disaster. All medical personnel must keep their
credentials current and must learn the signs and symptoms of
weapons of mass destruction, so that they will recognize
people who may have been exposed.
• They should learn what injuries may be sustained from various
disasters and know which types of disasters are most likely to
affect their communities, so that disaster triage and treatment
can save lives.
• Finally, they must take drills in their respective health care
facilities seriously. The more prepared the population and
health care providers are for all kinds of disasters; the fewer
lives will be lost.

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