A process, phenomenon or human

WORLD CONFERENCE FOR activity that may cause loss of life,

DISASTER RISK REDUCTION Hazard

injury or other health impacts,
property damage, social and economic
Sendai Framework Monitoring disruption or environmental
Hyogo Framework of Action degradation.
Global Risk Assessment Framework The lessening or minimizing of the
Mitigation
adverse impacts of a hazardous event.
Activities and measures to avoid
OIEWG on Indicators and Terminology Related Prevention
existing and new disaster risks.
to DRR
The ability of a system, community or
The open-ended society exposed to hazards to resist,
intergovernmental absorb, accommodate, adapt to,
expert working transform and recover from the effects
(OIEWG) group on Resilience of a hazard in a timely and efficient
indicators and manner, including through the
terminology preservation and restoration of its
relating to disaster essential basic structures and
risk reduction functions through risk management.
(A/71/644) was Processes or conditions, often
established by the Underlying development-related, that influence
UNGA in its Disaster Risk the level of disaster risk by increasing
A/RES/69/284 and Drivers levels of exposure and vulnerability or
endorsed by the reducing capacity.
UNGA in A/RES/71/276. The conditions determined by physical,
The report presents recommended indicators to social, economic and environmental
monitor the global targets of the Sendai Framework, factors or processes which increase
the follow-up to and operationalization of the Vulnerability
the susceptibility of an individual, a
indicators and recommended terminology relating to community, assets or systems to the
disaster risk reduction. impacts of hazards.

Examples of Key Terminology Endorsed in

A/RES/71/276
❖ Disaster
❖ Vulnerability
❖ Exposure
❖ Prevention
❖ Mitigation
❖ Resilience
❖ Hazard
❖ Underlying Disaster Risk Drivers
❖ Disaster Risk
A serious disruption of the functioning
of a community or a society at any
scale due to hazardous events
interacting with conditions of
Disaster
exposure, vulnerability and capacity,
leading to one or more of the
following: human, material, economic
and environmental losses and impacts.
The potential loss of life, injury, or
destroyed or damaged assets which
could occur to a system, society or a
Vulnerability community in a specific period of time,
determined probabilistically as a
function of hazard, exposure,
vulnerability and capacity.
The situation of people, infrastructure,
housing, production capacities and
Exposure
other tangible human assets located in
hazard-prone areas.
The World Conference on Disaster Risk
Reduction
❖ A series of United Nations conferences focusing on
disaster and climate risk management in the context
of sustainable development.
❖ Convened three times, with each edition to date
having been hosted by Japan:
o Yokohama in 1994
o Hyogo in 2005
o Sendai in 2015
❖ As requested by the United Nations General Assembly
(UNGA), the United Nations Office for Disaster Risk
Reduction (UNISDR) served as the coordinating body
for the Second and Third UN World Conference on
Disaster Reduction in 2005 and 2015.
❖
International Strategy for Disaster Reduction
(ISDR)
❖ Aims at increasing public awareness to understand
risk, vulnerability and disaster reduction globally.
❖ Adopted during the July 1999 IDNDR Programme
Forum, in Geneva, and ratified by the United Nations’
Economic and Social Council (ECOSOC) and General
Assembly during the second meeting of its
Commission on Sustainable Development. More than
20 speakers at the CSD spoke in favour of the
Strategy and the proposed institutional arrangements
in November 1999, and a resolution to that effect was
adopted.

Midterm Notes 1 | Disaster Nursing/Rolly Baldeviso.BSN-4A

Summary of the International Strategy (July 1999
IDNDR Program forum):
❖ While hazards are inevitable, and the elimination of all
risk is impossible, there are many technical measures,
traditional practices, and public experience that can
reduce the extent or severity of economic and social
disasters. Hazards and emergency requirements are a
part of living with nature, but human behavior can be
changed.
❖ In the words of the Secretary General,
“We must, above all, shift from a culture of
reaction to a culture of prevention. Prevention is
not only more humane than cure; it is also much
cheaper… Above all, let us not forget that
disaster prevention is a moral imperative, no less
than reducing the risks of war”.
VISION
❖ To enable all communities to become resilient to
the effects of natural, technological and
environmental hazards, reducing the compound
risks they pose to social and economic
vulnerabilities within modern societies.
❖ To proceed from protection against hazards to
the management of risk through the integration
of risk prevention into sustainable development.
GOALS
1. Increase public awareness of the risks that
natural, technological and environmental hazards
pose to modern societies.
2. Obtain commitment by public authorities to
reduce risks to people, their livelihoods, social
and economic infrastructure, and environmental
resources.
3. Engage public participation at all levels of
implementation to create disaster-resistant
communities through increased partnership and
expanded risk reduction networks at all levels.
4. Reduce the economic and social losses of
disasters as measured, for example, by Gross
Domestic Product.
OBJECTIVES
1. Stimulate research and application, provide
knowledge, convey experience, build capabilities
and allocate necessary resources for reducing or
preventing severe and recurrent impacts of
hazards, for those people most vulnerable.
2. Increase opportunities for organizations and
multi-disciplinary relationships to foster more
scientific and technical contributions to the public
decision-making process in matters of hazard,
risk and disaster prevention.
3. Develop a more proactive interface between
management of natural resources and risk
reduction practices.
4. Form a global community dedicated to making
risk and disaster prevention a public value.
5. Link risk prevention and economic
competitiveness issues to enhance opportunities
for greater economic partnerships.
Midterm Notes
6. Complete comprehensives risk assessments and
integrate them within development plans.
7. Develop and apply risk reduction strategies and
mitigation measures with supporting
arrangements and resources for disaster
prevention at all levels of activity.
8. Identify and engage designated authorities,
professionals drawn from the widest possible
range of expertise, and community leaders to
develop increased partnership activities.
9. Establish risk monitoring capabilities, and early
warning systems as integrated processes, with
particular attention being given to emerging
hazards with global implications such as those
related to climate variation and change, at all
levels of responsibility.
10. Develop sustained programs of public
information and institutionalized educational
components pertaining to hazards and their
effects, risk management practices and disaster
prevention activities, for all ages.
11. Establish internationally and professionally
agreed standards / methodologies for the
analysis and expression of the souci-economic
impacts of disasters on societies.
12. Seek innovative funding mechanisms dedicated
to sustained risk and disaster prevention
activities.
IMPLEMENTATION
❖ Conduct a national audit or assessment process of
existing functions necessary for a comprehensive and
integrated national strategy of hazard, risk and
disaster prevention, projected over 5-10 and 20 year
time periods.
❖ Conduct dynamic risk analysis with specific
consideration of demographics, urban growth, and the
interaction or compound relationships between
natural, technological and environmental factors.
❖ Build, or where existing, strengthen regional/sub-
regional, national and international approaches, and
collaborative organizational arrangements that can
increase hazard, risk and disaster prevention
capabilities and activities.
❖ Establish coordination mechanisms for greater
coherence and improved effectiveness of combined
hazard, risk and disaster prevention strategies at all
levels of responsibility.
❖ Promote and encourage know-how transfer through
partnership and among countries with particular
attention given in the transfer of experience amongst
those countries most exposed to risks.
❖ Establish national, regional/sub-regional, and global
information exchanges, facilities, or websites
dedicated to hazard, risk and disaster prevention,
linked by agreed communication standards and
protocols to facilitate interchange.
❖ Link efforts of hazard, risk and disaster prevention
more closely with the Agenda 21 implementation
process for enhanced synergy with environmental and
sustainable development issues.
❖ Focus multi-year risk reduction strategies on urban
concentration and mega-city environments.
2 | Disaster Nursing/Rolly Baldeviso.BSN-4A
❖ Institute comprehensive application of land-use
planning and programmes in hazard prone-
environments.
❖ Develop and apply standard forms of statistical
recording of risk factors, disaster occurrences and
their consequences to enable more consistent
comparisons.
❖ Undertake periodic reviews of accomplishments in
hazard, risk and disaster reduction efforts at all levels
of engagement and responsibility.
❖ Study the feasibility of specific alternative funding and
resource allocation modalities that can ensure
continued commitment to sustained risk and disaster
prevention strategies
UN Office for Disaster Risk Reduction (UNDRR)
❖ (formerly UNISDR) is part of the United Nations
Secretariat and it supports the implementation &
review of the Sendai Framework for Disaster Risk
Reduction adopted by the Third UN World Conference
on Disaster Risk Reduction on 18 March 2015
in Sendai, Japan. The Sendai Framework is a 15-year
voluntary people-centred approach to disaster risk
reduction, succeeding the 2005-2015 framework.
❖ UNDRR’s vision is anchored on the four priorities for
action set out in the Sendai Framework.
❖ UNDRR coordinates international efforts in Disaster
Risk Reduction (DRR) and it reports on the
implementation of the Sendai Framework for Disaster
Risk Reduction. It convenes the biennial Global
Platform on Disaster Risk Reduction.
❖ 1 May 2019, the UNDRR officially changed its acronym
to UNDRR (from UNISDR) to better reflect its name.
The former acronym had not been changed since the
office was called the International Strategy for
Disaster Risk Reduction
Post-Disaster: Disaster Management and Post-
disaster Stage: Response & Recovery
Linking to the Goals of Sustainable Development
1994 First World Conference on Natural
Disasters in Yokohama
❖ The First World Conference on Natural Disasters
(Yokohama, Japan - May 23 to 27, 1994)
❖ adopted the Yokohama Strategy for a Safer World:
Guidelines for Natural Disaster Prevention,
Preparedness and Mitigation and its Plan of Action,
endorsed by the UNGA in 1994.
❖ Main outcome of the mid-term review of the
International Decade of Natural Disaster Reduction
(IDNDR) and established 10 principles for its strategy,
a plan of action and a follow-up.
Midterm Notes
10 Principles of the Yokohama Strategy for a
Safer World
1. Risk assessment is a required step for the adoption
of adequate and successful disaster reduction
policies and measures.
2. Disaster prevention and preparedness are of primary
importance in reducing the need for disaster relief.
3. Disaster prevention and preparedness should be
considered integral aspects of development policy
and planning at national, regional, bilateral,
multilateral and international levels.
4. The development and strengthening of capacities to
prevent, reduce and mitigate disasters is a top
priority area to be addressed duri’ng the Decade so
as to provide a strong basis for follow-up activities
to the Decade.
5. Early warnings of impending disasters and their
effective dissemination using telecommunications,
including broadcast services, are key factors to
successful disaster prevention and preparedness.
6. Preventive measures are most effective when they
involve participation at all levels, from the local
community through the national government to the
regional and international level.
7. Vulnerability can be reduced by the application of
proper design and patterns of development focused
on target groups, by appropriate education and
training of the whole community.
8. The international community accepts the need to
share the necessary technology to prevent, reduce
and mitigate disaster; this should be made freely
available and in a timely manner as an integral part
of technical cooperation.
9. Environmental protection as a component of
sustainable development consistent with poverty
alleviation is imperative in the prevention and
mitigation of natural disasters.
10. Each country bears the primary responsibility for
protecting its people, infrastructure, and other
national assets from the impact of natural disasters.
The international community should demonstrate
strong political determination required to mobilize
adequate and make efficient use of existing
resources, including financial, scientific and
technological means, in the field of natural disaster
reduction, bearing in mind the needs of the
developing countries, particularly the least
developed countries.
2005 Second World Conference on Disaster
Reduction in Kobe
❖ The Second World Conference on Disaster Reduction
conference was held in Kobe, Japan from 18 to 22
January 2005. This conference took on particular
poignancy, as it came almost 10 years to the day
after the Great Hanshin earthquake in Kobe and less
than a month after the 2004 Indian Ocean tsunami.
Japan's long history of severe natural disasters,
prominence in international humanitarian aid and
development and its scientific achievements in
3 | Disaster Nursing/Rolly Baldeviso.BSN-4A
 monitoring dangerous natural phenomena also made
it a suitable conference venue.
❖ The upcoming conference had not garnered much
attention, but due to the 26 December, Indian Ocean
tsunami, the attendance grew dramatically and the
international media focused on the event. Japan's
Emperor Akihito opened the conference and welcomed
4,000 participants from around the world.
❖ The World Conference adopted plans to put in place
an International Early Warning Programme (IEWP),
which had first been proposed at the Second
International Conference on Early Warning in 2003 in
Bonn, Germany.
❖ The goal of the World Conference was to find ways to
reduce the toll of disasters through preparation, and
ultimately to reduce human casualties. Due to the
proximity to the devastating Indian Ocean tsunami,
developing a global tsunami warning system was high
on the agenda.
❖ Other topics included:
o pledges to reduce disaster damage
o healthcare after disaster
o early warning systems
o safe building standards
o agree upon cost-effective preventative
countermeasures
o a global database on relief and
reconstruction and a centre on water
hazards
Hyogo Framework for Action 2005-2015
I. Preamble
The World Conference on Disaster Reduction was held from
18 to 22 January 2005 in Kobe, Hyogo, Japan, and adopted
the present Framework for Action 2005-2015: Building the
Resilience of Nations and Communities to Disasters (here
after referred to as the “Framework for Action”). The
Conference provided a unique opportunity to promote a
strategic and systematic approach to reducing
vulnerabilities1 and risks to hazards. It underscored the
need for, and identified ways of, building the resilience of
nations and communities to disasters.
Challenges posed by Disasters
❖ Disaster loss is on the rise with grave consequences
for the survival, dignity and livelihood of individuals,
particularly the poor, and hard-won development
gains. Disaster risk is increasingly of global concern
and its impact and actions in one region can have an
impact on risks in another, and vice versa.
❖ In the past two decades, on average more than 200
million people have been affected every year by
disasters.
❖ This, compounded by increasing vulnerabilities related
to changing demographic, technological and socio-
economic conditions, unplanned urbanization,
development within high-risk zones, under-
development, environmental degradation, climate
variability, climate change, geological hazards,
competition for scarce resources, and the impact of
Midterm Notes
epidemics such as HIV/AIDS, points to a future where
disasters could increasingly threaten the world’s
economy, and its population and the sustainable
development of developing countries.
❖ Disaster risk arises when hazards interact with
physical, social, economic and environmental
vulnerabilities.
❖ Events of hydrometeorological origin constitute the
large majority of disasters. Despite the growing
understanding and acceptance of the importance of
disaster risk reduction and increased disaster
response capacities, disasters and in particular the
management and reduction of risk continue to pose a
global challenge.
❖ There is now international acknowledgement that
efforts to reduce disaster risks must be systematically
integrated into policies, plans and programmes for
sustainable development and poverty reduction, and
supported through bilateral, regional and international
cooperation, including partnerships.
❖ Sustainable development, poverty reduction, good
governance and disaster risk reduction are mutually
supportive objectives, and in order to meet the
challenges ahead, accelerated efforts must be made
to build the necessary capacities at the community
and national levels to manage and reduce risk.
❖ Such an approach is to be recognized as an important
element for the achievement of internationally agreed
development goals, including those contained in the
Millennium Declaration.
❖ The importance of promoting disaster risk reduction
efforts on the international and regional levels as well
as the national and local levels has been recognized in
the past few years in a number of key multilateral
frameworks and declarations.
The Yokohama Strategy:
lessons learned and gaps identified
❖ The Yokohama Strategy for a Safer World: Guidelines
for Natural Disaster Prevention, Preparedness and
Mitigation and its Plan of Action (“Yokohama
Strategy”), adopted in 1994, provides landmark
guidance on reducing disaster risk and the impacts of
disasters.
❖ The review of progress made in implementing the
Yokohama Strategy identifies major challenges for the
coming years in ensuring more systematic action to
address disaster risks in the context of sustainable
development and in building resilience through
enhanced national and local capabilities to manage
and reduce risk.
❖ The review stresses the importance of disaster risk
reduction being underpinned by a more pro-active
approach to informing, motivating and involving
people in all aspects of disaster risk reduction in their
own local communities. It also highlights the scarcity
of resources allocated specifically from development
budgets for the realization of risk reduction objectives,
either at the national or the regional level or through
international cooperation and financial mechanisms,
while noting the significant potential to better exploit
existing resources and established practices for more
effective disaster risk reduction.
4 | Disaster Nursing/Rolly Baldeviso.BSN-4A
❖ Specific gaps and challenges are identified in the B. Strategic Goals, the Conference resolved to adopt
following five main areas: a) The more effective integration of disaster risk
a) Governance: organizational, legal and policy considerations into sustainable development
frameworks; policies, planning and programming at all levels,
b) Risk identification, assessment, monitoring and with a special emphasis on disaster prevention,
early warning; mitigation, preparedness and vulnerability
c) Knowledge management and education; reduction;
d) Reducing underlying risk factors; b) The development and strengthening of
e) Preparedness for effective response and institutions, mechanisms and capacities at all
recovery. levels, in particular at the community level, that
❖ These are the key areas for developing a relevant can systematically contribute to building
framework for action for the decade 2005–2015. resilience to hazards;
c) The systematic incorporation of risk reduction
approaches into the design and implementation
II. World Conference on Disaster Reduction:
of emergency preparedness, response and
Objectives, expected outcome and strategic
recovery programmes in the reconstruction of
goals affected communities.
A. Objectives convened by the General Assembly
a) To conclude and report on the review of the Make Sure This Isn’t You!
Yokohama Strategy and its Plan of Action, with a
view to updating the guiding framework on
disaster reduction for the twenty-first century;
b) To identify specific activities aimed at ensuring
the implementation of relevant provisions of the
Johannesburg Plan of Implementation of the
World Summit on Sustainable Development on
vulnerability, risk assessment and disaster
management;
c) To share good practices and lessons learned to
further disaster reduction within the context of
attaining sustainable development, and to
identify gaps and challenges;
d) To increase awareness of the importance of
disaster reduction policies, thereby facilitating How do we respond, recover and rebuild to disaster in
and promoting the implementation of those order to decrease risk and increase our resiliency in
policies; transforming our society to one that is sustainable in the
e) To increase the reliability and availability of long-term?
appropriate disaster-related information to the
public and disaster management agencies in all
regions, as set out in relevant provisions of the
Johannesburg Plan of Implementation.
B. Expected Outcomes
❖ Taking these objectives into account, and
drawing on the conclusions of the review of the
Yokohama Strategy, States and other actors
participating at the World Conference on Disaster
Reduction (hereinafter referred to as “the
Conference”) resolve to pursue the following
expected outcome for the next 10 years:
Note: Key factors influencing resilience and
❖ The substantial reduction of disaster losses, in
decreasing disaster risk
lives and in the social, economic and
environmental assets of communities and
countries.
❖ The realization of this outcome will require the
full commitment and involvement of all actors
concerned, including governments, regional and
international organizations, civil society including
volunteers, the private sector and the scientific
community.

Midterm Notes 5 | Disaster Nursing/Rolly Baldeviso.BSN-4A

 The HFA identified five separate priorities for action
1. Ensure that disaster risk reduction (DRR) is a
national and local priority with a strong
institutional basis for implementation;
2. Identify, assess and monitor disaster risks and
enhance early warning;
3. Use knowledge, innovation and education to
build a culture of safety and resilience at all
❖ Hyogo Framework for Action 2005-2015 levels;
❖ Building the resilience of nations and communities to 4. Reduce underlying risk factors;
disasters 5. Strengthen disaster preparedness for effective
❖ Adopted by 168 Governments at the World response at all levels.
Conference on Disaster Reduction, held in Kobe,
Hyogo Prefecture, Japan, 18-22 January 2005

The Disaster Risk Management Model for SD from CGSS

Midterm Notes 6 | Disaster Nursing/Rolly Baldeviso.BSN-4A

What we DO NOT want?
❖ Actions taken in the aftermath of a disaster to:
❖ Reconstruct same as before
❖ Rebuilding the pre-existing vulnerabilities
❖ Community in same state as before the disaster
“Sustainable DEVELOPMENT” means …
“A managed process of continuous innovation and systemic
change in the direction of sustainability.”
i.e. Creating systems that can endure (i.e. resilient,
transformative, flourishing)

Sustainability is . . .
… a set of conditions and trends in a given system that can
continue indefinitely.

What WE WANT?

Sustainability is not about the Earth.

The Earth is Fine.

Sustainability is about the Survival of Humanity (the

human species) going forward- our children’s and their
children’s future

Principles Disaster Recovery and Rehabilitation This is what is at risk!

Recovery and rehabilitation is most effective:
• when communities and stakeholders recognize
that it is a long-term process;
• when activities are integrated with risk
management and sustainable development;
• when conducted with the participation of all
affected stakeholders;
• when services are provided in a timely, fair and
flexible manner.
4 Basic System Conditions for Sustainability
❑ Nature: Living within the Earth’s physical and
biological limits;
❑ Economy; Maintaining a vital, prosperous economy;
❑ Society: Supporting social stability, equity, and
development;
❑ Human Wellbeing: Making individual opportunity,
fulfillment, and happiness possible.

Disaster Response & Recovery Areas Some basic principles: An organization, community,
Governance, Leadership, or society will be sustainable if it…
Infrastructure
Decision-making
1. … understands its own systems, and the systems in
Health & sanitation Waste management
which it is embedded;
Mental health Mortality management
Public safely transportation 2. …. understands and accounts for limits and system
Communications Business vitality dynamics;
Emergency medical care Education & training 3. … looks for and responds to long-term systemic trends
Food security (procurement, that affect its ability to achieve its goals;
Children welfare
distribution) 4. … changes internally to meet and take advantage of
Housing Public services & utiliies
external conditions and trends;
Environmental management Infrastructure
5. … is resilient enough to withstand short-term shocks;
6. … does not undermine the conditions of its own
DRM & Sustainable Development existence;

Sustainability…
Systems science:
“A set of conditions and trends in a given system
that can continue indefinitely.”

Dictionary:
“The ability to endure”

Midterm Notes 7 | Disaster Nursing/Rolly Baldeviso.BSN-4A

 Hazard, exposure and vulnerability drive direct risk Sustainable Development Dialogues
in Disaster Risk Management Analysis

UN CONFERENCE ON SUSTAINABLE
DEVELOPMENT

Outcomes
1) “The future we want” Outcome Document
2) 700 Voluntary Commitments

Official Negotiations
❖ 3rd Preparatory Committee Meeting (13-15 June)
to agree the last version of the draft difficulty
of reaching a consensus the PrepCom invited
Brazil to conduct “preconference informal
“The future we want” Outcome Document
consultations in its capacity as host country”.
❖ UN SUMMIT -HEADS OF STATE (20/22 June): - 53 pages, 283 paragraphs;
Plenary and adoption of the outcome document - 6 sections:
I. Our common vision;
II. Renewing political commitment;
FARMERS
III. Green economy in the context of
INDIGENOUS WOMEN
sustainable development and poverty
PEOPLE eradication;
IV. Institutional framework for sustainable
development;
CHILDREN AND NGO
MAJOR GROUPS V. Framework for action and follow-up
YOUTH
Involved in Rio+20 VI. Means of implementation.

1.4.2. “The future we want” Outcome Document

SCIENCE AND BUSINESS AND SECTION I: OUR COMMON VISION
TECHNOLOGY INDUSTRY
- Recognizing that poverty eradication, changing
unsustainable and promoting sustainable patterns of
consumption and production, and protecting and managing
LOCAL WORKERS /
AUTHORITIES TRADE UNIONS the natural resource base of economic and social
development are the overarching objectives of and
essential requirements for sustainable development

1.4.4. “The future we want” Outcome Document

SECTION III: GREEN ECONOMY
❖ There are “different approaches” and tools available to

achieve SD → Green economy is one of the

important tools,
❖ Guidance on green economy policies:
o Reference to Rio Principles and past action
plans
o national sovereignty over natural resources;
o participation by all relevant stakeholders;
Midterm Notes 8 | Disaster Nursing/Rolly Baldeviso.BSN-4A
 o sustained and inclusive growth; Sustainable
Consumption and Production;
o international cooperation on finance;
o indigenous peoples and non-market
approaches;
o poverty eradication (social protection
floors).
1.4.7. “The future we want”
B. SUSTAINABLE DEVELOPMENT GOALS (SDGS)
❖ Still firmly committed to MDGs but also recognize
utility of a set of SDGs (based on Agenda 21
and the JPOI, Rio Principles);
❖ SDGs focused on priority areas selected on the
Outcome Document;
❖ established an intergovernmental process on
SDGs → working group will be constituted, to
submit a proposal for SDGs to the UNGA;
❖ need to assess targets and indicators for
SDGs.
1.4.8. “The future we want” Outcome Document
VI. MEANS OF IMPLEMENTATION
A. FINANCE: need for significant mobilization of
resources for SD → established an
intergovernmental process to propose a SD
financing strategy.
B. TECHNOLOGY: importance of access by all
countries to environmentally sound techn.
(included technology trasfer to developing
countries)
C. CAPACITY BUILDING: need for enhanced
capacity building for SD → UN agencies invited to
share knowledge and support cooperation
D. TRADE: international trade as engine for SD →
need of rule-based, open, trading system
Each of the 17 Goals and 169 Targets represent our
attempt to maintain or achieve certain system conditions
that we think are required for sustainability.
Midterm Notes
Disaster risk reduction references in goals and
targets
Goal 1. End poverty in all its forms everywhere
❖ 1.5 By 2030 build the resilience of the poor and
those in vulnerable situations, and reduce their
exposure and vulnerability to climate-related
extreme events and other economic, social and
environmental shocks and disasters
Goal 2. End hunger, achieve food security and
improved nutrition, and promote sustainable
agriculture
❖ By 2030 ensure sustainable food production
systems and implement resilient agricultural
practices that increase productivity and
production, that help maintain ecosystems, that
strengthen capacity for adaptation to climate
change, extreme weather, drought, flooding and
other disasters, and that progressively improve
land and soil quality
Goal 3. Ensure healthy lives and promote well-being
for all at all ages
❖ 3.d Strengthen the capacity of all countries,
particularly developing countries, for early
warning, risk reduction, and management of
national and global health risks
Goal 4. Ensure inclusive and equitable quality
education and promote life-long learning
opportunities for all
❖ 4.a Build and upgrade education facilities that
are child, disability and gender sensitive and
provide safe, non-violent, inclusive and effective
learning environments for all
Goal 6. Ensure availability and sustainable
management of water and sanitation for all
❖ By 2020 protect and restore water-related
ecosystems, including mountains, forests,
wetlands, rivers, aquifers and lakes
Goal 9. Build resilient infrastructure, promote
inclusive and sustainable industrialization and foster
innovation
❖ Develop quality, reliable, sustainable and
resilient infrastructure, including regional and
trans-border infrastructure, to support economic
development and human well-being, with a focus
on affordable and equitable access for all
❖ 9.a Facilitate sustainable and resilient
infrastructure development in developing
countries through enhanced financial,
technological and technical support to African
countries, LDCs, LLDCs and SIDS
Goal 11. Make cities and human settlements
inclusive, safe, resilient and sustainable
❖ 11.4 Strengthen efforts to protect and
safeguard the world’s cultural and natural
heritage
❖ 11.5 By 2030 significantly reduce the number of
deaths and the number of affected people and
decrease by% the economic losses relative to
GDP caused by disasters, including water-related
disasters, with the focus on protecting the poor
and people in vulnerable situations
9 | Disaster Nursing/Rolly Baldeviso.BSN-4A
 ❖ 11.6 By 2030, reduce the adverse per capita most encompassing international accord to date
environmental impact of cities, including by on disaster risk reduction.
paying special attention to air quality, municipal
and other waste management
Sendai Framework Monitoring: An overview
❖ 11.b By 2020, increase by x% the number of
cities and human settlements adopting and The Sendai Framework for Disaster Risk Reduction (2015–

implementing integrated policies and plans 2030) is an international document that was adopted by

towards inclusion, resource efficiency, mitigation the United Nations (UN) member states between 14 and 18

and adaptation to climate change, resilience to March 2015 at the World Conference on Disaster Risk

disasters, develop and implement in line with the Reduction held in Sendai, Japan, and endorsed by the

forthcoming Hyogo Framework holistic disaster UNGA in June 2015. It is the successor agreement to the

risk management at all levels Hyogo Framework for Action (2005–2015), which had been

❖ 11.c Support least developed countries, the most encompassing international accord to date on

including through financial and technical disaster risk reduction.

assistance, for sustainable and resilient buildings

utilizing local materials
Goal 13. Take urgent action to combat climate
change and its impacts*
❖ 13.1 Strengthen resilience and adaptive
capacity to climate related hazards and natural
disasters in all countries
❖ 13.2 Integrate climate change measures into
❖ Global Sendai Framework Targets
national policies, strategies, and planning
❖ Sendai Framework for Disaster Risk Reduction 2015–
❖ 13.3 Improve education, awareness raising and
2030
human and institutional capacity on climate
❖ Priority Areas
change mitigation, adaptation, impact reduction,
1. Understanding disaster risk;
and early warning
2. Strengthening disaster risk governance to
Goal 14. Conserve and sustainably use the oceans,
manage disaster risk;
seas and marine resources for sustainable
3. Investing in disaster risk reduction for resilience;
development
4. Enhancing disaster preparedness for effective
❖ 14.2 By 2020, sustainably manage and protect
response, and to "Building Back Better" in
marine and coastal ecosystems to avoid
recovery, rehabilitation and reconstruction.
significant adverse impacts, including by
strengthening their resilience, and take action for
their restoration, to achieve healthy and
productive oceans
Goal 15. Protect, restore and promote sustainable
use of terrestrial ecosystems, sustainably manage
forests, combat desertification, and halt and reverse
land degradation and halt biodiversity loss
❖ 15.1 By 2020 ensure conservation, restoration
and sustainable use of terrestrial and inland
freshwater ecosystems and their services, in
particular forests, wetlands, mountains and
drylands, in line with obligations under
international agreements
❖ 15.3 By 2020, combat desertification, and
restore degraded land and soil, including land a) Substantially reduce global disaster mortality by
affected by desertification, drought and floods, 2030, aiming to lower the average per 100,000
and strive to achieve a land-degradation neutral global mortality rate in the decade 2020–2030
world compared to the period 2005– 2015;
❖ Sendai Framework for Disaster Risk Reduction b) Substantially reduce the number of affected
2015–2030 people globally by 2030, aiming to lower the
❖ The Sendai Framework for Disaster Risk average global figure per 100,000 in the decade
Reduction (2015–2030) is an international 2020–2030 compared to the period 2005–2015;
document that was adopted by the United c) Reduce direct disaster economic loss in relation
Nations (UN) member states between 14 and 18 to global gross domestic product (GDP) by 2030;
March 2015 at the World Conference on Disaster d) Substantially reduce disaster damage to critical
Risk Reduction held in Sendai, Japan, and infrastructure and disruption of basic services,
endorsed by the UNGA in June 2015. It is the among them health and educational facilities,
successor agreement to the Hyogo Framework including through developing their resilience by
for Action (2005–2015), which had been the 2030;

Midterm Notes 10 | Disaster Nursing/Rolly Baldeviso.BSN-4A

 e) Substantially increase the number of countries
The Purpose of HVA
with national and local disaster risk reduction
strategies by 2020; ❑ The purpose is a prioritization process that will result

f) Substantially enhance international cooperation to in a risk assessment for “all hazards”

developing countries through adequate and ❑ The tool includes consideration of multiple factors

sustainable support to complement their national ❑ The focus is on organization planning and resources

actions for implementation of the present and /or the determine that no action may be required.

Framework by 2030; This is an organization decision

g) Substantially increase the availability of and

access to multi-hazard early warning systems and Is This Required?

disaster risk information and assessments to
people by 2030.
Sendai Framework for DRR 2015–2030 Global Goals
❑ The Joint Commission, previously called the Joint
Commission of Accreditation of Healthcare
Organizations (JCAHO), requests an HVA for
organizations to determine the focus of their
emergency planning
❑ There is no specific tool nor method defined

HVA Categories for Evaluation

Development
❖ The Sendai document emerged from three years
of talks, assisted by the United
International Strategy for Disaster Reduction,
during which UN member states, NGOs, and other
stakeholders made calls for an improved version
of the existing Hyogo Framework, with a set of
common standards, a comprehensive framework
with achievable targets, and a legally-based
instrument for disaster risk reduction.
❑ There are categories considered in a formal process of
assessing an HVA
❑ Most HVA tools include an assessment of the following
factors:
– Probability that an event will occur
– The risk of disruption to the organization
associated with the event scored as high,
moderate or low or a similar description.
– The level of preparedness
Nations
Probability of Occurrence
❑ The probability may be based on statistics and
objective information but also may be intuitive and
highly subjective.
❑ The following factors are often considered:
– Known risk
– Historical data
– Manufacturer or vendor statistics

PREPAREDNESS
Historical Data
Hazard Risk Vulnerability
❑ Natural events
Assessment ❑ Hazardous material releases
❑ Technological accidents
❑ Infrastructure problems
Hazard Vulnerability Assessment
Objective:
Risk Assessment
❑ Discuss methods of conducting a hazard vulnerability
❑ The risk of an event is assessed based on:
analysis (HVA)
– Threat to life and/or health
❑ Identify how the HVA is applicable to preparedness
– Disruption of services
and evacuation
– Damage for failure possibilities
❑ Practice effective training techniques in conducting a
– Loss of community trust
HVA
– Financial impact and legal issues

The HVA and the Relationship to Evacuation

Preparedness
❑ The HVA is a tool used to evaluate the potential risks
❑ Preparedness of the organization’s ability to manage
for a facility
risks, can include items such as:
❑ It is not an evaluation of the potential for evacuation
– Status of current plans
❑ However, risks identified in the process may focus the
– Training
organization toward the need to mitigate and prepare
– Insurance
for circumstances that could include evacuation
– Back up systems
– Community resources

Midterm Notes 11 | Disaster Nursing/Rolly Baldeviso.BSN-4A

 – Locations
Models
– Personal Protective Equipment (PPE)
❑ There are a number of models for an HVA. – Communication to employees with special
❑ Two well-known models are from needs
– American Society of Healthcare Engineering – Special situations - management of family
(ASHE) on site
– Kaiser Foundation What Does It All Mean?
❑ Both models can be adjusted to fit the organization
❑ HVA tools, used to prioritize specific and overall
❑ Security organizations and other vendors also market
relative risks, are based on mathematical formulas
HVA tools
that are either embedded in the document or
managed manually
Medical Center HVA Model ❑ The factors considered in the assessment includes the
❑ ASHE Model 2001 assumption that the risk occurs at the worst possible
– Human Events time and with a full patient census
– Natural Events Summary: What is the greatest risk?
– Technological Events
❑ The HVA process helps an organization prioritize in
❑ Kaiser Foundation Model 2001
the order of criticality
– Human Events
❑ The efforts to decrease the consequences of a
– Natural Events
possible event can be focused upon. This includes
– Technological Events
evacuation.
– Hazmat Events
Examples of HVA Tools
–
Natural Events ❑ American Society for Healthcare Engineering of the
American Hospital Association
❑ Risks common to the area or geography of the region,
❑ Kaiser Permanente’s interactive HVA tool available at:
for example: storms, earthquakes, floods, and
❑ Emergency Management Program Guidebook
tornadoes, and other natural causes of damage
Published by VHA Center for Engineering &
❑ The impact may be able to be mitigated or may result
Occupational Safety and Health, St. Louis, MO
in a partial or complete evacuation
vaww.ceosh.med.va.gov
❑ For review of an HVA sample go to: Click HVA under
index link

HRVA
❑ HRVA － Hazard, Risk and Vulnerability
Assessment provides the foundation within a
continuous emergency planning cycle needed to
maintain an effective emergency plan.
❑ It comes from evolving national and international
standards in the field of emergency management.

Mitigation Plans for Regions

❑ Other models use sophisticated software to determine
the hazards by cities, counties or regional areas
❑ Are used for the development of mitigation plans for
multi-jurisdictions

Why is this Important to Worker Well-being?

❑ Preparedness efforts, plans and resources are directly
related to the organization’s HVA
❑ Engineering controls may occur as a result of HVA
thus reducing risk for the work force
❑ Safety factors are considered
❑ Process promotes understanding of current resources
that may not have been known beyond the “expert”

Evacuation Implications
❑ When a risk is identified in the HVA that would
potentially result in an evacuation, the organization
should focus on issues that could impact the need to
evacuate or to mitigate the risk. Examples:
– Routes

Midterm Notes 12 | Disaster Nursing/Rolly Baldeviso.BSN-4A

❑ HRVA may seem complicated, but in practice, it
simply involves any person or group following the six-
step procedure.

HRVA Step #3
❑ Determine the “probable severity of damage” if the
emergency took place, which will result in a rating of
Catastrophic, Critical, Marginal or Negligible.

HRVA Step #1
❑ Select the emergency events from Lists A and B that
you feel could possibly have application for your
emergency plan. Only omit those you’re certain don’t
HRVA Step #4
have application (e.g., a tsunami would not apply if
you are not near an ocean). ❑ Determine the “vulnerability level” by finding the
combination of ratings you gave in Steps 2 and 3, and
noting the vulnerability of Low, Medium or High.

HRVA Step #5
❑ Prioritize the vulnerability levels from highest to
lowest (If you don’t have any High vulnerability
events, then start your list with the Medium and Low
events).

HRVA Step #6
❑ In sequential order (1st, 2nd, 3rd), transfer the list
HRVA Step #2 from Step 5 so that resources and priority of actions
can be identified, allocated, and tracked in accordance
❑ Assess the “probability of occurrence” (based on a
with the proactive: Prevention/Mitigation,
projected timeline and available historical data and
Preparedness, and the reactive: Response and
current expertise), which will result in a rating of
Recovery components of emergency management.
Frequent, Probable, Occasional, Remote or
Improbable.

Midterm Notes 13 | Disaster Nursing/Rolly Baldeviso.BSN-4A

 CONTINGENCY PLAN
“may but is not certain or possible to occur,
something liable to happen or eventual as an adjunct
or result of something else” (Merriam-Webster)
Contingency: Tertiary method of communication.
Method will not be as fast/ easy/ inexpensive/
convenient as the first two methods but is capable of
accomplishing the task. Often (but undesirably) the
HRVA receiver rarely monitors this method.

❑ This emergency planning tool is a good visionary

approach, but is not without its faults. Users can fall EMERGENCY PLAN
victim to subjectivity as they attempt to assess
”unforseen cicumstance that need immediate action,
vulnerabilities objectively. Success depends greatly on
urgenct need” (Merriam-Webster)
the effort and open-mindedness of those who choose
Emergency: If all else fails, this is the worst case
to use it. It can be used effectively to determine
option. It is usually ugly, but will get a message
reasonable allocation of resources, and as a
across.
continuous process to ensure that necessary actions
method of last resort and typically has significant
are being taken to maintain an effective emergency
Delays, costs, and/or impacts. Often only monitored
plan.
when the other means fail.
❑ An HRVA can also be used for various non-emergency
events (e.g., wedding, vacation, reunion) to help plan
for and carry out planning activities. P. A. C. E. Example
Primary: Sending short codes or texts from GPS
tracking devices
Alternate: Use of digital cellular communication with

PREPAREDNESS use of data to using landlines if available.

Contingency: Use of voice calls when the data
P.A.C.E. Plan network is down.
PACE is a methodology developed by the US Military to Emergency: Use of Hi Frequency (HF) radios which is
help build resilient communication plans for organizations not reliant on any cellular network.
that need to ensure communications regardless of the
situation. PACE is an acronym for Primary, Alternate,
Contingency, and Emergency. The PACE Plan System
The PACE plan system is expressed as a list showing
P. A. C. E. Plan the order of communication precedence; primary,
alternate, contingency, and emergency.
Primary
The plan designates the order in which organizations
Alternate
plan to move through available communications
Contingency
systems until contact can be established..
Emergency In the general plan, it is important to understand the
order in which you would plan to use various
communication systems and the agreed-upon method
PRIMARY PLAN
between groups.
“main, prime, chief importance, principal” (Merriam-
Webster)
Primary: The main form of communication.
METHODOLOGY
The best and intended method of communication The method requires the author to determine the
between parties. different parties that need to communicate and then
determine, if possible, the best four forms of
communication between each of those parties.
ALTERNATE PLAN
PACE also designates the order in which an element
“every other, be used instead, substitute” (Merriam- will move through available communications systems
Webster) until contact can be established with the desired
Alternate: If the primary fails, this is your secondary distant element(s).
form of communication. Ideally, each method will be completely separate and
Common but less-optimal method of but is capable of independent of the other systems of communication.
accomplishing the task. Often monitored concurrently For each method, the receiver must first sense which
with primary means. one the sender is using and then respond.
Once an organization has agreed upon the general
plan, detailed operational planning must follow. In the
s detailed plan, you can then designate the radio

Midterm Notes 14 | Disaster Nursing/Rolly Baldeviso.BSN-4A

 channel or talk group to be used if using radios, the
satellite phone numbers to be called. When you know
what systems will be used the PACE Plan ensures
everyone agrees on which systems to monitor and in
the correct order as the higher level of
communications fail.
Emergency Management and Communications
Managers should coordinate the development of PACE
plans for the many different functions and
departments within your organization to ensure that
Incident Command and clinical staff can maintain
critical communication links. Plans must reflect the
training, equipment status, and true capabilities of the
organization. If a clinical team has a disaster plan but
team members are untrained, lack the proper
equipment or contact information they will not be
effective in an emergency.
Departmental PACE plans should be coordinated with
Emergency Management and the Communications
Team. It is critical that individual departments nest
their plan within the larger Emergency Plan and with
the coordination of the organization’s communications
team to ensure that the resources are in place to
execute the plan and reduce unnecessary duplication
of assets.
CONCLUSION
Developing comprehensive PACE plans will not ensure
perfect communications in a disaster, but helps to
clear some of the fog and friction found in every
emergency situation.
The most important part of the PACE plan is the act of
planning itself.
P.A.C.E. planning is about mitigating risk by
developing 3 back up plans. If the Primary plan
doesn’t work, go to the Alternate. If the Alternate
doesn’t work, do the Contingency Plan. If that fails,
then accomplish you mission with the Emergency
plan. P.A.C.E. Planning isn’t rocket science, but it is a
simple and effective tool you can use to ensure that
you accomplish your mission and get the job done.
Midterm Notes
EMERGENCY DRILLS
INTRODUCTION
❖ Emergency drills are an important part of workplace
safety. By practicing emergency procedures, you can
ensure that your employees know what to do in the
event of a real emergency. This topic will discuss the
importance of workplace emergency drills and
exercises and provide tips for planning and conducting
a successful drill or exercise.
Emergency Drill
❖ An emergency drill is a procedure carried out to
practice how a building or organization would respond
to an unexpected event. Emergency drills are
designed to test the response of individuals and
groups to a simulated crisis, such as a fire, severe
weather event, or terrorist attack. The goal of an
emergency drill is to ensure that everyone knows
what to do in the event of an actual emergency.
❖ Emergency drills should be conducted regularly, and
participants should be given clear instructions on what
to do in the event of an emergency. The drill should
be designed to test the response of individuals and
groups to a simulated crisis, such as a fire, severe
weather event, or terrorist attack. The goal of an
emergency drill is to ensure that everyone knows
what to do in the event of an actual emergency.
What is the Importance?
❖ Emergency drills are important because they help
employees to be prepared for a real emergency. In
the event of an actual emergency, it is important that
employees know what to do and where to go. By
practicing emergency procedures in a drill, employees
can become familiar with the steps they need to take
to stay safe.
Designing an Emergency Drill
❖ A well-designed mock emergency drill can help your
organization assess its readiness and identify areas
that need improvement. But not all mock drills are
created equal. To be effective, a mock drill should be
based on a realistic scenario that has the potential to
occur in your community.
15 | Disaster Nursing/Rolly Baldeviso.BSN-4A
How to Conduct a Successful E-Drill?
1. Choose a scenario that is relevant to your community.
A mock emergency drill should be based on a realistic
scenario that has the potential to occur in your
community. For example, if you live in an area that is
susceptible to wildfires, choose a wildfire-related
scenario for your drill. If you live in a coastal
community, choose a hurricane-related scenario.
2. Make sure the scenario is achievable. The goal of a
mock emergency drill is to test your organization’s
readiness, not to see how well it can respond to an
impossible situation. Choose a challenging but
achievable scenario, and ensure all participants
understand the parameters of the drill.
3. Involve as many people as possible. A mock
emergency drill is an opportunity to test your
organization’s response plan, but it’s also an
opportunity to educate and engage your community.
Invite first responders, local officials, media, and the
general public to participate in the drill. The more
people you involve, the more realistic the experience
will be.
4. Debrief after the drill. Once the drill is over, take
some time to debrief all of the participants. Discuss
what went well and what could be improved upon.
Use the feedback to revise your organization’s
emergency response plan.
Emergency Drills
❖ Evacuation and shelter-in-place drills are scheduled
throughout the year to ensure the readiness of the
campus community in responding to any type of crisis
that requires building occupants to evacuate a
building or to seek protective shelter inside of a
building. Evacuation and sheltering-in-place are the
inverse of one another. You evacuate a building when
the conditions inside the building present a hazard to
human life, health or safety. If the conditions outside
of a building presented a hazard to human life, health
or safety, one would reverse the evacuation steps and
shelter inside a building.
1. Emergency Evacuation drills include alarm
activation to ensure fire protection and reliability,
along with an orderly, disciplined evacuation, followed
by a thorough inspection of the building to
immediately rectify any code related issues. Finally,
an on-site discussion is held with students, staff and
faculty to evaluate and improve, when necessary, the
performance and efficacy of these drills.
2. Shelter-in-place drills are a tactical response to a
possible chemical, biological, radiological, nuclear or
natural disaster. They are designed to provide a place
of refuge for people and to give them a level of
physical, emotional and mental comfort. During a
shelter-in-place drill, building occupants are directed
to pre-designated “shelter areas” within a building.
Midterm Notes
Types of Emergency Drills
❖ Many types of emergency drills can be conducted in
the workplace. Some of the most common include fire
drills, earthquake drills, and tornado drills. It is
important for employers to choose the right type of
drill for their workplace based on the hazards present.
❖ Fire drills are one of the most common types of
emergency drills conducted in the workplace. They are
designed to ensure that everyone in the building
knows what to do in the event of a fire. The drill
should include evacuating the building, using the
stairs, and assembling in a designated area.
❖ Earthquake drills are another common type of
emergency drill conducted in the workplace. These
drills are designed to ensure that everyone in the
building knows what to do during an earthquake. The
drill should include evacuating the building, using the
stairs, and assembling in a designated area.
❖ Tornado drills are another common type of
emergency drill conducted in the workplace. These
drills are designed to ensure that everyone in the
building knows what to do during a tornado. The drill
should include evacuating the building, using the
stairs, and assembling in a designated area.
Factors to Consider in Workplace Emergency Drills
❖ It is important for employers to choose the right type
of emergency drill for their workplace. The type of drill
should be based on the hazards present in the
workplace. By conducting the proper type of drill,
employers can ensure that their employees are
prepared in the event of an emergency.
❖ An effective workplace emergency drill should be
based on a well-developed plan that considers your
workplace’s specific needs. It should be designed to
test your emergency procedures’ effectiveness and
allow employees to practice their roles in an
emergency situation.
❖ When developing your workplace emergency drill
plan, there are several factors that you need to
consider:
– The type of emergencies that could occur in
your workplace
– The location of your workplace
– The number of employees in your workplace
– The ability of your employees to evacuate
the premises safely
– The availability of emergency services
❖ When developing your workplace emergency drill
plan, it is important to keep the following points in
mind:
– All employees should clearly state and
understand the purpose of the drill.
– The drill should be conducted at a time
when employees are not expecting it.
– Employees should be given enough time to
evacuate the premises safely.
16 | Disaster Nursing/Rolly Baldeviso.BSN-4A
 – The drill should be conducted in a realistic
manner and as close to a real emergency
situation as possible.
❖ When conducting a workplace emergency drill, it is
important to debrief your employees afterwards. This
will allow you to identify any areas where
improvements can be made. It will also provide
employees with the opportunity to raise any concerns
they may have about the drill or the emergency
procedures.
Midterm Notes
❖ Simulating a real event is necessary to polish your
disaster plans. “An organization that fails to plan,
is planning to fail”.
❖ Use tabletop exercises to evaluate your evacuation
procedures with your emergency team. You can test
for potential glitches and find unaddressed
complications by running hypothetical scenarios.
❖ “Work through the process of what an event will entail
and what resources you need to bring to bear.
Anticipate how people are going to go evacuate,
where they should go, and how you’re going to
communicate this to them.”
17 | Disaster Nursing/Rolly Baldeviso.BSN-4A
 Conclusion
❖ Emergency drills are an important part of workplace
safety. By knowing what type of drill to conduct and
how to execute it effectively, you can minimize the
risk of injury or death in the event of a real
emergency. Make sure your workplace is prepared for
any potential emergency by conducting regular drills
with your team. If you’re not sure where to start, our
guide on emergency drills will help get you started.
Stay safe!

Midterm Notes 18 | Disaster Nursing/Rolly Baldeviso.BSN-4A

 MEDICAL TRAUMA Measurement Temperature
Thermometer is a device that measures temperature or
Patient Assessment a temperature gradient.
o Oral (Mouth) 36.8 °C (98.2 °F)
o Rectal (Rectum) 37.5 °C (99.5 °F)
VITAL SIGNS
o Axillary (Armpit) 36.5 °C (97.7 °F)
Objective o Tympanic (Ear) 37.5 °C (99.5 °F)
Vital Signs o Temporal (Forehead) 36.5 °C (97.7 °F)
Enhances the First Responder's ability to take the vital
signs of the patient which includes the temperature, Temp Abnormalities
pulse, respiratory rate, perfusion and the mental Hypothermia is the condition of having an
status of the patient. This lesson provides the abnormally low body temperature, typically one that
knowledge and skills to properly perform the initial is dangerously low. <36.5°C
assessment. Hyperthermia is the condition of having a body
Vitals or VS is used to measure the body’s basic temperature greatly above normal. >37.2°C
functions.
These measurements are taken to help assess the
general physical health of a person, give clues to
HEART RATE
possible diseases, and show progress toward Pulse Rate or Heart Rate (HR) is the rate at which
recovery. the heart beats while pumping blood through the
The normal ranges for a person’s vital signs vary with arteries. Its rate is usually measured either at the
age, weight, gender, and overall health. wrist or the ankle and is recorded as beats per
5 primary vital signs (5VS) minute.
– Body Temperature
– Pulse Rate/Heart Rate (HR)
– Breathing Rate/Respiratory Rate (RR)
– Blood Pressure (BP)
– Pulse Oximetry (SpO2)
– Vital Signs
6th, 7th & 8th Vital Signs
– Level of Consciousness
– Pupillary Reaction
– Pain
– Skin Condition
– Capillary Refill
– Glasgow Coma Scale (GCS)
Measurement & Site PR
– Blood Glucose Level (CBG)
Additional Vital Signs Palpate on
– Height & Weight pulses counting
– Outlook (Mental Status) 1 minute
– Urinary Output Auscultate
– Capnograph directly on the
– Mean Arterial Pressure (MAP) chest

BODY TEMPERATURE
Indication of core body temperature is normally
tightly controlled (thermoregulation) as it affects the
rate of chemical reactions.
Establish a baseline for the individual's normal body
temperature for the site and measuring conditions.
Solicit any signs of systemic infection or inflammation Palpable Site
in the presence of fever, or elevated significantly
o Temporal (forehead)
above the individual's normal temperature.
o Facial (lower jaw)
Measured in degree Celsius or Centigrade (ºC) and
o Carotid (neck)
degree Fahrenheit (ºF)
o Axillary (armpit)
Varies on gender, recent activity, food and fluid
o Brachial (arm)
consumption, time of day, and, in women, the stage
o Radial (lateral wrist)
of the menstrual cycle.
o Ulnar (medial wrist)
36.5 degrees C (or Celsius) or 97.8 degrees F (or
o Apical (chest)
Fahrenheit) to 37.2 degrees C or 99 degrees F for a
o Femoral (inner thigh)
healthy adult.
o Popliteal (behind the knee)

Midterm Notes 19 | Disaster Nursing/Rolly Baldeviso.BSN-4A

o Tibialis posterior (ankle)
o Dorsalis pedis (top of foot)
Pulse Abnormalities
Pulsus alterans strong pulse followed by a weak
pulse over and over (progressive systolic heart
failure).
Pulsus bigeminus gallop rhythm (hoofbeats).
Pulsus bisferiens 2 pulse to each beat instead of 1
(aortic valve disease).
Pulsus tardus er parvus or anacrotic pulse slow
than normal tactile pulse (stiff aortic valve).
Pulsus paradoxus cannot be detected at radial
artery during respiration cause by exaggerated
decrease in BP during inspiration (cardiac or
respiratory condition)
Tachycardia elevated resting heart rate
Bradycardia decreased resting heart rate
Pulsatile intrinsic physiology of systole and diastole
Collapsing pulse (hyperdynamic circulation)
RESPIRATION RATE
RR is the number of breaths (inhalation-exhalation
cycles) taken within a minute.
Eupnea normal RR
Tachypnea increased RR
Bradypnea lower-than-normal RR
Normal Respiratory Rate
Normal Blood Pressure
Measurement RR
Human respiration rate is measured when a person is
at rest and involves counting the number of breaths
for one minute by counting how many times the chest
rises.
Midterm Notes
RR Abnormalities
Apnea cessation of
Dyspnea difficulty or discomfort during breathing
Hyperpnea increased depth in breathing
Tachypnea abnormal rapid
Hypopnea overly shallow breathing or low respiratory
rate
Bradypnea abnormally slow
Orthopnea shortness of breath (lying flat)
Platypnea shortness of breath (breathlessness)
relieved by lying down, worsen when sitting or
standing up
Biot’s respiration quick and shallow inspirations
followed by periods of apnea
Cheyne-Stokes respiration progressive deep and
sometimes faster breathing, followed by a gradual
decrease that results in a temporary stop in breathing
or apnea
Kussmaul breathing hyperventilation tend to be
rapid and relatively shallow
BLOOD PRESSURE
BP is the pressure exerted by circulating blood upon
the walls of blood vessels.
Refers to the arterial pressure in the systemic
circulation.
Blood pressure is usually expressed in terms of
the systolic (maximum) pressure
over diastolic (minimum) pressure.
Measured in millimeters of mercury (mm Hg).
Systole is the part of the cardiac
cycle when
the ventricles contract.
120 mmHg
Diastole is the part of
the cardiac cycle when the
heart refills with blood
following systole contraction.
80 mmHg
20 | Disaster Nursing/Rolly Baldeviso.BSN-4A

BP Measurement
Arterial pressure is most commonly measured via
a sphygmomanometer, which historically used the
height of a column of mercury to reflect the
circulating pressure or a dial in an aneroid.
Blood Pressure Points
Listen with the stethoscope to the brachial artery at
the antecubital area of the elbow and slowly
releases the pressure in the cuff.
“Whooshing" or pounding (1st Korotkoff sound) –
systolic blood pressure. Further release cuff pressure
until no sound can be heard (5th Korotkoff sound) –
diastolic arterial pressure.
BP Abnormalities
Hypotension is the abnormally low blood pressure,
which is considered too low only if noticeable
symptoms are present. Low Blood Pressure.
– Orthostatic hypotension is also called
postural hypotension results from a sudden
change in body position. Usually standing
up from suddenly from a seated or lying
position.
– Neurologic syncope is an inappropriate
drop of blood pressure while standing up.
Hypertension is a pathological increase in blood
pressure. High Blood Pressure.
– Essential hypertension (primary
hypertension or idiopathic
hypertension) is the form of hypertension
that by definition, has no identifiable cause.
Midterm Notes
– Secondary hypertension (inessential
hypertension) is caused by unidentified
secondary cause
– Hypertensive crisis is severely elevated
blood pressure (equal to or greater than a
systolic 180 or diastolic of 110)
• Hypertensive urgency no organ
damage
• Hypertensive emergency direct
organ damage
– Gestational hypertension or Pre-
eclampsia
– Hypertension in children
OXYGEN SATURATION
Pulse Ox is a non-invasive method for monitoring a
person's O2 saturation (SpO2 or Saturation of
peripheral oxygen).
Pulse Oxymetry
a sensor device is placed on a thin part of the
patient's body, usually a fingertip or earlobe, or in the
case of an infant, across a foot. The device passes two
wavelengths of light through the body part to a
photodetector.
Abnormalities in O2 Saturation
Hypoxemia is normally low level of oxygen in the
blood. More specifically, it is oxygen deficiency in
arterial blood.
Hypoxia, hypoxiation or anoxemia is a condition in
which the body or a region of the body is deprived of
adequate oxygen supply.
Pulse Ox Limitations
A falsely high or falsely low reading will occur when
hemoglobin binds to something other than oxygen:
– Hemoglobin has a higher affinity to carbon
monoxide than oxygen, and a high reading
may occur despite the patient actually being
hypoxemic. In cases of carbon monoxide
poisoning, this inaccuracy may delay the
recognition of hypoxia (low blood oxygen
level).
A falsely high or falsely low reading will occur when
hemoglobin binds to something other than oxygen:
– Cyanide poisoning gives a high reading,
because it reduces oxygen extraction from
arterial blood. In this case, the reading is
21 | Disaster Nursing/Rolly Baldeviso.BSN-4A
 not false, as arterial blood oxygen is indeed
high in early cyanide poisoning.
– Methemoglobinemia characteristically
causes pulse oximetry readings in the mid-
80s.

LEVEL OF CONSCIOUSNESS
Individual’s awareness and understanding of what is
happening in his or her surroundings
– Conscious (sensing, perceiving, and
choosing)
– Preconscious (memories that we can
access) Pupil Size Measurement
– Unconscious (memories that we cannot Dim the ambient light and ask the patient to fixate a
access) distant target. Using a penlight, illuminate the right
– Non-conscious (bodily functions without eye from the right side and the left from the left side.
sensation)
– Subconscious (“inner child,” self-image
formed in early childhood).

Pupil Reaction Abnormalities

Anisocoria or unequal pupils
Sluggish or slow reaction
Non-reactive

PUPILLARY RESPONSE
Physiological involuntary response of the pupil of the
eyes to light
Important in assessing underlying neurological cause
– Perfusion
– Oxygenation
– Condition PAIN ASSESSMENT
Assessed according to multidimensional approach,
Normal Pupillary Response determine the following:
The pupils are normally round and of approximately – Chronicity
equal size (Isocoria). – Severity
In the absence of any light, the pupils will become – Quality
fully relaxed and dilated. – Contributing/associated factors
Shone the pupils react briskly, simultaneous and – Location/distribution or etiology of pain, if
equal to light. identifiable
Pupils - Equal, Round & Reactive to Light and – Mechanism of injury, if applicable
Accomodation (PERRLA) – Barriers to pain assessment

Midterm Notes 22 | Disaster Nursing/Rolly Baldeviso.BSN-4A

Pain Assessment Tool CAPILLARY REFILL
Onset of the event. When the pain started Nail Blach Test or Capillary Refill Test (CRT) is a
Provocation or paliation. Any movement, pressure or rapid test used for assessing the blood flow through
other external factors make it worse. peripheral tissues.
Quality of the pain. Description of the pain. It's a quick test performed on the nail beds as an
Radiation or region. Where the pain moves to indicator of tissue perfusion (the amount of blood flow
another area to tissue) and dehydration.
Severity. The pain score on a scale 0 to 10.
Time (history). How long the condition has been
Assessing Skin Condition
going on and how it has changed since onset
Skin touching

Pain Assessment Tool with the wrist or

the back of the
hand.
Skin turgor

SKIN CONDITION
Assessment of skin color includes patient’s skin color,
temperature, and condition. While evaluating the skin,
continue to look for bleeding.
Skin color depends on blood circulating in the vessels
of the skin. Skin color also depends on the kind and
amount of pigment in the skin.
Normal Skin Color
Lightly pigmented individuals normally has a pink
color.
Capillary refill
is the ability of
the circulatory
system to restore
blood to refill the
capillaries.
GLASGOW COMA SCALE
GCS is a neurological scale that give a reliable,
objective way of recording the conscious state of a
person for initial as well as subsequent assessment.
Published in 1974 by Graham Teasdale and Bryan J.
Jennett, professors of neurosurgery at the University
of Glasgow's Institute of Neurological Sciences at the
city's Southern General Hospital, Scotland.

Elements of GCS

Skin Conditions EVM 456

COLORED POEM
“When I'm born I'm black, when I grow up I'm black,
when I'm in the sun I'm black, when I'm sick I'm
black, when I die I'm black, and you... when you're
born (points to white man) you're pink, when you
grow up you're white, when you're cold you're blue,
when you're sick you're blue, when you die you're
green and you dare call me colored”

Midterm Notes 23 | Disaster Nursing/Rolly Baldeviso.BSN-4A

GCS Interpretation HISTORY TAKING
Generally, brain injury is classified as:
Objective
– Severe, with GCS < 8–9
History Taking
– Moderate, GCS 8 or 9–12 (controversial) [4]

Enhances the First Responder's ability to effectively

– Minor, GCS ≥ 13
communicate with the patient and garner important
Movement:
information that determines the mechanism of injury
or nature of illness of the patient. This lesson
provides the knowledge and skills to properly
perform the initial assessment.

Components
History Taking
❑ Determining the chief complaint
❑ Mechanism of injury/nature of illness
❑ Associated signs and symptoms
❑ Investigation of the chief complaint
❑ Past medical history
❑ Pertinent negatives
❑ Px Hx are pertinent information obtained in order to
formulate a diagnosis of the patient and utilized as
basis for providing medical care to the patient.
Components of Px Hx
❑ Signs and symptoms
BLOOD GLUCOSE LEVEL • Sign is something you see in a patient
A mean of checking • Symptom is what patient tell you how
the blood sugar or they feel
glucose level at any ❑ Chief Complaint is usually the symptom that is
one time. bothering the patient the most.
Glucose meter or ❑ OPQRST Questions
glucometer is used • Onset, Provocation, Quality, Radiation,
to determine the Severity and Time
approximate
concentration of glucose in the blood.

Abnormal Blood Glucose Level

Hypoglycemia, low
blood sugar or
glucose, is when
blood sugar
decreases to below
normal.
Hyperglycemia,
or high blood
sugar is a condition
in which an
excessive amount of
glucose circulates in
the blood plasma.

Midterm Notes 24 | Disaster Nursing/Rolly Baldeviso.BSN-4A

 Emergency Action Principle II. Primary Assessment
❖ Primary assessment for all patient situations
Objective
1. Level of consciousness or LOC (AVPU)
Patient Assessment
2. ABCs
❖ Enhances the First Responder's ability to evaluate a
3. Identifying life threats
scene for potential hazards, to determine the number
4. Determine Mechanism or Injury (MOI) or Nature
of patients, whether additional help is necessary, and
of Illness (NOI)
to evaluate the mechanism of injury or nature of
5. Assessment of vital functions
illness.
6. Initial general impression (GI)
❖ This lesson provides the knowledge and skills to
properly perform the initial assessment. In this
1. Level of Consciousness
session, the student will learn about forming a
❖ Painful stimulus
general impression, determining responsiveness, and
o Pinch earlobe
assessing the airway, breathing, and circulation.
o Press down on bone above eye
Students will discuss how to determine priorities of
o Pinch neck muscle
patient care.
❖ Mental status oriented to:
❖ This lesson also teaches the knowledge and skills
o Person
required to continue the assessment and
o Place
management of the ill or injured patient.
o Time
o Event
EMERGENCY ACTION PRINCIPLE (EAP)
1. Scene-Size Up 2. ABC
2. Primary Assessment
3. Interventions
4. Secondary Assessment
5. Reassessment

3. Identify Life Threats

I. Scene-Size Up ❖ Perform rapid scan
❖ Quick assessment of the scene and surroundings ❖ Determine need for C-Spine Immobilization
❖ Scene management ❖ Transport decision (Pre-Hospital Care Strategies)
– Impact of the environment o “Load and Go”
– Addressing hazards o “Stay and Play” (“Treat and Run”)
– Violence o “Scoop and Run”
– Need for additional or specialized resources
– Standard precautions (BSI PPE) Transport Decision
– Multiple patient situations (Triage/MCI)
“Load and Go”
o The process of packaging a patient and loading
Scene-Size Up
them onto an ambulance to be taken to hospital.
❖ SAFETY FIRST o Criteria: Under the following circumstances a
❖ Make sure patient must always be a load and go:
safety is priority ✓ Altered Level of Consciousness.
before entering ✓ Any compromise to the Airway.
the scene. ✓ Any compromise to the Breathing.
Never become ✓ Any compromise to the Circulation.
a victim. o Life threatening injury is found
❖ Look for o Continue life support
potential hazards. o Stabilize any major injuries as quickly as possible
❖ When parking a unit, park it in a place that will offer o Administer Oxygen
great safety. o Load patient into stretcher or any means of
❖ Talk to law enforcement before entering the scene, transport
especially if it is a crime scene. o Transport to medical facility
❖ Assess the safety of the patient(s) and bystanders.
Move bystanders if necessary. “Stay and Play”
❖ Wear proper PPE and follow BSI techniques.
❖ The approach of pre-hospital trauma care in which the
❖ Evaluate the need for additional resources. Contact
patient receives treatment and/or stabilization on
dispatch if need more help.
scene before being transported to the hospital.
❖ When there are multiple patients, call for help and
❖ Research found effective in treating out-of-hospital
begin triage before beginning patient care.
cardiac arrest (OHCA), in which immediate care is
Midterm Notes 25 | Disaster Nursing/Rolly Baldeviso.BSN-4A
 delivered on site rather than during transport to the
emergency department (ED). (Westafer et. al., JAMA
2020 Sep 15)
❖ On-scene resuscitation for OHCA increases survival
rate, is dismal and transport may interrupt or reduce
the quality of chest compressions.
❖ EMS agencies should compare their protocols and
outcomes with those of high-performing systems,
paying particular attention to intra-arrest transport.
“Scoop and Run”
❖ Patient is transported as fast as possible to the
hospital without trying to stabilize him at the scene.
❖ Administering only Basic Life Support (BLS) at the
trauma site before rushing patients to a hospital while
they are still in their “platinum minutes”
EMS Phases
1. Detection
2. Reporting
3. Response
4. On-Scene Care
5. Care in Transit
6. Transfer to Definitive
Care
EMS Phases: 1. Detection
• The first vital aspect in the case of an emergency is
the detection of the problem, the extent of the
problem, and identifying ways in which people on site
can protect themselves from any danger around
them. This role is usually undertaken by civilians who
are often the first responders in such situations.
EMS Phases: 2. Reporting
❖ After the first responders have identified the problem
and taken measures to protect themselves and
others, they will call in for professional help, explain
the situation, and provide their location after which an
emergency medical dispatch is sent to the scene.
EMS Phases: 3. Response
❖ Calling for help is not the end of the first responders’
duty. While awaiting professional help, the civilians
are required to try to the most of their ability to
administer first aid to those that need it.
EMS Phases: 4. On-Scene Care
❖ This is usually the first role performed by the
professional medics. The Emergency Medical Services
(EMS) staff on arrival provide as much medical care
as they possibly can on the scene.
EMS Phases: 5. Care in Transport
❖ When a patient needs much more specialized care
than can be offered on the scene, EMS staff transport
them to the hospital. While in transit, the EMS staff
Midterm Notes
continue to utilize the medical equipment attached to
their mode of transport to help the patient and
administer as much medical care as possible.
EMS Phases: 6. Transfer to Definitive Care
❖ This usually is the stage at which emergency medical
personnel conclude their roles. At this point, the
patient is already at the hospital whereby they can
receive the appropriate medical care, personalized to
their needs. The EMS staff hand the patient over to
the doctors and await the next dispatch.
3. Identify Life Threats
❖ The Golden Period is the time from injury to definitive
care.
o Treatment of shock and traumatic injuries should
occur.
o Aim to assess, stabilize, package, and begin
transport within 10 minutes (“Platinum 10”).
4. Determine MOI and NOI
❖ Nature of Illness is the cause or what affects the
sickness.
❖ Mechanism of Injury or how the traumatic injury
occurs.
NOI: Medical
o Determine history of the patient
o Similarities of NOI and MOI
o Talk with bystanders and family members
o Use senses to check for clues
MOI: Trauma
MOI: Trauma
❖ Injuries that can potentially lead to serious outcomes.
❖ Easily injured areas: brain, spinal cord and eyes
❖ Factors to evaluate
o Amount of force applied to the body
o Length of time the force was applied
26 | Disaster Nursing/Rolly Baldeviso.BSN-4A
 o Areas of the body that are involved

6. General Impression
❖ How ill the patient is.
❖ Specific information:
– Location
– Gender
– Age (rough)
– Level of distress
❖ Gestalt of GI:
– Behavior
– Breathing
– Appearance of the skin

IV. Secondary Assessment

Detailed Physical Exam
❖ MEDICAL
❖ Individual body parts examined for signs of illness or
o History Taking
injury
o Focused assessment of pain
Performed for:
o Assessment of vital signs (VS)
❖ Trauma with significant MOI
o Detailed Physical examination
❖ Unresponsive medical patients
❖ TRAUMA
❖ Not all patients require a detailed PE
o Performing a rapid full-body scan (RTA) or Head-
to-Toe Examination
o Focused assessment of pain
o Assessment of vital signs (VS)
o Detailed Physical examination

Secondary Assessment: History Taking

❖ SAMPLE History
❖ OPQRST
V. Reassessment

RTA Boxing DCAP-BTLS ❖ Reassess patients and monitor condition while waiting
for professional help, en route or in transit
DCAP-BTLS
D- Deformities
C- Contusions
A- Abrasions
P- Penetrations
B- Burns
T- Tenderness
L- Lacerations
S- Swelling

Special Challenges
❖ Silence
❖ Overly-talkative
Focused Assessment on Pain ❖ Multiple symptoms
❖ Anxiety
❖ Anger and hostility
❖ Intoxication
❖ Crying
❖ Depression
❖ Confused
❖ Limited cognitive abilities
❖ Language barriers
❖ Hearing problems
❖ Visual impairments

Midterm Notes 27 | Disaster Nursing/Rolly Baldeviso.BSN-4A

 EMERGENCY ACTION PRINCIPLE
TRAUMA OVERVIEW
1. Scene Size-Up
2. Primary Assessment Trauma Objectives:
3. Interventions Soft Tissue Injuries
4. Secondary Assessment • Reviews the cardiovascular system and teaches the
5. Reassessment management of soft tissue injuries and burns.
Techniques of dressing and bandaging wounds will
also be taught in this lesson.
Physical Assessment: MEDICAL
Bleeding
1. Scene Size-Up • Describes the care of the patient with internal and
a. Scene Safety external bleeding. Techniques of dressing and
b. Nature of Illness bandaging wounds will also be taught in this lesson.
c. Number of Patients Recognition and Care for Shock
d. Require Additional Help • Reviews the cardiovascular system, teaches how to
e. C-Spine Stabilization recognize the signs and symptoms of shock, and the
2. Primary Assessment management and care for shock.
a. General Impression Muscle and Bone Injuries
b. Responsiveness/Level of Consciousness • Reviews the anatomy of and injuries to the
c. CAB musculoskeletal system. Presents information about
d. Chief Complaint/Apparent Life Threats injuries of the skeletal system. Reviews the anatomy
e. Patient Priority/Patient Transport Priority of the nervous system and the skeletal system.
• Physical Assessment: MEDICAL Head and Spinal Injuries
3. Secondary Assessment • Reviews the anatomy of and injuries to nervous
a. Focused History system. Presents information about injuries of the
i. Signs and Symptoms nervous system. Reviews the anatomy of the nervous
ii. Allergies system and the skeletal system. Discusses injuries to
iii. Medications the spine and head, including the mechanism of
iv. Past Pertinent History injury, signs and symptoms of injury, and
v. Last Oral Intake assessment.
vi. Events Leading to Present Illness Chest and Abdomen Injuries
b. Focused Physical Examination • Reviews the anatomy of and injuries to anatomical
i. IPPA systems within the chest (thorax) and abdomen.
c. Baseline Vital Signs Presents information particularly about injuries of the
4. Reassessment cardiovascular, respiratory, digestive, endocrine,
urinary and reproductive system. Reviews the
Physical Assessment: TRAUMA anatomy of the nervous system and the skeletal
system. Discusses injuries to the chest and abdomen,
1. Scene Size-Up
including the mechanism of injury, signs and
a. Scene Safety
symptoms of injury, and assessment particular to
b. Mechanism of Injury
internal bleeding.
c. Number of Patients
d. Require Additional Help
e. C-Spine Stabilization Newton’s Law of Motion
2. Primary Assessment In every action there is an equal and opposite reaction.
a. General Impression
b. Responsiveness/Level of Consciousness
c. Apparent Life Threats
d. CAB
e. Patient Priority/Patient Transport Priority
3. Secondary Assessment
a. Focused Physical Examination or Rapid
Trauma Assessment
b. Detailed Physical Examination
i. Head
ii. Neck
iii. Chest Mechanism of Injury
iv. Abdomen/Pelvis
❖ Easily injured areas: brain, spinal cord and eyes
v. Extremities
❖ Factors to evaluate
vi. Posterior
✓ Amount of force applied to the body
4. Reassessment
✓ Length of time the force was applied
✓ Areas of the body that are involved

Midterm Notes 28 | Disaster Nursing/Rolly Baldeviso.BSN-4A

Car Crash Trauma Classification to the Parts of the Body
• Polytrauma
• Head injuries
• Chest trauma
• Abdominal trauma
• Extremity trauma

Trauma Classification by type of force applied

• Blunt Trauma (blunt injury, non-penetrating or blunt
force trauma) physical trauma by a blunt force
✓ Contusion
✓ Abrasions
✓ Lacerations
✓ Bone fractures
• Penetrating Trauma pierces the skin and enters a
tissue of the body, creating an opening.
✓ Puncture and penetration

Bleeding
Assessment

Blood Vessels

Fall
Characteristics of External Bleeding

Bandages and Dressings

Bandages
❑ Adhesive
❑ Fabric Tape
❑ Field bandage
❑ Roller bandage
❑ Triangular
Midterm Notes 29 | Disaster Nursing/Rolly Baldeviso.BSN-4A
Dressings Shock Position
❑ Non-adherent
❑ Sterile gauze
❑ ABD dressing
❑ Roller gauze
❑ Oval eye
❑ Vasilinized gauze
❑ Telfa pad
❑ Adaptic pads
❑ Xeroform gauze

Bleeding Control

Midterm Notes 30 | Disaster Nursing/Rolly Baldeviso.BSN-4A

 DISLOCATION
Soft-Tissue Injuries
ABRASION

FRACTURE

LACERATION

BLAST

PENETRATING

CONTUSION

AVULSION AMPUTATION

BURNS

SPRAIN (Ligament)

STRAIN (Muscles)
IMMOBILIZE AND SPLINT

Midterm Notes 31 | Disaster Nursing/Rolly Baldeviso.BSN-4A

Head and Spine Injuries Cranial Injury

Intracranial Hemorrhage

Concussion vs. Contusion

Concussion
❑ Mildtraumatic brain injury (a simple disturbance) in
brain function with no resulting brain damage
❑ There is no actual interference within the structure of
the brain.
❑ Main symptoms are headaches and dizziness.

Contusion
❑ Deep bruising to the brain tissue which can cause
haemorrhaging, the evidence of which can be found in
the spinal fluid.
❑ Symptoms of blurred vision, disorientation,
unsteadiness whilst walking, vomiting and slurred
speech, which can ultimately develop into a coma.

Midterm Notes 32 | Disaster Nursing/Rolly Baldeviso.BSN-4A

 Lifting Rules to Prevent Injuries
Lifting, Moving and Positioning Position your feet properly on a firm, level surface and
Patients positioned shoulder-width apart.
Use your legs, not your back to do the lifting.
Don’t put your back at risk
DO NOT compensate when lifting with one hand.
Objective
AVOID leaning to either side. Keep your back straight
Provides students with knowledge of body mechanics,
and locked.
lifting and carrying techniques, and principles of
Keep the weight close to the body, or as close as
moving patients.
possible. This allows you to use your legs rather than
your back while lifting. The farther the weight is from
Body Mechanics your body, the greater your chance of injury.
Body Mechanics is the proper use of the body to Keep your back straight. Flex your knees and lean
prevent injury and to facilitate lifting and moving. from the hips, not the waist. If you are walking
To move patients without injury, you need to learn backward down stairs, ask a helper to steady your
proper techniques. back.
Correct body mechanics, grips, and devices are
important

Manual Handling Considerations

Power Whatyamacallit?

Object
o What is the weight?
o Do you require additional help in lifting?
Limitations
o Physical characteristics of each person? EMERGENCY MOVES
o Physical limitations both you and partner?
The scene is hazardous.
o Similar strength and height can lift and carry
Care of life-threatening conditions requires
together more easily.
repositioning.
Communications
You must reach your patient.
o Make a plan.
o Communicate plan for lifting and carrying.
o Continue communicate during the process to
make the move comfortable for the patient and
safe for the EMTs.

Communicate
o "We will lift when I say, 'Lift.'"
o "We will stop lifting when I say, 'Stop.'"
o "We will move in that specific direction when I say,
'Move.'"
o "We will stop moving when I say, 'Stop.'"
o "We will lower when I say, 'Lower.'"

Lifting
In lifting:
o Shoulder girdle aligned over pelvis.
o Hands held close to legs.
o Force goes essentially straight down spinal
column.
o Very little strain occurs.

Midterm Notes 33 | Disaster Nursing/Rolly Baldeviso.BSN-4A

 Portable Stretcher
URGENT MOVES
Folding Stretcher
The required treatment can only be performed if
patient is moved.
Factors at scene cause patient decline.

Stokes or Basket Stretcher/Litter

NON-URGENT MOVES
The required treatment can only be performed if
patient is moved.
Factors at scene cause patient decline.
Anatomical Positions

Patient-Carrying Devices
Wheeled Stretcher/Cot

Scoop Stretcher/Orthopedic Stretcher

Geriatric Considerations

Flexible Stretchers
Fabric or Evac Sheet

Bariatric Considerations

SKED Stretcher

Medical Restraints
o Apply restraint to each extremity.

Vacuum Mattress or VacMat o Assess circulation after restraints are applied.

Reeves Stretcher

Midterm Notes 34 | Disaster Nursing/Rolly Baldeviso.BSN-4A

 resources (and the ability to immediately supplement
TRIAGE them).
General Learning Objectives
Provide nursing students with instruction about: MCI vs MCS
o different types of triage.
➢ Mass Casualty Incidents are distinguished from
o method of conducting a verbal interview to
Multiple Casualty Situations by available resources:
assess a patient's health status
o with Mass Casualties, resources for each
o how to offer recommendations for treatment and
patient are limited,
referral.
o whereas with Multiple Casualties, full
resources can be brought to bear on each
Learning Objectives
individual patient.
Knowledge of operational roles and
responsibilities of the Nurse to ensure patient, Causes of MCI
public, and personnel safety in an event of a ➢ Radiation exposure (disaster)
Mass Casualty Incident (MCI). ➢ Dirty bomb
Principles of START Triage ➢ Bioterrorism
• Risks and responsibilities of emergency response ➢ Chemical weapons
• Risks and responsibilities of transport ➢ Mass shooting
SAVE ➢ Natural Disaster (e.g. Hurricane, Earthquake,
• Safe patient evacuation Tornado, Tsunami, etc)
• Criteria for utilizing air medical response ➢ Unintentional large-scale incident (e.g. building
• collapse, train derailment, etc)
Etymology of the word Triage ➢ Major pandemic
The French word “trier”, the origin of the word ➢ Explosions
“triage”, was originally applied to a process of
sorting, probably around 1792, by Baron Dominique Principles: Triage Classification
Jean Larrey, Surgeon in Chief to Napoleon's Imperial
➢ Minor (Green)
Guard.
➢ Delayed (Yellow)
Larrey was credited with designing a flying
➢ Immediate (Red)
ambulance: the Ambulance Volante.
➢ Deceased (Black)

Background of Triage
Used by first responders to quickly classify victims 3R’s Action
during a mass casualty incident (MCI) based on the ➢ Retreat
severity of their injury ➢ Reassess
Unlike standard medical triage, MCI triage is more ➢ Radio
utilitarian (i.e. the greatest good for the greatest
number of people)
Triage Classification: MINOR
Multiple triage systems exist, however evidence
regarding their effectiveness is lacking. ➢ Priority 3: Low Priority, Walking Wounded, Non-
In an effort to update and standardize MCI triage, the Urgent, Dismissed
Model Uniform Core Criteria (MUCC) were created as a ➢ Color Code Green
national guideline for MCI triage ➢ Symbol Ambulance Marked X
❑ These criteria have been endorsed by all major
national shareholders, including NAEMSP, ACEP,
ACS, NAEMT, NASEMSO, AMA, CDC, and others.
❑ Currently, the SALT triage system is the only one ➢ Relatively low priority. Capable of walking.
that meets the Model Uniform Core Criteria ➢ These patients are conscious and breathing with only
relatively minor injuries.
➢ Usually called upon to assist in treatment, evacuation
Mass Casualty Incident (MCI)
or other tasks.
➢ A mass casualty incident (often shortened to MCI ➢ Are not evacuated until all immediate and delayed
and sometimes called a multiple-casualty have been evacuated
incident or multiple-casualty situation) is any
incident in which emergency medical services
Triage Classification: Delayed
resources, such as personnel and equipment, are
overwhelmed by the number and severity ➢ Priority 2: Medium Priority, Emergent,
of casualties. Stable,Observation
➢ Mass Casualty Incident (MCI) defined as an incident ➢ Color Code Yellow
where the number of patients (or the rate of their ➢ Symbol Turtle
arrival to a medical facility) overwhelms local ➢ Currently in stable condition but require medical
assistance and placed under observation.

Midterm Notes 35 | Disaster Nursing/Rolly Baldeviso.BSN-4A

➢ Medical evacuation is delayed until all immediates
have been transported.

Triage Classification: Immediate

➢ Priority 1: High Priority, Urgent, Critical, Cannot
Wait
➢ Color Code Red
➢ Symbol Rabbit
➢ Require immediate life-saving treatment to survive
STEPS:
➢ Have a chance of survival if transferred immediately
1. Make sure you are safe. Your Personal Safety is
to definitive care
utmost priority.
2. Speak loudly and ask people to stand up and walk
towards you.
3. Guide ambulatory patient. Those Able to walk relocate
Triage Classification: Deceased to a certain area
– Minor (Green)
➢ Priority 0: No Priority, Expectant, Morgue,
4. Non-ambulatory patients are then assessed
Unsalvageable
– Delayed (Yellow)
➢ Color Code Black
– Red (Immediate)
➢ Symbol Ankh or Cross
– Deceased / Expectant / Unsalvageable
➢ Severely injured likey to die of injuries
(Black)
➢ In life-threatening medical crisis that they are unlikely
to survive given the care available
➢ Treatment is usually palliative, such as being given Rapid Assessment
painkillers, to reduce suffering.

SALT Triage
➢ Sort, Assess, Life-saving interventions, Treatment
and/or Transport
➢ Product of a CDC Sponsored working group to propose
a standardized triage method. The guideline, entitled
SALT triage, was developed based on the best
available science and consensus opinion.

START Rapid Assessment

Yes Respirations
➢ 30/min (bpm) - IMMEDIATE (RED)
➢ < 30/min (bpm) - check Perfusion
➢ Radial Pulse Absent OR Capillary Refill > 2
seconds - IMMEDIATE (RED)
➢ Control Bleeding - IMMEDIATE (RED)
➢ Radial Pulse Present OR Capillary Refill < 2
seconds - Check Mental Status
➢ Unable to follow simple command - IMMEDIATE

START System (RED)

➢ Follows Simple Command - DELAYED
➢ Simple Triage and Rapid Treatment
(YELLOW)
➢ A triage method used by first responders to quickly
No Respirations
classify victims during a mass casualty incident (MCI)
➢ Reposition or Open the Airway
based on the severity of their injury.
➢ No Respiration - DECEASED (BLACK)
➢ The method was developed in 1983 by the staff
➢ Respirations - IMMEDIATE (RED)
members of Hoag Hospital and Newport Beach Fire
Department in California, and is currently widely used
in the United States.
Midterm Notes 36 | Disaster Nursing/Rolly Baldeviso.BSN-4A
 JumpSTART Combined START-JumpSTART
➢ The JumpSTART Pediatric Triage MCI triage tool
(usually shortened to JumpSTART) is a variation of
the START triage system.
➢ Specific for triaging children in disasters.
➢ JumpSTART was created in 1995 and modified in 2001
by Dr. Lou Romig, a pediatric emergency and disaster
physician working at Miami Children's Hospital.

SAVE (Secondary Assessment of Victim

Endpoint)
1. Able to walk relocate to a certain area - Minor ➢ Applies after patients have been triaged with
(Green) START/jumpStart
2. Non-ambulatory patients are then assessed ➢ Designed for appropriation of limited resources for
✓ Delayed (Yellow) most gain in immediate on-scene care situations
✓ Red (Immediate) ➢ Three categories:
✓ Deceased / Expectant / Unsalvageable 1. Those who will die regardless of care
(Black) 2. Those who will survive whether or not they
receive care
No Respirations 3. Those who will benefit from limited
➢ Reposition or Open the Airway immediate field interventions
➢ Respirations - IMMEDIATE (RED)
➢ No Repiration - Check Pulse Triage
✓ No Pulse - DECEASED (BLACK)
✓ Yes Pulse - 5 Rescue Breaths
✓ Still No Respirations - DECEASED (BLACK)
✓ Respirations - IMMEDIATE (RED)

Yes Respirations
➢ < 15 or > 45/min (bpm) - IMMEDIATE (RED)
➢ 15-45/min (bpm) - check Perfusion
➢ Pulse Absent OR Capillary Refill Time (CRT) > 2
seconds - IMMEDIATE (RED)
➢ Control Bleeding - IMMEDIATE (RED)
➢ Pulse Present OR CRT < 2 seconds - Check Mental
Status
➢ Inappropriate - IMMEDIATE (RED)
➢ Appropriate - DELAYED (YELLOW)

Mass Casualty Incident

“Being the worst, makes you first!”

Midterm Notes 37 | Disaster Nursing/Rolly Baldeviso.BSN-4A

 TRIAGE QUICK TEST Limitations and Considerations
1. A 14-year-old male with a broken arm walking ➢ Critical patients are vulnerable.
around the scene. ➢ Trauma measures are problematic.
This patient is walking around the scene with what ➢ Categories do not differentiate among injury severities
appears to be an isolated extremity injury. This would be and survival probabilities, and are invalid based on
a green status as “walking wounded.” MINOR
categorical definitions and evacuation priorities
2. A 36-year-old man is unresponsive with brain matter ➢ Protocol doesn’t change to consider or address the
showing. size of incident, resources, and injury severities and
This patient is deceased and therefore given black status. prioritization within its categories whether it is 30,
This is a non-survivable wound. DECEASED 300, 3,000
3. A responsive 34-year-old female has pale, moist ➢ Resulting in inconsistent tagging and
skin and respirations of 32/minute. prioritizing/ordering of casualties and substantial
Rapid respiration and signs of shock place this patient in overtriage
the red category. IMMEDIATE
4. An unresponsive male patient has snoring
Remember during Triage
respirations. His breathing improves when you open
Manage scene before managing the patient.
his airway.
➢ How many patients?
If a patient with airway problems responds to minimal
➢ How many ambulances do I need to call in?
interventions, then he is placed in the red category.
IMMEDIATE ➢ What information needed so that it can be
integrated to the scene more smoothly?
5. A 66-year-old male patient is sitting on the ground.
➢ Where to enter from?
His eyes are open, but he can't answer or follow
➢ Which hospital to send the patients?
directions.
➢ Which medical facility is appropriate to receive
The patient can’t follow instructions and has an altered
mental status, which places him in the red category. the patients?
Look at those quiet patients before looking at the
IMMEDIATE
noisy ones.
6. A 50-year-old man has bilateral fractured femurs.
➢ Noisy patients already triaged themselves with a
He has a faint radial pulse and a respiratory rate of
patent airway, still perfusing and conscious
24.
The patient falls into the red category because of the mental status.
➢ “As long as a patient shouts he/she is still alive.”
signs of shock (faint radial pulse). IMMEDIATE
➢ Assess the quiet first and before moving with the
7. A 57-year-old female has a deformed tibia and
noisy ones.
fibula. She is oriented with respirations of 20 and a
pulse of about 100.
This patient does not fall into the walking wounded Triage Tagging
category and doesn’t have outward signs of shock,
elevated respirations or an altered mental status. This
makes her yellow. DELAYED
8. A 16-year-old female who is ambulatory and says
she is "OK."
Walking wounded is green. Remember that secondary
triage will catch any hidden injuries. MINOR
9. A 42-year-old woman with no obvious injuries and
without a carotid pulse.
Resuscitation isn’t performed in a multiple casualty
situation. This patient is deceased. DECEASED

10. A 19-year-old male with 2nd and 3rd degree burns

over about 80 percent of his body. Respirations 24
and pulse about 120.
This patient is critical (and may not survive). The patient
doesn’t fit the criteria for green or red. While it seems
contradictory, yellow is a spot that meets the triage
criteria and doesn’t take the resources for a more Telephone Triage
salvageable red tagged patient. DELAYED The process of managing a patient’s call to the office
to determine the urgency of the medical issue, the
level of provider who should respond, the appropriate
location for the patient to be seen (if necessary), and
the timing of appointment scheduling.

Midterm Notes 38 | Disaster Nursing/Rolly Baldeviso.BSN-4A

 Triage System
Triage Nurse
A nursing professional that helps patients determine
what type of care they need over the phone. They
often provide a cursory assessment of the patients
and help them decide if they need to seek emergency
treatment, make an appointment with a doctor, or
treat themselves at home.
✓ Crisis hotlines
✓ Physician offices
✓ Trauma centers
✓ Hospitals
✓ Outpatient care facilities
✓ Poison control centers
Unlike nurses who get to assess their patients
physically, telephone triage nurses don’t have that
Patient Safety Strategy
type of luxury.
✓ Educate patients about managing their Utilize written policies and protocols for office and
symptoms clinical staff to follow when triaging calls and providing
✓ Gather all the necessary information about advice. Conduct periodic chart audits to ensure that
your patients, such as their height, weight, policies and protocols are followed. Review the
and age guidelines annually and revise as circumstances
✓ Schedule consultations and refer to warrant.
specialists Train staff regarding questions to ask the caller and
✓ Provide support to medical response teams when to refer a call to the physician immediately. The
when they are bringing patients to hospitals physician will then know that if he or she is
✓ Assess the severity of the patient’s health summoned to take a call, the patient has an urgent or
condition emergent need.
Practice Telephone Triage Scenarios. Help your
newest triagers improve their skills by practicing
telephone triage scenarios before they get on the line
with real patients. Choose a range of scenarios, and
go over the possible outcomes of each call. This
practice will help your triage team be more confident
and composed when they need to make decisions in
real time.
Instruct staff members to follow the advice protocols
and check with the doctor first if there is any doubt
about proper instructions or advice. Failure to do so
may be considered the practice of medicine and
Triaging Calls practicing beyond their scope of practice.
Require that staff members refer calls directly to the
1. Gather the Right Information
physician if a patient calls a second time with a
✓ Name and basic demographics
complaint that was not resolved by previous
✓ Brief medical history
telephone advice.
✓ Description of the illness
Require an in-person examination if a patient calls a
✓ Chief complaint
third time with a complaint that was not resolved by
2. Ask Relevant Questions
previous telephone advice.
✓ life-threatening emergency or urgent problem
Document all calls in which medical information or
✓ follow-up questions should detect less urgent
advice is provided. Documentation should include the
issues and mild symptoms
date, time, patient’s name, name of caller as well as
3. Confirm Understanding
his or her relationship to the patient, complaints,
✓ repeat a brief synopsis back to the patient to
concerns, questions, and the advice given.
confirm that they heard everything correctly.
Document critical negative information that helped
4. Use Verbal Cues
determine the advice provided. i.e.: “Mother stated
✓ listen closely to the caller’s tone of voice, level of
the child has no fever, no lethargy, or neck stiffness,
concern, and level of anxiety while they speak
has a good appetite and is taking fluids.”
5. When in Doubt, See the Patient
Document the reasoning behind any deviations from
✓ don’t be held accountable for turning a patient
the written protocols.
away if they had a severe problem
End all calls by providing patient instructions on when
6. Give Instructions for Call-Backs
to call back or seek emergency care if symptoms
✓ encourage to call back if the condition gets worse
worsen or persist.
7. Document Telephone Interactions
✓ “if it’s not recorded, it wasn’t done”

Midterm Notes 39 | Disaster Nursing/Rolly Baldeviso.BSN-4A

 If your hospital is having trouble keeping up with the
pace of phone calls, it may be time to hire a medical
call center. This will ensure you have the bandwidth to
thoroughly speak with all callers and reduce the
chance of triage error.

Grab and Go Kit

After an emergency, you may
need to survive on your
own for several days.
Being prepared means
having your own food,
water and other supplies
to last for several days.
A disaster supplies kit is a
collection of basic items your
household may need in the event of an emergency.

TIP
Rotate items annually.
✓ Making sure the clothes you have stored still fit!
✓ Foods are still edible and far from the date of
expiration.
✓ Equipments or items are still in maximum
working conditions

How should I store my kit?

• Store these items in something that is portable and
easily carried, like a backpack or tub/suitcase with
wheels.
• Keep this kit in a designated place and have it ready
in case you have to leave your home quickly.
• Make sure all family members know where the kit is
kept.

What other places should I have a kit?

Work
• Be prepared to shelter at work for at least 24 hours.
Your work kit should include food, water and other
necessities like medicines, as well as comfortable
walking shoes, stored in a “grab and go” case.
Car
• In case you get stranded, keep a kit of emergency
supplies in your car.
Midterm Notes 40 | Disaster Nursing/Rolly Baldeviso.BSN-4A
 Unattended Cooking or Candles
Fire Safety & Prevention Never leave an open stove or lit candle unattended.
Objectives Unlike other causes, unattended cooking/candles
• To educate participants on how to avoid fires and fire involves the presence of active fire. Leaving it
related injuries. unattended can lead to serious accidents.
• To create awareness of fire deaths and injuries and Cooking Fires
their common causes.  Cooking is usually associated with Gas. We know that
• To inform participants of their personal responsibility Fire and Gas, if not controlled properly, is not a good.
toward fire safety and injury prevention.  Pay attention to what you’re cooking.
 If you leave the room, turn off the stove.
INTRODUCTION  Don’t cook if you’re sleepy or if you’re impaired.
➢ BFP NHQ 2023 January-February 1,984 fire  Keep flammable items away from heat sources.
incidents (GMA News 2023 March 2, BFP Spokes  Clean your stovetop frequently to avoid grease build
SUPT. A. Atienza) up.
➢ Most common cause is electrical ignition Candles
➢ About 500 LGU no fire trucks and active fire Unattended candles are a leading fire cause.
stations. • Candle safety tips:
o Use flameless candles.
MOST COMMON CAUSE o When you leave the room, blow out the candle.
1. Electrical Connections o Keep anything that could burn at least a foot
2. Cooking Fire away
3. Open Pit Flames o Don’t set the candles on anything combustible.
4. Candles – Fires can start when the candle burns
5. Cigarettes down to the base.
6. Flammable Chemicals Grease Fires
7. Combustible Gases • Always have the matching lid nearby!
8. Arson – If you have a small grease fire you can
9. Fireworks smother it with the lid.
10. Ignition Sparks NEVER PUT WATER ON A GREASE FIRE
Nearly half of all home fires originate in the
Faulty Electrical Connections / Electrical Overloading kitchen
Smoking
➢ Electrical ignition which is related to the use of
➢ Cigarettes can smolder for hours.
appliances, old wiring and extension wires as well as
➢ Don’t smoke inside.
poor maintenance of electrical wiring.
➢ Discard smoking materials in a fire safe
➢ Poor/Damaged Wire Quality. Electrical Overloading
container.
occurs when the current being passed through the
➢ Use a proper, heavy ashtray which won’t tip
wires exceed the capacity limit the wires can handle;
easily. Don’t improvise!
this can heat up the wires and melt, leading to fire.
➢ Smoking
➢ Don’t smoke in bed.
Electrical Safety ➢ Don’t smoke if you’re tired, taking medications,
Do not overload electrical sockets. or if you’ve been drinking or are otherwise
Do not run cords under rugs or furniture. impaired.
o They can become worn, overheat, and cause a ➢ After a party, check indoor and outdoor furniture
fire. and cushions for smoldering cigarette butts.
Avoid putting cords against walls or across doorways. Flammable Chemicals
Use power strips equipped with overload protection. ➢ Some chemicals can ignite and explode if not stored
Make sure all power strips and extension cords are properly
tested and approved by a laboratory such as UL ✓ Fuels
(Underwriter’s Laboratories) ✓ Solvents
Electrical Connections and Electrical Faults have been ✓ Cleaning Agents
the top cause of fires in Metro Manila with an average ✓ Thinners
of 53.85% of the total number of fires yearly. What ✓ Adhesive
are the general causes of Electrical fires? ✓ Paints
Use of substandard materials ✓ Other Liquids (alcohol, acetone, celluloids, etc.
Wrong Installation Practices ➢ Make sure to always store flammable liquids in their
Malpractice in actual use approved containers.
Improper maintenance Practices ➢ Seal them properly and place them in the proper
location with the moderate temperature indicated in
its packaging.

Midterm Notes 41 | Disaster Nursing/Rolly Baldeviso.BSN-4A

FLAMMABLES
• Flammable gas - flammable range in air at 20 °C and
a standard pressure of 101.3 kPa.
• Flammable liquid - flash point of not more than 93
°C.
• Flammable solids - readily combustible, or may cause
or contribute to fire through friction.
• Fire Calls Causes
• FIRE (Sunog, Apoy, Kalayo)
ELEMENTS IN FIRE SAFETY
FIRE TETRAHEDRON
➢ The fire triangle was changed to a fire tetrahedron to ACTIVE FIRE PROTECTION
reflect this fourth element. A tetrahedron can be
described as a pyramid which is a solid having four
plane faces. Essentially all four elements must be
present for fire to occur, fuel, heat, oxygen, and a
chemical chain reaction.
PASSIVE (AFP)
o Fire-resistance rated walls
o Fire-resistant glass
o Fire-resistance rated floors
o Occupancy separation
o Closures (fire dampers)
o Firestops
o Grease ducts
o Cable coating
o Spray fireproofing
o Fireproof cladding
o Enclosures
Active fire protection (AFP) is an integral part of fire
protection. AFP is characterized by items and/or
systems, which require a certain amount of motion
and response in order to work, contrary to passive fire
protection.
All AFP systems are required to be installed and
maintained in accordance with strict guidelines in
order to maintain compliance with the local building
code and the fire code.
AFP works alongside modern architectural designs and
construction materials and fire safety education to
prevent, retard, and suppress structural fires.

PASSIVE FIRE PROTECTION

Passive fire protection (PFP) is components or
systems of a building or structure that slows or
impedes the spread of the effects of fire or smoke
without system activation, and usually without
movement.
Contain a fire to the compartment of fire origin
Slow a fire from spreading from the compartment of
fire origin
Slow the heating of structural members
Prevent the spread of fire through intentional
openings (e.g., doors, HVAC ducts) in fire rated
assemblies by the use of a fire rated closure (e.g., fire
door, fire damper)
Prevent the spread of fire through penetrations (e.g.,
holes in fire walls through which building systems
such as plumbing pipes or electrical cables pass) in
fire rated assemblies by the use of fire stops

Escape Routes
When the smoke alarm sounds, you may only have
FIRE PROTECTION seconds or minutes to escape safely.
ACTIVE (AFP) Have a meeting place for everyone to gather outside.
➢ Manual Plan two ways out, in case one way is filled with
o Fire Blanket smoke or fire.
o Fire Extinguisher Know your escape routes and practice the
o Standpipe
➢ Automatic
Fire Drills
o Sprinkler system
A simulation of evacuation that helps prepare
o Gaseous clean agent
participants for an emergency situation
o Foam suppression system
FIRE CODE of the Philippines
o Expansion (low, Medium, High)
The Implementing Rules and Regulations (IRR) of RA
o Electronically controlled
9514, or the Fire Code of the Philippines, serves as
the framework that guides the BFP in the

Midterm Notes 42 | Disaster Nursing/Rolly Baldeviso.BSN-4A

 implementation of the law to ensure public safety and Carbon Monoxide (CO) Poisoning
to promote economic development through the High levels of CO can be fatal, causing death within
prevention and suppression of all kinds of destructive minutes.
fires.
DepEd Memo Fire & Earthquake Drills
DepEd Order No. 53, s. 2022 - Mandatory
Unannounced Earthquake and Fire Drills in Schools,
requiring all public elementary and secondary schools
to conduct unannounced earthquake and fire drills
every first and third week of every month. (Office of
the Undersecretary for Operations (OUOPS)

Smoke Alarms/Detectors
An electronic fire-protection device that automatically
senses the presence of smoke, as a key indication of
fire, and sounds a warning
o ionization
o photoelectric
Sprinkler System
o combination
An active fire protection method, consisting of a water
Alarm Placement and Maintenance
supply system providing adequate pressure and flowrate to
Make sure you can hear the alarm in every place in
a water distribution piping system, to which fire sprinklers
your home.
are connected.
They should be loud enough to wake you from sleep.
A. Dry pipe systems
Check once a month.
o Dry pipe valve (a specialized type of check
Change batteries once a year.
valve)
Replace every 10 years.
B. Wet pipe sprinkler systems
o Automatic sprinklers and automatic alarm
Fire Alarms Detectors
check valve
o

EXTINGUISHING FIRE
FIRE CONTROL MEASURES
Cooling
Smothering
Starving
Interrupting the Chain Reaction

Cooling:
limiting temperature by increasing the rate at which
Smoke heat is lost from the burning material
Breathing smoke can kill you! COOLING THE FIRE
❖ Smoke is toxic. One of the most common methods of extinguishing a
❖ If you must escape through smoke, fire is by cooling with water.
Get Low and Go under the smoke. The rate at which heat is lost from the fire may be
greater than the rate of heat production and the fire
Carbon monoxide (CO) Poisoning caused by inhaling will die away.
combustion fumes. CO replaces the oxygen (O2) in red When water is applied, it undergoes changes as it
blood cells preventing O2 from reaching your tissues and absorbs heat from the fire:
organs. ✓ Its temperature will rise
✓ It may evaporate (boil)
✓ It may react chemically with the burning material
The properties of a good cooling agent are therefore:
✓ High specific heat capacity (thermal capacity)
✓ High latent heat of vaporisation
✓ High heat of decomposition
Water is a good cooling agent because of its high
thermal capacity and latent heat of vaporisation. This,
combined with the fact it is available in large
quantities, makes it by far the most widely useful fire
extinguishing agent.

Midterm Notes 43 | Disaster Nursing/Rolly Baldeviso.BSN-4A

Smothering:
limiting oxygen by preventing air from reaching the
seat of the fire to allow the combustion process to
reduce the oxygen content in the confined
atmosphere until it extinguishes itself
SMOTHERING THE FIRE
If the oxygen supply to the burning material can be
sufficiently reduced, burning will cease. Prevent fresh
air from reaching the seat of the fire, allowing the
combustion to reduce the oxygen content in the
Fire Extinguishers
confined atmosphere until it extinguishes itself, for
example by: A fire extinguisher is a handheld active fire protection
✓ Snuffing out candles device usually filled with a dry or wet chemical used
✓ Smothering a pan with a fire blanket to extinguish or control small fires, often in
✓ Wrapping a person in a fire blanket emergencies.
✓ Applying a blanket of foam over the burning It is not intended for use on an out-of-control fire that
surface, thus separating the fuel from the air could endanger the user (i.e., no escape route,
Smothering can also be achieved by removing the smoke, explosion hazard, etc.), or otherwise requires
oxygen in the atmosphere, thus extinguishing the fire, resources, and/or expertise of a fire brigade.
for example, by:
✓ Introducing carbon dioxide (CO2) to the Classification Fire Extinguishers
immediate vicinity of the fire
✓ Introducing an inert gas to the immediate
vicinity of the fire, such as through systems
installed to protect computer server rooms

Starving:
limiting fuel by removing potential fuel from the vicinity
of the fire, removing the fire from the mass of
combustible materials or by dividing the burning
material into smaller fires that can be extinguished
more easily
STARVING THE FIRE
In some cases, a fire can be extinguished simply by
removing the fuel source. This may be accomplished
in a number of ways, such as stopping the flow of
liquid or gaseous fuel, removing solid fuel in the path
of the fire or allowing the fire to burn until all of the
fuel is consumed.
Fires can be starved of fuel by removing potential fuel
from the vicinity of the fire, for example:
✓ Back burning forestry fires
✓ Draining fuel from burning oil tanks
✓ Removing cargo from a ship's hold
✓ Creating firebreaks in peat, heathland and forest
fires
✓ Removing vehicles in the proximity of the fire
✓ Creating firebreaks in thatch roofs
✓ Removing tyres not affected by the fire from a
Parts of a Fire Extinguishers
tyre dump

Interrupting:
inhibiting the chemical chain reaction by applying
extinguishing media to the fire that inhibit the
chemical chain reaction at the molecular level)
INTERRUPTING THE FIRE
Dry powder, Bromochlorodifluoromethane (BCF) and
other halon extinguishers work by releasing atoms
that interrupt the chemical chain reaction. They also
create an inert gas barrier.

Midterm Notes 44 | Disaster Nursing/Rolly Baldeviso.BSN-4A

 Other Types of Extinguishers 5. Ensure the pressure gauge is in the operable range or
position.
6. Examine the extinguisher for obvious physical
damage, corrosion, leakage, or clogged nozzle.
7. Make sure it is full, this can be done by just lifting the
extinguisher or you can weigh it

MOUNTING
1. Extinguisher Cabinet: mounted to the surface of the
wall, semi-recessed into the wall, or fully-recessed
into the wall. Can include a break-front panel that has
proven to be a deterrent to theft and tampering as to
access the extinguisher requires actually breaking the FIREXT (FE)
panel which would produce sounds and possibly alert
individuals nearby that someone is tampering.
2. Hanger: specifically designed for the type of
extinguisher being mounted, which typically comes
with the extinguisher.
3. Bracket: a strap-type bracket that helps ensure that
the extinguisher does not become dislodged.
4. Signage and location visible from near and far away,
from different angles, and that signs protrude 90°
from the mounting wall making them highly visible
from both sides, especially if the cabinet is recessed
into the wall. Fire is FAST!
5. No permeant structure, an open door, or anything • There is little time to escape. It only takes
piled that obstructs the view of the sign. minutes for thick black smoke to fill your home
6. These signs are often made of corrosion resistant Fire is DEADLY!
materials so they can be used in indoor and outdoor • Smoke and toxic gases kill more people than
areas. Select models come with glow in the dark flames do
properties so the extinguisher can be identified in Fire is DARK!
dark areas, at night, or in blackout situations • Fire isn’t bright, it’s pitch black. Fire starts
bright, but quickly produces black smoke and
complete darkness
MAINTENANCE
Smoke is POISONOUS
1. Perform a monthly fire extinguisher inspection.
• Get low to the ground and go under the smoke
2. Confirm the extinguisher is visible, unobstructed, and
to your exit to escape through smoke. GET LOW
in its designated location.
AND GO!
3. Make sure everyone can easily access the fire
Fire is HOT!
extinguisher.
• Heat is more threatening than flames. Room
4. Verify the locking pin is intact and the tamper seal is
temperature can rise to over 1,000˚F
unbroken.
(537.778˚C) at eye level

Midterm Notes 45 | Disaster Nursing/Rolly Baldeviso.BSN-4A

Fire can be SILENT!
• If there is a fire, pull the fire alarm on your way
to notify everyone inside, the fire department
and the neighbors
• Fight Fire with Fire!
• PASS
• Use fire extinguisher on small firesonly
• Fire Fighting is for Fire Fighters!
• When in doubt, get out!

Fire Safety for PWDs

• Have smoke alarms on every level of your home,
inside bedrooms and outside sleeping areas.
Interconnect your alarms, so when one sounds, they
all sound.
• If you are deaf or hard of hearing, use smoke alarms
with a vibrating pad, flashing light or strobe light.
These accessories start when your alarm sounds.
• Test your alarms every month.
• Plan your escape around your activities
✓ Know two ways out of every room.
✓ If possible, live near an exit.
✓ You’ll be safest on the ground floor if you live in
an apartment building.
✓ If you live in a multistory home, sleep on the
first floor.
✓ Being on the ground floor and near an exit will
make your escape
✓ easier.

American Sign Language (ASL)

Midterm Notes 46 | Disaster Nursing/Rolly Baldeviso.BSN-4A